11/01/2017 House of Commons


11/01/2017

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Order. Urgent question, Caroline Lucas. To ask the Secretary of State

:00:07.:00:19.

for business energy and industrial strategy if you will make a

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statement on the sale of the Green Investment Bank. Government has set

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up its plans for the sale of the green investment back laid before

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Parliament on the 3rd of March 20 16. Government intends to move the

:00:35.:00:38.

GIB into the private sector that it can increase its access to private

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capital. Potential bidders are interested in GIB because of its

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green specialism and we are asking potential investors to confirm their

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commitment to GIB values and how they propose to protect them as part

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of the bid for the company. The government has created a special

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share held by independent trustees to protect GIB's green purposes in

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future. As I'm sure that the house will appreciate the sale is

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commercially sensitive so I cannot comment on the identity of any

:01:20.:01:23.

bidders discussions taking place between the government and potential

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bidders. All parties have been required to sign confidentiality

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agreements. The restrictions applied to the government and the bidders.

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Thank you. I thank the Minister for his reply, but it gives little

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reassurance as everyone knows who the preferred bidder is. McQuarrie

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has a worrying track record. I'm putting the question would support

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from across the house. This week we heard that the Green Investment Bank

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stands on the brink of not only being flopped off but being broken

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up. Founded in 2012 the GIB has been widely recognised as a true success

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story, kick-starting innovative low carbon projects across the UK. Yet

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this preferred bidder, McQuarrie, not only has a dismal and terrible

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environmental record, it has an appalling track record of asset

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stripping. So why has the government given preferred bidder status to

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this company? What assessment has it made of McQuarrie's called given

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that in 2005 the board of the London stock exchange said McQuarrie were

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unfit to undertake takeovers. Changes suggest that McQuarrie is

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planning to hollow out the GIB. Why have ten new companies been set up?

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Can he confirm that the changes made at the last year were made at the

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behest of McQuarrie? Why is the government infighting and asset

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stripper to take over the Green Investment Bank? Isn't this exactly

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the wrong time to be selling off the Green Investment Bank given that the

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government has decided to embark upon a new industrial strategy which

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must to be in accord with our own climate change commitments have low

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carbon projects at its core. And finally will the Minister admit that

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this selling of could lead to the bank being fatally undermined as an

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inn during institution. Will he stop the killing off of the Green

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Investment Bank? Will you hold the sale process with immediate effect.

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I think the honourable lady knows that is a string of questions that I

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am not able to answer. She will also know that I cannot make any public

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comment on the identity of bidders for the process under way for

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reasons I elaborated at the top. She is drawing a lot of imprecations

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from media speculation. It would be irresponsible for me to comment on

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that. I will try to give her reassurance which flows back to the

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objectives behind the sale, which I set out in the statement. It is

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precisely been those we want the Green Investment Bank to be more

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unfettered from because rates of state that we are putting it into

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the private sector. The objectives had been discussed in this House, we

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are looking at very clear objectives around securing value for money for

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the taxpayer which must be out primary responsibility. We want to

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ensure that it can be reclassified to the private sector. We have also

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been clear that the reason we want to move it into the private sector

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is two enable it to grow and become a going concern. Investors will be

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buying into the green business plan. These are the criteria we have set.

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These are the criteria against which we are evaluating the proposals

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before us. The Green Investment Bank is a horrendous Conservative success

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story, devised by the Conservatives before 2010 and introduced by a

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Conservative led government. It has been a great catalyst for investment

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in the green economy, in particular the wind farm of the East Anglia

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Coast. There is a concern that if the press stories are to be believed

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regarding asset stripping and loss of jobs, it won't be able to perform

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that role in future. Will my honourable friend consider in that

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light a pause to the process so that we can ensured the Green Investment

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Bank will continue to perform its great role that it has done since

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2012? I will join my honourable friend in saluting what was a great

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success story of the coalition government, let's maintain the

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season of goodwill, but under a Conservative led coalition. It was

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the right thing to set up. It was asked that did it it was a great

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success. Mobilising on the last figures about ?8 billion of private

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investment into the critical area of infrastructure. So a great success

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story. Can I assure him, and I know he is to experienced to be

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influenced by such speculation in the media, that we are not being

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naive in this process. We have set some clear criteria, we have one a

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genuinely competitive process, and we are now evaluating the proposals

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before us. But through the lens of the criteria that we have set, which

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include value for money, deep is a vocation -- reclassification and the

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Ford plans for a dynamic, ongoing concern seeking to mobilise for

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private capital into the green industries. We need to mobilise a

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lot of private sector capital to get the mean energy we need. I will

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admit it has been a great success story. It is also a Labour success

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story. It first appeared in our 2010 manifesto and I'm glad that the

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coalition government took it up. If it is a success story, why are you

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selling it off? Is it to be the case of public, good, private bad? I'm

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telling you quite simply that given the assessment of Macquarie and what

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we have seen of them, it has a history of asset stripping. How

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exactly will the Minister protect his valuable public institution from

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having its assets sold off? That is a fair question. We know the garment

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plan to hold a share of the company which will maintain the green

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approach. What oversight for the Government have of those companies

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once the sale goes through? The Prime Minister told us that

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industrial strategy would be at the heart of her government. Yet now the

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Government is selling off an institution that has exceeded from

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scratch and against the odds in attracting investment to our Green

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info structure. The ministers have been outmanoeuvred by Macquarie and

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we have no confidence that it will not happen again. Will the

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Government agreed to stop the sale of the green investment bank today

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until such time as its green purpose and core assets can be genuinely

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protected? If the Minister will not, does he accept that the Green

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Investment Bank's fate rests on his shoulders?

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I will pass over the bizarre claim that the green investment bank is a

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Labour success story by virtue of it being mentioned in a 2010 manifesto

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with nothing done for 13 years of government before that. We started

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with low levels of green investment, which we have done. I will warn them

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against speculation. He reflects on the head of its and values of the

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private sector. He should be aware, holding the position he does, that

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we need to mobilise a huge amount of private capital. It is private

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capital, not public capital that will make the difference in terms of

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the big shift in infrastructure. What he misses is the critical role

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that the state has played in correcting a market failure. The

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fact we have 18 competitive process and private investors want to buy

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this as a going concern because of its green specialism actually

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indicates that the market failure has been corrected. The fact these

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institutions have mobilised capital into this infrastructure is a key

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sign. It will do more and be an even more successful institution as a

:10:54.:11:01.

going concern. The Government has a whiz been clear that the green

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investment bank was always created as possibly going to the private

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sector. Will it remain as green investment. I know he is dedicated

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to environmental issues, so will he give us assurances that we will

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stick to our laudable manifesto pledge of leaving the are met in a

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better situation than we found it? -- leading the environment? I will

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pay to be to do her record and authenticity in regard to the

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protection of environment and climate change? I will give her this

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assurance. We have taken before Parliament the whole procedure for

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protecting the green purpose of the Green Investment Bank through the

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special share arrangement, that will be held by an independent company

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and will have the power to approve or reject any proposed changes to

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the two Lord Pannick's green purposes. -- to the Green Investment

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Bank's green purposes. It was selected through a genuinely

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independent process. She will see that the names are independent and

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extremely credible. That is a mechanism we have set up. I will

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return to this point around the objectives of the sale. We want this

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to go into the private sector to do more of what it is doing, unfettered

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by the inevitable restrictions that the state has to put on it at this

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stage. Thank you for granting this urgent question and I thank the

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honourable men before putting it forward, and we support it. The

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Prime -- the Minister said that he wants to see this continued and it

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will not be happening if it is asset stripped. The wrong reports will see

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a 90% fall in renewable investment. That must be addressed and the Green

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Investment Bank should be the vehicle for that. What assurances

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other that assets will be re-invested in green infrastructure?

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What reassurances can he give us that the HQ in Edinburgh will

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continue? How will the Government ensure that the shortfall in

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investment in renewables will be met? Finally, in light of the

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forthcoming industrial strategy and emissions reduction plan, will he

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pours the sale so Parliament can properly look at these and see what

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role the won can play in that process? -- the Green Investment

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Bank can play in that process? It would be nice if you paid more

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recognition of the extraordinary progress this country has made

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towards clean energy and we now generate more electors are deep from

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renewables than from coal, which is a pivotal moment in this country.

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Green Investment Bank will pay an abortive role in being a catalyst

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for that investment. In terms of the assurances he seeks, which I

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understand and share, it is part of our process of evaluating proposals

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before us against the criteria that we have set out, being very

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transparent about, agreed through the House, it is true that lends

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that we are now evaluating the proposals before us. That obviously

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includes attitudes to the workforce and sensitivities around jobs in

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Scotland. These are part of the criteria that we're looking at the

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proposals with regard to. I cannot say much because of the concert and

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jealousy -- confidentiality situation we are in.

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For the member and the opposite bench to make a sweeping statement

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that private investment is bad... When he looks at the golden share,

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will he consider if it could be possible for the golden share not to

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just provide guarantees for future implement but on the existing

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portfolio? Perhaps for the first couple of years, during the transfer

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to any bidder. I thank my honourable friend for that observation. The is

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right about his first point. It couldn't have been clear from the

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opposition front bench, R Blick good, try that bad. That will have

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been noted in the business community, reinforcing the question

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asked about the attitude of the party opposite about it. With regard

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to the maintenance of assets, I have set out the mechanisms for it. They

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are bust. Parliament agreed they were robust. What I would say about

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so-called asset stripping and freedom to sell assets, let's not

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get ourselves into a position where we are just hoping assets for ever,

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and that is a good thing. We would not want that for Green Investment

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Bank under its current situation. We have to be practical in terms of the

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limitations that we would place on a private sector bid. I come back to

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the point, we are clear about the criteria we are setting for the sale

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and we are looking at proposals to a holistically view of the criteria we

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have set, which include the need for reassurance about the forward plans

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for the organisation, the level and ambition in terms of mobilising

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private sector capital into this critical area of clean

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infrastructure. I think if the interest of consensus, there was

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spotty support for the Green Investment Bank from the get go,

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there is cross-party concern, I say to the Minister, about this. Lord

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Barker, a minister in the last Parliament, Vince cable and people

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on this side of the House. Is the key question this, they promised a

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new approach to industrial strategy with a new Department in contrast to

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their predecessor, who did not use the term industrial strategy. What

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has changed? If there is a moment to prove their commitment to this new

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strategy, it is this, their plans around the tent won. -- it is their

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plans around the Green Investment Bank. There was a need to do it, we

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did it, they didn't. His party had plenty of opportunity to do it. He

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talks about the need for continued commitment in investment in

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renewables. I think we have shown that. One of the most decisive steps

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this Department has taken in the short time we have been in power is

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the announcement of the new contract for difference auction which will be

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the next age of support for the more mature renewable sources. The whole

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point, where think there is a diversion to view about this, is

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that the party opposite things that state ownership is a good in itself

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whereas, in this situation, we have moved on. This important

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organisation has done a great job, not to liberate it. So that it can

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do more. -- we want to liberate it. It is true that led we're looking at

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the proposals before us. Thank you Mr Speaker. Would my

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honourable friend agreed that it's not about the assets that are owned

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that already exist that bother in the future is there a greater or

:19:17.:19:21.

lesser amount in renewable green projects. This will be a success if

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the level of investment in new projects increases as a result of

:19:29.:19:33.

privatisation. I'm delighted to detect that question from my right

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honourable friend who was in many ways the Guardian angel of the

:19:38.:19:41.

coalition government in terms of the deliberations that led to the

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establishment of this. He is right and makes a fundamental point. We

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should not be judging this organisation for what it is at the

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moment, it's about what it can be about the levels of future

:19:54.:19:56.

investment and the commitment to the Green purpose of this organisation.

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I don't think this government could have clearer about that. It's about

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the future. Can I give the Minister the opportunity to answer the

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question I posed to him at select committee yesterday. How can he

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reconcile insisting on preserving the green purposes of the bank and

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preventing asset stripping from a new buyer with satisfying the ONS

:20:20.:20:22.

classification is about public sector control and on balance Street

:20:23.:20:32.

requirements post disposal? He is making a game presumptions about

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asset stripping. He knows the structure we set up because he was

:20:39.:20:43.

involved in the Parliamentary debate around it. There is a lot of concern

:20:44.:20:48.

in this house about protecting the integrity of the green purpose of

:20:49.:20:51.

the GIB which is why we have gone through this process which is

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robust. It's about setting up the green chair and the government's

:20:57.:21:02.

mechanism around it. That has had the agreement of Parliament and is

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the system we have put in place. Also I come back to the human

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motives of people wanting to buy this organisation to grow it and to

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do more with it. The authenticity and integrity of those proposals are

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what we are evaluating. I'm sure the Minister will share my slight

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amusement that the opposition this afternoon are arguing about

:21:25.:21:34.

everything you read about the Green Investment Bank you should believe,

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but yesterday they said the opposite. Private investors are keen

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to come in and it shows the purpose it served and without the

:21:42.:21:44.

restriction it could deliver more investment, not less. My honourable

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friend has made the from the parental -- the fundamental point I

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was trying to make. As a market failure been corrected? There is

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evidence of the large amount of Private investment flowing into the

:22:09.:22:14.

green infrastructure. We want to make sure the GIB is free and

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unfettered from the state to do more. The environmental audit

:22:20.:22:25.

committee's report into the cell found ministers had rushed to

:22:26.:22:30.

privatise it without consultation and stated that the bank should

:22:31.:22:35.

continue to exist as a low investor, or its sale should not proceed. We

:22:36.:22:41.

don't want a repeat of the Royal Mail debacle where the public as it

:22:42.:22:44.

was sold off at ?1.4 billion before it's true -- below its true value.

:22:45.:22:52.

Is it not extraordinary that the bank's assets were restructured last

:22:53.:23:00.

November or it done at the request of the shareholder Executive to

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present itself to the preferred bidder? I do believe that is the

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case at all. We have a responsibility to deliver value for

:23:14.:23:20.

money to taxpayers. We are conscious of the deal if it materialises to

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present it well to the public we serve and represent. That's why

:23:25.:23:28.

value for money is the top of our list in terms of the criteria. We

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are setting high standards in terms of the presentation of this deal and

:23:33.:23:39.

the delivery of materials. Can I remind the Minister that during the

:23:40.:23:43.

cause of the enterprise built the government rejected our amendment

:23:44.:23:46.

which would have guaranteed the green purpose of the bank. Can he

:23:47.:23:51.

give this assurance to the bank today that after privatisation would

:23:52.:23:54.

the Green Investment Bank be free to invest in fracking projects? To the

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substantive point about the protection of the green procedure

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and if the honourable gentleman disagrees that fine, but Parliament

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recognise that we have set up a robust mechanism whereby the green

:24:14.:24:17.

purpose of the organisation is set in the articles of association and

:24:18.:24:24.

any change to that needs to be done through a resolution to the

:24:25.:24:28.

trustees. It's worth recognising the integrity of these people. James

:24:29.:24:42.

Curran, Lord take this on, Peter Young, a good group of people set up

:24:43.:24:46.

by rigorously independent processes to safeguard the integrity of the

:24:47.:24:55.

green purpose of the bag. We were told that we will be the greenest

:24:56.:25:01.

government ever and yet the failed Greendale Project collapse.

:25:02.:25:05.

Investment in renewable resources have slashed and we have slipped in

:25:06.:25:09.

the world ranking for low carbon economies. Will he look urgently at

:25:10.:25:17.

the financial and economic reasons why it it is crucial that we invest

:25:18.:25:22.

in these areas and reverse the decision he is making today on the

:25:23.:25:27.

Green Investment Bank. You're struggling a bit of an old horse. --

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flogging. They've is real investment going into clean energy in this

:25:37.:25:40.

country. The Hinckley deal made one of the biggest commitments in the

:25:41.:25:45.

world to low carbon energy. There is no question about this government's

:25:46.:25:48.

commitment to the transition to a low carbon economy. We inherited a

:25:49.:25:56.

situation where we were operating on a far to lower base and it was a

:25:57.:26:00.

coalition government led by conservatives that change that. The

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minister refused to name the bidders for the Green Investment Bank but

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then he went on to say that private companies were saying they wanted to

:26:12.:26:15.

buy the Green Investment Bank because of its success. Which

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private companies were saying that what did the Minister make the

:26:19.:26:29.

quotation up? I'm not sure what part of the confidante Richard -- part of

:26:30.:26:36.

the confidentiality he does not understand. We are selling a going

:26:37.:26:44.

concern and we are not entering proposals that don't respect that.

:26:45.:26:50.

When is this government going to learn the lessons of the past on

:26:51.:26:57.

selling off public assets? I was here when Mrs Thatcher decided to

:26:58.:27:02.

sell off not only electricity, but gas and then finally water. She said

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we were going to be a British share owning democracy. That was the

:27:12.:27:16.

phrase. Now if you look at the list, you'll find that some of them are

:27:17.:27:22.

owned in Germany, some are owned in France, some like McQuarrie is in

:27:23.:27:27.

Australia, who brought up the Birmingham toll road in a flash

:27:28.:27:32.

under the Tory government. -- Macquarie. And now we are having

:27:33.:27:37.

another lecture on how he is going to preserve the identity of the

:27:38.:27:42.

Green Investment Bank. History tells us it is not possible. It will go to

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those who are reading for it and it will not be just Britain. We are

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just being the process of leaving the EU and now the chances are it

:27:55.:27:59.

will be somebody in the EU that will be buying up British assets. Maybe

:28:00.:28:06.

not this. Why don't you learn the lessons? One of the lessons of

:28:07.:28:13.

privatisation is record levels of investment that have flowed into

:28:14.:28:16.

organisation since they have been privatise. I respect the experience

:28:17.:28:23.

and sincerity and integrity, but I think he is totally wrong and I have

:28:24.:28:28.

a strong instinct that the honourable gentleman would still

:28:29.:28:34.

like British Telecom to be a government owned company. In the

:28:35.:28:42.

Financial Times Vince Cable raise concerns about asset stripping and

:28:43.:28:47.

he thought that was Macquarie's objective. Ed Davey said he thinks

:28:48.:28:51.

it is unlikely that the golden share would give ministers enough clout to

:28:52.:28:57.

influence the bank's investment strategy. Those two people who were

:28:58.:29:01.

very much involved in setting up the bank should be taken seriously and

:29:02.:29:06.

we should act upon those concerns? I'd take seriously all the concerns

:29:07.:29:10.

expressed by politicians, past and present, because it is important

:29:11.:29:16.

through this urgent question that the message comes out of the house

:29:17.:29:20.

to potential bidders about the concerns that people have. I

:29:21.:29:25.

absolutely respect that and the individuals that she mentioned, but

:29:26.:29:29.

she says I'm dismissing media speculation. I'm not, I'm just not

:29:30.:29:33.

commenting on it because Minister shouldn't. Thank you for the

:29:34.:29:45.

reminder of the involvement of the Liberal Democrats in the initiation

:29:46.:29:49.

of the Green Investment Bank breg. Vince Cable said that he is

:29:50.:29:53.

unconvinced that the golden share will prevent the asset stripping of

:29:54.:29:56.

the company and therefore will threaten the original intentions of

:29:57.:30:00.

the Green Investment Bank at its inception. They are hol arrangements

:30:01.:30:10.

under which the special share solution was reached and discussed.

:30:11.:30:14.

It was debated through Parliament and settled through that process. My

:30:15.:30:19.

personal view is that it's a robust mechanism in itself, given its legal

:30:20.:30:26.

underpinning, given the integrity and independence of the people that

:30:27.:30:29.

have been selected to be the trustees and guardians of this

:30:30.:30:33.

process, but I also come back to the fundamental point about the

:30:34.:30:38.

motivation behind people who might want to make, by this organisation

:30:39.:30:46.

and the criteria and the discipline we will have been evaluating those

:30:47.:30:50.

proposals and deciding whether we go ahead or not. I along with many

:30:51.:30:55.

colleagues fought for the headquarters of the Green Investment

:30:56.:30:59.

Bank to come to Edinburgh which it now has over 50 staff. How many of

:31:00.:31:04.

those 50 staff will remain in Edinburgh after privatisation? Can I

:31:05.:31:08.

just say, many people have mentioned Vince Cable but the legacy of Vince

:31:09.:31:14.

Cable is the botched privatisation of Royal Mail and that's why people

:31:15.:31:21.

have concerns. By its nature, it invests in projects the markets

:31:22.:31:24.

won't touch when the projects come on stream they are much more

:31:25.:31:28.

profitable than normal projects. If a preferred bidder sells it off,

:31:29.:31:31.

they will sell it at great profit the taxpayers expense. I've agreed

:31:32.:31:44.

to meet with a member of Parliament in that area because I recognise the

:31:45.:31:48.

importance of the process and jobs. It was the right decision to locate

:31:49.:31:55.

part of the organisation then and jobs are part of what we want to

:31:56.:32:00.

hear a commitment to staff are ongoing organisation is part of what

:32:01.:32:06.

we to hear from bidders. But because he has mentioned stuff, let me place

:32:07.:32:09.

on record and I hope this is shared by members across the house the

:32:10.:32:12.

admiration and respect the government has for the senior

:32:13.:32:16.

management team and all start at GIB, led by Sean Smith and -- Lord

:32:17.:32:22.

Smith and Sean 's Kingsbury, not just for what they have achieved,

:32:23.:32:29.

but the professionalism with which they have conducted themselves. The

:32:30.:32:32.

Green Investment Bank has made substantial investment in Wales in

:32:33.:32:40.

partnership with five local authorities. It's a model that works

:32:41.:32:44.

well. What guarantees can diminish the give that the new owners will

:32:45.:32:48.

invest in this sort of way and in the regions and nations of the

:32:49.:32:52.

United Kingdom rather than abroad or possibly in the golden Southeast?

:32:53.:32:57.

Again, I'll come back to the main points regarding the questions we

:32:58.:33:01.

ask of bidders in the criteria we set. We want to achieve value for

:33:02.:33:07.

money and we are selling an ongoing concern. We are determined to

:33:08.:33:12.

protect the green purpose of the organisation and we want to hear

:33:13.:33:15.

plans for the mobilisation of future investment. If models are working

:33:16.:33:25.

and professional organisations for whom will be bidders, they will pay

:33:26.:33:29.

regard to it. That's what we want to hear from bidders and we are at the

:33:30.:33:33.

point in the process where we are evaluating it. I can't say any more.

:33:34.:33:39.

For the sake of transparency can you let the house know whether or not

:33:40.:33:41.

the Green Investment Bank will be able to invest in fracking in the

:33:42.:33:47.

future? The Green Investment Bank will be required under this process

:33:48.:33:55.

to continue to respect the green purpose of the organisation as set

:33:56.:33:58.

out in the articles of the Association and therefore the degree

:33:59.:34:03.

to which the proposals fit the criteria are a judgment to be made

:34:04.:34:07.

by management and the trustees we have set up to be independent

:34:08.:34:09.

guardians of this process. When Vince Cable was legislating for

:34:10.:34:20.

the bank, we were guaranteed it would operate throughout the UK and

:34:21.:34:27.

operating in Northern Ireland and not protruding cross-border

:34:28.:34:31.

projects. One of the first investments was in Northern Ireland,

:34:32.:34:34.

in my own constituency. Many of us are concerned that the quality of

:34:35.:34:37.

that investment and that reach will be lost in this sell-off. When the

:34:38.:34:44.

Minister talks about integrity in relation to this, it is not

:34:45.:34:48.

something that people associate readily with the preferred bidder.

:34:49.:34:55.

I'm not going to comment on the identity or character or values of

:34:56.:35:00.

any bidder at this stage but I will join him in recognising the good

:35:01.:35:07.

work done and the approach taken by the Green Investment Bank in

:35:08.:35:09.

ensuring that the investors they make are spread across the country.

:35:10.:35:15.

I come back to the point I was saying, our motivation for this

:35:16.:35:19.

being in the private sector is for this to grow in the private sector

:35:20.:35:31.

across the UK. Having listened to the Minister rewrite history from

:35:32.:35:38.

2010 on the Government's appalling approach in this area. The Green

:35:39.:35:46.

Investment Bank was an success story that had cross-party support. What

:35:47.:35:50.

guarantees without breaking any confidential at the around the

:35:51.:35:58.

negotiations that are going on, can he give to this House that moving

:35:59.:36:04.

forward that those risky investments that bank is so good at supporting

:36:05.:36:08.

will continue and that the green investment moving forward will

:36:09.:36:12.

continue in as good a state as it is now in five years' time or even

:36:13.:36:22.

better? I'm forced to repeat a large amount of what I have said before.

:36:23.:36:26.

We have set up through a process agreed to the Parliamentary process

:36:27.:36:32.

a mechanism for protecting the green purposes of the organisation going

:36:33.:36:36.

forward. Beyond that, as I have said, we are very serious about

:36:37.:36:39.

selling this as a going concern, serious about wanting to see

:36:40.:36:44.

positive proposals for growth and future investment, we're at that

:36:45.:36:47.

point where we are evaluating proposals from bidders against that

:36:48.:36:53.

lens. I will say that we are and will be in the process by the

:36:54.:36:59.

attitudes of the senior management team. Last year, Macquarie, to quote

:37:00.:37:07.

a company at random, made its largest ever profit, and it did so,

:37:08.:37:13.

as the markets will tell the Minister, by selling off Moto,

:37:14.:37:24.

Britain's largest motorway service company and selling the profits to

:37:25.:37:31.

shareholders. What is there in the current safeguards that. The future

:37:32.:37:35.

buyer, whoever they may be, from doing the same kind of thing as Tim

:37:36.:37:39.

two has always done, selling assets, taking the money out of the company

:37:40.:37:47.

and using it to pay shareholders? -- the same kind of thing as Macquarie.

:37:48.:37:53.

He has chosen a company at random, I will not talk about any companies at

:37:54.:38:03.

all. The safeguards we have set up a protected by law. An important part

:38:04.:38:12.

of that is the forward intention and the intention to mobilise private

:38:13.:38:22.

capital in the future. With Brexit and the uncertainty around that, is

:38:23.:38:28.

this not a risky idea, to sell the Green Investment Bank at this time?

:38:29.:38:34.

Can the Minister tell me how he envisages government ensuring there

:38:35.:38:37.

will be money available for those new, innovative technologies that

:38:38.:38:41.

will be important to areas like mine in Hull and the Humber? With respect

:38:42.:38:46.

to the honourable lady, I'm not sure why exit is related to this process

:38:47.:38:51.

and the decisions underpinning it. Her fundamental point about the need

:38:52.:38:56.

to invest in energy innovation, I agree with her 110%. That is why our

:38:57.:39:04.

Department has a ?500 million spending review portfolio dedicated

:39:05.:39:13.

to a wider system of budgetary support for energy-efficient

:39:14.:39:21.

systems. If we are to give the carbon reduction, we have to

:39:22.:39:30.

continue to innovate. We have to support that. The Green Investment

:39:31.:39:37.

Bank employs 55 employees out of the head office in my constituency. When

:39:38.:39:43.

it was setup in 2012, the Business Secretary Vince Cable, said that

:39:44.:39:48.

Edinburgh has a lot going for it in terms of asset management and

:39:49.:39:53.

finance sectors and also its proximity to green energy activity.

:39:54.:39:56.

We also said that choosing Edinburgh supported the wider narrative of

:39:57.:40:02.

binding Scotland into the UK in the run-up to the independence

:40:03.:40:04.

referendum. Will the Minister meet with me to discuss how such promises

:40:05.:40:12.

can be delivered to those 55 employees in my constituency? I

:40:13.:40:21.

extend the same invitation, I will meet any colleagues who are affected

:40:22.:40:27.

by this proposal. My question is in regard to the bidding process. I

:40:28.:40:30.

wonder what the minister's view is on the potential bidder, Macquarie,

:40:31.:40:38.

the cuff link buccaneers, and whether he believes in the most

:40:39.:40:43.

recent experience as Thames Water owners, where they saw off hundreds

:40:44.:40:46.

of millions of dividend payments shipped off to investors, minimal

:40:47.:40:52.

tax paid, and disappointing investment in the network. The

:40:53.:40:57.

honourable lady has made her point and she will know what point I can

:40:58.:41:02.

make. I cannot comment on the identity of any bidder at this

:41:03.:41:12.

point. If green investments are profitable, attractive and sound as

:41:13.:41:17.

has been claimed, there should be no concern about the introduction of

:41:18.:41:20.

private finance for such projects. Is not surprised that given the

:41:21.:41:24.

pressure on the public purse at the moment, this House is not welcoming

:41:25.:41:31.

another source of funds? He makes an aborted point about the increased

:41:32.:41:34.

attractiveness investment in renewable energy and low carbon

:41:35.:41:43.

infrastructure. What I say in terms of not just what has happened in the

:41:44.:41:45.

UK but around the world, governments has -- governments have seen

:41:46.:41:55.

dramatic falls and the cost of capital attached to them makes them

:41:56.:42:00.

a more investor bowl proposition. It helps reinforce our argument that,

:42:01.:42:04.

in many ways, this makes it the right time to liberate the Green

:42:05.:42:08.

Investment Bank from state control, to be able to play a bigger part in

:42:09.:42:18.

the market. The gold escape group has supported

:42:19.:42:24.

innovative projects throughout the UK that not only help us drive down

:42:25.:42:35.

costs, can he keep them warning that the bank is heading for break-up and

:42:36.:42:39.

halt the sale so it remains a single public institution that is one step

:42:40.:42:45.

ahead of the market? Lord Barker is a good friend of mine, I hold him in

:42:46.:42:53.

great respect, I reassure him and the House that the Government is not

:42:54.:42:56.

being naive in this process. We are clear about the pride teary --

:42:57.:43:06.

criteria we set. The Minister has been clear that the

:43:07.:43:09.

creation of the special share and the Government arrangements around

:43:10.:43:12.

that will protect the integrity of the green purpose in future

:43:13.:43:16.

investments. Can I press on more detail at about how the special

:43:17.:43:21.

share will protect successful bidders from off-loading current

:43:22.:43:29.

projects? I make two points on that. Firstly, the special share is set up

:43:30.:43:33.

to protect the integrity of the green purpose, which is set out in

:43:34.:43:36.

the articles of association, they are there to read now. Any proposed

:43:37.:43:41.

changes to that need to be improved by the trustees that had been

:43:42.:43:44.

selected independently. That is the mechanism. To the point, I will go

:43:45.:43:52.

back to what we were talking about before, it is not a sensible view

:43:53.:43:58.

that investment company should hold onto assets for ever. If they get

:43:59.:44:04.

attractive offers to buy the rest -- to divest assets, they would look

:44:05.:44:15.

seriously at that. We will look at future investment, what this could

:44:16.:44:21.

become under private ownership. He is right when he says that there was

:44:22.:44:26.

cross-party support for the green investment bank. There was not

:44:27.:44:29.

cross-party support for support in Scotland for removing support for

:44:30.:44:34.

carbon capture or indeed wind energy. Given how disastrous his

:44:35.:44:38.

party's policies have been in Scotland, it might explain why they

:44:39.:44:41.

don't do so well with the electorate in Scotland. Will he commit to all

:44:42.:44:46.

of the projects that have been invested in that total hundreds of

:44:47.:44:51.

millions of pounds in Scotland, regardless of whether the buyer is,

:44:52.:44:56.

they will continue and see them in? I dispute her analysis. This country

:44:57.:45:04.

has made enormous progress in the shift to green energy and Scotland

:45:05.:45:06.

has been a big part of that. Again, I point her to the recent admit to

:45:07.:45:15.

the next round of contract auctions. Last year, we generated 25% of our

:45:16.:45:19.

electricity from renewable sources. Issue looks at the starting point in

:45:20.:45:23.

2010, how argument falls away. To her point about continued

:45:24.:45:29.

investment, I point to my earlier comments. When taken alongside the

:45:30.:45:36.

cuts to renewable energy and the abolition of the Department of

:45:37.:45:39.

energy and climate change last year, does the sell-off of the green

:45:40.:45:44.

investment bank now show that the Government is no longer committed to

:45:45.:45:49.

being a world leader on climate change and sustainability? I'm

:45:50.:45:54.

afraid that is total nonsense. If she wants proof points about, one of

:45:55.:45:59.

the first actions of this Department within days of the new government

:46:00.:46:04.

warming it was to lower the fifth carbon Budget. She knows how

:46:05.:46:09.

ambitious that is. That was not the actions of a government that is

:46:10.:46:13.

shirking its responsibilities in elation to Britain's role in

:46:14.:46:22.

mitigating climate change. Is the managed to -- is are seeking any

:46:23.:46:28.

assurances that the sales of assets must be 100% free invested in green

:46:29.:46:32.

energy and the UK? I have laboured the point to exhaustion that one

:46:33.:46:37.

about priorities is to protect the integrity of the green purpose of

:46:38.:46:41.

the organisation. What we want to hear from bidders is their plans for

:46:42.:46:46.

future investment. Order. Point of order. The Attorney General is

:46:47.:46:55.

making a speech today, indeed may have already made the speech which

:46:56.:46:59.

is paving the way for more military drone strikes against jihadi 's.

:47:00.:47:05.

This looks like, smells like, walks like a policy announcement, Mr

:47:06.:47:09.

Speaker. Mr Speaker, you will be aware of concerns in this House

:47:10.:47:14.

about the use of drones, the lack of parliamentary scrutiny of their use,

:47:15.:47:17.

and their terms of engagement, and the risk acknowledged by the

:47:18.:47:22.

Attorney General of civilian casualties associated with their

:47:23.:47:24.

deployment. Given the controversial nature of drones, do you, Mr

:47:25.:47:28.

Speaker, I agree that any step change in the use, a policy shift,

:47:29.:47:33.

is a matter that should be raised and debated in this House, not

:47:34.:47:40.

trailed in a speech? I am grateful to the Right Honourable Jedward for

:47:41.:47:43.

his point of order and for his courtesy in giving the advance

:47:44.:47:48.

notice of his intention to raise it. I share his concerns that policy

:47:49.:47:57.

announcements should be made in this House, rather than outside of it. I

:47:58.:48:01.

am not familiar with the contents of the speech and I am not in a

:48:02.:48:05.

position to pronounce as to whether the Attorney General's speech and

:48:06.:48:14.

outs to an absence of policy change. That said, he has made his concern

:48:15.:48:18.

clear and no doubt it will have been heard on the Treasury bench. He can

:48:19.:48:22.

be sure it will be conveyed to the relevant ministers. I think the

:48:23.:48:28.

fairest thing I can say is, let us await events and perhaps I might add

:48:29.:48:33.

that, as the right honourable gentleman, is a former deputy Leader

:48:34.:48:38.

of the House, he will be well aware of and personally closely familiar

:48:39.:48:44.

with the instruments available for backbench scrutiny of the executive

:48:45.:48:51.

in this place. If there are no further points of order, we come now

:48:52.:48:52.

to the ten minute rule motion. I beg to move that lead be given to

:48:53.:49:04.

bring in a Bill to make provision for the affairs, property and

:49:05.:49:09.

affairs of missing persons and for connected purposes.

:49:10.:49:16.

Sooner or later all parents come to the realisation that our children

:49:17.:49:24.

are slipping away. Those calling, then toggling them running. The

:49:25.:49:28.

gentle guiding hand no longer needed as with great delight as they

:49:29.:49:33.

discover the trick of balancing on two wheels and there they go,

:49:34.:49:37.

pedalling off down the lane. That first day at school, then a few days

:49:38.:49:43.

later, a few years later, the hand starts to slip from yours when you

:49:44.:49:48.

get anywhere near the school gates. Those teenage bedroom years spent in

:49:49.:49:52.

self-imposed solitary confinement. The date when they cram all the

:49:53.:49:57.

stuff into the boot of the car and it is off to university. First job

:49:58.:50:02.

are moving into their first home. All bittersweet moments for most

:50:03.:50:07.

parents because for most of us, we know they will return. Not so for Mr

:50:08.:50:15.

and Mrs Laurence, parents of Claudia, a missing person since the

:50:16.:50:19.

18th of March 2009, nearly eight years ago. We could never imagine

:50:20.:50:27.

the rising panic of those first few minutes, hours and days when they

:50:28.:50:31.

realised something was wrong. Increasingly frantic calls and

:50:32.:50:35.

players going unanswered. Voicemails never retrieved. Those turned into

:50:36.:50:46.

weeks, weeks to months, months two years. The fate of Claudia is still

:50:47.:50:52.

unknown, still be subject of a police investigation. Many faults

:50:53.:50:57.

hopes raised over the years, a lead, a prosecution, nothing. Hopes

:50:58.:51:02.

raised, hopes dashed. When a person disappears with no explanation the

:51:03.:51:06.

friends and family are left with an unbelievable amount to cope with.

:51:07.:51:10.

With all those unanswered questions and difficult emotions. These

:51:11.:51:16.

desperate situations are worsened by the need to pick up the pieces of

:51:17.:51:21.

their lives, pay the mortgage, the rent, the car loan, the insurances.

:51:22.:51:26.

Data protection of financial services law prevents even the

:51:27.:51:29.

closest relative from dealing with the finances. As Mr Laurence told

:51:30.:51:36.

me, banks, insurance companies, mortgage lenders all say we can't

:51:37.:51:40.

accept your instructions, you are not our customer. He went on to say,

:51:41.:51:45.

you are at your lowest ebb and you have to fight all these problems.

:51:46.:51:51.

It's terribly distressing. I firmly believe that the vast majority of

:51:52.:51:56.

members join this house because they want a better world for all our

:51:57.:52:00.

children but there are some problems we will never be able to solve. The

:52:01.:52:05.

floors of mankind will always be there. Our police forces cannot

:52:06.:52:09.

prevent and solve all crimes, but we can help. We can ease the burden in

:52:10.:52:16.

a small but very important way. Under the current law of England and

:52:17.:52:22.

Wales won a person disappears the property is effectively left

:52:23.:52:25.

homeless. No one has legal authority to protect it on their behalf. This

:52:26.:52:29.

can lead to assets depreciating and property falling into despair and

:52:30.:52:36.

leaving those behind without the access to finances that the missing

:52:37.:52:44.

person would have provided. A guardian of the affairs of the

:52:45.:52:47.

missing person will fill this void and will provide a practical

:52:48.:52:55.

financial solution to those left behind. The court will have the

:52:56.:53:00.

power were to appoint a guardian of the application of a person with a

:53:01.:53:03.

sufficient interest in the property and affairs of someone who is

:53:04.:53:07.

missing. In essence the provisions of the bill will mean that generally

:53:08.:53:12.

the person will have to be missing for at least 90 days. The Guardian

:53:13.:53:17.

will take control of the property and financial affairs of the missing

:53:18.:53:20.

person and will have authority to act on behalf of the missing person.

:53:21.:53:23.

They will be able to use the property of the missing person to

:53:24.:53:30.

help those left the hound -- left behind they will be accountable and

:53:31.:53:35.

will be supervise. The terms of the appointment will be for a period of

:53:36.:53:39.

up to four years but will be renewable by application to the

:53:40.:53:43.

court. The small fee involved will be payable by the missing person's

:53:44.:53:47.

estate so there will be little or no cost to the taxpayer. Crucially the

:53:48.:53:53.

Guardian will act in the best interest of the missing person. The

:53:54.:54:07.

proposals draw and a Presidents used in Australia and under the mental

:54:08.:54:12.

capacity act 2005. Many of us have benefited from similar powers in

:54:13.:54:25.

different situations. Quite simply, this legislation fills a gap in the

:54:26.:54:31.

Lord that few people even realise exists. There are around 4000

:54:32.:54:35.

missing people occurrences every year and I would like to thank

:54:36.:54:41.

everyone connected to support and campaign organisation missing

:54:42.:54:44.

people, many of whom are involved because they have also lost a loved

:54:45.:54:50.

one. I would like to offer particular axe to Mr and Mrs

:54:51.:54:53.

Laurence who have a deep connection with my constituency. They

:54:54.:54:57.

championed the cause of guardianship, even though it can no

:54:58.:55:02.

longer help the situation. I am also grateful to members from across the

:55:03.:55:06.

house and from the other players who have pledged their support for this

:55:07.:55:09.

motion, particularly to my honourable friend from York and

:55:10.:55:15.

Selby and the honourable member for York Central who have done so much

:55:16.:55:19.

work on this already. Missing people have many tragic stories of loved

:55:20.:55:27.

ones lost and hearts broken of those left behind. Husbands, wives,

:55:28.:55:34.

fathers, mothers, brothers, sisters and children. This is possibly one

:55:35.:55:39.

of those all too rare occasions where members can certainly make a

:55:40.:55:45.

difference, simply by supporting this straightforward bill. I'm

:55:46.:55:50.

grateful to the Justice select committee, the work of the all-party

:55:51.:55:54.

group for runaway and missing children and crucially government

:55:55.:55:56.

ministers who have pledged their full support for this bill. All I

:55:57.:56:02.

ask, Madam Deputy Speaker, respectfully, is for the support of

:56:03.:56:06.

all honourable members to guarantee its passage through the house and

:56:07.:56:13.

into legislation. Here, here. The question is that the honourable

:56:14.:56:16.

member have leave to bring in the bill. I think the ayes habit. Who

:56:17.:56:33.

will bring in the bill. Christina Rhys, Nigel Adams, David Warburton,

:56:34.:56:40.

lin supple Roberts, Rebecca Powell, Doctor Philippa Whitford and myself.

:56:41.:57:00.

Guardianship missing Persons Bill. Second reading what day? 3rd of

:57:01.:57:24.

February. We now come to the opposition Day motion on NHS and

:57:25.:57:29.

social care funding in the name of the Leader of the Opposition. I

:57:30.:57:32.

informed the house that the speaker has selected amendment eight in the

:57:33.:57:36.

name of the Prime Minister. I called John Ashworth to move the motion.

:57:37.:57:40.

I'm grateful Madam Deputy Speaker and I want to move the motion that

:57:41.:57:45.

stands in my name and the name of my right honourable friend. Can I begin

:57:46.:57:48.

by paying tribute to the staff working in the NHS. To the nurses,

:57:49.:57:57.

doctors, paramedics, all the staff. We say thank you for all the hard

:57:58.:58:01.

work, commitment goodwill and commitment to this winter crisis. I

:58:02.:58:08.

have a pleasure of meeting some of those staff at St George 's Hospital

:58:09.:58:12.

in tooting it on the the pressures they have been facing last night I

:58:13.:58:18.

convened a summit of various royal colleges and trade unions working in

:58:19.:58:26.

the health service. Many will colleges have spoken out today,

:58:27.:58:30.

warning of the underfunding and understaffing. In the last few days

:58:31.:58:34.

I have received messages from doctors and clinicians from across

:58:35.:58:37.

the country who all tale of the immense pressure, strain and crisis

:58:38.:58:43.

we are basing this winter. Let me share with the house some of the

:58:44.:58:49.

stories I have been told and I have excluded the names of hospitals and

:58:50.:58:54.

trusts so as not to cause undue stress and alarm, but let me offer a

:58:55.:58:58.

flavour of what I have heard. One doctor told me there was a point

:58:59.:59:03.

when A was full and we had no space for a major trauma call that

:59:04.:59:07.

was coming in. The trauma case was going to have to be put into a

:59:08.:59:11.

corridor because the resuscitation area was full. Another story. In my

:59:12.:59:17.

A corridor care is not unusual, it is now the norm. We are trying to

:59:18.:59:29.

keep patients save, but there are not enough of us and we are on our

:59:30.:59:33.

knees. Doctors and nurses are in tears. Let me just finish and I will

:59:34.:59:40.

gladly give way. Another story. Over the weekend my bosses repeatedly

:59:41.:59:43.

asked for ambulances to be diverted away from our hospital because we

:59:44.:59:48.

have no beds, but we have multiple requests denied. The A is

:59:49.:59:55.

perpetually round with trolleys. I have many more examples, but I'm

:59:56.:59:58.

sure the house understands the broader point I'm trying to make. I

:59:59.:00:07.

will give way. I thank my honourable friend for giving way. There is

:00:08.:00:10.

unprecedented pressure in Wirral as well. As recently as last week there

:00:11.:00:19.

has been A attendances and GP referral was massively up in and

:00:20.:00:26.

unprecedented way. Extra beds have been laid on and they are full. Last

:00:27.:00:31.

week all elected in patient appointments were cancelled and the

:00:32.:00:35.

ambulance turnarounds have reached up to five others. The Prime

:00:36.:00:38.

Minister did not seem to think there was a crisis in the NHS at Prime

:00:39.:00:43.

Minister's Questions. If this isn't a crisis, but my honourable friend

:00:44.:00:49.

tell us what is? She makes a point eloquently and powerfully represents

:00:50.:00:52.

her constituents as she always does in this place. I hope the secretary

:00:53.:00:57.

of state can respond to some of the points that have been made. I did

:00:58.:01:00.

promise my honourable friend from Stoke, I will give way later. I'm

:01:01.:01:09.

grateful for my honourable friend giving way. The Royal Stoke in my

:01:10.:01:14.

city is under intense pressure. No doubt we will hear from the

:01:15.:01:17.

Secretary of State that this is part of the winter pressure. Winter

:01:18.:01:21.

hasn't really started, we haven't really had a winter and yet this is

:01:22.:01:24.

the pressure we have been under not for a few weeks, but for months. The

:01:25.:01:33.

whole NHS system is broken. An eloquent point about the situation

:01:34.:01:37.

facing Stoke and many of us are aware of the situation facing state

:01:38.:01:41.

for some time. I hope the Secretary of State can touch on the situation

:01:42.:01:45.

in Stoke because it is sadly something we have had to refer to

:01:46.:01:50.

over again. I promise I will try to give way to as many honourable

:01:51.:01:55.

members as possible. Let me assure the Secretary of State I will pass

:01:56.:02:00.

on the names of these trusts and hospitals so he could look into the

:02:01.:02:05.

matters that have been raised. Let's be clear. These desperate stories

:02:06.:02:08.

are not the words of politicians trying to score political points,

:02:09.:02:13.

but the honest heartfelt considered testimonies of doctors and

:02:14.:02:18.

clinicians on the front line in our hospitals. They just simply want to

:02:19.:02:22.

do the very best for their patients and many clinicians want to speak

:02:23.:02:26.

out but of course they feel they can't speak out and this is why

:02:27.:02:30.

these remarks have been made anonymously because according to

:02:31.:02:41.

reports on the BBC, hospital trusts have received instructions from the

:02:42.:02:48.

Prime Minister not to speak out. But the Secretary of State verified

:02:49.:02:50.

those reports in his remarks in a few moments. I give way. What he is

:02:51.:02:57.

describing, and I've worked in the NHS over this Christmas period, it

:02:58.:03:02.

has been a very tough winter so fair, but this is nothing new. I've

:03:03.:03:07.

worked in the NHS over 20 years and under previous governments we had

:03:08.:03:11.

ambulances queueing around the block to get into A and major incidents

:03:12.:03:15.

declared because there were four. This is not a new problem. We accept

:03:16.:03:23.

that? Said to the honourable lady and I entirely respect her work as I

:03:24.:03:29.

believe a nurse before she came into this place... I begged the

:03:30.:03:36.

honourable lady Pozner pardon. She is still a nurse. If we are not

:03:37.:03:41.

raising these matters on behalf of our constituents we are failing in

:03:42.:03:45.

our responsibility as members of Parliament because we must never

:03:46.:03:49.

forget that this is just not about the staff in our NHS, it is about

:03:50.:03:53.

patients and their safety which has always got to be our absolute

:03:54.:03:59.

priority. I will give way. Thank you for giving way. I echo the point he

:04:00.:04:04.

made about this being about patients across the country. My constituent

:04:05.:04:09.

was my mother Angela has been waiting for an acute mental health

:04:10.:04:13.

but for over a week. She was taken to A where they couldn't treat

:04:14.:04:17.

locally in Liverpool because it was full. She was treated for the

:04:18.:04:21.

physical help the facts in an ambulance and sent home and her

:04:22.:04:24.

family are devastated and are very concerned about her condition. These

:04:25.:04:27.

stories we need to focus on today. More broadly on the issues of mental

:04:28.:04:41.

health provision... On the specifics of that case, I have the Secretary

:04:42.:04:44.

of State will respond to my honourable friend when he responds

:04:45.:04:50.

to the debate. My honourable friend talked about patient care. She is

:04:51.:04:56.

right. All of us across this out, all many of us, will have been

:04:57.:04:59.

getting stories from constituents, telling of their recent experiences

:05:00.:05:05.

in hospital. I have been given some examples. I will share them with the

:05:06.:05:11.

House. Again, I will not reveal the names of trusts and hospitals, I

:05:12.:05:15.

will pass them on after the debate. A mother of four children, under ten

:05:16.:05:20.

years old, as a secondary tumour in her leather. She was due to go into

:05:21.:05:23.

hospital this Thursday to have it removed. Her surgery has been

:05:24.:05:28.

delayed for at least two macro weeks due to the hospital coping with a

:05:29.:05:32.

winter crisis and there being no beds available. She has not yet been

:05:33.:05:36.

given a new date. Someone else got in touch this morning whose wife has

:05:37.:05:41.

been on the waiting list for a knee replacement since April last year.

:05:42.:05:44.

An appointment for early December was cancelled owing to the hospital

:05:45.:05:50.

being and black colour. Weeks later, the hospital phoned with another

:05:51.:05:54.

appointment for today, which was cancelled yesterday. Again, these

:05:55.:06:01.

are not agents trying to score political points or politicise

:06:02.:06:11.

matters, they are wanting possibly to be done. I will give way. I thank

:06:12.:06:19.

him. We on this side care deeply about patients. Personally, as

:06:20.:06:24.

another parliament, I not on individual stories and challenges

:06:25.:06:26.

experienced by my constituents. He has surely seen the guidance from

:06:27.:06:31.

the NHS providers organisation representing NHS providers who are

:06:32.:06:34.

not always friends of the Government am about who said this week that we

:06:35.:06:39.

also need to be careful in extrapolating from individual

:06:40.:06:45.

incidents in hospitals under particular pressure. Yes, times are

:06:46.:06:51.

tough in the NHS, there are winter pressures, but he should not make

:06:52.:06:53.

inappropriate use of individual stories. The lady ought to be

:06:54.:06:59.

careful. I will be charitable but you would not one to give the

:07:00.:07:04.

impression that she is dismissing these examples that I am reading

:07:05.:07:10.

out. With respect to NHS providers, they have continually warned of the

:07:11.:07:16.

chronic underfunding of the NHS under this government. NHS providers

:07:17.:07:19.

have continually warned that head forehead spending in this country

:07:20.:07:27.

will be falling. She should quit all of the facts from the NHS providers.

:07:28.:07:33.

I thank you for giving way he is telling some shocking stories. Was

:07:34.:07:40.

he shocked to hear people heckling in Prime Minister's Questions, what

:07:41.:07:45.

about Wales? There is more funding in Wales than in England. We have

:07:46.:07:50.

brand-new hospitals including my own constituency and we have had a new

:07:51.:07:54.

treatment fund announced to allow better access to treatment. My

:07:55.:07:58.

honourable friend makes a powerful point about Wales. As a member for

:07:59.:08:03.

Cardiff, he will understand what is happening in the Welsh NHS. I will

:08:04.:08:11.

give way. Then I will make some progress if I may. Would he accept

:08:12.:08:17.

that every winter for as long as I can remember, we have had a winter

:08:18.:08:22.

crisis in the NHS? It usually happens after Christmas because, in

:08:23.:08:29.

winter, the demands on the service become unpredictable. Infections

:08:30.:08:32.

spread and you lose staff and there are bound to be parts of the system

:08:33.:08:35.

that come under real strain and no one is trying to minimise the fact

:08:36.:08:40.

that they do. Apart from producing this year's crop of stories of very

:08:41.:08:44.

unfortunate incident in various places, does he have any policy

:08:45.:08:51.

proposal to make at all apart from simply spending more money wherever

:08:52.:08:56.

the reports are coming from? He is very experienced, but he will know

:08:57.:09:03.

that this is one of the worst winters for probably 20 years.

:09:04.:09:08.

Actually, he casually suggests that this happens every year. I remove

:09:09.:09:12.

the years of a Labour government when it didn't happen. Ireland and

:09:13.:09:19.

the years of a Labour government when it went further than the

:09:20.:09:23.

financial settlements that he was delivering as the Chancellor of the

:09:24.:09:25.

Exchequer and more than doubling the money going into the NHS. If I may,

:09:26.:09:30.

I really would like to make a little bit of progress. I promised my or

:09:31.:09:36.

for friends and mothers of the other side that I will give way as much as

:09:37.:09:40.

possible but I am aware there are many members waiting to speak. I

:09:41.:09:42.

will make some progress and then give an opportunity for people to

:09:43.:09:47.

make an intervention. We are all becoming far too familiar with the

:09:48.:09:53.

grim statistics. In September, 50 of the 152 trusts call for urgent

:09:54.:09:58.

action to cope with demand. The number of patients being turned away

:09:59.:10:06.

from A at a record high. 15 hospitals ran out of beds in one day

:10:07.:10:11.

in December. Last night, the BBC revealed leaked documents from NHS

:10:12.:10:16.

improvements that showed that there were more than 18,000 trolley waits

:10:17.:10:22.

of four hours or more. Almost a quarter of patients waited longer

:10:23.:10:28.

than four hours in A last week. Just one hospital met its target.

:10:29.:10:33.

Since the start of December, hospitals of only seen 82 percent of

:10:34.:10:42.

patients within the target. Ministers can try and deny what is

:10:43.:10:46.

going on and I cannot deny these facts about what is happening this

:10:47.:10:53.

winter in the NHS and their watch. We know that what happens in the NHS

:10:54.:10:57.

in winter is a signifier of a wider crisis. Across the piece, bed

:10:58.:11:03.

occupancy levels now routinely exceed the recommended maximum

:11:04.:11:11.

levels, often to levels higher than 95%. We have an NHS going through

:11:12.:11:14.

the largest financial squeeze in its history. Indeed, the former

:11:15.:11:21.

Secretary of State said they plan for five years of NHS austerity,

:11:22.:11:25.

they were never expecting ten years of NHS austerity. We have seen 4.6

:11:26.:11:33.

billion cut from the social care Budget and as the Kings fund said,

:11:34.:11:36.

is there a problem? Because there is a

:11:37.:11:47.

simply a series of cuts affecting our hospitals. It has been a

:11:48.:11:55.

position of utter complacency. Things had only been falling over in

:11:56.:11:59.

a couple of places, he said. When he came to the House on Monday to make

:12:00.:12:03.

his statement, he did not commit to extra emergency funding for social

:12:04.:12:08.

care, he didn't promise that the financial settlements would be

:12:09.:12:12.

reassessed in the March Budget. In fact, it is worse than that. When he

:12:13.:12:15.

was making his statement, his own spin doctors were telling the Health

:12:16.:12:21.

Service Journal, this is on the day when the winter crisis is leading

:12:22.:12:24.

the news and he's making a statement in his house, come his spin doctors

:12:25.:12:32.

were saying that, there is no prospect of additional funding to

:12:33.:12:34.

support emergency care any time before the next election. So nothing

:12:35.:12:39.

for social care, nothing for emergency care, nothing to tackle

:12:40.:12:42.

understaffing, nothing to tackle underfunding. Thank you very much(!)

:12:43.:12:49.

What did we get in response? A downgrade of the four our A

:12:50.:12:55.

target. He shakes his head, he says nonsense. I will remind him of what

:12:56.:13:02.

he said. We need to have an honest discussion with the public about the

:13:03.:13:07.

purpose of A departments. He said he wanted to provoke a discussion,

:13:08.:13:12.

he wanted to provoke a discussion. He has certainly provoked a

:13:13.:13:16.

backlash, not these by blaming the public for turning up at A

:13:17.:13:22.

departments. He said, the four our target is a promise to sort out all

:13:23.:13:27.

urgent health problems within four hours. He was his clarification, but

:13:28.:13:38.

not all health problems, however minor. We have now seen a letter to

:13:39.:13:43.

trust a few weeks ago which talks of the need to broaden Harrah oversight

:13:44.:13:50.

of A They said, we believe there is merit in broadening out oversight

:13:51.:14:00.

response further than a single metric. Can he answer our questions.

:14:01.:14:06.

I know he avoided the questions yesterday and Sky News. Does he

:14:07.:14:11.

recall that in 2015, he Arthur Abraham you on these matters are

:14:12.:14:16.

waiting times. Bruce Keogh said that A standards have been important in

:14:17.:14:24.

making sure that people get access to emergency care. I do not consider

:14:25.:14:28.

there is a chase for changing the standard this time. The Secretary of

:14:29.:14:33.

State still agree with Bruce Keogh? If he does agree, can he tell us,

:14:34.:14:38.

why did he make his remarks on Monday when he said we need have a

:14:39.:14:41.

discussion about future of the A standard. If he wants to lead a

:14:42.:14:47.

discussion about the future of the standard, what discussions has he

:14:48.:14:53.

had with the Royal College of Nursing medicines? They argue that

:14:54.:14:58.

the standard is a vital measure of performance and safety. It should

:14:59.:15:01.

apply to at least 95% of all patients attending emergency

:15:02.:15:05.

departments. If he is still committed to that standard, is he

:15:06.:15:09.

still committed to maintaining it at 95%? My honourable friend has had

:15:10.:15:22.

one bite at the cherry. If he doesn't mind, I will make some

:15:23.:15:27.

progress for now. I will do my best to get as many people in if I may.

:15:28.:15:34.

Does the Secretary of State agree that the four hour standard is a

:15:35.:15:39.

reasonable proxy for patient safety? Does he agree that every reach of

:15:40.:15:43.

the standard can be regarded as a potentially elevated...? I will give

:15:44.:15:52.

way, she has been persistent. If the honourable gentleman were to read

:15:53.:15:56.

the Government amendment, he said he endorses and supports the 95% target

:15:57.:16:08.

for A waiting times. I will pay tribute to the bunch is doing and

:16:09.:16:15.

loneliness -- is doing and loneliness. The Secretary of State

:16:16.:16:22.

did the English between urgent and minor... He heckles so much, the

:16:23.:16:32.

web, it is sometimes difficult to hear what he is saying. Can he tell

:16:33.:16:37.

us how he would define the difference between urgent at minor

:16:38.:16:43.

care for this for our standard? Can he tell is the minimum severity of

:16:44.:16:47.

physical injury or other medical problem switch will be needed for a

:16:48.:16:50.

patient to qualify for access to A? How will we determine these new

:16:51.:16:55.

standards? How quickly will they be available? Which injuries will

:16:56.:17:04.

qualify? If the Secretary of State is not moving away from this

:17:05.:17:07.

standard, I'm afraid he needs to clarify matters urgently because the

:17:08.:17:10.

oppression has been given that he is moving away from that standard. Not

:17:11.:17:16.

by me, but by his own remarks on Monday. If he is not moving away

:17:17.:17:22.

from the standard, can he give a guarantee that he will not shift

:17:23.:17:25.

away at all throughout the Parliament from the standard and it

:17:26.:17:29.

will remain at the current rate it is now? I will give way. I was in

:17:30.:17:38.

the chamber on Monday and listened carefully. He was challenged on the

:17:39.:17:41.

target and asked if he was watering it down, he said explicitly that far

:17:42.:17:46.

from watering it down, he was recommitting the Government to it

:17:47.:17:50.

and he actually said, and he was generous to the Labour Party, it is

:17:51.:17:53.

one of the best things the NHS did. I think that was clear.

:17:54.:18:01.

I will say to the right honourable gentleman, the former chief Whip,

:18:02.:18:06.

the Secretary of State said we need to be clear it is a promise to sort

:18:07.:18:09.

out all urgent health problems within four hours, not all health

:18:10.:18:15.

problems. The Secretary of State enemy to cover the House and make

:18:16.:18:19.

these remarks and said these hares running. You should make his

:18:20.:18:25.

objections not to meet but to the Secretary of State. I will move on a

:18:26.:18:31.

little bit. If the Secretary of State is not abandoning the

:18:32.:18:40.

standard, we look forward to him making that clear. He has also said

:18:41.:18:43.

and implied that we need to educate the public that so they do not turn

:18:44.:18:49.

up at A departments. That was the implication of his remarks on

:18:50.:18:52.

Monday. Can he tell us how he's going to do that? What will be the

:18:53.:18:57.

cost of locations of expanding to the public not turning up at Axa

:18:58.:19:02.

macro departments? Will we see a large advertising campaign? The

:19:03.:19:09.

heat: local authorities whose budgets have been cut question Mike

:19:10.:19:13.

would he give the new resources for this education campaign?

:19:14.:19:19.

He makes an important point. The key thing is in the 90s when Labour took

:19:20.:19:27.

over in 97, the health service was in crisis and is today, but the

:19:28.:19:32.

point I want to make is isn't part of the problem people go to A

:19:33.:19:37.

because they cannot see their GP? It is difficult to get to the GP which

:19:38.:19:42.

is why we have the pressures on A and it will get worse with community

:19:43.:19:49.

pharmacy cuts this year, losing them from our towns and streets because

:19:50.:19:56.

of the cuts pursued. The figure of 3000 community pharmacy is being

:19:57.:20:00.

lost, was what the previous minister said to MPs. I will give way one

:20:01.:20:04.

last time and then I must make progress. I had a debate in

:20:05.:20:10.

Westminster Hall on pharmacies and integration in the NHS and not one

:20:11.:20:15.

single Labour MP from the backbench bother to take part. Not one. Labour

:20:16.:20:26.

MPs have raised these matters for weeks, including urgent questions

:20:27.:20:30.

and an Opposition Day debate. On that point, I presume what the

:20:31.:20:37.

honourable lady meant was there were two backbench Labour members who

:20:38.:20:44.

took part in the debate. Would he agreed the point about community

:20:45.:20:49.

pharmacies and GPs and investment in social care is it says the

:20:50.:20:52.

government money if it does it, that is why they should make the

:20:53.:20:55.

investment now to take pressure off A I'm grateful for him correcting

:20:56.:21:02.

the record on the debate in Westminster Hall. The Secretary of

:21:03.:21:10.

State denies he will water down the A target, we welcome that but will

:21:11.:21:14.

watch carefully to ensure he does not sneakily water it down for the

:21:15.:21:19.

remaining years of Parliament. Can he tell us what he expects to happen

:21:20.:21:23.

as we go through winter, because we know whether warnings have been

:21:24.:21:28.

issued and we could be heading for a cold snap. Could he update us on

:21:29.:21:33.

urgent preparations put in place to ensure the NHS can cope? Is the NHS

:21:34.:21:40.

prepared for a flu outbreak. What is his assessment if overstretched

:21:41.:21:45.

hospitals could cope if there is a flu outbreak? So far it appears

:21:46.:21:48.

ministers have buried their heads in the sand and that will not do. I

:21:49.:21:58.

will give way. I'm grateful. Honourable members both made the

:21:59.:22:03.

point of the issues in the NHS are historic. On Radio 4 today, the

:22:04.:22:11.

right honourable member for 's Leigh accepted he had not spent the right

:22:12.:22:18.

money on social care. Will he accept these are historic and not new? The

:22:19.:22:25.

honourable lady refers to the history. Under this government the

:22:26.:22:30.

NHS is going through its largest financial squeeze in its history and

:22:31.:22:33.

when we had a Labour government we more than doubled the investment

:22:34.:22:37.

going into the NHS. Because he is a member from the East Midlands I will

:22:38.:22:40.

give way to the honourable member from Corby. I am grateful. I agree

:22:41.:22:46.

we need to have an honest debate. Would he accept he stood on a

:22:47.:22:50.

general election manifesto that would have spent billions less on

:22:51.:23:00.

the NHS? Willy set out exactly what services he would spend less on in

:23:01.:23:03.

the NHS now. We stood on a manifesto that would have delivered more

:23:04.:23:07.

doctors and nurses and he stood on a manifesto that said they would cut

:23:08.:23:12.

the deficit and not the NHS. They are cutting the NHS and failing on

:23:13.:23:21.

the deficit. Can I ask the Secretary of State direct questions about

:23:22.:23:25.

Worcestershire. I was grateful for his remarks on Monday. Can I press

:23:26.:23:30.

him further, because it has been reported NHS England was warned of

:23:31.:23:35.

the bed crisis on 22nd of December and I would be grateful if he could

:23:36.:23:39.

update the house on urgent meetings he is having on Royal Worcestershire

:23:40.:23:43.

and where we will be closer to knowing the outcome of an enquiry

:23:44.:23:49.

and in the context of that, we know the STB for the Worcestershire area

:23:50.:23:53.

is proposing a number of acute beds productions. I wonder in the context

:23:54.:24:02.

of the issues that appear to be fair, witty remark upon that whether

:24:03.:24:06.

he thinks that is the right to follow. The NHS is going through

:24:07.:24:14.

this winter crisis and then it is about to go on another top-down

:24:15.:24:21.

reorganisation, if you like, aimed at... He says bottom-up, they are

:24:22.:24:26.

not. They are being told they have to fill a financial gap. Of 21.76 4

:24:27.:24:43.

billion. That is the reality that STPs have to face. We have seen

:24:44.:24:48.

community hospitals closed. It will mean a number of a deeply Mac

:24:49.:24:52.

downgraded and it will mean acute beds lost in places like Devon for

:24:53.:24:58.

example, where the STP talks of an overreliance on bed. They talk about

:24:59.:25:11.

vulnerable services such as maternity and paediatrics. In

:25:12.:25:15.

London, a city with the worst health inequalities they are expected to

:25:16.:25:21.

deliver better health outcomes for its growing 10 million residents

:25:22.:25:27.

with 4.3 billion less to spend. I ask the Secretary of State, can he

:25:28.:25:33.

explain to the house how he expects the NHS to perform in future winters

:25:34.:25:39.

when we have a growing elderly population and STPs are pursuing

:25:40.:25:44.

cuts to beds and A and wider services? I was recently briefed by

:25:45.:25:52.

an excellent and respected GP and clinical psychiatrist who had been

:25:53.:25:57.

authors of our county's STP. Can he explain how on earth they are

:25:58.:26:01.

responsible for a top-down reorganisation? I have been told by

:26:02.:26:08.

NHS England who would told by the Secretary of State, that is how. The

:26:09.:26:20.

right honourable member mentioned spending, but does he share my

:26:21.:26:31.

concern infection spreading of arrogance, complacency, from being

:26:32.:26:36.

out of touch from family suffering and witnessing in action on an epic

:26:37.:26:43.

scale? I think he makes his point extremely well. I would not want to

:26:44.:26:50.

be so mean about the Secretary of State. I'm grateful. We have heard

:26:51.:27:00.

ludicrously the suggestion that Labour did not perform on spending

:27:01.:27:05.

or performance at our track record was excellent and it is not just my

:27:06.:27:08.

words but the words of the former Prime Minister who said in 2011, I

:27:09.:27:13.

refuse to go back to the days when people had to wait hours to be seen

:27:14.:27:19.

in A or months to have surgery. Let me be clear we went. He knew

:27:20.:27:23.

that Labour had a good record and the NHS used to be good, why do the

:27:24.:27:30.

Tories not admit it? I remember Shadow Health Secretary is when we

:27:31.:27:33.

were in government opposing every penny piece of money Labour was

:27:34.:27:41.

putting into the NHS and I remember Shadow Health Secretary who now sits

:27:42.:27:46.

in the cabinet, talking about the A target as being, quote,

:27:47.:27:52.

indecent. It is no wonder we are sceptical about government

:27:53.:27:55.

intentions on this A target when we look at their history. I will

:27:56.:28:04.

give way. I'm grateful. He is talking about the Labour years and

:28:05.:28:08.

record of the NHS, does he recall Labour closing not only maternity at

:28:09.:28:15.

one hospital but accident and emergency in 2005, as well? I do not

:28:16.:28:22.

have the details of the Sussex STP to hand but presumably if it is

:28:23.:28:29.

suggesting closures, the honourable gentleman will campaign against

:28:30.:28:33.

closures and knock on the door of the Secretary of State if those

:28:34.:28:35.

remarks are an indication of his view on these matters. He is saying

:28:36.:28:42.

everything was rosy under Labour but it was ten years ago the Mid

:28:43.:28:45.

Staffordshire scandal broke in which hundreds of elderly patients more

:28:46.:28:52.

had died and expected to, it was a terrible scandal and he should

:28:53.:28:55.

remember that because our shadow spokesman were holding a Labour

:28:56.:29:04.

government to account at the time. I take all deaths in hospitals

:29:05.:29:09.

seriously. My commitment to patient safety is unswerving and I will

:29:10.:29:13.

raise matters, whether it is Royal Worcestershire or elsewhere, not in

:29:14.:29:17.

a partisan way with the Secretary of State. I was not being partisan when

:29:18.:29:22.

I ask questions about while Worcestershire. I will raise matters

:29:23.:29:26.

because that is the responsible thing to do. It is not becoming of

:29:27.:29:30.

the honourable gentleman to play politics in that way. Madam Deputy

:29:31.:29:37.

Speaker, the culpability for the state the NHS is in today lies at

:29:38.:29:42.

the door of Downing Street. A government that promise to protect

:29:43.:29:48.

the NHS and cut the deficit and it didn't. The government gives away ?1

:29:49.:29:56.

billion tax cuts to corporations. The government wastes billions

:29:57.:30:01.

pushing the NHS in the direction of fragmentation and greater

:30:02.:30:03.

outsourcing while ignoring lengthening queues of the sick and

:30:04.:30:09.

elderly in our constituencies. Yesterday we saw the Secretary of

:30:10.:30:13.

State on Sky losing his ministerial car and being chased down the

:30:14.:30:17.

street, his approach laid bare, not a clue where he is going. Nothing to

:30:18.:30:25.

say, not facing up to the problems. Last year he blamed junior doctors.

:30:26.:30:31.

On Monday he blamed the patients and today he blames Simon Stephens.

:30:32.:30:35.

Tomorrow he will blame the weather. It is time he started pointing the

:30:36.:30:40.

finger at himself and not everybody else, the NHS is in crisis,

:30:41.:30:45.

ministers are in denial. I say to the government on behalf of

:30:46.:30:50.

patients, their families, our behalf of NHS staff, please get a grip. I

:30:51.:30:57.

commend our motion to the house. The question is as on the order paper. I

:30:58.:31:01.

call Jeremy Hunt to move the amendment. I beg to move the

:31:02.:31:08.

amendment standing in the name of my right honourable friend the Prime

:31:09.:31:12.

Minister. I want to thank the Shadow Health Secretary for bringing the

:31:13.:31:15.

debate, he is right to draw attention to pressures in the neck

:31:16.:31:20.

chess but I am regrettably going to have to spend much time correcting

:31:21.:31:24.

totally inaccurate assertions -- in the NHS. That is a shame because it

:31:25.:31:31.

is an important debate for constituents and the NHS and the

:31:32.:31:34.

country deserves a proper debate but that is difficult when we have

:31:35.:31:39.

misinformation at a time when the NHS faces sustained pressure. I am

:31:40.:31:43.

pleased to see the Leader of the Opposition in his place. I think he

:31:44.:31:47.

is rather a fan of my Parliamentary appearances recently. It is a Jeremy

:31:48.:31:55.

think, he says. If only. I wish to address one part of my speech to him

:31:56.:32:02.

because it is an area of policy for which he is perhaps more personally

:32:03.:32:06.

responsible. Winter is a challenging period and I want to repeat thanks

:32:07.:32:11.

the Shadow Health Secretary said and the banks I gave on Monday to NHS

:32:12.:32:18.

staff. -- my thanks. On Tuesday, the NHS had its bid -- busiest day,

:32:19.:32:27.

treating a record number of patients in four hours. And 2500 more

:32:28.:32:33.

patients within the four-hour standard everyday compare to 2010.

:32:34.:32:38.

As we discussed on Monday, the NHS made record numbers of preparations

:32:39.:32:44.

for the winter because it is difficult, including 3000 more

:32:45.:32:47.

nurses and 1600 more doctors on full-time employment. I will address

:32:48.:32:54.

so that it does get dealt with early what the Shadow Health Secretary

:32:55.:32:57.

talked about with respect to Worcestershire. I met colleagues

:32:58.:33:03.

there on Monday. A huge amount of action is being taken but we should

:33:04.:33:07.

say it is totally not acceptable for anyone to wait 35 hours on a trolley

:33:08.:33:12.

and we expect the hospital to ensure it does not happen again. There are

:33:13.:33:19.

plans to open additional capacity. We have had capacity made available

:33:20.:33:23.

by Worcester community trust. It supplied its chief operating officer

:33:24.:33:29.

to be based at the trust to facilitate discharges, and we have a

:33:30.:33:35.

new chief executive, the trust is in special measures and the new chief

:33:36.:33:38.

executive will start later this spring. What is wrong about what the

:33:39.:33:45.

Shadow Health Secretary has said is the suggestion that winter problems

:33:46.:33:53.

are unusual. The NHS had difficult winters in 99, 2008 and 2009, as The

:33:54.:33:59.

Right Honourable member said. I will give way in a moment. He remembers

:34:00.:34:04.

difficult winters from his time as Health Secretary. There are things

:34:05.:34:08.

that are different today and one of them is compared to six years ago,

:34:09.:34:16.

we have 340,000 more over 80s, many honourable, many with dementia, and

:34:17.:34:21.

we know when people of that age go to A at this time of year there is

:34:22.:34:27.

an 80% chance they will be admitted. I will give way. I thank him. He

:34:28.:34:34.

talks about correcting points and it is important the house has

:34:35.:34:40.

information. Can I repeat the question, the latest figures, can he

:34:41.:34:44.

tell us the number of people remaining in hospital, that could be

:34:45.:34:49.

discharged, because there is no community support they have stayed

:34:50.:34:52.

in hospital. Could he give us that figure?

:34:53.:35:01.

It was around 7000 beds last year, which is far too many. Which is why

:35:02.:35:07.

it was announced that a new package of support worth around ?400

:35:08.:35:11.

million, I will just answer his question, I said I would write to

:35:12.:35:14.

him and I will. He may have noticed there are other issues we are

:35:15.:35:18.

dealing with which is why I may not have had time to sign the letter.

:35:19.:35:22.

What the Communities Secretary announced, ?400 million extra over

:35:23.:35:27.

the next two years will make a significant difference and he should

:35:28.:35:33.

recognise that. I am grateful for him giving way, there will be

:35:34.:35:35.

constituents who are concerned about the headlines they have read. I am

:35:36.:35:40.

pleased the secretary of state will correct some of the points that were

:35:41.:35:44.

made. They also want to know what is being done and what should be done.

:35:45.:35:49.

I listened for 33 minutes to the Shadow Secretary of State, the

:35:50.:35:52.

Labour spokesman of the NHS, not a single new idea other than spending

:35:53.:35:58.

money. Could my right honourable friend provide practical answers to

:35:59.:36:03.

allay concerns in the papers. That is why I will be talking later about

:36:04.:36:07.

what our solutions are to these problems. I will give way but I also

:36:08.:36:11.

want to make some progress, which I will do now. I want to talk about

:36:12.:36:17.

something else that is different today in our AMD departments

:36:18.:36:21.

compared to six years ago. Which -- a and E departments. We also insist

:36:22.:36:28.

on much higher standards of safety and quality. On Monday, I

:36:29.:36:32.

congratulated labour for the introduction of the four our target.

:36:33.:36:38.

I support it. We should all member that four years after that standard

:36:39.:36:42.

was introduced, we started to see some horrific problems among staff

:36:43.:36:48.

in the a and E departments, many thought they would be fired if they

:36:49.:36:52.

missed the target. What Robert Francis said about this that the

:36:53.:36:57.

failure of its staffs were "Imparts the consequence of allowing a focus

:36:58.:37:01.

on reaching national access targets." While we retain targets,

:37:02.:37:06.

we will not allow them to be followed slavishly in a way that

:37:07.:37:17.

damages patient care. My point is that that is why we have a new

:37:18.:37:21.

inspection regime which makes it harder to cut corners in a way that

:37:22.:37:25.

frankly used to happen which meant beds were not being washed. There

:37:26.:37:29.

was poor infection control and ambulances were being used as

:37:30.:37:34.

waiting rooms and so on. I will give way. I am grateful for him outlining

:37:35.:37:40.

the steps he is taking in this emergency but does he also recognise

:37:41.:37:44.

that the major cause of the problems in A are the lack of staff we

:37:45.:37:48.

have? As a result of that, does he regret the huge cuts there were two

:37:49.:37:55.

training projects in 2010, 2011, 2012, which is having an impact now

:37:56.:37:59.

on the number of doctors and nurses in our NHS? I agree Stockman was

:38:00.:38:07.

critical in this but we have more doctors in A departments, more

:38:08.:38:12.

consultants, more than 11,000 additional doctors. We are

:38:13.:38:17.

recognising the pressures being faced in the NHS. 1600 more doctors

:38:18.:38:21.

since this time last year, this is something we are doing a lot about.

:38:22.:38:25.

I will give way once more on this side. Does my right honourable

:38:26.:38:30.

friend agree that learning Best practice within the NHS, the

:38:31.:38:36.

hospitals that manage to integrate and help with social care, such as

:38:37.:38:40.

Wigan and Salford hospitals who reduced and created those beds, that

:38:41.:38:44.

is an example of best practice is that the whole NHS can learn from?

:38:45.:38:51.

My honourable friend is absolutely right, it is a mistake in this

:38:52.:38:55.

debate, which I understand that opposition parties want to do, to

:38:56.:38:59.

put it down to government funding but in the country, we see a lot of

:39:00.:39:04.

variability. This period of the year is always difficult but some

:39:05.:39:07.

hospitals are doing superbly well in challenging circumstances. We have

:39:08.:39:12.

just heard some of the hospital is doing well and there are a number. I

:39:13.:39:19.

will give way to as many people as I can but I also want to address the

:39:20.:39:23.

substantive point is that the Shadow Health Secretary said. He talked

:39:24.:39:28.

about the four our target and in his motion and hit in his speech, he

:39:29.:39:32.

made the totally spurious suggestion that we are not committed to that

:39:33.:39:36.

target. I remind him of what might right honourable friend said, quoted

:39:37.:39:43.

me as saying on Monday, what I said was not just committing the

:39:44.:39:46.

government to the target but that it was one of the best things the NHS

:39:47.:39:53.

does. I also said that we need to find different ways to offer

:39:54.:39:57.

treatment to people who do not need to be in A This is hardly rocket

:39:58.:40:04.

science. When you have pressure in A, it is sensible and indeed, I

:40:05.:40:08.

would argue the duty of the Health Secretary to suggest that people who

:40:09.:40:16.

can relieve pressure on A do so. I am grateful to the Health Secretary

:40:17.:40:21.

for giving way, yesterday at Crawley Hospital, and acute care unit was

:40:22.:40:26.

opened which precisely to ensure that those people who don't need to

:40:27.:40:31.

attend A are properly directed to the most appropriate care. Which is

:40:32.:40:35.

good for them as individual patients and good for the whole system as

:40:36.:40:42.

well. He is absolutely right. To back up his point, we had a report

:40:43.:40:47.

from the OECD yesterday that said that in Australia, Belgium, Canada,

:40:48.:40:53.

France, Portugal, at least 20% of A visits are inappropriate. NHS

:40:54.:40:58.

England's figure is that this is up to 30%. That is why we need the

:40:59.:41:02.

public's help to relieve pressure. That is what I meant when I talked

:41:03.:41:07.

about an honest discussion. I give way. The Secretary of State told us

:41:08.:41:15.

a moment ago that there are 300,000 more people over the age of 80,

:41:16.:41:18.

surely he would know this information when his government took

:41:19.:41:20.

over seven years ago from the sensors data. Why is it that we are

:41:21.:41:27.

now seeing on the front pages of newspapers that one in four of A

:41:28.:41:33.

awards are unsafe and that we have similar challenges across the

:41:34.:41:38.

country West Chamakh we did know that information and that is why we

:41:39.:41:42.

thought it was totally responsible to cut the NHS budget in 2010. As a

:41:43.:41:49.

result of that, we have 11,000 more doctors and in her own local

:41:50.:41:54.

hospital, every single day, we are treating within four hours, 243 more

:41:55.:42:02.

people. What I said, I will make some progress and then give way. I

:42:03.:42:07.

could have put what I said on Monday a different way. I could have said

:42:08.:42:10.

that we have to persuade those people not in medical emergencies to

:42:11.:42:14.

use other parts of the system to get the help they need. I didn't

:42:15.:42:17.

actually say that but I will tell you who did say that, the Labour

:42:18.:42:22.

health minister in Wales, Mark Drake that, in January last year. And

:42:23.:42:27.

frankly, when the NHS is under the pressure it is under, it is

:42:28.:42:30.

responsible for the party of the city criticised the Health Secretary

:42:31.:42:35.

in England for Sanogo same thing that the Health Secretary in Wales

:42:36.:42:43.

is also saying. -- for saying the same thing. I am grateful, I think

:42:44.:42:50.

the Secretary of State is so in confusion in the House and the

:42:51.:42:54.

country on this question and again today. If what he is saying is the

:42:55.:42:58.

same as my honourable friend the Health Secretary of Wales that we

:42:59.:43:01.

want to divert people who don't need to go to A from doing so, then I'm

:43:02.:43:07.

sure everybody in this House would support that. But what we suspect he

:43:08.:43:12.

is saying is that the four our waiting target is going to be

:43:13.:43:18.

disappointed to some people turning up to ten par and that is the

:43:19.:43:21.

downgrading he is talking on if that is the case, he should come clear

:43:22.:43:26.

and he should be clear whose job it is going to be to do supply the

:43:27.:43:30.

target to some people with minor ailments. I did not say that and I

:43:31.:43:37.

didn't say it because we are not going to do it. Let me tell him, we

:43:38.:43:43.

did have an intervention from a Welshman, rather inconvenient truth

:43:44.:43:45.

about what is happening in Wales. Last you, and par performance with

:43:46.:43:50.

10% lower than in England and in Wales, they have not hit the A

:43:51.:43:55.

target for eight years. We are not going to let that happen in England.

:43:56.:44:00.

I noticed the Shadow Health Secretary quoted a number of people

:44:01.:44:03.

but one organisation he didn't quote was the Royal College of emergency

:44:04.:44:08.

medicine, I wonder if the reason is because of what they said about

:44:09.:44:12.

Wales this week. They said emergency care in Wales is in a state of

:44:13.:44:17.

crisis. "Performance Is as bad, if not worse than England in some

:44:18.:44:24.

areas. " In areas Labour is in contrast -- labour is in control,

:44:25.:44:33.

these issues are worse. I say that, not to make the political point but

:44:34.:44:38.

to say that it is blatantly ridiculous to start trying to play

:44:39.:44:41.

politics when you have winter pressures in the NHS because this

:44:42.:44:45.

happens in the whole NHS, in Wales as well as in England. I'm going to

:44:46.:44:49.

make progress but I will give way to my honourable friend. I thank him,

:44:50.:44:57.

can I reiterate the point he made about the four our target. During

:44:58.:45:00.

the Labour government I was working in the NHS and significant pressure

:45:01.:45:05.

was put on us by managers to meet the four our target and negate

:45:06.:45:08.

clinical need and often patients were prioritised according to

:45:09.:45:12.

meeting the target rather than the clinical need and that was a

:45:13.:45:16.

disgrace. That is exactly the problem we had with mid staffs. What

:45:17.:45:21.

we had was a culture in the NHS where people were hitting targets

:45:22.:45:26.

but missing the point. While targets are important, management tools, it

:45:27.:45:32.

is important they followed in a sensible way that puts the welfare

:45:33.:45:37.

of patients first. I would like to make another point about Wales why

:45:38.:45:42.

we have the privilege of someone who aspired to lead the Labour Party

:45:43.:45:47.

here, as the current leader of the Labour Party is no longer in this

:45:48.:45:51.

place. I want to make this point, something England and Wales have in

:45:52.:45:55.

common is the need to make sure that if we want all senators to A that

:45:56.:45:59.

people are able to get to see their GP. I have said many times that

:46:00.:46:04.

people wait too long to see their GPs. I have to say in all honesty,

:46:05.:46:09.

the GP contract changes in 2004 were a disaster. Because the result of

:46:10.:46:16.

those changes were that 90% of GPs opted out of out-of-hours care. But

:46:17.:46:21.

we have been putting that right. Now, 17 million people in England,

:46:22.:46:27.

30% of the publishing, have access to weekend and evening GP

:46:28.:46:31.

appointments. More than that, in this Parliament, we have committed

:46:32.:46:36.

to a 14% real terms increase in the GP budget, that is an extra ?2.4

:46:37.:46:42.

billion. And we sped that to see an extra 5000 doctors working in

:46:43.:46:46.

general practice. I give way to the honourable lady. I received a very

:46:47.:46:54.

distressed e-mail this morning from a senior NHS manager who has written

:46:55.:47:00.

to me saying" I truly despair there will not be an NHS this time next

:47:01.:47:04.

year. " You need to listen on the opposition benches, you need to

:47:05.:47:10.

listen and understand what your secretary of state is doing to the

:47:11.:47:14.

health service. I will give you a pr cis of what they are talking

:47:15.:47:22.

about it. The honourable lady will return to has it, there are 33

:47:23.:47:25.

members wishing to speak in this debate, it is an important debate,

:47:26.:47:29.

if she can keep intervention in brief, I will let her but very

:47:30.:47:40.

brief. Thank you madam touch to Speaker, I shouldn't have used the

:47:41.:47:47.

word "You." The government knows the NHS is in crisis, foundation trust

:47:48.:47:50.

are failing, GPs are on their knees, so they are, the government are

:47:51.:47:56.

handling it back to local areas and saying you fix it and by the way,

:47:57.:48:04.

there is no money. All I would say is that I hope that people in the

:48:05.:48:09.

NHS don't listen to much to what the Labour Party says about the state of

:48:10.:48:13.

the NHS and listen to what the government is saying which is giving

:48:14.:48:17.

a more accurate picture. As I will go on to explain. I will make some

:48:18.:48:21.

progress and I will then give way further. The second part of the

:48:22.:48:25.

motion talks about funding. And there is never questioned at all

:48:26.:48:29.

that we will be needing to look after 1 million more people over 65

:48:30.:48:35.

in five years' time, we will need to continue increasing investment in

:48:36.:48:38.

the NHS and the social care system. That is happening this year with an

:48:39.:48:44.

extra ?3.8 billion going into the NHS, going in this year. They are

:48:45.:48:48.

remind honourable members, it is ?1.3 billion more than they

:48:49.:48:51.

themselves promised when they stood for election last year. I will just

:48:52.:48:56.

say this, it is not enough to talk about extra funding, you act -- you

:48:57.:49:01.

have to actually deliver it. They have to answer to their own

:49:02.:49:05.

constituents why Fort two elections in a row they have missed less money

:49:06.:49:09.

to the NHS than the Conservatives and the one area they are

:49:10.:49:12.

responsible for the NHS, they have cut funding.

:49:13.:49:16.

I think he is taking the right measured tone that was absent

:49:17.:49:25.

earlier. We recognise the NHS is under financial pressure but some of

:49:26.:49:30.

these are historic, reflecting in my area poor PFI contracts forced upon

:49:31.:49:34.

them in the Gordon Brown sleight of hand. He is right. What we did not

:49:35.:49:43.

hear from the party opposite was in 2010 we inherited a ?70 billion PFI

:49:44.:49:48.

overhang that is making it difficult for hospitals to recruit staff

:49:49.:49:52.

because they are having to pay so much money to pay for it. An example

:49:53.:50:00.

of how we are spending money practically on the ground to make

:50:01.:50:06.

sure patientss get a better deal is in Lincolnshire where, with a

:50:07.:50:10.

shortage of GPs, the local health authority is offering ?20,000 as a

:50:11.:50:15.

golden hello to do GPs. Isn't that the way of managing resources and

:50:16.:50:20.

attracting the best talent to our areas and helping ensure patients

:50:21.:50:24.

get the best care? She is right. I have talked about these issues when

:50:25.:50:29.

I've visited her. The trick is to solve the problem we will have to

:50:30.:50:33.

have a dramatic increase in people working in general practice, which

:50:34.:50:37.

is why we are funding the second biggest increase in NHS history for

:50:38.:50:44.

GPs. It is a shame the Leader of the Opposition is not here because this

:50:45.:50:48.

is the bit I wanted to address to him, his proposal to put extra

:50:49.:50:55.

funding into the NHS by scrapping corporation tax cuts. This reveals a

:50:56.:50:58.

fundamental misunderstanding about how you fund the NHS. Corporation

:50:59.:51:06.

taxes or cut so we can boost jobs and strengthen the economy, so we

:51:07.:51:12.

can fund the NHS. The reason we have been able to protect and increase

:51:13.:51:16.

funding in the NHS in the last six years when the party opposite was

:51:17.:51:21.

not willing, is because we have created 2 million jobs and given

:51:22.:51:25.

this country the fastest-growing economy in the G7. That is more

:51:26.:51:30.

important posts Brexit. To risk that growth, which is what their proposal

:51:31.:51:35.

would do, would not just risk funding for the NHS, it would be

:51:36.:51:39.

dangerous for the economy and mortally dangerous for the NHS. I

:51:40.:51:45.

want to understand what he will say about the four-hour target. Is it

:51:46.:51:58.

conceivable that some of the people who are currently within the A

:51:59.:52:02.

target will at some stage fall outside the target in the future? I

:52:03.:52:09.

am committed to people using A falling within the four-hour target.

:52:10.:52:15.

I also think we need to be more effective out diverted people who do

:52:16.:52:19.

not need to go to A to other places as happens in Wales and

:52:20.:52:25.

Scotland and is the only sensible thing. Going back to funding, for

:52:26.:52:30.

all the heat in this chamber on debates on the NHS, probably the

:52:31.:52:34.

biggest difference between the two sides is not on policy, but on the

:52:35.:52:39.

ability to deliver the strong economy the NHS needs to give it the

:52:40.:52:45.

funding required. I am afraid the proposal today in the motion

:52:46.:52:49.

revealed that divide more starkly. I am grateful. We have this debate at

:52:50.:52:55.

the election about the need for the stronger economy to pay for the NHS

:52:56.:52:59.

and the public decided we won that argument. Can I give another example

:53:00.:53:05.

from his friend Jeremy, from yesterday, he made a proposal to cap

:53:06.:53:12.

high pay. The top 1% of taxpayers pay 27% of income tax revenues and

:53:13.:53:17.

that proposal would cut funding available to the NHS and damaged the

:53:18.:53:22.

services staff have produced. It is the worst kind of gesture politics

:53:23.:53:28.

because it may get him more votes or Momentum supporters, but it would

:53:29.:53:35.

damage the NHS. Would he agree with me that rather than making

:53:36.:53:40.

meaningless and totally underfunded promises on more money for the NHS

:53:41.:53:47.

contrary to their manifesto back in 2015, members opposite would do

:53:48.:53:52.

better to recognise the demographic changes, ageing population need for

:53:53.:53:57.

the NHS to change, and to support the locally developed plans for

:53:58.:54:04.

change in the NHS, the STPs? She is absolutely right. People in the

:54:05.:54:10.

country will find it hugely ironic that the party that spent so much

:54:11.:54:16.

energy in the last Parliament campaigning against top-down

:54:17.:54:18.

reorganisation is now campaigning against locally driven changes. I

:54:19.:54:25.

will give way and then I will conclude. As the government points

:54:26.:54:35.

out often, they want to hand decisions to local groups, but could

:54:36.:54:41.

he give an explanation too worried patients in the south and west of

:54:42.:54:47.

Cumbria as to why the local health services are suggesting the changes

:54:48.:54:51.

to A in the west and potentially in the South? I know he spent time

:54:52.:54:59.

looking at this area. I would like to use this moment to congratulate

:55:00.:55:03.

his local trust for coming out of special measures and the progress

:55:04.:55:09.

they are making. In a way, that is the answer, because his local trust

:55:10.:55:13.

was in special measures and north Cumbria is still in special measures

:55:14.:55:17.

and we have profound worries about patient care in both trusts but we

:55:18.:55:22.

still do in North Cumbria. That is why the status quo is not an option

:55:23.:55:27.

that we understand the concerns of constituents about proposals being

:55:28.:55:35.

made. What does he make of this talk among professionals in relation to

:55:36.:55:39.

the potential for a flu outbreak and what does he make of the doctor who

:55:40.:55:41.

wrote to me on Sunday saying she is wrote to me on Sunday saying she is

:55:42.:55:49.

concerned they are too busy to isolate patients coming in who need

:55:50.:55:53.

oxygen and they are too busy to cover that, to isolate patients so

:55:54.:55:57.

others do not capture potential flu epidemic? There is a concern about a

:55:58.:56:07.

growth in respiratory infections and that is causing capacity

:56:08.:56:10.

constraints. We are watching what is happening on this carefully but we

:56:11.:56:17.

have 13 million people vaccinated this year against flu which is a

:56:18.:56:25.

record. Money is important, but can I support the Health Secretary in

:56:26.:56:28.

not viewing these issues so the three that lends? My local trust,

:56:29.:56:32.

Sherwood forest cover has some of the worst finances of any trust,

:56:33.:56:38.

almost all due to a PFI deal signed by Gordon Brown. My trust is

:56:39.:56:43.

improving. It is under pressure this winter but management says it is not

:56:44.:56:47.

in crisis, and that is a trust improving because of quality

:56:48.:56:53.

management, reform and good quality processes. That is absolutely the

:56:54.:57:00.

point. We miss a trick and I think the Shadow Health Secretary is in

:57:01.:57:04.

some ways more reasonable than his leader on these issues, if we say it

:57:05.:57:09.

is simply an issue... That is probably terminal for his career! If

:57:10.:57:17.

we say it is just about money, we forget the debate we went through on

:57:18.:57:21.

schools 20 years ago when there was a debate about money and we realised

:57:22.:57:26.

it is about standards and quality or so and that has happened in Sherwood

:57:27.:57:30.

forest and I congratulate the hospital. It is important we don't

:57:31.:57:34.

let debates about funding eclipse the progress we need to make

:57:35.:57:44.

standards. I am going to conclude, because lots of people want to come

:57:45.:57:52.

in. He made as his central claim, his words, the culpability for what

:57:53.:57:57.

is happening in the NHS lies at the door of Downing Street. I think I

:57:58.:58:01.

owe it to the country and this House to set the record straight on this

:58:02.:58:07.

government's record on the NHS, not just 11,000 more nurses and 11,000

:58:08.:58:11.

more doctors and on cancer we are starting treatment for 130 more

:58:12.:58:16.

people every day and have record survival rates, not just the fact we

:58:17.:58:21.

have 1400 more people getting mental health treatment every day and some

:58:22.:58:25.

of the highest dementia diagnosis rates in the world, not just the

:58:26.:58:30.

fact we are doing 5000 more operations every day and despite

:58:31.:58:35.

that, MRSA rates have hard. We have the NHS with more doctors, nurses,

:58:36.:58:41.

and despite difficult winters, patients saying they have never been

:58:42.:58:45.

treated more safely and with more dignity and respect. Next year, the

:58:46.:58:52.

NHS will be 70 years old and this government's vision is simple, we

:58:53.:58:57.

want it to offer the safest, highest quality care anywhere in the world,

:58:58.:59:02.

and when you have difficult winters and an ageing population, that makes

:59:03.:59:06.

things more challenging, but it makes us more determined and means

:59:07.:59:11.

we are backing the NHS plan, more GPs, it means better mental health

:59:12.:59:16.

provision and a NHS turning heads in the 21st century just as it did when

:59:17.:59:25.

it was founded in the 20th. Here we are again debating the NHS. We had

:59:26.:59:33.

the statement... All on my own because this is predominantly a

:59:34.:59:39.

crisis, this is NHS England, not a crisis that is NHS Scotland, as I

:59:40.:59:47.

will talk about. The problem is we are talking about patients who are

:59:48.:59:52.

suffering, patients who may suffer from more infections. We are talking

:59:53.:59:58.

about staffing tears, who are desperate, who feel they cannot

:59:59.:00:01.

deliver the care they would expect to deliver. This is not just a

:00:02.:00:10.

matter of isolated stories. We hear from NHS improvement that only one

:00:11.:00:15.

trust met the target in December. Only nine out of 152 made it over

:00:16.:00:23.

90%. This is not something that is just a matter of Joe from Wiltshire

:00:24.:00:29.

and Mike from Leeds, this is something happening on a major

:00:30.:00:34.

scale. 50 out of 152 trusts have declared a black or red situation

:00:35.:00:41.

over December, and 158 diverts of ambulances. It is not just normal

:00:42.:00:48.

winter pressures, it is not what the honourable lady opposite who is an

:00:49.:00:52.

A nurse and people like myself and other medics in the chamber have

:00:53.:00:57.

seen in our careers. This is a really bad winter, and yet we have

:00:58.:01:02.

not had a really bad winter, we have not had bitter weather, we have not

:01:03.:01:08.

had a flu epidemic. What we have seen when we look at the four-hour

:01:09.:01:13.

data is the last one published was October, when the NHS in England

:01:14.:01:19.

managed to achieve the four-hour target 83.7% of the time, 5% down

:01:20.:01:25.

from the same time the previous year and compares with 93.9% in Scotland.

:01:26.:01:31.

Scotland managed 93.5% in Christmas week. I'm sorry, the crisis in

:01:32.:01:38.

Scotland, we have our challenges, but it is not the same as discussed

:01:39.:01:45.

here. I will happily give way. I am grateful. Will she confirmed,

:01:46.:01:51.

though, that throughout the whole of 2016, which includes winter, summer,

:01:52.:01:58.

autumn and spring, the Scottish Government's A target was only met

:01:59.:02:05.

in seven out of the 52 weeks? I'd be delighted to agree but I would like

:02:06.:02:10.

to point out that NHS England did not make it over 90% anywhere in

:02:11.:02:16.

2016, so I think perhaps the honourable gentleman might want to

:02:17.:02:20.

check the NHS England figures before having a punt at me. NHS England is

:02:21.:02:27.

performing 8-10% lower than NHS Scotland, which has been the top

:02:28.:02:32.

performing of the nation 's for the last 19 months. We have not done

:02:33.:02:38.

that from magic, we face the same ageing population, exactly the same

:02:39.:02:43.

increased demand and complexity and exactly the same indeed often worse,

:02:44.:02:48.

shortage of doctors than NHS England, because of our rural areas.

:02:49.:02:54.

It is not something that is a different measure, we use the same

:02:55.:02:58.

measure, but if you look at the data, there is a difference and it

:02:59.:03:03.

has been maintained. The Secretary of State is right, winter is

:03:04.:03:08.

challenging. Summer is when A is often busier for attendances because

:03:09.:03:11.

the children are on companies and people go out and do silly things.

:03:12.:03:20.

-- are wrong trampolines. But the people who come to A are sicker,

:03:21.:03:25.

older, more complicated, and that is the problem that we have at the

:03:26.:03:32.

moment. What we have not seen is any summer respite in NHS England. The

:03:33.:03:39.

worst performance in the summer was 80.8%. The best performance was

:03:40.:03:46.

86.4%. NHS England is under pressure in the summer and when you add the

:03:47.:03:51.

winter on top, it is no wonder we are talking about the situation is

:03:52.:03:56.

doctors, nurses, patients and relatives are describing. I remember

:03:57.:04:01.

my first health debate after my maiden speech was an Opposition Day

:04:02.:04:07.

debate on the four-hour target. I commented at the time and still

:04:08.:04:13.

maintain that this target is not a stick for each party to hit each

:04:14.:04:17.

other over the head with. But it is a thermometer to take the

:04:18.:04:22.

temperature of the acute service. It does that really well. Because what

:04:23.:04:27.

it measures is not just people coming in through the front door,

:04:28.:04:31.

but how they are moving through the hospital, and how they are moving

:04:32.:04:33.

out. We are seeing a system that is

:04:34.:04:44.

completely overheated. The comments about it not being anything unusual

:04:45.:04:49.

and just a normal winter and everyone is whingeing means the

:04:50.:04:53.

government isn't recognising the problem. And the first step to

:04:54.:04:57.

dealing with any problem is to recognise it. Then you can look at

:04:58.:05:02.

how you want to tackle it. I thank her for giving way. I would remind

:05:03.:05:05.

her the point that Prime Minister made in prime ministers questions on

:05:06.:05:10.

the Tuesday after Christmas that the NHS received the highest number of

:05:11.:05:16.

visitors it has ever received, A receiving the highest number of

:05:17.:05:19.

visitors it has ever received in its history. Doesn't that show the

:05:20.:05:24.

challenges facing the NHS nationally and locally? Those are extraordinary

:05:25.:05:29.

figures and the Secretary of State is very much doing his best to help

:05:30.:05:34.

the professionals deal with those numbers. I would totally accept that

:05:35.:05:39.

the NHS has been under inordinate pressure am absolutely is busiest

:05:40.:05:44.

day in its history. But with an ageing population that has been

:05:45.:05:48.

discussed for years, we should have been able to see this coming. If in

:05:49.:05:53.

the next few months we get a massive flu epidemic, we are really going to

:05:54.:05:57.

see things keel over. What we can't have is the debates we have already

:05:58.:06:03.

had in this chamber about STPs, taking more beds away. I totally

:06:04.:06:07.

agree with the Secretary of State that some of it is that patients

:06:08.:06:12.

could be seen somewhere else. But it is not a matter of changing the four

:06:13.:06:18.

our target and saying someone won't count is that we provide better

:06:19.:06:23.

automotives. If we provide better alternatives, people will go to

:06:24.:06:27.

them. We have discussed community pharmacies in this chamber and it

:06:28.:06:31.

has been recognised that the minor ailments service we have in Scotland

:06:32.:06:35.

can deal with five or 10% of those patients. We have located out of

:06:36.:06:43.

hours GP 's units beside our A, someone sent along the corridor into

:06:44.:06:50.

the next building if it is a GP and not A that they need to see. We do

:06:51.:06:56.

need to educate the public but the public will use an alternative

:06:57.:07:00.

service if it is there. If it isn't, then if they turn up at A and they

:07:01.:07:05.

keep sitting there, someone will see them. We shouldn't blame them for

:07:06.:07:12.

that. I thank her for giving way. She is right to say we have an

:07:13.:07:15.

ageing population but it is predictable. The significant thing

:07:16.:07:20.

is that in 2008, the UK was spending around the same as all the major EU

:07:21.:07:27.

nations, we are now spending considerably less than major

:07:28.:07:32.

nations, isn't that what is causing the problem? I don't think money is

:07:33.:07:36.

the only problem, I do accept part of it is how things are done. The

:07:37.:07:41.

Secretary of State talks about the variation and hospitals performing

:07:42.:07:44.

well but only one of them is meeting the target. Only nine of them are

:07:45.:07:49.

over 90%. It is not that the majority are doing well and few are

:07:50.:07:55.

failing, we will come onto STPs in a minute, in how we deliver the NHS is

:07:56.:08:00.

crucial but change costs money. Therefore you have two invest in

:08:01.:08:07.

alternatives in your community services, primary care, step up and

:08:08.:08:11.

step down to take that pressure. At the moment, one of the concerns

:08:12.:08:16.

about the STPs is because they don't have the money. What we see are a

:08:17.:08:19.

lot of them are starting that way and thinking they will shut A and

:08:20.:08:25.

a couple of wards and community beds which we need more of. To fund

:08:26.:08:30.

change in primary and social care. And in actual fact, the system will

:08:31.:08:36.

fall over, you need to have double running and develop alternatives and

:08:37.:08:39.

then you are able to gradually send patients into that. I was enjoyed

:08:40.:08:48.

listening to her well-informed remarks, I agree also that most

:08:49.:08:52.

people don't want to go to A if they can avoid it. Would she agree

:08:53.:08:56.

that part of the problem is when people phone general practices, they

:08:57.:09:00.

tend to either not be offered an appointment in a reasonable time

:09:01.:09:05.

frame or they can't get to see the doctor that they closely associate

:09:06.:09:09.

with and that particular applies to people with chronic and long-term

:09:10.:09:14.

conditions. A report makes there today that we need to address that

:09:15.:09:18.

as a matter of urgency and possibly seven days a week general practice

:09:19.:09:24.

may paradoxically be mitigating against the possibility of providing

:09:25.:09:28.

people with that continuity of care during core hours. I think having

:09:29.:09:34.

access to a GP and I think many doctors in general practice would

:09:35.:09:38.

accept the argument for something like a Saturday morning, that people

:09:39.:09:44.

who are work, but someone who can't see their favourite doctor is

:09:45.:09:49.

actually very unlikely to go to A and wait eight hours to see a doctor

:09:50.:09:53.

they have never seen in their life. I don't think it is that, I think

:09:54.:09:57.

people feel they can't find an alternative. If it is taking three

:09:58.:10:02.

or four weeks to get any appointment with their GP if they don't yet have

:10:03.:10:06.

a community pharmacy that will offer a service, and eventually they end

:10:07.:10:11.

up at A Therefore it is the service of last resort for people.

:10:12.:10:15.

They go there and just stay there. We have do develop those other

:10:16.:10:20.

alternatives first and as the honourable gentleman says, no point

:10:21.:10:23.

in their right mind will choose to go and wait four hours in A if

:10:24.:10:28.

they could be seen in half an hour at a community pharmacy. I have do

:10:29.:10:32.

disagree with her because winter pressures that we are seeing at the

:10:33.:10:38.

moment, tend not to be people with short-term conditions, they tend to

:10:39.:10:41.

be the chronically sick. And those people want to have a relationship

:10:42.:10:45.

with a particular practitioner who understands their needs and

:10:46.:10:50.

understands the family contest, surely that is the essence of

:10:51.:10:54.

general practice. I totally agree with that. But the chances of them

:10:55.:11:00.

having their doctor on a Saturday morning or Sunday afternoon is

:11:01.:11:03.

reduced. One of the things they have done in Scotland is to identify that

:11:04.:11:10.

40% of admissions from 5% of patients. Because those patients are

:11:11.:11:14.

automatically flagged. No matter what they ring up with, they will

:11:15.:11:18.

get a double appointment because it is not just the chest infection or

:11:19.:11:23.

the year in infection, you have to look at how it interferes with

:11:24.:11:28.

everything else. It is not a catastrophe of people living longer,

:11:29.:11:33.

those of us who are medical in-house do remember that was definitely the

:11:34.:11:36.

point of why we went into medicine and that is the point of the NHS.

:11:37.:11:41.

But we are not ageing very well. From about 40 or 50 onwards, people

:11:42.:11:46.

are starting to accumulate conditions that maybe they wouldn't

:11:47.:11:49.

have survived in the past. By the time they are 70, they have four or

:11:50.:11:57.

five things that make treating them a challenge. I have friends still

:11:58.:12:01.

working on the front line and they say it is not even just numbers but

:12:02.:12:06.

complex T. Someone comes with what sounds like an easy issue but in

:12:07.:12:11.

actual fact, with their diabetes and their renal failure and their

:12:12.:12:15.

previous heart attack, it is a complex issue. And this is part of

:12:16.:12:18.

the problem we face. We need to be looking forward to preparing for

:12:19.:12:26.

that. STPs need to be thinking about being designed around old people.

:12:27.:12:30.

Not being designed around young people who can come in and have an

:12:31.:12:34.

operation as a day case and go away. That is not what we are facing.

:12:35.:12:39.

Older people need longer in hospital. Even medically before they

:12:40.:12:44.

reach the point of being able to go home, it will take them a couple of

:12:45.:12:54.

days longer to be strong enough, they probably live alone. They

:12:55.:12:57.

probably do not have family near them. They will need a degree of

:12:58.:13:03.

convalescent support, they will need social care. This is really where

:13:04.:13:08.

the nub of the problem lies, that social care funding has gone down.

:13:09.:13:12.

And therefore more people are stuck in hospital or more people end up in

:13:13.:13:17.

hospital who actually wouldn't have needed to be there in the first

:13:18.:13:21.

place. I'm grateful to her for giving way. In terms of the

:13:22.:13:25.

frailties of older people, just as Scotland led the way with a primary

:13:26.:13:31.

school introducing the daily mile, is there something we can learn from

:13:32.:13:35.

countries like Andorra that have a focus on exercise for older people.

:13:36.:13:40.

So they are not as frail in their 70s and 80s? I think the prevention

:13:41.:13:46.

and public health message is crucial. I think that is one of the

:13:47.:13:51.

other challenges we have. I am grateful the Secretary of State no

:13:52.:13:56.

longer talks about 10 billion because actually, the increase in

:13:57.:14:00.

the Department of Health budget is 4.5 billion, part of that has been a

:14:01.:14:04.

reduction in public health funding. Just at a time where we need to move

:14:05.:14:08.

it to a totally different scale, whether it is children doing the

:14:09.:14:12.

daily mile, adults doing the daily mile, maybe we should run up to

:14:13.:14:16.

Trafalgar Square there and back every lunchtime. I am sure that

:14:17.:14:20.

would do all of us the power of good. We need to invest in these

:14:21.:14:25.

things that prevent. One of the points I would make is that when we

:14:26.:14:30.

end up desperate, and whether it is patching up how the NHS runs or

:14:31.:14:34.

dealing with illnesses we didn't bother to prevent, we always end up

:14:35.:14:39.

spending more money. I am grateful to her for giving way. She knows how

:14:40.:14:45.

much I respect what she is saying and she is the chairman of the

:14:46.:14:49.

all-party running group and I endorse the daily mile and encourage

:14:50.:14:53.

all adults, Park runs are a good example of that. They happen across

:14:54.:14:59.

the nation. My question to her, her huge expertise in Scotland,

:15:00.:15:04.

including NHS England learned from Scotland, what is best practice?

:15:05.:15:08.

Could she give us some example is a best practice in Scotland, hospitals

:15:09.:15:13.

and trusts that we can take away and learn from? I think the whole issue

:15:14.:15:17.

is down to sustainability. That is the idea of the sustainability and

:15:18.:15:22.

transformation plans, those who have heard me speak know that I support

:15:23.:15:26.

the idea in principle. The idea is to go back to place -based planning

:15:27.:15:32.

on an integrated basis for a community. That is what the

:15:33.:15:37.

difference is with Scotland, what we have focused on is integration. We

:15:38.:15:42.

got rid of hospital trusts in 2004, PCTs in the late 2000s, and since

:15:43.:15:52.

April 2014, we set up integrated joint boards. That is a bag of money

:15:53.:15:57.

from the NHS, a bag of money from the local authorities goes on the

:15:58.:16:01.

table and a group sit around and work out what is the best way to

:16:02.:16:05.

deal with that interface and to support social care. Because anyone

:16:06.:16:09.

in this chamber or anyone with family members who have been stuck

:16:10.:16:14.

in hospital, they know that you get into a bickering situation. Mrs

:16:15.:16:17.

Bloggs is in a bed so the local authority are not interested because

:16:18.:16:22.

she is sick, they are busy with Mrs Smith who has just fallen off a

:16:23.:16:26.

ladder trying to put her curtains up and is not considered safe because

:16:27.:16:30.

she is leaving the gas on. You have all this perverse obstruction and

:16:31.:16:39.

that is what gets rid of that. I thank her for giving way, I welcome

:16:40.:16:43.

the tone she brings to this debate, unlike what we saw earlier. One of

:16:44.:16:48.

the points she makes is the importance of integrated care,

:16:49.:16:50.

social and health. Does she believe that with further evolution in

:16:51.:16:55.

England in the major cities, there is a huge opportunity to move that

:16:56.:17:01.

agenda forward south of the border? You I think the whole idea of STPs

:17:02.:17:07.

going to areas, we simply have geographical health wards, that is

:17:08.:17:11.

the only layer we have. We are not wasting huge amounts of money on

:17:12.:17:16.

layers and layers. You can integrate. For an STP to work, it

:17:17.:17:20.

has to make sense geographically and that might be a county, maybe

:17:21.:17:23.

something bigger or smaller. Personally I think they should have

:17:24.:17:31.

a statutory position. We have 211 CCGs, an average of six CCGs for

:17:32.:17:37.

every STP. That is a waste of layers, that is going to be very

:17:38.:17:42.

difficult to integrate. One of the biggest difference is, is we got rid

:17:43.:17:48.

of in 2004, the purchaser provider split. There is no evidence in

:17:49.:17:55.

25-year is of any clinical benefit from the purchaser provider split.

:17:56.:17:59.

The internal market now the external market. It is estimated the cost of

:18:00.:18:05.

running that market are between five and ?10 billion a year. That is

:18:06.:18:08.

money that is not actually going to health care but either going to

:18:09.:18:12.

bidding, tendering, administration or profit. I think, we can't do an

:18:13.:18:19.

overnight change but if we made a principled decision to work our way

:18:20.:18:24.

back to the NHS as the main provider of public health treatment and

:18:25.:18:30.

integration of care through the STP or a macro, I think we could reach a

:18:31.:18:36.

point of sustainability. As I said earlier, you have two actually both

:18:37.:18:41.

protect things like into hospitals and community services. Invest in

:18:42.:18:46.

them. We have rebuilt three cottage hospitals as modern hospitals in our

:18:47.:18:50.

health wards. That is where you want to put an older person on their own

:18:51.:18:54.

with a chest infection who actually needs a few days of antibiotics and

:18:55.:18:59.

TLC and decent feeding. You don't want them in the big hospital, you

:19:00.:19:05.

want them close to home. What we are seeing with the ST people macro is

:19:06.:19:08.

that people seek community hospitals as easy to get rid of. It is only an

:19:09.:19:14.

efficiency saving if what you are getting rid of is inefficiency. If

:19:15.:19:18.

you are slashing and burning, what you are ending up doing is spending

:19:19.:19:19.

more money in the end. Much of what she says is music to my

:19:20.:19:32.

ears, as someone who is campaigning to save the local General Hospital,

:19:33.:19:36.

but I wonder if we could have the benefit of her views on the role of

:19:37.:19:43.

patients and consultation in all of this when considering and

:19:44.:19:48.

transformation plans. Not just consultation in the way it has often

:19:49.:19:52.

been done in the past - here we are, we have made a decision, we are

:19:53.:19:57.

telling you about it. Unfortunately, that is very much what we have heard

:19:58.:20:02.

around the STP process, partly because it has been so short, and

:20:03.:20:06.

partly, another, because it is budget- centred and not patient-

:20:07.:20:10.

centred care. They have all been given a number, and if you are not

:20:11.:20:14.

meeting it, do not bother submitting your plan. That will not give an

:20:15.:20:20.

integrated service. The public also have to be involved, but I think the

:20:21.:20:23.

front line clinicians, they are the people who work in the service. They

:20:24.:20:28.

know where the bottlenecks are, they know where -- they know what is the

:20:29.:20:36.

horseshoe nail that the service is missing that is holding it back, and

:20:37.:20:42.

if you have clinician- led redesign, as I was involved in in my health

:20:43.:20:46.

board 17 years ago the breast cancer, you can end up where you

:20:47.:20:50.

track the part of the patient. You very quickly imagine yourself that a

:20:51.:20:55.

patient, UCD bottlenecks, and that is where you focus investment. I

:20:56.:21:02.

read an article yesterday, -- you see the bottlenecks. I read an

:21:03.:21:09.

article about management consultants coming in advising to shut a board,

:21:10.:21:17.

increase parking spaces, and that was not good value for money for ?2

:21:18.:21:24.

million. I thank her for eloquently pushing issues that face all of us,

:21:25.:21:27.

no matter where we are from. Would she agree with me that the use of

:21:28.:21:30.

good health care data for those clinicians, enabling patients to be

:21:31.:21:34.

seamlessly put through the system are important. Many people don't

:21:35.:21:40.

realise that their information from the GP does not go into the acute

:21:41.:21:49.

service and at the social care. I believe that would help patients. I

:21:50.:21:55.

would not say we are super IT wizards in Scotland, but we did not

:21:56.:22:02.

get involved in the care. Data issue, which is now a shadow over

:22:03.:22:09.

the NHS in England. Nothing goes in the post. All of our letters back

:22:10.:22:18.

are electronic. I block my dictation machine during a clinic and when I

:22:19.:22:23.

finish, they all go away. They are on their way by 2pm. We have already

:22:24.:22:28.

done that. AGP can e-mail my colleagues and say, I do not know

:22:29.:22:32.

whether you need to see this person or not. And what I have heard from

:22:33.:22:36.

clinicians is, we cannot e-mail about a patient. Because of the

:22:37.:22:44.

wrong move around the data service, that is holding things back. Our GPs

:22:45.:22:49.

use a care summary, so if they have a palliative patient, that will be

:22:50.:22:53.

put on the out of our system so that if there is a call about that person

:22:54.:22:58.

who has been accepted as being in terminal care, the doctor already

:22:59.:23:04.

knows. We not throwing them in an ambulance. We're keeping them

:23:05.:23:06.

comfortable. We have had a discussion on the aim is for them to

:23:07.:23:14.

be at home. It is about sharing information, which is the first

:23:15.:23:18.

step, and that is something that England has to get. In finishing

:23:19.:23:24.

off, I think, really, integration... I'm sorry if I was taking too long

:23:25.:23:32.

for the lady at the back. I think, really, integration is the key, and

:23:33.:23:38.

it is possible, through the STPs, but only if they are designed around

:23:39.:23:43.

patients, safety and services, and not just starting with a bottom line

:23:44.:23:51.

and working backwards. Order. Before I call the next speaker, it will be

:23:52.:23:55.

obvious to colleagues that there are a great many people who wish to

:23:56.:23:59.

speak this afternoon, and that the debate although it has advanced a

:24:00.:24:03.

long way in time, has not advanced very far as far as the number of

:24:04.:24:08.

people called is concerned, so we now have to have a time limit of ten

:24:09.:24:18.

minutes. Surely less. I can see there was some surprise at that. Ten

:24:19.:24:27.

minutes for the moment. Anyone who can do arithmetic will be aware that

:24:28.:24:31.

it will need to be reduced later, so I suggest starting working on your

:24:32.:24:35.

speeches now. Doctor Sarah Wollaston. Thank you, Madam Deputy

:24:36.:24:41.

Speaker, and I will be mindful of those comments. Thank you for the

:24:42.:24:47.

member's thoughtful and thought-provoking comments. I would

:24:48.:24:53.

like to endorse what she said and expand on some of those points. We

:24:54.:25:00.

have heard that NHS staff are facing unprecedented demand over the

:25:01.:25:03.

winter, but the point is, it is not just winter pressures, they are

:25:04.:25:06.

extending into the summer. As we heard, it is not just about numbers

:25:07.:25:10.

but about the complexity and the frailty of those who are presenting

:25:11.:25:18.

in our A departments. The 4-mac- our target -- the four-hour target,

:25:19.:25:26.

the trusts that were most successful in getting close to that target are

:25:27.:25:33.

those that see this as a systemic issue where both health and care

:25:34.:25:37.

staff are all contributing to this, not just some box ticking exercise,

:25:38.:25:40.

but because they recognise that fundamentally this is an issue about

:25:41.:25:46.

patient safety and about the quality of patient experience. That is why

:25:47.:25:50.

the target matters and the Secretary of State is right to endorse that. I

:25:51.:25:54.

think he is also right to raise the fact that sometimes we need to be

:25:55.:25:59.

more nuanced about our targets and to be able to be open to listening

:26:00.:26:03.

to what clinicians are telling him about how we can improve the way

:26:04.:26:07.

targets are applied. I think it would be a great shame if in this

:26:08.:26:16.

House, because of political for raw Ballance political upheaval, we fail

:26:17.:26:23.

to have those discussions. I would urge the Secretary of State to

:26:24.:26:26.

listen to clinicians in terms of where we can improve targets. He has

:26:27.:26:31.

made it clear that we are right to keep the four-hour target. I would

:26:32.:26:35.

also like to say, in talking about this as a whole system issue, of

:26:36.:26:40.

course, with accident and emergency, it is a barometer, as my honourable

:26:41.:26:44.

friend has pointed out, for wider system pressures. I would like to

:26:45.:26:49.

focus my remarks on integration of health and social care, and also,

:26:50.:26:53.

with those colleagues across this House who have called for a

:26:54.:26:57.

convention in how we review the funding of this as a whole system

:26:58.:27:01.

issue, we have heard it is the 70th birthday of the NHS next year, and

:27:02.:27:05.

what could be a better president than politicians changing the debate

:27:06.:27:09.

and the way we talk about funding of health and social care, and to do so

:27:10.:27:16.

in a collaborative manner that works out the right solution for our

:27:17.:27:20.

patients? The consequences of us not doing that are really profound for

:27:21.:27:25.

our constituents, and they won't thank us for not being prepared to

:27:26.:27:30.

put aside party differences and work towards the right solution, because

:27:31.:27:34.

ultimately, this is about a demographic change that we are

:27:35.:27:38.

simply not prepared for. We did this for pension age, recognising that

:27:39.:27:44.

had to be a different debate, given the change in longevity. Over the

:27:45.:27:52.

decade to 2015, we have seen a 31% increase in the number of those

:27:53.:27:56.

living to 85 and older, and of course, that is a cause for

:27:57.:28:00.

celebration, but what we are not seeing is a commensurate increase, a

:28:01.:28:08.

matching increase, in the disease- free life expectancy. Unfortunately,

:28:09.:28:12.

we are also not making sufficient progress on tackling inequality. And

:28:13.:28:17.

I welcome the Prime Minister's focus on that. In her very first speech,

:28:18.:28:21.

she talked about the burning injustice of health inequality and

:28:22.:28:25.

tackling that, but I believe we have a role in this House in doing that

:28:26.:28:30.

together in a consensual manner. I give weight to my right honourable

:28:31.:28:38.

friend. I thank the honourable lady for allowing me to intervene. Does

:28:39.:28:44.

she share my welcomer the Prime Minister's response today that she

:28:45.:28:48.

is prepared to meet with us and other members of Parliament from

:28:49.:28:52.

across this house with the hope that this might start a more constructive

:28:53.:28:57.

approach? I thank the right honourable gentleman. Absolutely, I

:28:58.:29:00.

thought it was extraordinarily encouraging to hear the Prime

:29:01.:29:04.

Minister prepared to consider the centimetre with us across the House.

:29:05.:29:09.

I would urge colleagues who feel this is a better way forward to sign

:29:10.:29:14.

up to this and two, themselves, speak to their party whips and make

:29:15.:29:18.

it clear that there is widespread support for considering this. I give

:29:19.:29:25.

way. I wonder if on this vital issue the honourable lady wants to say

:29:26.:29:28.

something about what her own party did admit to my previous times when

:29:29.:29:33.

we have tried to get important cross-party working on health and

:29:34.:29:36.

social care, in that once they made it an election issue and produced

:29:37.:29:43.

posters on a death tax, and the second time just walked away from

:29:44.:29:47.

talks. This is exactly not the kind of debate we want to be having.

:29:48.:29:54.

Let's look to the future and say that where we are now, if the

:29:55.:29:59.

honourable lady would let me finish, what I would say now is that we are

:30:00.:30:04.

in a different part of the electoral cycle, and whilst I accept her

:30:05.:30:08.

comments, I was still a clinician in the NHS at the time that that

:30:09.:30:13.

happened, and I, like many of those who work in health and social care,

:30:14.:30:20.

look at this place and think... I watch the debate we have here and

:30:21.:30:23.

think, surely there has to be a better way. I would ask the

:30:24.:30:26.

honourable lady perhaps to put that aside and look to the future rather

:30:27.:30:30.

than be looking backwards, because I don't think we're going to get

:30:31.:30:34.

anywhere, so I think what our constituents want us to do as

:30:35.:30:38.

politicians is to recognise the scale of the challenge and get to

:30:39.:30:42.

grips with it. I am going to take one more intervention, then I am

:30:43.:30:46.

conscious of time. I thank the honourable lady for giving way.

:30:47.:30:50.

Looking to the future, would you not agree with me that there should be a

:30:51.:30:55.

new funding settlement, certainly in terms of the budget for the NHS and

:30:56.:30:58.

social care, and bring both together? At the moment, we have had

:30:59.:31:04.

cuts of 4.6 billion. That is exactly what I hope. We must end the silos

:31:05.:31:10.

of health and social care, thinking of this money being a health pound

:31:11.:31:14.

or a social care pound, and think of it as a patient pound and a taxpayer

:31:15.:31:19.

pound, and how we get the best from that, which brings me onto a point I

:31:20.:31:22.

would like to raise directly with the Secretary of State. There is an

:31:23.:31:27.

example that has happened in my constituency. There is the Torbay

:31:28.:31:31.

and South Devon NHS Foundation Trust, which has formed an

:31:32.:31:36.

integrated care organisation. Across health and social care, there are

:31:37.:31:41.

people, passionate people, about this, who sweated blood to get this

:31:42.:31:45.

organisation off the ground. They recognise the benefits. It is talk

:31:46.:31:52.

about not just nationally but internationally, a recognised way of

:31:53.:31:54.

doing this better bust I regret to say that because of the scale of the

:31:55.:31:59.

financial pressure on the ICO, what we are now hearing is that the NHS

:32:00.:32:03.

is pulling out of the risk sharing agreement next year. I'm afraid this

:32:04.:32:07.

is totally unacceptable. I hope the Secretary of State meet with me to

:32:08.:32:13.

discuss the pressures facing the ICO, because it has achieved the

:32:14.:32:16.

kind of things we're talking about in this debate. They can have their

:32:17.:32:25.

pooled risk sharing and working together to genuinely get people out

:32:26.:32:28.

of hospital more rapidly who do not need to be there ban is happening in

:32:29.:32:32.

other various, to put people from social care into hospitals to see

:32:33.:32:38.

how we can speed that process up, and unfortunately, if that risk

:32:39.:32:41.

share falls apart, we will see one of the key pillars of how we want to

:32:42.:32:45.

improve the flow through hospitals and at the other end breaking down.

:32:46.:32:50.

Part of the reason, as I understand it, is, unless the control totals

:32:51.:32:55.

are met, what is put at risk if the funding that they are hoping to use

:32:56.:33:00.

to improve the facilities in the accident and emergency department,

:33:01.:33:03.

because the challenge for Torbay isn't the way they work together to

:33:04.:33:07.

get people out of hospital, it's the facilities at the front door, and

:33:08.:33:11.

they could do so much there. We have this odd paradox that we could end

:33:12.:33:15.

up improving the facilities at the front door but worsening the ability

:33:16.:33:20.

of the facility to respond at the point where we are trying to get

:33:21.:33:24.

people cared for in the community. I would say a certain degree of

:33:25.:33:26.

financial challenge would have the effect of bringing health and social

:33:27.:33:30.

care organisations to work more closely together because they know

:33:31.:33:34.

it makes sense, but when there are unrealistic targets being set, and

:33:35.:33:39.

what we can find is that we can go the other way and it starts to mean

:33:40.:33:42.

that people have to retreat to protect their budget silos. I have

:33:43.:33:46.

the Secretary of State will look closely at what is happening there

:33:47.:33:49.

and meet with me to discuss whether or not we can't just get this back

:33:50.:33:53.

on track again for next year. Although I am confident that the

:33:54.:33:57.

local authority and the NHS staff -- the NHS staff and those in the trust

:33:58.:34:03.

will continue to work together. They have an extraordinary tradition of

:34:04.:34:06.

doing so. I think there are threats, and as I say, I hope they can be

:34:07.:34:10.

addressed, because this is about the entire flow from the front door

:34:11.:34:13.

right the way through to getting people cared for back at home, but

:34:14.:34:17.

more widely, there is an issue here that we now have more than 1 million

:34:18.:34:22.

people who are not able to receive the care that they need in

:34:23.:34:27.

communities. In my area, we have a prime provider in special measures,

:34:28.:34:32.

and these are financial issues. Yes, there is much the NHS can do that

:34:33.:34:36.

isn't about money. We know there is a lot of variation that can't be

:34:37.:34:40.

explained just by financial challenge and demographics alone,

:34:41.:34:43.

but finance is inevitably part of this. Finance and workforce - these

:34:44.:34:48.

are the key challenges we face, and we have to work together across all

:34:49.:34:51.

parties, in my opinion, to achieve that.

:34:52.:34:55.

In closing, on a slightly separate point, let me raise the front page

:34:56.:35:04.

of the Times newspaper today which I think his extraordinary

:35:05.:35:07.

disappointing. This is the second time we've seen a major national

:35:08.:35:13.

newspaper reporting events the Chief Executive of the NHS, Simon

:35:14.:35:17.

Stephens. I would like to invite the Secretary of State or the minister

:35:18.:35:21.

closing the debate to unequivocally support the Chief Executive of the

:35:22.:35:25.

NHS. What he is doing, when it comes to a select committee, as chair I

:35:26.:35:30.

ask him to respond to a question, I expect him to be truthful and

:35:31.:35:34.

transparent in his answers and I think that he should be commended

:35:35.:35:39.

for doing so, and not find himself the subject of briefings. I would

:35:40.:35:43.

invite someone to unequivocally support him and ask for best to

:35:44.:35:51.

stop. Dame Rosie Winterton. Thank you. Thank you Madam Deputy Speaker.

:35:52.:35:57.

I think that the debate so far has shown the huge level of concern from

:35:58.:36:04.

the public and from NHS staff, about the crisis in the NHS and social

:36:05.:36:09.

care. And, I would say that I think the honourable member reflected some

:36:10.:36:15.

of the views of the select committee, but I would ask all

:36:16.:36:19.

members opposite to really take seriously these concerns, and not

:36:20.:36:26.

dismiss them. All honourable member 's must surely be getting

:36:27.:36:31.

representations from staff, and from patients. About what is happening

:36:32.:36:37.

locally. I would like to pay tribute to all health and social care staff

:36:38.:36:41.

in Doncaster, particularly at Doncaster Royal Infirmary whose work

:36:42.:36:47.

I've seen first-hand and I know how dedicated and committed they are to

:36:48.:36:54.

caring for patients in the most difficult of circumstances. At the

:36:55.:36:59.

end of December, they've managed to achieve 90% against the 95% I get

:37:00.:37:04.

and had good ambulance hand the times, as well are as good support

:37:05.:37:10.

from the council and partners. But they are facing real pressures and

:37:11.:37:15.

are fearful about pressure is still to come, especially if there is a

:37:16.:37:20.

cold spell, as predicted. That is why the mixed messages from the

:37:21.:37:23.

secretary of state have been extremely damaging. Madam Deputy

:37:24.:37:30.

Speaker, I was the health minister for four years and had

:37:31.:37:34.

responsibility for emergency care. I know how important it is to work

:37:35.:37:40.

with NHS staff to help to implement targets, and not give the impression

:37:41.:37:47.

that the NHS is somehow giving up on those targets. The lead from the top

:37:48.:37:54.

is incredibly important. There has was been controversy about targets.

:37:55.:37:59.

But, as health minister, I have visited many A departments. There

:38:00.:38:04.

is absolutely no doubt in my mind that the A target has led to

:38:05.:38:12.

improved care for patients and dramatically reduced the waiting

:38:13.:38:16.

times, which the evidence has shown and has been clear. That is what

:38:17.:38:22.

happened. One of the striking things about those visits was seeing how

:38:23.:38:28.

consultants, nurses, ambulance teams, all members of the health

:38:29.:38:32.

care team while working together. They would work out protocol so

:38:33.:38:37.

that, for example, nurses could take over some of the work that had

:38:38.:38:42.

previously been done by consultants. Nurse practitioners and emergency

:38:43.:38:49.

care consultants. So, they could ease the burden and share between

:38:50.:38:56.

the team the work that was needed. Triage became the norm. Seeing who

:38:57.:39:01.

needed treatment urgently from a consultant, and who could be seen by

:39:02.:39:07.

a nurse practitioner. I would always ask staff, is the target getting in

:39:08.:39:12.

the way? Or, is it helping? Invariably, the answer would come

:39:13.:39:16.

back that it is helpful in making us work together more effectively. I

:39:17.:39:20.

vividly remember a nurse practitioner saying, please do not

:39:21.:39:24.

abandon the target because it is making the consultants sit down with

:39:25.:39:28.

us and look at the whole team. And for patients, the difference is

:39:29.:39:32.

crucial. For their working life as well, they were not seeing patients

:39:33.:39:39.

who had been sitting around for hours and hours and were feeling

:39:40.:39:41.

very depressed and tomorrow lowest. That made the difference to the

:39:42.:39:48.

health care team as well. -- and demoralised. As well as improving

:39:49.:39:52.

care for the patients. I will give way... With the right honourable

:39:53.:39:57.

lady agree that it is not so much meeting the target which is

:39:58.:40:02.

important but getting patients seen quickly, expeditiously and well.

:40:03.:40:06.

And, there is not an A Department in this country who does not want to

:40:07.:40:13.

improve its position in a league table of response times. They all

:40:14.:40:16.

want to do that and the difference which now applies did not apply

:40:17.:40:24.

quite so much when she was Minister, but that level of comparison is much

:40:25.:40:29.

better. I ever so gently suggest that whilst a four-hour target was

:40:30.:40:33.

important when she was Minister, that importance has degraded over

:40:34.:40:36.

time because everyone is trying to see patients more quickly? I do not

:40:37.:40:41.

agree with the honourable gentleman on that. I think that the experience

:40:42.:40:50.

of implementing the four our target led to much better diagnosis of the

:40:51.:40:55.

type of treatment that people needed -- four hour. Also better

:40:56.:41:01.

interaction with the community. Let me come onto that, I also think the

:41:02.:41:05.

secretary of state and maybe the honourable gentleman is guilty of

:41:06.:41:08.

that as well, was trying to separate the target within the accident and

:41:09.:41:16.

emergency department from what went on outside that. I see the

:41:17.:41:20.

importance and putting the two together and I would like to say

:41:21.:41:23.

something about that because providing the alternative treatment,

:41:24.:41:27.

which is maybe what he is getting out, means proper support from the

:41:28.:41:31.

community and it is bringing those two together which makes it possible

:41:32.:41:36.

to achieve the target but it was a driver. I give way to the honourable

:41:37.:41:41.

lady who I know has some experience. In my experience in working to try

:41:42.:41:45.

to meet the four-hour target, there's often an emphasis... In the

:41:46.:41:49.

past there was one, and emphasis which took priority over everything

:41:50.:41:53.

else including patient care and clinical need, sometimes it was

:41:54.:41:58.

abused. Huge pressure was put onto staff to meet that four-hour target

:41:59.:42:02.

and patient care suffered, I have seen it myself, it has suffered as a

:42:03.:42:07.

result of to meet targets. What I would say is that I think it is a

:42:08.:42:12.

way... It is always important, I did this as the health Minister, to look

:42:13.:42:16.

out for the feedback from clinicians was. I can see, because it was

:42:17.:42:22.

starting during my time as health minister, that we constantly had to

:42:23.:42:27.

look at whether what was the 95% target, whether there was clinical

:42:28.:42:30.

reason as to why there should be a reduction on that. It became clear

:42:31.:42:33.

that there were some patients who needed longer to be assessed,

:42:34.:42:37.

because of their particular condition. I can see that is why it

:42:38.:42:43.

would be reduced to 95% but the point that I am making is that it

:42:44.:42:47.

was based on the clinical need and I think what happened last week was

:42:48.:42:51.

the impression was given that it was, my goodness, we had to cope

:42:52.:42:56.

with winter pressures, let's reduce the target in order to meet it,

:42:57.:43:03.

rather than make an assessment about clinical need, I think it is

:43:04.:43:08.

completely the wrong message for the NHS and I think that was the wrong

:43:09.:43:14.

thing to do. I want to briefly set out some areas where I think we can

:43:15.:43:22.

bring the community input together with what is happening in emergency

:43:23.:43:30.

departments themselves, in order to produce some of the pressures. I

:43:31.:43:39.

think the first point was made by my honourable friend from the front

:43:40.:43:42.

bench, social care is absolutely vital in ensuring that people do not

:43:43.:43:51.

end up in A, good social care. I have previously raised problems that

:43:52.:43:55.

I think the current proposition by the government to, in a sense, move

:43:56.:44:01.

responsibility to local councils to raise the money, is particularly

:44:02.:44:03.

unfair in areas like mine because they simply cannot raise through a

:44:04.:44:08.

council preset the same amount of money as can be made in other less

:44:09.:44:15.

deprived... Better off areas. It simply does not work. We needed

:44:16.:44:19.

probably more than any other area but our ability to raise money will

:44:20.:44:28.

be less. I've been speaking to NHS staff in Doncaster, senior staff,

:44:29.:44:32.

and there are some real problems in terms of the emergency care

:44:33.:44:38.

staffing. What they are telling me is that it will take years, and

:44:39.:44:42.

there are more doctors being trained, I accept that, but it will

:44:43.:44:46.

take years for those to come through and the single most effective thing,

:44:47.:44:54.

the most effective step, to ease the pressure at the moment and A

:44:55.:45:00.

departments would be to immediately increase funding into social care.

:45:01.:45:06.

Because, that would keep people away from accident and emergency

:45:07.:45:09.

departments, and that could be done straightaway. There are the personal

:45:10.:45:15.

out there but it just needs the government to make the decision, as

:45:16.:45:20.

my honourable friend from the front bench said, to increase funding.

:45:21.:45:25.

Secondly, we had to look seriously at the problem with GP shortages,

:45:26.:45:29.

because again, as others have said, if a patient is waiting three weeks

:45:30.:45:33.

for an appointment with a GP, they are bound to end up in A This is

:45:34.:45:37.

something which needs to be addressed quickly with proper,

:45:38.:45:41.

forward looks at exactly where the gaps are occurring in GP services. I

:45:42.:45:51.

have said before that I think PCTs, or the care commissioning groups

:45:52.:45:56.

now, or NHS England, should take over practices and employ salaried

:45:57.:46:00.

GPs which would make a huge difference. Community pharmacists,

:46:01.:46:06.

again, if people had confidence that going to the pharmacy would save

:46:07.:46:10.

them a visit to A, that would relieve pressure on the system. I

:46:11.:46:14.

hope that the minister can assure us that he is looking seriously at the

:46:15.:46:18.

community pharmacy forward view which sets out how pharmacists can

:46:19.:46:22.

be integrated into the NHS and social care. Whilst I have him here,

:46:23.:46:29.

I do want to touch briefly on mental health, because the Prime Minister

:46:30.:46:32.

answered a question today about mental health and the crisis people

:46:33.:46:37.

can get into where they end up in A She particularly talked about

:46:38.:46:40.

young people and I would urge the Minister to look at the role and

:46:41.:46:45.

educational psychologists can play in mental health for children and

:46:46.:46:52.

not then ending up in A Finally, I do also want to say that one of

:46:53.:46:59.

the things in my experience of a health minister was that you needed

:47:00.:47:05.

people on the ground locally, to help the organisations across the

:47:06.:47:10.

whole spectrum. Local government through social care, pharmacists,

:47:11.:47:15.

GPs, ambulances, working with A departments. That reorganisation,

:47:16.:47:23.

the ?2 billion reorganisation which took away PCTs and SHAs, that has

:47:24.:47:29.

made it much more difficult, the changes that are needed. I hope that

:47:30.:47:34.

the Minister will look seriously at how it is happening because local

:47:35.:47:38.

knowledge can be vital in these circumstances. So, I believe that

:47:39.:47:43.

from the contribution to the secretary of state, it seems as

:47:44.:47:47.

though he was trying to use every excuse not to face up to the reality

:47:48.:47:52.

of what is happening, and I think it sends a terrible message to NHS

:47:53.:47:58.

staff, and I hope that as a result of the debate today, the concerns

:47:59.:48:02.

which have been raised will be taken on board by ministers and the

:48:03.:48:06.

Secretary of State, and they will come back to the house with a proper

:48:07.:48:09.

plan which recognises the problems and offers real solutions.

:48:10.:48:16.

The house was right to assume that ten minutes per person is

:48:17.:48:25.

unsustainable, after the next speaker I will reduce the time limit

:48:26.:48:30.

to seven minutes. But the time limit remains, the house will be very glad

:48:31.:48:34.

to know, at ten minutes first Sir Simon Burns. Thank you, Madam Deputy

:48:35.:48:44.

Speaker. I welcome the debate today, to have the opportunity to discuss

:48:45.:48:48.

an issue which is extremely important to all honourable members

:48:49.:48:52.

on all sides of the house, because there is a significant problem

:48:53.:49:00.

during the recent weeks because of the extra increasing number of

:49:01.:49:05.

people needing services at A and from the health services locally. I

:49:06.:49:11.

would like to pay tribute to the magnificent work often in very

:49:12.:49:15.

difficult circumstances that doctors, nurses, consultants and

:49:16.:49:21.

other staff, and people in general practice, carry out on a day-to-day

:49:22.:49:26.

basis, not simply during a winter crisis period, but throughout the

:49:27.:49:30.

year, looking after people to the best of their abilities. I think

:49:31.:49:36.

that my own hospital, Broomfield Hospital in Chelmsford, is in

:49:37.:49:40.

difficult circumstances and doing a fantastic job to provide the best

:49:41.:49:47.

possible care in good times and more difficult times, and I am certainly

:49:48.:49:51.

aware as a constituency MP that there are been some problems for

:49:52.:49:56.

some of my constituents in the last week or so because of the demands

:49:57.:50:02.

and pressures but we have to look at what we can do to move forward in a

:50:03.:50:07.

positive, not partisan, politicised way. To make sure that our

:50:08.:50:14.

constituents get the best treatment is possible.

:50:15.:50:18.

There is no point in just shouting, as my honourable friend, the cherub

:50:19.:50:26.

a health select committee said, and engaging in -- the chair of the

:50:27.:50:33.

health select committee said, in engaging in yah boo politics. I have

:50:34.:50:38.

to say, I am extremely proud of the record of this Government in the way

:50:39.:50:43.

it has been committed to funding the NHS over the last seven years, and

:50:44.:50:49.

its commitments for the next three or four years. We made sure when we

:50:50.:50:55.

came into office at a time of austerity, where Government

:50:56.:50:57.

department budgets were cut, that the health Department budget was one

:50:58.:51:03.

of the few departments whose budgets were protected so that they got a

:51:04.:51:09.

real terms increase in funding every year since we came into power,

:51:10.:51:17.

albeit, I will accept, it was a modest real terms increase, but it

:51:18.:51:22.

showed our commitment and our intent to invest in improving the National

:51:23.:51:27.

Health Service. I am also proud of the fact that I and all my

:51:28.:51:30.

honourable and right Honourable friends on this side of the House

:51:31.:51:35.

fought the last general election on a commitment that we were going to

:51:36.:51:39.

substantially, over the five-year period of this Parliament, increase

:51:40.:51:43.

funding on the NHS to what has turned out to be bit chewed up ?10

:51:44.:51:50.

billion, which is more, I say in a very gentle way, than was on offer

:51:51.:51:56.

to the country from certain other parties. I am also pleased that my

:51:57.:52:02.

right honourable friend, the Secretary of State, and the Minister

:52:03.:52:05.

of State for health, have been planning for any potential strains

:52:06.:52:13.

on demand during this winter period with the provision of ?400 million

:52:14.:52:20.

to local health economies, and other measures like the vaccination

:52:21.:52:28.

programme, a preventative measure to get a record number, 30 million

:52:29.:52:32.

people, vaccinated to try to offset some of the potential health

:52:33.:52:38.

problems that can flow during a winter period. That is using

:52:39.:52:42.

foresight, that is using planning to try and minimise problems, and at

:52:43.:52:50.

the same time, providing funding to back up their actions, and that is

:52:51.:52:53.

what a responsible Department of Health should do and has done. Now,

:52:54.:53:04.

you can demand as much money as you like for the health service, but my

:53:05.:53:10.

argument is that, yes, the health service does have to have extra

:53:11.:53:16.

money, year in, year out but it shouldn't just be thrown at an

:53:17.:53:22.

issue. There is a far bigger part of the equation, and that is building

:53:23.:53:28.

upon the performance and the standards and the quality of care

:53:29.:53:32.

that that health service is going to provide to our constituents. Very

:53:33.:53:40.

briefly... I thank the honourable member, and I absolutely agree with

:53:41.:53:44.

what he is saying about increased resources, but would he agree that

:53:45.:53:49.

we need more resources now for integrated health and social care,

:53:50.:53:53.

and this is the time to remove the NHS as a political football and have

:53:54.:53:57.

a cross-party review? I certainly agree that under the leadership of

:53:58.:54:02.

the Department of Health, we should work with anyone and everyone to

:54:03.:54:06.

come up with a solution. I was the Minister for social care in the late

:54:07.:54:16.

1990s, before we left office, where integrating health and social care

:54:17.:54:19.

was in its very early, formative stage. And the ambitions were

:54:20.:54:25.

immense and tremendous. I'm afraid, the reality has not matched the

:54:26.:54:33.

ambitions of what was being said in the 1990s, and that is why I was

:54:34.:54:40.

particularly interested in hearing the comments of my honourable

:54:41.:54:43.

friend, the chair of the select committee. Because yes, we have to

:54:44.:54:49.

look at that, but we also have to look, pushing the funding side to

:54:50.:54:53.

one side for the moment, is building on the work that my right honourable

:54:54.:54:58.

friend, the current Secretary of State for Health, has particularly

:54:59.:55:02.

invested in, which is patient safety and raising standards and dignity

:55:03.:55:07.

for patients in our hospitals and throughout the health system. And

:55:08.:55:14.

also making sure that we cut out waste and inefficiency is. Now,

:55:15.:55:17.

there was the Nicholson challenge when I was at the Department of help

:55:18.:55:23.

the second time round, in 2010. The challenge was, over three or four

:55:24.:55:29.

years, to save ?20 billion by cutting out waste, by sharing best

:55:30.:55:35.

practice to improve the quality of care, and I know from the bait just

:55:36.:55:47.

before Christmas that the NHS achieved ?19.4 billion worth of

:55:48.:55:52.

those savings. The beauty of that was, not only was it creating

:55:53.:55:58.

greater effectiveness and efficiency in the delivery of health care and

:55:59.:56:03.

sharing best practice, but it also didn't mean that the Treasury got

:56:04.:56:10.

?19.4 billion that they could spend or do with as they wished. It was

:56:11.:56:16.

?19.4 billion that was reinvested in patient care. Yes. Was it not the

:56:17.:56:23.

case that a significant proportion of that was due to wage freezes for

:56:24.:56:29.

NHS medical and nursing staff, and therefore that is not something that

:56:30.:56:33.

can easily be repeated? The honourable lady is absolutely right

:56:34.:56:39.

that if you are earning under ?20,000... Sorry, if you are earning

:56:40.:56:44.

over ?20,000 a year, there was a wage freeze, but that was in keeping

:56:45.:56:49.

with the policy throughout the public sector, including members of

:56:50.:56:53.

Parliament and ministers. The important thing was that they were

:56:54.:56:58.

able, by a variety of means, one of them was a pay freeze, but others

:56:59.:57:03.

were by improving the delivery of service, cutting out inefficiencies,

:57:04.:57:12.

in effective ways of operating and getting rid of almost 20,000 surplus

:57:13.:57:18.

managers so that you can then concentrate on having clinicians,

:57:19.:57:23.

nurses, ancillary workers and everyone else to work towards

:57:24.:57:29.

patient care, that achieved that. And that is the right way forward.

:57:30.:57:39.

We cannot give up on that in also continuing to see if we can... I am

:57:40.:57:42.

about to finish, I'm afraid. Finally, a lot has been said about

:57:43.:57:50.

the STP programme. We had one in mid and South Essex. I have to say that

:57:51.:57:57.

I strongly support it, because it is completely focused on improving and

:57:58.:58:00.

enhancing the quality of accident and emergency care. What annoys me

:58:01.:58:08.

is those who wish to politicise it for grubby political reasons. It

:58:09.:58:13.

involves, and funnily enough, I am not talking about honourable members

:58:14.:58:19.

opposite. It involves three hospitals, with three A

:58:20.:58:24.

departments. The proposals, not one of those A departments will be

:58:25.:58:30.

close, yet, as soon as the proposals were put out, and on the assumption,

:58:31.:58:34.

correctly I suspect, that most people have not read the proposals,

:58:35.:58:41.

the word went out that my local A department was going to be closed

:58:42.:58:44.

down by the Department of Health because of this nasty Government's

:58:45.:58:51.

proposals to save money. The exact opposite was the case. If one read

:58:52.:58:58.

the documents, all three A are remaining open. What is happening,

:58:59.:59:02.

and it is building on what happens now, is that if you have a heart

:59:03.:59:07.

attack, you are taken immediately to Basildon Hospital, because that is

:59:08.:59:12.

the specialist for cardiothoracic treatment. If you need treatment for

:59:13.:59:17.

burns up plastic surgery, you come to Broomfield Hospital in

:59:18.:59:20.

Chelmsford, because that has one of the finest units in the of Europe.

:59:21.:59:25.

If you have head injuries, you will go down to the east of London, to

:59:26.:59:31.

Romford, because that is a specialist area for people with head

:59:32.:59:35.

injuries. Now, if I had any of those conditions, I would want, for me or

:59:36.:59:40.

my constituents, the best possible treatment from the best experts

:59:41.:59:44.

available, and that is what is happening. And that will be built

:59:45.:59:48.

upon, enhanced and improved. That is an improvement, that is not a cut.

:59:49.:59:55.

That is not taking away services from local communities. But for

:59:56.:00:00.

those people who have an agenda where they want to play politics,

:00:01.:00:08.

they will tell people anything, in the hope it will frighten them, to

:00:09.:00:13.

try to discredit the work of the NHS. So, I am pleased we've had the

:00:14.:00:18.

opportunity to discuss this matter also it is very tricky, there was no

:00:19.:00:27.

simple answer. It is not unique. We frequently have winter crises,

:00:28.:00:30.

particularly because of the ageing population and the increasing demand

:00:31.:00:32.

that the health service has had to deal with in recent years. But we

:00:33.:00:38.

must not lose sight of the fact that we have an NHS and a Government that

:00:39.:00:44.

is determined to further improve and enhance the quality of care, the

:00:45.:00:51.

safety and the standards of care, for all our constituents, aided and

:00:52.:00:56.

abetted by a first-class service that is working under very difficult

:00:57.:01:03.

circumstances often. Thank you, Madam Deputy Speaker. It is very

:01:04.:01:08.

important to talk more widely about the NHS, about its importance, its

:01:09.:01:13.

funding, and perhaps about its organisation too, but today's debate

:01:14.:01:19.

is to bring focus to the current crisis in many parts of our National

:01:20.:01:23.

Health Service, and to ask the Government to do something about it.

:01:24.:01:27.

Undoubtedly, our National Health Service is highly valued. It has a

:01:28.:01:32.

dedicated staff, and it provides excellent services, but in many

:01:33.:01:37.

parts of the country, it is under pressure, and today's debate does

:01:38.:01:41.

call for specific actions to address the crisis. It calls for more

:01:42.:01:46.

funding for social care now, and it calls for an improved settlement for

:01:47.:01:51.

both the National Health Service and social care in the next budget. So,

:01:52.:01:55.

in our general discussion about how things might be reorganised and

:01:56.:01:59.

changed in the future, it's very important not to lose focus on the

:02:00.:02:03.

current problems, and those are the reasons for today's debate. That has

:02:04.:02:09.

been -- there has been a lot of discussion about what is happening

:02:10.:02:12.

in hospitals, and inevitably that will be so, because that is where

:02:13.:02:18.

there is, in many areas, a crisis in A, and great pressure on hospital

:02:19.:02:23.

services. But there has also been reference to services provided by

:02:24.:02:29.

our health service outside of hospitals - community services - and

:02:30.:02:33.

it is important to focus on them as well, not just because they are

:02:34.:02:36.

important in their own right, that because if they are working

:02:37.:02:40.

effectively, they can prevent hospital admissions and indeed

:02:41.:02:44.

improve people's health. Those services include community health

:02:45.:02:48.

services. That involves the GP services, the absolute bedrock of

:02:49.:02:56.

our national health service, nurses, physios and pharmacies. The National

:02:57.:03:03.

Health Service does have some responsibility, but local

:03:04.:03:10.

authorities, currently under ever increasing pressure, Opera narrowly

:03:11.:03:14.

responsible for social care. I am concerned about the cats that the

:03:15.:03:17.

Government has imposed on community pharmacists. Pharmacists are

:03:18.:03:22.

absolutely essential to our National Health Service. They are part of the

:03:23.:03:26.

NHS, they are privately run, in the name. They offer advice as well as

:03:27.:03:32.

specific services, and they can often prevent people having to go,

:03:33.:03:36.

not just a hospital, but to their local GP, where the pharmacist is

:03:37.:03:41.

able to give proper advice and services. It is of great concern

:03:42.:03:46.

that the Government's plan for cuts to community pharmacists will put

:03:47.:03:50.

pharmacies in areas like mine, in Liverpool, at risk. I also deplore

:03:51.:03:56.

the reduction in independent pharmacists who provide such an

:03:57.:04:01.

excellent service. So, I do ask the Government to think again about its

:04:02.:04:05.

cuts to community pharmacies, a vitally important part of our health

:04:06.:04:09.

service. When they are closed, it will be far too late. The Government

:04:10.:04:13.

should act now and should not go ahead with those cuts, which will

:04:14.:04:19.

have a dramatic effect on places such as Liverpool and other places

:04:20.:04:22.

in the country. I also asked honourable members to think more

:04:23.:04:27.

about social care and what is happening. In Liverpool, we're

:04:28.:04:31.

facing a major crisis in social care. As local authority funding has

:04:32.:04:38.

been cut severely, and is to be cut again. 58% of Liverpool City

:04:39.:04:45.

Council's budget has already been cut, and ?90 million more of savings

:04:46.:04:51.

is demanded of the next three years, half of that to be achieved in the

:04:52.:04:53.

next year. There has been a reduction in social

:04:54.:05:04.

care provision. Social care packages reduced from 40,000 to 9000, many

:05:05.:05:10.

more cuts in the pipeline. Providing social care is essential, not just

:05:11.:05:15.

to enable people to leave hospital when they are healthy and ready to

:05:16.:05:20.

leave, that is a very important issue. But also, to enable people to

:05:21.:05:27.

live a constructive life. There are many people who are currently

:05:28.:05:30.

fearful of impending and possible cuts to their social care packages.

:05:31.:05:35.

Who believe that they will not be able to live reasonable lives within

:05:36.:05:39.

their own home if essential services are cut. I asked the government to

:05:40.:05:44.

again think about what they are doing and telling us that the better

:05:45.:05:51.

care fund is an answer is not the case, in Liverpool, ?35 million is

:05:52.:05:57.

promised for the fund in the coming years but that will only scratch the

:05:58.:06:01.

surface of the problem. In areas like Liverpool and areas where it is

:06:02.:06:05.

difficult to raise money, a 1% increase in the council tax fund

:06:06.:06:10.

will raise ?1.4 million. Neither of these things address looming and

:06:11.:06:17.

very real crisis in social care, and I urge the government to look again

:06:18.:06:24.

at this and not talk about platitudes. It is not fair, not plan

:06:25.:06:28.

to be there, there needs to be an urgent approach for something to be

:06:29.:06:33.

done. Mental health has been raised by a number of honourable members

:06:34.:06:44.

and in my constituency, I mentioned two instances. Assistance has been

:06:45.:06:53.

withdrawn, like opening letters for normal queries, that has gone.

:06:54.:06:58.

Another example is from a man who faces very serious until health

:06:59.:07:03.

conditions and he has a condition which means he cannot work. He was

:07:04.:07:11.

promised specialist help in York but the offer was withdrawn as it was

:07:12.:07:17.

made in error. That is unforgivable. I have followed this through, and he

:07:18.:07:23.

was promised local treatment, although it was very unclear as to

:07:24.:07:26.

whether it would be appropriate. That has not been offered in the way

:07:27.:07:32.

it was suggested. I have followed it up but I know that 14 months on from

:07:33.:07:36.

the time that he was offered help for a very incapacitating and

:07:37.:07:42.

extremely Sirius mental health condition, nothing has happened.

:07:43.:07:47.

That is simply not good enough and I will pursue it further -- serious.

:07:48.:07:52.

That is one illustration of cruel cuts on mental health services and

:07:53.:07:57.

how they are affecting individuals. I agree that we should look more

:07:58.:08:00.

generally at funding for our national health service but the

:08:01.:08:07.

crisis to date, the government has to act now. I am very pleased to

:08:08.:08:14.

follow the honourable lady, and before I start off on my remarks, I

:08:15.:08:19.

am sorry the honourable member for Central Ayrshire is no longer in her

:08:20.:08:24.

place, I particularly enjoyed her remarks because in her contribution,

:08:25.:08:31.

she actually set out a number of constructive policy amendments

:08:32.:08:36.

trawling on the Scottish example where we could reflect on them --

:08:37.:08:42.

drawing. And improve the situation. In his 33 minute contribution, I did

:08:43.:08:47.

not hear a single contribution from the shadow secretary of state which

:08:48.:08:50.

is disappointing and something he may reflect on otherwise the debate

:08:51.:08:55.

will not move far forward. I may also say that I suspect it was

:08:56.:08:59.

because she was under the Central for Ayrshire in clinical experience,

:09:00.:09:03.

I enjoyed the contribution from the right honourable member for

:09:04.:09:06.

Doncaster Central who, after a period of unforced violence as

:09:07.:09:10.

opposition Chief Whip, was clawing on her ministerial experience

:09:11.:09:19.

demonstrating I think it is valuable when they draw on their own

:09:20.:09:23.

experience and bring it to the debate -- drawing on her experience.

:09:24.:09:29.

With the motions before us today, the Labour motion we are debating

:09:30.:09:34.

talked about the four-hour target, and the funding issues. I want to

:09:35.:09:38.

touch on those in my inevitably brief speech. I raised this in the

:09:39.:09:44.

intervention I made earlier, I was in the house on Monday and the

:09:45.:09:48.

secretary of state was very clear. I do not understand why Labour members

:09:49.:09:53.

fail to see this. He did not, in any way, water down the target and as I

:09:54.:09:57.

said, the right honourable member for Exeter challenged him on it. The

:09:58.:10:02.

secretary of state specifically said he recommitted the government to

:10:03.:10:05.

that target and was generous in paying tribute to the Labour

:10:06.:10:08.

government for having introduced it, saying it was one of the best things

:10:09.:10:15.

about the NHS. I think the shadow secretary of state said in his

:10:16.:10:19.

remarks that somehow the secretary of state had talked about making

:10:20.:10:22.

sure that target applied to those with urgent health problems, and had

:10:23.:10:29.

somehow set is secretly outside of the House of Commons. I looked

:10:30.:10:33.

carefully at the secretary of state 's oral statement which she gave in

:10:34.:10:37.

the House of Commons two days ago and they were explicit in making

:10:38.:10:41.

sure that the four-hour standard related to urgent health problems

:10:42.:10:44.

and specifically talked about the NHS England's medical director for

:10:45.:10:50.

acute care said, that no country in what has it four-hour standard for

:10:51.:10:55.

all health problems, it is for urgent health problems and if we are

:10:56.:10:58.

too protected for vulnerable patients, that is what we need to

:10:59.:11:03.

do. -- protected. That is incredibly valuable. I would like to say,

:11:04.:11:09.

because it is related to the motion, about social care funding and the

:11:10.:11:14.

charge that keeps being thrown by the opposition about local authority

:11:15.:11:17.

decisions. It is entirely true that in the last parliament the coalition

:11:18.:11:22.

government had to make savings to local government budgets, because of

:11:23.:11:27.

the impact of the financial crisis, and how unprepared the country had

:11:28.:11:33.

been left due to the previous Labour government. In the dramatic

:11:34.:11:37.

financial crisis that we inherited with a budget deficit of 11%, we had

:11:38.:11:43.

to make savings. But local councils had choices about the decisions that

:11:44.:11:48.

they made and where the cuts fell. In Gloucestershire, the county

:11:49.:11:50.

council prioritised spending on adult social care, and said it was

:11:51.:11:55.

the single most important service it delivered, not just for older people

:11:56.:11:59.

but a said the budget goes on provisions for with disabilities,

:12:00.:12:05.

including learning disabilities, and it protected the budget in cash

:12:06.:12:08.

terms which is one of the reasons why we are the best performers in

:12:09.:12:14.

the region for no delayed patient discharge timings in the acute

:12:15.:12:19.

sector. Of course, there problems and challenges but the hard-working

:12:20.:12:23.

health and social care staff do an excellent job... His comments about

:12:24.:12:29.

the local governor and are just ludicrous. The level of cuts that

:12:30.:12:34.

were placed were far greater than any other government department. You

:12:35.:12:37.

cannot introduce that kind of level of cuts and say to local Gottman,

:12:38.:12:41.

you had to decide. Of course it would lead to social care problems

:12:42.:12:46.

-- government. The point was made that Mike authority had cuts as well

:12:47.:12:52.

and had to make choices. It had to make difficult cuts. But it chose to

:12:53.:12:59.

prioritise the single most important service it delivered, adult social

:13:00.:13:02.

care, which meant it had to make difficult cuts in other areas which

:13:03.:13:07.

were not easy but difficult. That choice to put adult social care at

:13:08.:13:11.

the top of the list of priorities was the right choice six years ago

:13:12.:13:15.

and remains the right choice today. Or I simply say is if councils

:13:16.:13:19.

choose to put adult social care at the bottom of their list of

:13:20.:13:24.

priorities, I do not think it was the right decision to have made. I

:13:25.:13:30.

would also like to say that I have been to visit the A department, I

:13:31.:13:38.

do not have an acute A department in my constituency but my

:13:39.:13:41.

constituency is served by an A department in Gloucester and

:13:42.:13:46.

Cheltenham. I went to visit the new Chief Executive at Gloucestershire

:13:47.:13:49.

hospitals NHS Foundation Trust to visit with some of the staff in the

:13:50.:13:55.

A department. That hospital has had its challenges, she is a new

:13:56.:13:58.

Chief Executive and is working hard with her management team on turning

:13:59.:14:03.

around a performance in A which has not been up to scratch. I spoke

:14:04.:14:07.

to her about the processes that are being put in place and I'm confident

:14:08.:14:12.

with the hard-working staff they have at that hospital, with that

:14:13.:14:15.

improve leadership, that they will be able to hit the targets the

:14:16.:14:20.

government has asked them to do. I've joined the police on a night

:14:21.:14:28.

shift, and I saw compassionate staff offering care in pressured

:14:29.:14:36.

circumstances. Would you agree that the STB process is to enhance

:14:37.:14:42.

capacity elsewhere in the county, including bolstering and enhancing

:14:43.:14:45.

provisions at Cheltenham General Hospital? The whole point about this

:14:46.:14:54.

process is making sure that we have capacity across the health sector.

:14:55.:14:57.

One of the things I thought was important from what the secretary of

:14:58.:15:03.

state said, and is in the Prime Minister's amendment to the debate

:15:04.:15:07.

today, which is why will be supporting that amendment, it talks

:15:08.:15:10.

about other changes to the health and social care system. I agree

:15:11.:15:14.

completely with what the chair of the select committee has said, in

:15:15.:15:22.

Gloucester we are fortunate, unlike the member for Central Ayrshire. We

:15:23.:15:27.

are lucky that for our county we have a single CCG and county

:15:28.:15:30.

council. They work very well together with a lot of joint working

:15:31.:15:34.

and increasingly over time they want to bring health and social care

:15:35.:15:38.

together which is exactly what the chair of the select committee said,

:15:39.:15:41.

it is the right thing to do and what the member for Central Ayrshire said

:15:42.:15:44.

they have done in Scotland which helps deliver a better service. The

:15:45.:15:50.

more we can improve capacity in the system, we can make sure people

:15:51.:15:54.

access primary care where they need to and access social care where they

:15:55.:15:57.

need to, and take pressure off the accident and emergency system. When

:15:58.:16:03.

I visited the A department, they have a very good triage department

:16:04.:16:06.

in place, if you gone there for conditions which can be treated in

:16:07.:16:11.

general practice, we have general practitioners based in the A

:16:12.:16:16.

department, ready to ensure that you are signposted and treated in an

:16:17.:16:20.

appropriate setting, and not damaging the ability of the service

:16:21.:16:23.

to properly deliver that acute care to those who really needed, and I

:16:24.:16:27.

think those kinds of steps are the things we had to look at going

:16:28.:16:32.

forward. Of course, give way. With those people fall within the

:16:33.:16:36.

four-hour target? That's the heart of the debate we're having at the

:16:37.:16:41.

moment as whether four hours should cover more urgent and more elective

:16:42.:16:46.

problems in A departments? I don't know the detail of the statistics

:16:47.:16:50.

and how they measured but you want to Mitchell that those -- you want

:16:51.:16:55.

to make sure that those people who walk through and do not need urgent

:16:56.:17:03.

care, they still need appropriate care. Whether it is to a community

:17:04.:17:08.

pharmacy or general practice, or using information services which the

:17:09.:17:13.

NHS provides online or on the telephone, it is making sure people

:17:14.:17:17.

go to the right settings which is not right at the moment. That is why

:17:18.:17:22.

it is being acknowledged and worked on in future. Finally, I would also

:17:23.:17:26.

like to say that I think the government's moods in terms of

:17:27.:17:33.

devolving spending power and decision-making to local areas --

:17:34.:17:37.

moves. In what will take place in greater Manchester, enabling the

:17:38.:17:44.

ability of bringing social care together, I have encouraged my

:17:45.:17:49.

authority as it leads the devolution proposals as it is an ambitious ask

:17:50.:17:55.

and I hope the government will look seriously at it in the months ahead.

:17:56.:18:05.

Catherine West... Thank you. I do not know what the coral is of Chief

:18:06.:18:12.

Whip... I believe it is a crop of whips! I wonder if I can begin on a

:18:13.:18:24.

slightly less happy note -- the plural is. Quoting from an education

:18:25.:18:28.

psychologist who has written to me this week saying that "I and my

:18:29.:18:33.

colleagues are often in disbelief about the amount of work we need to

:18:34.:18:37.

manage, the difficulties in working across services because of cuts and

:18:38.:18:42.

changes to policy. Everyone is perpetually exhausted and burnt out.

:18:43.:18:46.

When we are not ill at work because of training, illness or leave, we

:18:47.:18:52.

feel guilty and relieved simultaneously". Her e-mail

:18:53.:18:56.

describes how she is the only clinical psychologist on duty in the

:18:57.:18:59.

whole of a very busy in London constituency. Mr Speaker, I wanted

:19:00.:19:11.

to comment briefly on the juncture between primary and secondary care.

:19:12.:19:18.

And, indeed, acute care as well. I think many of us have experience in

:19:19.:19:23.

the last 18 months of fighting for a generally pack -- general

:19:24.:19:26.

practitioners service. And the Westbury clinic which is just

:19:27.:19:30.

between the constituency of Hornsey and Wood Green and Tottenham, it has

:19:31.:19:35.

been quite a battle ground in the last 12 months and we've really had

:19:36.:19:39.

to fight for the services of basic general practitioners for our

:19:40.:19:45.

constituents, both myself and the honourable member for Tottenham.

:19:46.:19:50.

I think this is replicated across the country and is what is leading

:19:51.:19:57.

to the build-up in individuals, as the Secretary of State said

:19:58.:20:02.

previously, we have so many people coming who probably could be seen by

:20:03.:20:05.

a GP but cannot get an appointment so they turn up to accident and

:20:06.:20:11.

emergency. I am grateful. Thank you, Mr Speaker. In Stoke-on-Trent,

:20:12.:20:14.

certainly, one of the problems we face is that we are something like

:20:15.:20:21.

six GPs away from the whole system collapsing, because as they retire

:20:22.:20:24.

or leave for other reasons, those patients are going onto the ever

:20:25.:20:29.

smaller number of GPs that there are. And that means that if another

:20:30.:20:38.

couple of GPs retire, and two our Brit -- are due to retire, the whole

:20:39.:20:42.

system is likely to collapse in Stoke-on-Trent. What will that do to

:20:43.:20:47.

A? I think it is that sort of situation which does lead to an

:20:48.:20:52.

individual patient waiting 35 hours on a trolley to be seen, as we saw

:20:53.:20:57.

this weekend. I know a number of members have made this point, but it

:20:58.:21:03.

bears repetition, that it seems quite disgraceful that one blames

:21:04.:21:07.

one's staff when this is going wrong, when clearly the

:21:08.:21:10.

responsibility lies with politicians and the Government. I was quite

:21:11.:21:16.

upset to see that the front page of today's Times blames the senior

:21:17.:21:22.

civil servant at the heart of the NHS, when really it is about poor

:21:23.:21:27.

planning from the Government. On the subject of poor planning, I am sure

:21:28.:21:34.

the honourable lady, like the rest of the House, heard James O'Brien

:21:35.:21:41.

speaking on LBC yesterday, describing his experience of having

:21:42.:21:44.

conjunctivitis over the holidays and having to go to a community pharmacy

:21:45.:21:47.

because he could not get a GP appointment. Is this the time when

:21:48.:21:55.

we should be supporting, not closing, community pharmacies?

:21:56.:21:59.

Whether it was a Brexit fever madness that took over or not, I

:22:00.:22:06.

don't know, but there was a moment when cutting community pharmacists

:22:07.:22:10.

seemed the right thing to do, especially when it was the wrong

:22:11.:22:15.

thing, particularly with the impact of the illnesses we all fall prey to

:22:16.:22:21.

over the winter months. In my earlier intervention, I ask the

:22:22.:22:23.

Secretary of State for Health about the influenza epidemic, and he

:22:24.:22:28.

assured me on the number of vaccinations, and that more people

:22:29.:22:31.

had been vaccinated against seasonal flu. But the point I was making was

:22:32.:22:36.

that went tragically people do get the flu, and I understand there is

:22:37.:22:39.

quite an increase in the number of young people getting it, not

:22:40.:22:45.

necessarily in the group where they would be advised to be inoculated,

:22:46.:22:51.

they are suffering, and the doctors don't have time to isolate those

:22:52.:22:54.

individual cases, which means there is a real risk, given how busy the

:22:55.:23:02.

staff are, that that flu could become an epidemic, and I hope that

:23:03.:23:06.

the Secretary of State, having given us assurances today, will take the

:23:07.:23:08.

point up farther with chief executives of acute trusts. Briefly,

:23:09.:23:13.

on the question of social care, just to give colleagues an indication, in

:23:14.:23:19.

2010, when I was a council leader, we had a social care budget for

:23:20.:23:23.

children. It is nothing to do with schools, just children will stop

:23:24.:23:29.

?102 million. The same local authority now, in a busy London

:23:30.:23:36.

area, now has 420 17-18, a budget of 26 million. If you're telling me

:23:37.:23:40.

that the needs are half as much as they were, or that families need

:23:41.:23:51.

half as much support, I would be very surprised. That cut is deeply

:23:52.:23:57.

worrying for the children who are in desperate need of social care. On

:23:58.:24:02.

the adult social care side, of course, that is equally worrying,

:24:03.:24:06.

where on Monday, the Secretary of State told us that we shouldn't

:24:07.:24:11.

worry because ?600 million is going into social care. Well, I wouldn't

:24:12.:24:16.

worry, except that I happen to know that between 2010 and 2015, four 8p

:24:17.:24:23.

was taken out. Anyone who has even Key stage two maths will know that

:24:24.:24:35.

that does not add up. If you take... Not only that, but I feel very sorry

:24:36.:24:43.

for cancelled because they in -- if they increase council tax it is not

:24:44.:24:48.

popular. And if they don't do it, they are blamed for not sorting out

:24:49.:24:51.

the social care crisis. We know that the amounts raised even in an area

:24:52.:24:55.

where the preset does bring back a lot of money as a local authority,

:24:56.:24:59.

that doesn't help in the longer term, because it is a short-term fix

:25:00.:25:03.

and it is not fixing the problem we need to be looking at, which is

:25:04.:25:06.

basically having more homes where older people can live comfortably,

:25:07.:25:11.

have fewer faults and accidents, be warmer so they are not suffering

:25:12.:25:15.

from fuel poverty, and therefore stay out of accident and emergency,

:25:16.:25:18.

which is about long-term planning. As we know, we have hardly build any

:25:19.:25:23.

new homes, even new homes for older folk where we could be using that as

:25:24.:25:27.

a change to help families come into those homes, thereby sobbing another

:25:28.:25:28.

problem, and we end up with this crisis of older people being in

:25:29.:25:46.

accident and emergency, and on occasion, even being on a trolley

:25:47.:25:49.

for 35 hours, which I still feel I can't quite believe. I am sure the

:25:50.:25:52.

newspapers are telling the truth, but it does seem that 35 hours is an

:25:53.:25:55.

awfully long time not to be seen on a trolley. In relation to melt

:25:56.:25:57.

ill-health, the member for Tottenham and I had a debate earlier in the

:25:58.:26:02.

year, followed by a meeting with the local sub region of members of

:26:03.:26:07.

Parliament. We were very worried about people suffering mental health

:26:08.:26:13.

problems. We have a perfect storm at the moment for people suffering from

:26:14.:26:17.

mental health. Number one, the cuts in benefits. We are in the seventh

:26:18.:26:21.

year of austerity, and there was no doubt that people with mental health

:26:22.:26:25.

problems are right at the bottom of the pile where those cuts are

:26:26.:26:30.

concerned. Two, housing and those programmes that help people with

:26:31.:26:36.

mental health problems stay in their tenancies. That has been cut back,

:26:37.:26:39.

there is no one to support them, and it is part of the reason why they

:26:40.:26:43.

fall ill. Number three, the cutbacks to the number of nurses. We have

:26:44.:26:47.

fewer mental health nurses than two years ago in the system. And of

:26:48.:26:53.

course, begs. A constituent came to see me at my surgery in November,

:26:54.:27:01.

saying he had fallen ill with a mental health problem. He was amazed

:27:02.:27:07.

at the poor level of care he received, including because there

:27:08.:27:11.

was no one really to diagnosing properly. He was given no indication

:27:12.:27:22.

about what sort of service. He was sent about 20 miles away to another

:27:23.:27:26.

hospital to be cared for, causing great stress and worry for his

:27:27.:27:30.

family. Mr Speaker, in conclusion, the whole of the health system is in

:27:31.:27:36.

crisis and needs our urgent attention, and I do hope that

:27:37.:27:40.

despite all the demands, the political demands, that the Brexit

:27:41.:27:43.

process will create, that we will not forget not just the most

:27:44.:27:48.

vulnerable but our basic, universal NHS for all. Andrea Jenkins. Thank

:27:49.:27:57.

you, Mr Speaker. I would like to begin by objecting to the

:27:58.:28:00.

exaggerated language used by Mike Adamson, the chief executive of the

:28:01.:28:04.

British Red Cross, over the weekend. What was said by him does a huge

:28:05.:28:09.

disservice to our hard-working health care professionals in the

:28:10.:28:15.

NHS. It was sloppy and irresponsible language. The Red Cross does some

:28:16.:28:19.

fantastic work, which I'm sure we agree on both sides of the Hours,

:28:20.:28:25.

but as a registered charity, the organisation is legally obliged not

:28:26.:28:29.

to be political, and if Mike Adamson cannot remain neutral, I suggest he

:28:30.:28:33.

examine his position carefully. As a member of the health committee and

:28:34.:28:38.

chair and co-founder of the patient safety all party Parliamentary

:28:39.:28:41.

group, health care is extremely important to me, and I am proud to

:28:42.:28:45.

be a Conservative member of Parliament under this Government. It

:28:46.:28:49.

is thanks to this Government and this Health Secretary that the NHS

:28:50.:28:55.

funding is at record levels. Mr Speaker, the Government's commitment

:28:56.:29:01.

to delivering a seven-day NHS, expanding access to GP surgeries and

:29:02.:29:06.

hospital-based consultants at evenings and weekends, and the NHS

:29:07.:29:12.

has made more extensive winter preparations than ever before. In

:29:13.:29:16.

the run-up to the winter period, as the Secretary of State stated

:29:17.:29:20.

earlier, there were over 1600 more doctors and 3000 more nurses than

:29:21.:29:24.

just a year ago. This is a record to be proud of and something that would

:29:25.:29:30.

not have been achieved if we had had the opposition party running our

:29:31.:29:34.

National Health Service. Mr Speaker, as chair of the patient safety APG

:29:35.:29:41.

Gee, I am pleased to say that the Government has introduced a new

:29:42.:29:48.

OFSTED- style safety regime to improve patient safety. Hospital

:29:49.:29:51.

infections have been virtually halved since 2010. The level of MRSA

:29:52.:29:57.

is virtually half, and CDP sealed cases are down by 20%. It is this

:29:58.:30:02.

Health Secretary that has taken the lead on this issue and putting

:30:03.:30:06.

patients at the heart of the NHS. Record numbers of people are being

:30:07.:30:09.

treated in our health service, and there are pressures on the service,

:30:10.:30:13.

but it is not this Conservative Government that is a threat to the

:30:14.:30:18.

NHS. If we look at the appalling situation of the NHS in

:30:19.:30:20.

Labour-controlled Wales, where they are cutting funding, and as our

:30:21.:30:26.

latest statistic shows, they are failing to meet the four-hour A

:30:27.:30:32.

tigers by a wide margin, it is easy to see who is the defender of the

:30:33.:30:37.

NHS and who would cut investment. To conclude, Mr Speaker, it is this

:30:38.:30:42.

Government that is increasing spending on our NHS, focusing on

:30:43.:30:46.

improving patient safety, and is dedicated to providing the best

:30:47.:30:53.

possible service. I am grateful for the opportunity to raise some

:30:54.:30:58.

serious concerns about this Government's refusal to fully fund

:30:59.:31:02.

our NHS. We are seeing this Government running out of places to

:31:03.:31:07.

cut corners to save money. We see a lack of respect and compassion given

:31:08.:31:14.

to people who need health care. We see those needing care at home

:31:15.:31:18.

having to make do with 15 minute flying visits. We have seen the

:31:19.:31:23.

pressure in A department building over the last six years, and yet,

:31:24.:31:28.

every year, we have reached a winter crisis. Somehow, this is a surprise

:31:29.:31:32.

that the Government. We have seen A waiting times increasing to the

:31:33.:31:37.

point where now over 1.8 million people are more than four hours, an

:31:38.:31:46.

increase of 400% since 2010. Bed blocking is increasing as our

:31:47.:31:49.

underfunded social care services struggle to deal with the demand. We

:31:50.:31:53.

have seen an increase in the number of patients waiting on trolleys to

:31:54.:31:57.

be treated or admitted and the number of hospitals running out of

:31:58.:32:02.

beds increasing. We are also about to see a 12% cut to community

:32:03.:32:06.

pharmacies, which will lead to the closure or reduction in services on

:32:07.:32:13.

our local pharmacies, and the time it takes to get a GP and appointment

:32:14.:32:22.

-- a GP appointment in policing -- increasing. If we want a care system

:32:23.:32:26.

that works with compassion and treats those in the professionally

:32:27.:32:30.

and efficiently, this Government has to fund it. In 2015, the head of the

:32:31.:32:41.

NHS, Sir Simon Stephens, said that the NHS needed ?8 billion. It was

:32:42.:32:46.

this party which committed to fund it the Labour Party didn't. If she

:32:47.:32:50.

is so keen on funding the NHS, why didn't the Labour Party pledged to

:32:51.:32:56.

do so back in 2015? Pharmacies, this Government failed to grasp that cuts

:32:57.:33:01.

to one service directly impact upon another. Let me be clear, only two

:33:02.:33:05.

months ago I stood in this chamber to condemn the Government proposing

:33:06.:33:12.

to cut community pharmacies by 12%. That would potentially see 25% of my

:33:13.:33:18.

42 pharmacies facing closure in Bradford West. This highlights the

:33:19.:33:22.

short-sighted approach taken by this Government. They are attacking all

:33:23.:33:27.

forms of primary health care and front line services that people rely

:33:28.:33:31.

upon. If the figures are correct, nearly 30% of people that attended

:33:32.:33:37.

A services in Bradford Royal Infirmary, within my constituency,

:33:38.:33:40.

over the last month, they could have been treated elsewhere for minor

:33:41.:33:47.

ailments. Many would go to the local pharmacy board to see their GP, but

:33:48.:33:53.

what is this Government's long-term approach to the systematic issues if

:33:54.:33:57.

they continue to water down primary care services? All we will see is

:33:58.:34:02.

the number of visitors unnecessarily attending A increase and the

:34:03.:34:06.

problems faced by those needing access to services increase. Let's

:34:07.:34:11.

talk about GP services. We are seeing the same impact from a

:34:12.:34:15.

reduction in GP services. Only a few months ago, I campaign with the

:34:16.:34:19.

local community to save manning health practice. That was

:34:20.:34:26.

temporarily put on hold. However, we have managed to stop this centre in

:34:27.:34:30.

the short-term, but I know that others are right risk in my

:34:31.:34:36.

constituency, and many GPs face uncertain future is due to funding

:34:37.:34:40.

restraints. It paints not only a picture of under picked --

:34:41.:34:43.

underfunding of primary care services, but also a picture of a

:34:44.:34:47.

strategy that simply does not work together. Even a simple

:34:48.:34:50.

understanding of health care provision would allow us to see that

:34:51.:34:55.

if we decrease NHS services in one sector, it impacts upon the rest of

:34:56.:34:56.

it. This will increase pressures on

:34:57.:35:04.

service providers but this government continues to underfund,

:35:05.:35:08.

and cut funding to all aspects of front line services, and expect the

:35:09.:35:13.

quality of care to remain the same. Where is the long-term planning that

:35:14.:35:17.

would ensure people are getting access to the care that they deserve

:35:18.:35:22.

and are entitled to? Local government social care funding,

:35:23.:35:26.

again, we see the same strategy from this government with social care

:35:27.:35:32.

funding. With cuts to care funding has been dramatic, as members have

:35:33.:35:36.

highlighted. Nearly ?4.6 billion has been taken out of the sector since

:35:37.:35:41.

2010. Mainly from local governor and funding cuts. My district of

:35:42.:35:44.

Bradford has had to announce that they will need to find another ?8

:35:45.:35:50.

million in savings in their budgets going forward. They are trying to be

:35:51.:35:54.

innovative and find ways to make sure that this does not affect from

:35:55.:35:59.

front line care by putting resources into prevention. As far as I am

:36:00.:36:03.

concerned, this government still fails to recognise the impact of

:36:04.:36:11.

deprivation on our care needs. One of the most deprived constitutions,

:36:12.:36:15.

mental health issues go hand-in-hand with deprivation. The cuts to local

:36:16.:36:18.

government funding make this even more evident. It is not the work of

:36:19.:36:22.

our exceptional health care staff which causes this crisis. It is the

:36:23.:36:28.

reduction in funding, and the short-term strategy of this

:36:29.:36:31.

government to which is responsible, and it is time that they wake up and

:36:32.:36:35.

provide the health care provision that people deserve. Thank your very

:36:36.:36:41.

much Mr Speaker, many of my constituents are extremely fortunate

:36:42.:36:46.

to be served by the Luton and Dunstable Hospital, which was named

:36:47.:36:49.

checked twice by the secretary of state in his statement on Monday.

:36:50.:36:55.

One of the things they do extremely well is that they have an excellent

:36:56.:36:59.

streaming process in A with good alternatives where

:37:00.:37:07.

A services are not suitable. It gives them high standards. Social

:37:08.:37:15.

care is provided by Central Bedfordshire Council which has been

:37:16.:37:19.

extremely innovative in building extra care provisions for older

:37:20.:37:25.

people. I visited these provisions which are hugely popular and are in

:37:26.:37:29.

central locations. They are much cheaper than residential care. And,

:37:30.:37:33.

they provide a much better living environment for older people. This

:37:34.:37:38.

is exactly the sort of thing that we need to see a lot more of across the

:37:39.:37:44.

country. I think these are two examples of really good individual

:37:45.:37:48.

practice, within the NHS and social care. And, what we need to be much

:37:49.:37:52.

better at is spreading good practice across the country as a whole. It is

:37:53.:37:58.

just worth putting on the record in this debate that since this time

:37:59.:38:05.

last year, we do have over 1600 more doctors, 3100 more hospital nurses

:38:06.:38:11.

since 2010, over 11,000 more doctors and nurses. The proportion of

:38:12.:38:16.

patients harmed by the NHS fell by over one third between 2012 and

:38:17.:38:27.

2015. Infraction is 50% lower than a year ago. A tremendous achievement.

:38:28.:38:32.

Health spending in England is actually 1% higher than the OECD

:38:33.:38:37.

average. And, the UK is spending more on long-term care as a

:38:38.:38:42.

percentage of GDP than Germany, Canada and USA. The King 's fund has

:38:43.:38:48.

also that STBs are the best hope for the future of the NHS in England --

:38:49.:38:56.

S T P. The head of NHS providers has said that the system as a whole is

:38:57.:38:59.

doing slightly better than this time last year. This is dependent on

:39:00.:39:03.

having a strong economy and I would argue that this party has

:39:04.:39:08.

demonstrated confidence in running the economy. I'm not complacent, I

:39:09.:39:14.

recognise there is an arms race between the extra provisions the

:39:15.:39:16.

government has put in and increasing demands on the NHS. One issue which

:39:17.:39:22.

disappoints me is that we do not have enough focus on holiday in

:39:23.:39:26.

these debates, it is always about funding. I draw attention again to

:39:27.:39:31.

the initiative brought in by the government just before Christmas,

:39:32.:39:39.

which is projected to save ?1.5 billion, and could be redirected to

:39:40.:39:46.

patient care across 18 specialties. Low infections, less provision

:39:47.:39:51.

operations, and we are using data to shine the spotlight on variability.

:39:52.:39:57.

That is absolutely key for our constituents and, in relation to

:39:58.:40:01.

mental health and the welcome statement by the Prime Minister on

:40:02.:40:05.

Monday, I was delighted to hear emphasis on first aid for mental

:40:06.:40:09.

health, something that will take place within our schools. Equally as

:40:10.:40:14.

important, if not more so, I would say, is the issue of keep fit for

:40:15.:40:18.

mental health, what do we need to do, all of us, to maintain good

:40:19.:40:23.

mental health? The mental health foundation says we have to talk

:40:24.:40:26.

about our feelings, eat well, keep in touch with family and friends,

:40:27.:40:31.

take a break, accept who we are, keep active, drink sensibly, ask for

:40:32.:40:38.

help and look after others. Those ten pointers are not as well-known

:40:39.:40:41.

as they should be, I am pleased to put them on the record just now but

:40:42.:40:46.

it is crucial that we all look after our mental health which will help to

:40:47.:40:51.

reduce the stigma within this area. Another area that I am passionate

:40:52.:40:55.

about is doing something about obesity, we have a National Health

:40:56.:41:02.

Service and we do not do enough to keep our fellow citizens healthy. I

:41:03.:41:10.

would like to see more emphasis done following an academic of the

:41:11.:41:13.

University of Oxford, she published an article in the Lancet just before

:41:14.:41:19.

Christmas showing that where GPs offer a referral to 12 one-hour

:41:20.:41:24.

weekly sessions to obese patients, there was a significant reduction in

:41:25.:41:29.

their obesity. In 2015, a quarter of adults were obese... Honourable

:41:30.:41:38.

member like me is a regular reader of the Daily Mail, their proposal

:41:39.:41:43.

that are obese or heavy smokers or both, they are denied medical

:41:44.:41:49.

treatment until they lose weight or stop smoking. Would he recommend to

:41:50.:41:56.

the front bench that policy? I'm fixing on how we can keep ourselves

:41:57.:42:00.

healthy to reduce demands on the NHS by behaving responsibly. 40% of

:42:01.:42:14.

children aged 2-15, 80% in lower households. Those figures showed

:42:15.:42:19.

shame as all. That is why I mentioned the Daily Mail, and the

:42:20.:42:26.

scheme brought in by that school in Stirling, we need to see more of

:42:27.:42:30.

that and the strength and obesity policy. My daily newspaper at the

:42:31.:42:35.

moment is the China daily which is delivered free to my office at the

:42:36.:42:40.

moment. I was intrigued to see, Mr Speaker, that universities in China,

:42:41.:42:44.

students had to take a physical fitness test lasting 50 minutes. I'm

:42:45.:42:56.

not suggesting that we introduce it here, but we should look around the

:42:57.:42:59.

world to see what other countries are doing to promote keeping

:43:00.:43:05.

populations fit and healthy and reduce pressure on health services.

:43:06.:43:09.

At the other end of the age spectrum, we need to do a lot more

:43:10.:43:12.

to keep older people fit and healthy, as many issues of social

:43:13.:43:19.

care would be greatly lessened if older people were to stay healthy in

:43:20.:43:24.

later life. I am very proud to be associated with the Buzzard's 50

:43:25.:43:30.

plus organisation in my constituency, which helps older

:43:31.:43:36.

people take regular exercise at local leisure centres. In Andorra,

:43:37.:43:41.

where I mentioned earlier, this is normal for the whole population.

:43:42.:43:46.

Older people in the 70s and 80s regularly take place in water

:43:47.:43:50.

aerobics classes and go to the gym. When a BBC correspondence went there

:43:51.:43:53.

a few years ago, some of the women he spoke to were in their 70s and

:43:54.:43:59.

taking part -- correspondent. They said what is more important than

:44:00.:44:04.

keeping yourself it? If you don't keep your body moving, you won't

:44:05.:44:08.

keep your mind in shape. We need more of that kind of activity within

:44:09.:44:16.

our own country -- keeping yourself fit. We have heard from the opposite

:44:17.:44:24.

benches today about the so-called annual winter crisis, as if the

:44:25.:44:27.

situation at the moment that we are in has always been there. There have

:44:28.:44:32.

been crises but nothing like on the scale that we have recently seen. We

:44:33.:44:38.

are hearing about corridors being used as wards, and I have seen it in

:44:39.:44:42.

my own local hospital when I took my young son to hospital. When we went

:44:43.:44:48.

through into the water and salt use of trolleys with patients on there,

:44:49.:44:55.

before my little son was seen to -- and saw the use of trolleys. In

:44:56.:45:01.

December of last year, the minister in his place at the moment, the

:45:02.:45:06.

honourable member for nut low, answered that question. -- Ludlow.

:45:07.:45:14.

Could the government give figures for patients left queueing in

:45:15.:45:18.

corridors? I was told there were no such figures. The government and

:45:19.:45:21.

minister is well aware this is going on in hospitals up and down the

:45:22.:45:24.

country and if the government does not collect these figures centrally,

:45:25.:45:32.

if hospitals collect those figures, the government should ask for them.

:45:33.:45:37.

If the hospitals do not, they aren't really carrying out the duty of care

:45:38.:45:41.

to our constituents because I think that it is important that we know

:45:42.:45:48.

how many are being held in corridors. We hear stories of

:45:49.:45:52.

ambulances being redirected and bed occupancy is over 85%

:45:53.:45:58.

recommendations and in some cases over 95% that we are seeing. We have

:45:59.:46:04.

heard about the ?4.6 billion in cuts in the social care funding. And

:46:05.:46:09.

already, whilst it has not been explicit, we are seeing talk about a

:46:10.:46:17.

discussion on the downgrade in the four-hour A weight. I know myself,

:46:18.:46:25.

in Preston, there is difficulty in getting GP appointments -- wait. If

:46:26.:46:28.

I bring to see the doctor, I'm often told that we had to wait 2-3 weeks

:46:29.:46:34.

to see that Doctor. It's probably 2-3 hours at the very least if I go

:46:35.:46:39.

to the hospital and it is a serious case that we are looking at. No

:46:40.:46:46.

wonder A is in crisis. There is a whole cohort of doctors in their mid

:46:47.:46:50.

to late 50s looking forward to retirement. I know the number of

:46:51.:46:54.

doctors has increased, we heard that today from the Health Secretary, but

:46:55.:46:58.

I do not think it is anywhere near meeting the number leaving the

:46:59.:47:01.

service or going to work elsewhere as well. On the social care sector,

:47:02.:47:08.

we are seeing in Lancashire tens of millions of pounds of cuts in

:47:09.:47:15.

Lancashire County Council which is leaving the elderly vulnerable and

:47:16.:47:19.

more likely to have accidents at home which is putting her Sian A

:47:20.:47:25.

as well. The Cinderella service has always been there, -- putting

:47:26.:47:33.

pressure on A as well. They do not get the support that they deserve

:47:34.:47:36.

and I've seen in my own constituency since the closure of the acute

:47:37.:47:45.

mental health ward hospitals, the agent Dale unit, how mental health

:47:46.:47:50.

patients have been decanted across Lancashire because they do not have

:47:51.:47:55.

the support they need in Preston itself. Over a five-month period

:47:56.:48:04.

last year, we saw a 16% increase in attendance at A in Preston

:48:05.:48:09.

Hospital and over the same period, average attendances increased from

:48:10.:48:16.

217 to 225 per day. A small percentage of the increase was due

:48:17.:48:20.

to the version of Chorley hospitals A and I'm sure if the member for

:48:21.:48:25.

Chorley was here today, he would echo what I have just said. But that

:48:26.:48:31.

is not all down to the closure of Chorley's A Many of the patients

:48:32.:48:35.

who would have gone there are now going to weaken and going elsewhere.

:48:36.:48:42.

The problem in Preston, as well as Chorley and elsewhere, the

:48:43.:48:44.

government should not be allowing wards to close when they demand --

:48:45.:48:49.

when the demand is so high. Ambulance arrivals have increased

:48:50.:48:55.

from 68 to 91, according to the north-west Ambulance Services. In

:48:56.:49:01.

the meantime, a return to a 24-hour A service that Chorley Hospital

:49:02.:49:05.

has been ruled out. At best, there would be a 12 hour A service

:49:06.:49:10.

sometime later this month. At Preston, we have 134, Alta 138, of

:49:11.:49:20.

the A departments up and down the country when 95% of patients are not

:49:21.:49:24.

seen within the four ours. Which means that only four hospitals, A

:49:25.:49:33.

in the country, our meeting the four-hour standard. Mr Speaker, I

:49:34.:49:37.

believe this is a disgrace. And, it is testimony to the cuts and

:49:38.:49:43.

austerity being forced on the NHS and local government social services

:49:44.:49:45.

departments up and down the country. I call upon the government to

:49:46.:49:50.

increase spending on social care, and further fund the NHS at this

:49:51.:49:52.

years budget as a of urgency. It's a pleasure to follow the member

:49:53.:50:06.

for Preston in today's debate. I am also conscious that I am following

:50:07.:50:13.

many more learning members -- learned members, from both sides of

:50:14.:50:19.

the chamber, who bring very valuable experience from the front line

:50:20.:50:25.

within the NHS. Like probably all members across the chamber, I

:50:26.:50:31.

receive letters, visits from constituents, with concerns and

:50:32.:50:35.

issues about the NHS, about their own health issues, and some of them,

:50:36.:50:39.

as we all know, Mr Speaker, can be very sad and the motive, and we all

:50:40.:50:45.

do our utmost to help them and what can be very difficult situations.

:50:46.:50:50.

But let's not forget the many positive stories and experiences we

:50:51.:50:56.

hear also. Many of us in the chamber, again, will have had our

:50:57.:51:00.

own very positive experiences about the NHS as well, and away it has

:51:01.:51:04.

helped us and our families and continues to do so, and I think it

:51:05.:51:08.

would be wrong and unfair of us not to recognise those today. So, I

:51:09.:51:12.

would like to start by thanking those NHS staff and those who work

:51:13.:51:22.

in the health and social care services, not just for the work they

:51:23.:51:27.

do at this time of year but for the work that they do throughout the

:51:28.:51:31.

year, day in, day out. My mother was a home-care rather many years, and

:51:32.:51:36.

my sister is a practice nurse, so I often hear from them what it is like

:51:37.:51:42.

to work on the front line. I also include the Manor Hospital, our

:51:43.:51:51.

local hospital in Walsall, and they, like many hospitals, have their own

:51:52.:51:55.

precious to face. We heard today, on the Tuesday after Christmas, A saw

:51:56.:52:00.

the highest number of patients, and I believe all those involved in

:52:01.:52:03.

health care are working extremely hard to this. I include the

:52:04.:52:09.

Secretary of State and his ministers in this, in the work that they do to

:52:10.:52:13.

tackle this immediate problem, and what are doing in moving us towards,

:52:14.:52:21.

I'm sure, a better and more sustainable future. Hospitals across

:52:22.:52:24.

the country are facing huge pressures, and as I said, as we

:52:25.:52:31.

enter the winter period. We have an increasingly ageing population but

:52:32.:52:34.

also one that is increasing in terms of numbers as well. There are many

:52:35.:52:38.

more treatment options available than ever before. Some of them come,

:52:39.:52:45.

we all know, at a high cost, but a cost we would like to be able to

:52:46.:52:50.

meet to help those patients. All of these factors place challenges and

:52:51.:52:55.

pressures on the NHS, its staff and its resources. The impact of an

:52:56.:52:58.

ageing population is something that has been raised with me by some of

:52:59.:53:05.

my local GPs, and the need to recognise and tackle this. I know

:53:06.:53:08.

that local GPs in my surgery would be very welcoming the Minister if he

:53:09.:53:14.

would like to drop by Oldridge on his way back to Shropshire one

:53:15.:53:21.

Friday for a very useful and positive roundtable discussion, so

:53:22.:53:24.

there is an invitation for you there, Minister. Also, the

:53:25.:53:32.

importance of having an integrated and effective social care system is

:53:33.:53:35.

part of this too. I don't believe that whilst money is an important

:53:36.:53:42.

factor, it is not just about that. The Secretary of State said earlier

:53:43.:53:45.

that we miss a trick if we say that it is. We forget it is also about

:53:46.:53:50.

safety, standards and quality, and making progress on these areas too.

:53:51.:53:55.

I can recall, a number of years ago, the headlines were always about MRSA

:53:56.:54:03.

and some of those really nasty hospital bugs and infections, and we

:54:04.:54:07.

have gone a long way in terms of the work we are doing to combat those. I

:54:08.:54:10.

am proud this Government is committed to the NHS, and that as we

:54:11.:54:17.

enter the inter--- the winter period, we have nearly 1800 more

:54:18.:54:21.

doctors, nearly 3000 more hospital nurses than we had a year ago. We

:54:22.:54:27.

launched the largest ever flu vaccine programme. We allocated ?400

:54:28.:54:33.

million to local health Systems for winter preparing this. There are

:54:34.:54:40.

12,000 additional GP sessions over the festive period. Of course, there

:54:41.:54:47.

is more to do, and there always will be, but I believe that we are

:54:48.:54:50.

writing to the challenge and that we will continue to do so and I am sure

:54:51.:54:55.

the Secretary of State and his team will continue to rise to that

:54:56.:55:03.

challenge as well. I don't intend to take too long, because I am mindful

:55:04.:55:07.

of the fact that the motion before us largely talks about NHS England,

:55:08.:55:12.

but I am goaded to speak by the repeated references by the current

:55:13.:55:17.

Secretary of State, and indeed the previous Prime Minister, and the

:55:18.:55:22.

current Prime Minister, to the NHS in Wales, and the relative

:55:23.:55:26.

performance of eight. I want to use a few minutes to try and set the

:55:27.:55:29.

record straight and give a clearer illustration of the relative

:55:30.:55:34.

performance of the two NHSs. Before I do, I wanted to reflect on the

:55:35.:55:37.

speech the Prime Minister gave, and interesting, thoughtful speech

:55:38.:55:42.

earlier this week about her desire to create a shared society, as she

:55:43.:55:47.

put it, in Britain. As many members did, I read it and thought it was

:55:48.:55:51.

precisely what all governments ought to be doing in this country at all

:55:52.:55:55.

times. I thought I would briefly read one passage. She said: That is

:55:56.:55:59.

why I believe that the central challenge of our times is to

:56:00.:56:03.

overcome division and to bring our country together to create a society

:56:04.:56:07.

that respects the bonds we share as a union of people and of nations.

:56:08.:56:11.

And I completely agree with the current Prime Minister about that,

:56:12.:56:14.

but I find it impossible to reconcile that stated objective and

:56:15.:56:21.

the rhetoric that we hear from a current Prime Minister with the

:56:22.:56:26.

reality of the way in which she, and in particular her predecessor, have

:56:27.:56:30.

sought to divide this country, in particular, on the issue of the NHS,

:56:31.:56:35.

illegitimately, in my view, demeaning the performance of the NHS

:56:36.:56:42.

in Wales, demoralising staff and destroying confidence and faith in

:56:43.:56:46.

the NHS in Wales in Welsh citizens. All of those things I think, have

:56:47.:56:51.

been completely illegitimate, and I hope with a few short statistics to

:56:52.:56:54.

illustrate how misleading some of the representation has been in

:56:55.:57:01.

recent years. I would say that it was in fact 37 times, the first

:57:02.:57:06.

autistic, that the previous Prime Minister referred in a disparaging

:57:07.:57:11.

fashion to the NHS in Wales, using it on every occasion as a political

:57:12.:57:15.

attempt to mitigate against criticism of the NHS in England, and

:57:16.:57:21.

in my view, breaking the bonds, those important bonds, between

:57:22.:57:24.

different parts of the UK. I will set out a few facts. The truth is,

:57:25.:57:29.

the budget for Wales, the entire budget, is about ?15 billion per

:57:30.:57:36.

annum. Of that, ?7.1 billion is spent on the NHS, that's 48% of all

:57:37.:57:41.

spending by the Government in Wales. The difference between that and

:57:42.:57:45.

England is enormous, because in England, of course, the entire

:57:46.:57:50.

budget of the NHS is ?120 billion and the entire budget of the

:57:51.:57:56.

country, if you like, is around ?750 billion, so around 16% of the budget

:57:57.:58:04.

in England is spent on the NHS, Violet is about 40% in Wales. --

:58:05.:58:15.

while it is about. The Government has manipulated statistics on this

:58:16.:58:18.

issue. The second thing the Government has done repeatedly in

:58:19.:58:21.

the last six years, and we heard it three times already today, is

:58:22.:58:26.

referred to the lesser rate of spending per head in Wales compared

:58:27.:58:31.

to England. In 2010, the Welsh Government chose to reduce spending

:58:32.:58:40.

in the NHS by 1%. A 1% reduction in order to increase spending and

:58:41.:58:45.

prioritise education in Wales. Since then, we have seen successive rounds

:58:46.:58:51.

of investment by the Welsh Government, ?80 million announced

:58:52.:58:54.

this week for a new treatment fun, ?40 million last week for capital

:58:55.:58:59.

spending. It's now broadly comparable in percentage terms. If

:59:00.:59:03.

you look at per capita spending last year, we spent in wells around ?2026

:59:04.:59:10.

on the NHS, violin England it is ?228. -- 2000 ?228. It is

:59:11.:59:20.

negligible. Wales spent 6% more per head than England overall. Those are

:59:21.:59:23.

the realities of comparative spending. Their rise some things

:59:24.:59:30.

where the Welsh NHS does worse. You do wait longer for some diagnostic

:59:31.:59:35.

treatment in Wales, and there is a need to spend more on MRI scanners

:59:36.:59:39.

and CT scans, but part of the issue there is to do with an older, more

:59:40.:59:46.

sick, post-industrial population, rural sparsity, lesser ability to

:59:47.:59:51.

attract people to more far-flung hospitals, all perfectly explicable,

:59:52.:59:54.

reasonable solutions. In England over the last nine months, we have

:59:55.:00:00.

seen rising waiting lists, the biggest we have seen in the last

:00:01.:00:05.

nine years. In other areas, Wales does well. Ambulance response times,

:00:06.:00:11.

getting therein eight minutes and 77% of those calls are met in Wales

:00:12.:00:17.

will stop cancer treatment times - most people would agree to is vital

:00:18.:00:24.

to get people treated. The target is consistently missed in England,

:00:25.:00:31.

averaging 81%. In Wales, it is 86%. Let's look at A, given that is the

:00:32.:00:35.

crucial area we're looking at today. The four-hour target, in Wales 83%

:00:36.:00:42.

of people are seen within that target. In England, it is presently

:00:43.:00:50.

88%. In England, whether our 150 A departments, versus the six or seven

:00:51.:00:55.

we have in wells, another completely ludicrous and meaningless

:00:56.:01:00.

statistical comparison, of those 150 A trust departments in England are

:01:01.:01:07.

below the Welsh average. In several of the Welsh trusts, out of the sex,

:01:08.:01:16.

they are up at the 96-98% mark. It is another illustration have how

:01:17.:01:20.

misleading and abuse of it has been the Tories to use the Welsh NHS as a

:01:21.:01:24.

stick to political points in this place. In conclusion, I want to say

:01:25.:01:30.

two things. The truth about the Welsh NHS is that it performs

:01:31.:01:33.

excellently in some areas and could be improved in others. As the OECD

:01:34.:01:39.

said in a 10-year of all the help care systems across this country, no

:01:40.:01:43.

part of Britain performs their miserably better than any other.

:01:44.:01:50.

That is the truth of the differences between our NHS in this country. The

:01:51.:01:56.

minister, the Prime Minister and others need to remember that they

:01:57.:02:00.

are ministers for the whole of the UK, not just for England, and their

:02:01.:02:05.

duty is to increase the bonds of solidarity, not destroy them. Thank

:02:06.:02:11.

you very much, Mr Speaker. I think this has been an absolutely

:02:12.:02:14.

first-rate debate this afternoon, with a number of extremely fine

:02:15.:02:19.

contributions. I was particularly taken, as ever, by the remarks of my

:02:20.:02:23.

honourable friend, the chair of the select committee, who pointed out

:02:24.:02:25.

rightly that we are all living longer, which is great, but

:02:26.:02:30.

unfortunately our healthy lives are not expanding, which causes problems

:02:31.:02:34.

for A, who have to deal with that. Although we talk about large numbers

:02:35.:02:39.

of people passing through A, and they deal with Bobby below the time,

:02:40.:02:42.

the truth of the matter is that it is those with chronic and long-term

:02:43.:02:50.

complicated conditions who tend to use the lion's share of resources in

:02:51.:02:56.

A and the secondary care system. As we get older, there will be more

:02:57.:03:00.

and more of those cases, and we need to prepare for that. We also need to

:03:01.:03:05.

mitigate against them, and one thing that has not been discussed terribly

:03:06.:03:08.

much this afternoon is prevention and public health and our need to

:03:09.:03:12.

ensure that we deal with things that are avoidable. The Prime Minister

:03:13.:03:17.

rightly in her excellent speech on Monday on the shared society said

:03:18.:03:23.

that we live in a country where, if you're poor, you will die on average

:03:24.:03:28.

nine years earlier than others. That is an absolutely appalling thing. We

:03:29.:03:32.

should all be ashamed of that in this country. Now, half of that

:03:33.:03:36.

health inequality is because of tobacco consumption and the fact

:03:37.:03:42.

that if you are in a manual occupation, you are far more likely

:03:43.:03:45.

to be a smoker and smoke more than if you are a professional or

:03:46.:03:52.

managerial person. We have to be serious about controlling the

:03:53.:03:57.

scourge of tobacco, and I would really encourage ministers to

:03:58.:04:01.

produce the Tobacco control plan as quickly as possible. It is overdue

:04:02.:04:05.

now, and we do need to deal with this. I would hope very much that it

:04:06.:04:11.

will contain some helpful remarks on the tobacco duty escalator. I hope

:04:12.:04:17.

it might contain some remarks on the licensing of retailers, and serious

:04:18.:04:20.

conversations with supermarkets, the aim being to reduce availability of

:04:21.:04:24.

tobacco, re-juice consumption and therefore reduce the burden of

:04:25.:04:28.

disease affecting our National Health Service and having appalling

:04:29.:04:33.

consequences for citizens. I very much support the amendment on the

:04:34.:04:35.

order paper today. I am sorry that I was not present

:04:36.:04:46.

when the honourable lady who speaks for the SNP was present when she was

:04:47.:04:50.

making her remarks about community hospitals, I'm sorry about that

:04:51.:04:54.

because community hospitals are particularly important to me and I

:04:55.:04:56.

would like to have contributed in response to some of her remarks. I

:04:57.:05:01.

have community hospitals in my area, and I had one particular that serves

:05:02.:05:08.

Shaftesbury and is threatened with closure is because of STP plans, we

:05:09.:05:12.

need to be very careful about short-term funding cuts which may

:05:13.:05:15.

appear to be expedient, if we have not properly costed out a service

:05:16.:05:21.

like that because it is certainly the case that Community Hospital

:05:22.:05:25.

beds, providing the case mix is right and traditionally they've been

:05:26.:05:30.

pretty appalling, in providing that right, providing a cost-effective

:05:31.:05:34.

means of treating people, particularly the elderly, in a

:05:35.:05:38.

setting close to their homes and not in acute hospitals which is the

:05:39.:05:42.

wrong place for elderly and sick people, and steals quite effectively

:05:43.:05:46.

with the delayed discharge problems that afflict our system at the

:05:47.:05:54.

moment. We are often faced with the political choice of whether to pose

:05:55.:06:01.

for expediency, our own expediency, the closure or reorganisation of

:06:02.:06:05.

services. I face it in my own constituency and was pleased to hear

:06:06.:06:08.

from my right honourable friend, the MP for Chelmsford. That we need to

:06:09.:06:15.

be brave, sometimes, in approaching that. It is certainly the case that

:06:16.:06:19.

if you want to drive up standards and outcomes in the NHS we had to

:06:20.:06:23.

increasingly look at specialist centres which inevitably means

:06:24.:06:26.

service reconfiguration and probably mean some closures, which will be

:06:27.:06:30.

disagreeable to many colleagues, but it is certainly the case that

:06:31.:06:35.

standards, and outcomes, I improved in things like cancers, strokes and

:06:36.:06:38.

heart attacks if we have specialist centres which have regional and

:06:39.:06:47.

subregional services. I would not be one to oppose closure or

:06:48.:06:51.

reconfiguration for its own sake and we have two always understand that

:06:52.:06:54.

resources are finite and we need to get the most and the best outcomes

:06:55.:07:01.

available. I say gently that we need to look at funding and be aware of

:07:02.:07:12.

the campaign supported by me and the right honourable member for North

:07:13.:07:15.

Norfolk in relation to a commission or convention, which seems to me a

:07:16.:07:18.

nonpartisan way of reaching a problem in how we will

:07:19.:07:27.

fund the NHS going forward. I commend it to him and I look forward

:07:28.:07:31.

to hearing that the prime ministers prepare to meet colleagues and see

:07:32.:07:37.

if this can be a productive way forward. We do not spend as much on

:07:38.:07:42.

the NHS as we need to spend, that's the bottom line. It is no good that

:07:43.:07:53.

people say we spend 1% of the OECD average. Most people in this country

:07:54.:07:57.

would not wish to be compared to it, we need to close that gap and as the

:07:58.:08:02.

government of the day made clear, several years ago now, we need to

:08:03.:08:08.

close the gap with the EU 15, particularly countries like France,

:08:09.:08:12.

Germany and the Netherlands whose outcomes are much better than this

:08:13.:08:15.

country and it is no coincidence that they spend much, much more on

:08:16.:08:19.

health care. Today, the chief executive of the NHS is being

:08:20.:08:23.

examined in a committee, I hope one of the things he will be examined on

:08:24.:08:27.

is the ?22 billion efficiency measures that he felt might be

:08:28.:08:32.

achievable in the five-year forward view, clearly two years into that

:08:33.:08:38.

five-year forward view, those efficiency savings will not be met,

:08:39.:08:42.

they never were going to be met. They need to determine how they are

:08:43.:08:46.

going to make up that difference between the efficiency measures that

:08:47.:08:54.

the NHS can reasonably achieve and those projected two years ago. May I

:08:55.:08:59.

finish by congratulating the Minister, the government, for

:09:00.:09:03.

achieving what they have. We've heard how things have improved in

:09:04.:09:07.

relation to things like activity, hospital infections, there is much

:09:08.:09:11.

more to do and I hope particularly that he will look at this funding

:09:12.:09:16.

issue. This is a very important issue and I congratulate my

:09:17.:09:19.

honourable friend on bringing it to the house. The pressures on our

:09:20.:09:21.

National Health Service have a multitude of consequences.

:09:22.:09:31.

Limited financial resources, ageing populations and global competition

:09:32.:09:35.

for skills, but there are many aspects which do have a political

:09:36.:09:38.

origin and the covenant cannot continue to avert their eyes from

:09:39.:09:42.

that. Today, I want to talk about my own

:09:43.:09:47.

experience of pressures on staff in the NHS and those in A are facing.

:09:48.:09:51.

And walking a mile in the shoes of those on the front line making

:09:52.:09:56.

life-and-death decisions daily. My exposure to these pressures are

:09:57.:09:59.

professional and personal. Professionally, like many other MPs,

:10:00.:10:04.

I spent time in the A departments of Chester Royal Hospital recently

:10:05.:10:09.

-- Chesterfield. Shadowing staff on the watch. But exposure to those

:10:10.:10:13.

issues are also personal. Last year on Friday, July the 15th,

:10:14.:10:17.

my father died from an aneurysm and four days earlier he had spent -- he

:10:18.:10:27.

had been sent home with what a vascular surgeon described at the

:10:28.:10:33.

inquest as classic aneurysm symptoms.

:10:34.:10:37.

He presented at the A Department with severe pain in his right groin,

:10:38.:10:42.

and was described as being confused and not communicating. After five

:10:43.:10:46.

hours in A, he was sent home in a taxi and four days later he died in

:10:47.:10:56.

my arms. It was particularly haunting, and

:10:57.:10:58.

what was wanted was his response to the question of why my father was

:10:59.:11:05.

sent home, there were pressures in the department that day, you said it

:11:06.:11:09.

was nonstop on the Friday afternoon, particularly busy and from one case

:11:10.:11:12.

to the next comic he constantly had to decide as he did most days, which

:11:13.:11:19.

should be in a hospital bed and which to send him this time. Every

:11:20.:11:24.

day, we had to make these choices, he said. I probably sent home five

:11:25.:11:27.

people that they who should have been in a bed. Those are the choices

:11:28.:11:31.

we are left with when there simply are not enough. He asked if my

:11:32.:11:36.

father minded going home and when he did not object, he put him in a

:11:37.:11:43.

taxi. Doctor Steven Hitchens, an out of hours Doctor at Chesterfield

:11:44.:11:50.

Royal, said that the hospital would confirm today that they are

:11:51.:11:55.

experiencing severe pressures in A, the clinical decision unit,

:11:56.:12:03.

this all comes from a toxic combination of underinvestment,

:12:04.:12:08.

staff cuts, poor planning and GP surgery shortages. He says this is a

:12:09.:12:11.

failure from the Scotland plain and simple. They are to blame and they

:12:12.:12:17.

have to take responsibility -- failure from this government. To

:12:18.:12:24.

keep the wheels vaguely on, it's a grim determination of

:12:25.:12:28.

professionalism. In the government have thought emergency departments

:12:29.:12:31.

can soak up exploitation and abuse but we cannot. We have exceeded

:12:32.:12:38.

acceptable tolerances long ago. This is what the experience of people

:12:39.:12:42.

working in the system is, how can we be surprised when it leads to

:12:43.:12:46.

personal catastrophes? How can we also be surprised when doctors who

:12:47.:12:54.

have had tens of thousands of pounds spent on their training move to

:12:55.:12:58.

other countries where they feel they are more appreciated? Those concerns

:12:59.:13:06.

were echoed when I shadowed the Department at Chesterfield Royal.

:13:07.:13:11.

There were those who were not urgent cases and should have been at a GP

:13:12.:13:13.

surgery. When I asked one man and he had come

:13:14.:13:18.

to A, you try for three days to get a doctor 's appointment.

:13:19.:13:26.

-- he had tried. Problems could have been sorted out and identified if

:13:27.:13:29.

they were seen early enough, but the escalate without access to primary

:13:30.:13:35.

care. The budgets in 2011 and 2012 were

:13:36.:13:39.

catastrophic for the provision of the next generation of staff and we

:13:40.:13:42.

are reaping the full costs of those decisions. Aside from the ethics of

:13:43.:13:47.

relying on overseas staff to keep our NHS sustainable and the impact

:13:48.:13:51.

on health services on developing countries, it's crazy that at a time

:13:52.:13:54.

and there is a global shortage of trained medical staff, the

:13:55.:13:59.

government cuts off the flow of new recruits.

:14:00.:14:05.

It is similar in nursing. In 2011, 20 5525 students enrolled in nursing

:14:06.:14:08.

to recourses but cuts to budgets meant that within two years of the

:14:09.:14:15.

Tory covenant, we are more than 10% down. Staff shortages -- Tory

:14:16.:14:22.

government. And it should ?2 billion has been spent on agency staff in

:14:23.:14:26.

recent years, this money could have been spent on additional staff and

:14:27.:14:29.

is not being spent as it should be on patient care. What we need to

:14:30.:14:34.

remind ourselves, if things were different under a Labour government,

:14:35.:14:39.

they led to record NHS satisfaction levels, achievement of 98% weighting

:14:40.:14:44.

targets, a sustainable GP system and in the words of the King's Fund, the

:14:45.:14:49.

most efficient health system in the world. It led to higher patient

:14:50.:14:53.

expectations yet, under the government, this process has been

:14:54.:14:56.

eradicated. In 2008, after 11 years of Labour

:14:57.:15:00.

investment, health spending caught up with leading EU nations. The OECD

:15:01.:15:06.

has shown that once again, spending is significantly below leading

:15:07.:15:10.

nations again. I am ashamed to say that I am grateful that my father

:15:11.:15:14.

had his first life-threatening aneurysm on holiday in Germany, the

:15:15.:15:18.

quality of emergency care he received their saved his life and

:15:19.:15:21.

gave his family three more years with him. I regret that last year

:15:22.:15:24.

the same could not be said of our NHS. We have it within our hands to

:15:25.:15:29.

make our NHS the service admired around the world. Whilst the

:15:30.:15:35.

challenges that face it are substantial they are predictable. If

:15:36.:15:39.

the government listened to those who questioned cuts to training, the

:15:40.:15:45.

impact of GP shortages in A, the impact of care cuts in the poorest

:15:46.:15:49.

areas in our health service, we would not be facing the crisis that

:15:50.:15:54.

we do today. So, the call for further action on A waiting times

:15:55.:15:58.

and investment in our care system cannot be ignored. The government

:15:59.:16:06.

seems to provide -- the scale of this crisis will engulf them if they

:16:07.:16:10.

do not take action now. The elderly struggle to cope and disabled are

:16:11.:16:13.

stuck in their homes not taking advantage of what we take for

:16:14.:16:18.

granted. People are sent home from A to die. We must do better. Thank

:16:19.:16:30.

you very much. There is no NHS A waiting crisis in my constituency

:16:31.:16:35.

because there is no A unit in my constituency because it was closed a

:16:36.:16:41.

dozen years ago by the Labour government and people had to access

:16:42.:16:45.

emergency services by travelling almost ten miles on single

:16:46.:16:51.

carriageway roads up to East Surrey Hospital, which is the legacy of the

:16:52.:16:55.

party opposite in my constituency. I am pleased to say, Mr Speaker, that

:16:56.:17:02.

since 2010, services have been returning to Crawley Hospital, as a

:17:03.:17:08.

direct consequence of the enhancements of the health budget is

:17:09.:17:13.

which this government has committed to and still commits to. I know that

:17:14.:17:20.

it is often dismissed by the Labour opposition, and others. But, it is

:17:21.:17:25.

quite significant that the NHS asked for an additional ?8 billion in the

:17:26.:17:31.

coming period. And, the Conservative Party in government are delivering

:17:32.:17:38.

10 billion of extra investment. It has a very real effect, that is not

:17:39.:17:44.

tonight -- not to deny that there are huge pressures on the health

:17:45.:17:50.

service, as many members have said in this debate. We have an ageing

:17:51.:17:56.

population and a growing population. Fortunately, people are living

:17:57.:17:59.

longer and we have new drugs available to treat conditions where

:18:00.:18:02.

previously they were not able to be treated. That puts additional

:18:03.:18:08.

pressure on our health service and the way -- and they can be nice

:18:09.:18:14.

problems to have with a population living longer. The way to address it

:18:15.:18:22.

is not using this as some sort of political tit-for-tat, but the

:18:23.:18:27.

health service and well-being is something that we all share, both us

:18:28.:18:34.

as individuals, Mr Speaker, and for our families and loved ones as well.

:18:35.:18:40.

I would prefer that we focus on constructive arguments as to how we

:18:41.:18:48.

address increasing health care needs as a nation, rather than political

:18:49.:18:53.

point scoring which we have had a lot of today. I would have to say

:18:54.:18:58.

that in the 33 minutes of the shadow health spokesman speaking as other

:18:59.:19:03.

right honourable member 's have mentioned, we have not seen one

:19:04.:19:09.

policy suggestion as to how, under Labour administrations, we would see

:19:10.:19:17.

a different approach to the National health service. Mr Speaker, this

:19:18.:19:22.

week, I'm delighted to say that Crawley, my constituency, celebrates

:19:23.:19:29.

the 70th anniversary of being designated a new town. I think one

:19:30.:19:33.

of the most disastrous decisions in that 70 years has been in 2005, as I

:19:34.:19:43.

mentioned, the loss of A, but I mentioned previously that some

:19:44.:19:47.

services are returning and only yesterday, I am pleased to report to

:19:48.:19:53.

the house that a new clinical assessment unit was opened, which

:19:54.:20:01.

precisely seeks to do what we have been discussing, which is to take

:20:02.:20:05.

pressure off A whereby those people who should not be being

:20:06.:20:12.

treated in an emergency situation are triage and signposted to better

:20:13.:20:14.

support services. The clinical assessment unit that

:20:15.:20:28.

opened yesterday seeks to do that and will be successful. Also opened

:20:29.:20:30.

in recent years in Crawley Hospital a new 24-hour a week urgent care

:20:31.:20:38.

centre and an out of hours GP surgery as well. All of these things

:20:39.:20:43.

are ways, as we strive to get to that 24/7 NHS, all of these things

:20:44.:20:53.

are ways that we can better serve patients and as a whole on the

:20:54.:20:58.

health system relieve pressure on emergency care, which, of course,

:20:59.:21:01.

particularly at this time of year and almost every winter comes under

:21:02.:21:08.

additional strain. So, this evening, Mr Deputy Speaker, I will be

:21:09.:21:15.

supporting the Government's amendment to the opposition motion

:21:16.:21:20.

that was initially submitted. Because, I do think we need to

:21:21.:21:25.

recognise the hard work that our staff in the NHS put in. I think we

:21:26.:21:30.

do need to recognise the initial investment. I think we need to

:21:31.:21:33.

recognise that it isn't just about the funding, but it is also, Mr

:21:34.:21:38.

Deputy Speaker, about the way we deliver health care in an acute

:21:39.:21:44.

setting when people present. And also, finally, in my closing

:21:45.:21:49.

remarks, I would like to briefly touch on social care as well. Health

:21:50.:21:55.

care and social care are, of course, inextricably linked. We have an

:21:56.:21:59.

ageing population, as many Right Honourable member is have mentioned.

:22:00.:22:03.

And they have, of course, increasing health needs. -- members one of

:22:04.:22:09.

those areas is an increased health need in terms of dementia. I'm

:22:10.:22:13.

pleased to say Crawley was one of the first designated dementia free

:22:14.:22:18.

towns and that isn't just a label, multi-agency working between health

:22:19.:22:21.

and local authorities and indeed voluntary and private sectors to

:22:22.:22:26.

ensure that those with dementia are better supported. Again, I am

:22:27.:22:32.

delighted to announce that recently a new award, the piper Ward opened

:22:33.:22:39.

in Crawley Hospital, a dementia ward specifically to better treat the

:22:40.:22:44.

health and social care needs of our elderly population. Mr Deputy

:22:45.:22:49.

Speaker, there is much more that I would want to contribute to this

:22:50.:22:54.

vitally important debate today, and indeed throughout this Parliament,

:22:55.:23:03.

but with limited time I will let other honourable and Right

:23:04.:23:06.

Honourable member is have their contribution. Thank you.

:23:07.:23:12.

Thank you, Mr Deputy Speaker command may I start this afternoon by paying

:23:13.:23:17.

tribute to my friend for his incredibly moving speech this

:23:18.:23:20.

afternoon. Mr Deputy Speaker, people are dying, literally. We are no

:23:21.:23:27.

longer sane people will die unnecessarily, we are in the present

:23:28.:23:30.

tense and we are hearing horror stories from around the country of

:23:31.:23:34.

people dying on hospital trolleys and at home waiting for ambulances

:23:35.:23:38.

to arrive. These are lies that potentially could have been saved

:23:39.:23:41.

had it not been for this crisis. People are dying in hospitals

:23:42.:23:49.

undetected, and overworked nurses. A constituent went to visit her rant

:23:50.:23:54.

that in hospital and found him dead on the ward in his bed because the

:23:55.:24:00.

nurses were overworked. He died alone while his relatives were at

:24:01.:24:04.

home completely unaware of quite how seriously ill he was. I am somewhat

:24:05.:24:10.

bemused to hear member after member stand up and defend the government

:24:11.:24:13.

when the facts are absolutely clear about what is going on. There seems

:24:14.:24:18.

to be a sense of severe denial going on. How can this be ignored? How can

:24:19.:24:23.

the government sit back and save the solution is to discard the waiting

:24:24.:24:27.

time targets? It is not the people who turn up with sore throats

:24:28.:24:31.

clogging up the system, it is genuinely sick people, people who

:24:32.:24:35.

desperately need adequate attention. Another constituent who arrived at

:24:36.:24:38.

A last week was told she would have to wait at least ten hours to

:24:39.:24:42.

see a doctor. This is not good enough. We are one of the richest

:24:43.:24:48.

nations in the world. It transpired she had sepsis, a potentially fatal

:24:49.:24:52.

illness, and it was only down to an overworked and stressed triage nurse

:24:53.:24:56.

who recognised her symptoms and immediately instigated treatment

:24:57.:24:59.

that she is alive today and able to come to me and talk about her

:25:00.:25:03.

horrendous story. Her treatment was started in the hospital corridor

:25:04.:25:06.

where she sat on a chair on an intravenous drip because there were

:25:07.:25:12.

no beds available. Not just in the hospital but in any of the

:25:13.:25:16.

neighbouring hospitals within the trust. The theme is always the same

:25:17.:25:20.

from all of my constituents who come to me with their horrendous

:25:21.:25:23.

experiences. The doctors and nurses and other health care staff are

:25:24.:25:27.

doing absolutely everything they can. They are literally on their

:25:28.:25:30.

knees. Nobody wants to blame them, they can see what is being asked of

:25:31.:25:34.

them is far beyond what anybody would be asked of in any other

:25:35.:25:38.

profession but they can all see the system is literally at breaking

:25:39.:25:44.

point. And instead of berating the Red Cross for suggesting that our

:25:45.:25:48.

NHS is in the midst of a humanitarian crisis, let's stop for

:25:49.:25:50.

a moment and think about why they have had to use that term and let's

:25:51.:25:55.

talk about what we can do. A friend of mine recently attended an

:25:56.:25:58.

outpatient appointment at our local hospital and mentioned to the

:25:59.:26:02.

overworked junior doctor, to whom we owe so much, how incredible junior

:26:03.:26:05.

doctors who were treated so appallingly recently. He pleaded

:26:06.:26:10.

with her, with my friend, to tell me just how bad things were, however

:26:11.:26:16.

overworked they were, how the NHS was crumbling around us and by his

:26:17.:26:19.

colleagues couldn't perform to the best of their abilities because of

:26:20.:26:21.

the horrendous pressure they were under. He talked about working 12,

:26:22.:26:27.

14 hour shifts with a ten minute break. He told her that he loved his

:26:28.:26:32.

job, it was a vocation, never a job. He was proud of his country and of

:26:33.:26:35.

the National Health Service. The only thing that kept him from

:26:36.:26:39.

working here instead of fleeing abroad like many of his friends had

:26:40.:26:43.

was the fact that he cared for his NHS so much. When is the Secretary

:26:44.:26:49.

of State going to stand up and take some responsibility for what is

:26:50.:26:54.

going on? People waiting hours for ambulances, people waiting hours in

:26:55.:26:58.

A, people lying on trolleys being treated, in seminar rooms, in

:26:59.:27:03.

corridors. Where does it end? We are already seen creeping privatisation

:27:04.:27:06.

of the NHS with companies like virgin care putting profits before

:27:07.:27:11.

patients. Is the end goal to move to an American-style system where

:27:12.:27:14.

people are literally dying on the streets? Where you turn up at A

:27:15.:27:18.

and the first question they have you got insurance and can you prove it?

:27:19.:27:23.

My constituency is served by two hospitals, Dewsbury district and

:27:24.:27:27.

Huddersfield Royal Infirmary. Both of which are due to be downgraded,

:27:28.:27:31.

losing vital services and beds as the respective trusts struggle to

:27:32.:27:34.

meet the financial pressures placed upon them. One of the hospitals that

:27:35.:27:38.

are supposed to pick up the resulting demand from these

:27:39.:27:41.

downgrades is Pinderfields Hospital in Wakefield which last week warned

:27:42.:27:45.

people against attending A before the downgrades have even taken

:27:46.:27:50.

place. These downgrades go ahead, I am in absolutely no doubt that lives

:27:51.:27:54.

will be lost. I plead with the ministers and Secretary of State,

:27:55.:27:58.

now, to stop these downgrades and bring forward the much-needed funds

:27:59.:28:01.

that could potentially save the lives of my constituents. It was

:28:02.:28:06.

very interesting to hear the Prime Minister refer to these hospitals

:28:07.:28:08.

today during Prime Minister's Questions and she talked about the

:28:09.:28:12.

fact there were two hospitals in the trust, if somebody can pass on that

:28:13.:28:16.

there are three hospitals within the trust. I quoted this before but

:28:17.:28:19.

again I feel today is more relevant than ever. The founder of our great

:28:20.:28:24.

National Health Service said the NHS will last as long as there are folk

:28:25.:28:28.

left with the faith to fight for it. Since the benches opposite appeared

:28:29.:28:31.

to have lost faith and stopped fighting, it is our duty on these

:28:32.:28:37.

benches now more than ever to step up that fight. I wouldn't like to

:28:38.:28:42.

speculate where members -- when members of the opposite bench last

:28:43.:28:48.

visited an NHS hospital outside of an official visit. In between

:28:49.:28:56.

Christmas and New Year. I thank the honourable member for his

:28:57.:29:00.

intervention. Perhaps then he should show some more empathy towards the

:29:01.:29:04.

patients that are waiting on trolleys for ten hours just to be

:29:05.:29:08.

seen. One thing I have known for sure is many thousands of my

:29:09.:29:12.

constituents rely on the services every day. The message from them is

:29:13.:29:16.

unequivocal, the NHS needs the funds and needs them now. I was admonished

:29:17.:29:22.

today by the Speaker for berating the Prime Minister during Prime

:29:23.:29:24.

Minister's Questions and I will continue to do that, let's be

:29:25.:29:28.

absolutely clear, while this mismanagement of our National Health

:29:29.:29:31.

Service is ongoing and I will never, ever stop fighting for our NHS. I

:29:32.:29:40.

appreciate the opportunity to speak in this debate, and for the record,

:29:41.:29:44.

the last time I was in an NHS hospital was when I was working on a

:29:45.:29:50.

night shift on Saturday night. I declare an interest as a nurse who

:29:51.:29:55.

has worked during this winter crisis this year. But I have also worked

:29:56.:29:59.

during winters for the last 20 years as a nurse who has been qualified

:30:00.:30:04.

for over 20 years. Thank you for giving way. I apologise for doing so

:30:05.:30:10.

so early in her speech but the previous speaker is too busy

:30:11.:30:13.

congratulating herself on her own speech that the honourable member

:30:14.:30:24.

for Lewes was working in an NHS hospital on Saturday. That is not of

:30:25.:30:29.

interest to the Labour benches but I have been a nurse for over 20 years

:30:30.:30:33.

and have seen winter crises and this is not an unusual thing to happen.

:30:34.:30:37.

There is no doubt this year there is more pressure than ever before and

:30:38.:30:41.

we have heard there are record numbers of people attending A But

:30:42.:30:46.

there have been winter crises year-on-year under many previous

:30:47.:30:49.

governments. It wasn't unusual when I worked in A for patients to be

:30:50.:30:55.

treated in corridors, on chairs, where ever there was a space. It

:30:56.:30:59.

wasn't unusual for ambulances being queued up around the block waiting

:31:00.:31:03.

for hours to unload patients. I dispute it, I'm still working in the

:31:04.:31:07.

NHS and I dispute the Lady's chuntering from the other side. It

:31:08.:31:12.

was not unusual... I want to make progress and there are others who

:31:13.:31:16.

want to speak. It was not unusual for major incidences to be declared

:31:17.:31:21.

because we could not take any more patients. It was not unusual for

:31:22.:31:25.

neighbouring hospitals to declare major incidences and we would have

:31:26.:31:29.

to take up the slack. I'm sure the truth hurts but that is actually

:31:30.:31:33.

what happened over my 20 years experience of working in the NHS and

:31:34.:31:37.

in this winter crisis over the last few days. It is absolutely

:31:38.:31:42.

outrageous for members opposite to suggest this is something new. They

:31:43.:31:45.

are in denial if they believe this hasn't been happening for many years

:31:46.:31:49.

and I will tell you a story. The party opposite is so fixated on the

:31:50.:31:54.

four hour rule that managers used to bully us and tell us which patients

:31:55.:31:57.

would get a bed, not on clinical need but on the need of the target

:31:58.:32:02.

that was about to expire. For example, one night I was working in

:32:03.:32:06.

a busy A when an elderly gentleman was admitted and have fallen at home

:32:07.:32:10.

and broken his hip and had to be nursed on a trolley in the middle of

:32:11.:32:14.

a busy corridor. Before our target was looming. At three and a half

:32:15.:32:17.

hours he called out to me and said nurse, nurse, I need to go to the

:32:18.:32:22.

toilet. I had no cubicle to put that man in. He couldn't get off his

:32:23.:32:25.

trolley because he had broken his hip. The best I could do under a

:32:26.:32:29.

Labour government was to wheel a curtain around him and in the middle

:32:30.:32:33.

of a busy hospital corridor with his war medals on his chest he went to

:32:34.:32:38.

the toilet. He got to the ward in four hours, his target was met but

:32:39.:32:42.

that was not good care and its members opposite think that was I

:32:43.:32:45.

think this is a new problem they have been burying their heads in the

:32:46.:32:52.

sand. I will not give way. SPEAKER: Border. If the Honourable Lady wants

:32:53.:32:58.

to give way she will not, you cannot shout two at once. It is recognised

:32:59.:33:02.

if you are going to give weight you will give way but if not it is the

:33:03.:33:07.

choice of the Speaker. Thank you, Mr Speaker. These problems are not new.

:33:08.:33:11.

I have worked in outpatient settings as well wear A Tigers have had an

:33:12.:33:15.

impact on patients waiting for elective surgery -- targets. There

:33:16.:33:21.

were such pressure from a Labour government it saw me seeing elective

:33:22.:33:25.

patients with breast cancer having their operations cancelled time

:33:26.:33:28.

after time after time because of emergency admissions. I had to tell

:33:29.:33:33.

a young man who had had her operation cancelled three times

:33:34.:33:35.

while she had a young family waiting for Christmas. She was waiting to

:33:36.:33:40.

have a mastectomy and have her breasts removed from breast cancer

:33:41.:33:44.

but the only bed we had left was in a postnatal ward where she had

:33:45.:33:48.

recovered from her operation, waking up next young mums learning to

:33:49.:33:52.

breast-feed. That was in the attempt to meet for our targets. Don't tell

:33:53.:33:59.

that services have reduced. -- four our targets. Staff were put under

:34:00.:34:02.

severe pressure, not with quality of care in mind but targets and I will

:34:03.:34:06.

make no apologies in making that clear. I am a supporter of four our

:34:07.:34:11.

targets, I was enthusiastic when they were introduced, a way of

:34:12.:34:15.

monitoring performance and improving service but they came the absolute

:34:16.:34:19.

king above everything else. I congratulate the Secretary of State

:34:20.:34:21.

because one of the things he has introduced is looking at the

:34:22.:34:25.

outcomes, what happens to a patient when admitted and if they have to

:34:26.:34:29.

stay there for about half hours to avoid an admission or to get full

:34:30.:34:32.

care what is the problem with that? If they have to go within two hours

:34:33.:34:36.

because they have been adequately treated, fantastic. But we should

:34:37.:34:40.

not be held to account by and are Britt Reid four hour rule which has

:34:41.:34:45.

no clinical significance -- butchery for our rural. -- arbitrary. I just

:34:46.:34:58.

want to touch on the issue of money. Money is of importance and as the

:34:59.:35:02.

publishing grows and as our ageing population grows, as our ability to

:35:03.:35:05.

treat more patients grows we will need more funding for health care

:35:06.:35:09.

and social care. It is worth noting that in my area, there are trusts

:35:10.:35:17.

either side of my constituency with the same funding looking after the

:35:18.:35:21.

same numbers of population, one is in special measures, unable to deal

:35:22.:35:25.

with its discharges, and so has queues and unable to meet its for

:35:26.:35:29.

our targets. Another one along the coast five miles away is rated as

:35:30.:35:35.

outstanding -- four our targets. It does not have the same pressure of

:35:36.:35:41.

four our weights. They can discharge patients speedily. There is

:35:42.:35:47.

something about the money and what it amounts to. Labour put a huge

:35:48.:35:50.

amount of money into the NHS but much was squandered. ?10 million on

:35:51.:35:55.

a failed IT project that never saw the light of day, PFI deals still

:35:56.:35:59.

today costing the NHS ?2 billion a year. How much could be done with

:36:00.:36:03.

that ?2 billion? One brief intervention.

:36:04.:36:08.

I commend her for making what is a very balanced speech, making the

:36:09.:36:16.

point that meeting targets does not equate to delivering good health

:36:17.:36:19.

care, although they do have their place. Would she agree with me that

:36:20.:36:23.

one of the biggest challenges in A is a consistent lack of ability to

:36:24.:36:29.

recruit middle grade doctors in a number of A up and down the

:36:30.:36:32.

country and that is one of the biggest problem is that has not been

:36:33.:36:37.

addressed, to date? I absolutely agree. There's a problem recruiting

:36:38.:36:42.

in the south-east, my constituency, although health care professionals

:36:43.:36:46.

because it is an expensive place to live. I agree with you on that. If

:36:47.:36:51.

we are to move forward, we need to work in a more cross-party way, and

:36:52.:36:56.

to continue to use four our targets as a stick to beat the government

:36:57.:37:00.

with does nothing for cross-party working, so we need to stop the

:37:01.:37:04.

political cheap shots that are being used, we need to recognise that

:37:05.:37:08.

money isn't always the solution, it's about how it is spent and what

:37:09.:37:12.

difference it can make. It also has to be clinically led and, as

:37:13.:37:16.

politicians we can work together but we don't work with health care

:37:17.:37:20.

professionals are both in primary and secondary care, then I fear

:37:21.:37:24.

that, in future, we'll be sitting here again and talking about another

:37:25.:37:31.

winter crisis in years to come. Thank you very much, Mr Deputy

:37:32.:37:35.

Speaker. I would like to join many others in commending those people

:37:36.:37:40.

who work in the NHS and in the care system including the honourable

:37:41.:37:47.

member for Lewes. I just commended the honourable member for Lewes as

:37:48.:37:52.

somebody who works in the NHS as well as the member for central

:37:53.:37:58.

supper, who also works in the NHS, I think without payment -- central

:37:59.:38:04.

Suffolk. It is important to acknowledge that there are many

:38:05.:38:07.

people in the NHS working under incredible strain and we owe them a

:38:08.:38:14.

debt of gratitude. I want to be very clear that I support the Labour

:38:15.:38:22.

motion, and I recognise the importance of access standards in

:38:23.:38:26.

our NHS. I remember when I first arrived here in 2001, my first

:38:27.:38:33.

debate in Westminster Hall was waiting times standards for people

:38:34.:38:37.

with orthopaedic cases, and people then were waiting three years the

:38:38.:38:41.

treatment, sometimes, so the waiting time standards that were introduced

:38:42.:38:46.

dramatically changed people's experience of health care, and we

:38:47.:38:51.

should celebrate that, but sometimes it distorts behaviour and those

:38:52.:38:54.

distortions ought to be addressed as the honourable member for Lewes was

:38:55.:38:59.

making clear. With the ambulance standards there was a very serious

:39:00.:39:03.

distortion of behaviour, which often causes enormous frustration for

:39:04.:39:07.

paramedics who also working on the ludicrous amounts of pressure. The

:39:08.:39:14.

other points I would make on access standards is that, whilst I totally

:39:15.:39:17.

applaud the Labour government introducing access standards, they

:39:18.:39:22.

didn't introduce them for mental health. That is why we now have to

:39:23.:39:27.

complete the picture. Now, the government has confirmed that it

:39:28.:39:33.

accepts in full the task force report on mental health, but that

:39:34.:39:39.

report includes the proposal to work -- to roll out comprehensive maximum

:39:40.:39:42.

waiting time standards in mental health so that someone with mental

:39:43.:39:46.

health has exactly the same right as anyone else to get access to good

:39:47.:39:51.

quality evidence -based treatment on a timely basis, and I would urge the

:39:52.:39:55.

government, and it was in an amendment to be tabled for this

:39:56.:39:59.

debate which has not been called, I urge the government, they have

:40:00.:40:02.

accepted that report, let's now make sure that it is implemented, because

:40:03.:40:07.

it amounts to discrimination in the health service. How can he possibly

:40:08.:40:11.

justify the fact that someone with mental ill-health does not have the

:40:12.:40:14.

right to timely treatment which other people enjoy? We have the end

:40:15.:40:19.

that discrimination, it seems to me. The final thing I wanted to address

:40:20.:40:23.

relates to the question I asked the Prime Minister today. Asking her to

:40:24.:40:29.

meet with a group of cross-party MPs, putting forward the proposal

:40:30.:40:32.

that the government should establish what we are calling an NHS and care

:40:33.:40:39.

convention, and it's an opportunity, we feel, to engage with the public

:40:40.:40:43.

in a mature debate about the scale of the challenge we all face, we can

:40:44.:40:47.

trade insults across this Chamber, we all know in our heart of hearts

:40:48.:40:52.

that the system is under unsustainable pressure. That is the

:40:53.:40:56.

truth, we know that. At some point the member for Lewes conceded the

:40:57.:41:00.

point, that we will need extra resources in the future. Let's plan

:41:01.:41:05.

now, and that we get everybody on board, get cross-party support, and

:41:06.:41:11.

just as under the Labour government in the last decade, sometimes you

:41:12.:41:15.

need a process to unlock a problem that ordinarily, partisan politics

:41:16.:41:20.

has not been able to resolve. And I am pleased, I welcome the fact that

:41:21.:41:24.

the Prime Minister agreed today to meet with a group of us who are

:41:25.:41:28.

making this call. We have set up a petition on the Parliament website

:41:29.:41:33.

so that any member of the public can join this call, and I would urge

:41:34.:41:36.

honourable members across this House, if you support, if the member

:41:37.:41:41.

support this call, then join in it. I actually think that it is in the

:41:42.:41:46.

government's political interest to do it, but fundamentally it is in

:41:47.:41:49.

the interest of the citizens of this country that we, together in this

:41:50.:41:58.

House, collectively address an enormous existential challenge the

:41:59.:42:02.

NHS and the care system. We surely cannot tolerate over 1 million older

:42:03.:42:07.

people not getting access to the care and support that they need. And

:42:08.:42:11.

I don't want to live in a country where your access to care and

:42:12.:42:14.

support in old age depends on whether you can pay for it, but we

:42:15.:42:18.

are in genuine risk of slipping towards that situation, and if we

:42:19.:42:23.

all believe that that is not tolerable, then we have a duty to

:42:24.:42:28.

Act, and we must be prepared to Act together, not just trade insults at

:42:29.:42:34.

each other. I think there is a real opportunity now to do what the

:42:35.:42:38.

public is desperately pleading for, to bury our differences, to work

:42:39.:42:43.

together, to achieve a long-term, sustainable settlement for the NHS

:42:44.:42:49.

and the care system. I thank you. Thank you, Mr Deputy Speaker. Mini

:42:50.:42:54.

for integration of health and social care is the most important issue

:42:55.:42:57.

facing the NHS today. The most productive way to address this issue

:42:58.:43:02.

or bed blocking is to integrate services, pool resources and

:43:03.:43:06.

dramatically raise the profile and support of community health

:43:07.:43:09.

professionals in care and support providers. We often hear of the

:43:10.:43:13.

problems facing the health services. I'm going to concentrate on the

:43:14.:43:18.

solutions. In November last year I set up a local health inquiry and

:43:19.:43:21.

identified a number of people across the constituency and we, together,

:43:22.:43:29.

are investigating what health and social care should and could look

:43:30.:43:33.

like in West Cornwall. This is all part of the process in kernel and

:43:34.:43:37.

the hours of silly. We're asking this question of representatives of

:43:38.:43:42.

health and social care providers, we are talking to NHS providers and

:43:43.:43:45.

managers, health campaigners, daycare managers, pharmacists,

:43:46.:43:49.

mental health clinicians, hospitals and matrons, age UK, etc, and I am

:43:50.:43:57.

including my predecessor in this discussion. All the clinicians we

:43:58.:44:00.

have met have identified savings that can be made through integration

:44:01.:44:03.

that they believe would improve patient care. The results of this

:44:04.:44:09.

inquiry were set up with clear recommendations that have concluded

:44:10.:44:16.

and art at the considered as part of the sustainability planning process"

:44:17.:44:19.

and the Isles of Scilly. It is clear from the evidence we have heard that

:44:20.:44:23.

extra funding will be needed to implement the transformation that

:44:24.:44:28.

has been planned. Already health services in Cornwall and on the

:44:29.:44:31.

Isles of Scilly have a deficit that runs into tens of millions of

:44:32.:44:36.

pounds. Delivering rural health services is an expensive and

:44:37.:44:39.

underfunded exercise in Cornwall and the hours of Scilly, and in that

:44:40.:44:45.

part of the country, we need a fair funding arrangement for health and

:44:46.:44:50.

social care. People in my constituency agree that we must

:44:51.:44:53.

integrate health and social care. They also agree that extra funds are

:44:54.:44:58.

urgently needed to fund the integration of these services. Any

:44:59.:45:03.

Autumn Statement the Chancellor confirmed government plans to

:45:04.:45:05.

continue to increase the tax allowance threshold for workers. I

:45:06.:45:11.

completely agree with efforts to lower the tax burden. Constituents

:45:12.:45:18.

have asked me to look at ways where we can raise taxes in order to help

:45:19.:45:23.

the integration of health and social care. On that basis, would the

:45:24.:45:26.

government consider opposing the increase that was announced in the

:45:27.:45:32.

Autumn Statement and use the revenue generated to fund the transformation

:45:33.:45:36.

of integrated services? This could provide ?6 billion towards the rest

:45:37.:45:42.

of this Parliament that would assist health and social care providers to

:45:43.:45:45.

make the improvements they need, to reduce costs in the long run whilst

:45:46.:45:52.

improving patient care? One example where extra funding would have

:45:53.:45:55.

dramatic results is increasing the pay and support of care and support

:45:56.:46:00.

workers. In West Cornwall, some of those community care workers are

:46:01.:46:04.

paid as little as ?7 20 per hour, but they do incredibly important

:46:05.:46:07.

work in keeping people at home and keeping them in safe conditions. As

:46:08.:46:14.

a result of this low pay and the pressure on them, we struggle to

:46:15.:46:19.

recruit and retain these valuable employees. If we were to look at

:46:20.:46:23.

increasing the taxable threshold just for a short time, this money

:46:24.:46:27.

would help to integrate the services that we all are committed to, and

:46:28.:46:32.

help to make the savings and improvements in patient care that we

:46:33.:46:38.

all long to see. Thank you, Mr Deputy Speaker. In Cumbria, the

:46:39.:46:44.

government says that its regime for the NHS is about transforming health

:46:45.:46:50.

and social care to create a Centre of Excellence for integrated health

:46:51.:46:55.

and social care provision in rural, remote and dispersed communities.

:46:56.:46:58.

This sounds fantastic. It sounds exactly what we need. So, if this is

:46:59.:47:05.

the case, while local people so concerned with the actual proposals

:47:06.:47:11.

that there was a petition for a vote of no-confidence in this regime and

:47:12.:47:16.

why did the Secretary of State himself say in this morning's debate

:47:17.:47:20.

that he has profound concerns about the quality of care in Cumbria? West

:47:21.:47:27.

Cumbria has seen rapid population growth due to the proposed nuclear

:47:28.:47:35.

new-build along with proposed tidal energy projects. There are concerns

:47:36.:47:38.

that none of this is being taken into account. Today I want to focus

:47:39.:47:47.

my particular concerns about the proposals for maternity services and

:47:48.:47:50.

community hospitals. Firstly, maternity. The highly skilled and

:47:51.:47:57.

experienced midwives in West Cumbria have told me that the success

:47:58.:48:02.

regime's preferred maternity option is not their preferred option. The

:48:03.:48:10.

idea behind the Success resume is to bring care closer to home with a

:48:11.:48:15.

model that would ensure provision of safe, high-quality care providing a

:48:16.:48:19.

first class experience. But the midwives ask, how can this be

:48:20.:48:23.

achieved by the proposals looking to change maternity care at West

:48:24.:48:30.

Cumberland Hospital, where the Success regime's preferred option

:48:31.:48:33.

sees the choice of birthplace removed from hundreds of women and

:48:34.:48:37.

would potentially see severe delays in women and babies receiving

:48:38.:48:44.

life-saving assistance. The clinical outcomes and satisfaction rates

:48:45.:48:47.

currently at West Cumberland Hospital under the maternity care

:48:48.:48:51.

system they have now are excellent, and provide safe, high-quality care.

:48:52.:48:57.

And these proposed changes would bring in inequality, in terms of

:48:58.:49:02.

fair access to maternity services across the county, and discriminate

:49:03.:49:06.

against West Cumbrian women having a choice about their maternity care.

:49:07.:49:12.

This will affect those particularly who are vulnerable to deprivation

:49:13.:49:13.

and social isolation. The proposals would see around 700

:49:14.:49:21.

additional women deliver their babies at Carlisle every year. But

:49:22.:49:28.

where are they going to be cared for? The Cumberland infirmary in

:49:29.:49:31.

Carlisle already struggles with its current workload. West Cumbria and

:49:32.:49:39.

mothers need proper answers. And, in addition to this, there is a

:49:40.:49:44.

proposed new Garden Village is to be built south of Carlisle with up to

:49:45.:49:50.

12,000 new homes. So how on earth is the West Cumberland infirmary in

:49:51.:49:57.

expected to cope? And now turning to community hospitals. I am

:49:58.:49:59.

particularly disappointed in the consultation document that there are

:50:00.:50:05.

no options for the current situation we have regarding beds at Maryport

:50:06.:50:11.

and Wigton community hospitals. All of the proposals remove all of the

:50:12.:50:16.

beds. This will be particularly difficult for families with patients

:50:17.:50:22.

having end of life care because their relatives are often elderly

:50:23.:50:25.

and have their own medical conditions and with no transport of

:50:26.:50:30.

their own travelling to visit family members can be particularly arduous.

:50:31.:50:34.

And both hospitals serve areas with large amounts of deprivation and

:50:35.:50:39.

very poor transport links. For patients and their families in

:50:40.:50:43.

Maryport they may have to travel to community hospitals or acute

:50:44.:50:47.

hospitals, journey times would be long with poor bus links, which is

:50:48.:50:52.

obviously difficult for elderly and disabled people. The people of

:50:53.:50:56.

Maryport feel so strongly about it they have run a passionate campaign

:50:57.:51:01.

to show the Success Regime just how much Maryport hospital means to

:51:02.:51:05.

them, how much it is an integral part of the local community, and

:51:06.:51:08.

they are deeply upset at the removal of the beds. It is imperative that

:51:09.:51:15.

all services are delivered as close to people's homes as possible. This

:51:16.:51:19.

must include the retention of beds at all of our community hospitals

:51:20.:51:26.

and keep consultant level maternity services at West Cumberland

:51:27.:51:32.

Hospital. I would like to finish about a very personal experience, if

:51:33.:51:37.

I may, and this is in particular reference to beds in community

:51:38.:51:41.

hospitals. Not long before Christmas my father was taken seriously ill.

:51:42.:51:47.

He was transferred. We managed to get him transferred from the Acute

:51:48.:51:51.

Hospital to his local Community Hospital. This was within walking

:51:52.:51:56.

distance of his home. It was a hospital where he knew the staff,

:51:57.:51:59.

the district nurse was able to call in to see him. When it became clear

:52:00.:52:06.

that he was at the end of his life we tried very hard to get him to

:52:07.:52:13.

move home. We got to the stage of having a hospital bed in the living

:52:14.:52:16.

room. Unfortunately this was not possible. However, unlike my

:52:17.:52:22.

honourable friend, the member for Chesterfield, my father had a good

:52:23.:52:31.

death in his Community Hospital. I believe that all my constituents

:52:32.:52:33.

should be able to have the opportunity that me and my family

:52:34.:52:40.

had when we were able to be with my father at the local Community

:52:41.:52:44.

Hospital where he knew the staff, where he knew the district nurse who

:52:45.:52:49.

came to see him. I think if we remove palliative care from our

:52:50.:52:52.

community hospitals we are making a terrible mistake. Thank you, Mr

:52:53.:53:00.

Deputy Speaker. There was constituency faces real challenges

:53:01.:53:04.

in health care, ageing ovulation and demand for local NHS is growing

:53:05.:53:08.

rapidly. There is no doubt that our primary health care system is under

:53:09.:53:11.

considerable strain and so is the adult social care system and the

:53:12.:53:17.

record demands in hospitals. Calling this a crisis is a disservice to

:53:18.:53:21.

those in the Clinical Commissioning Group and our local hospital trust

:53:22.:53:24.

who have worked so hard to prepare for the incredible challenges they

:53:25.:53:29.

are facing this winter. Demanding the four Amys that serve our

:53:30.:53:33.

constituency was higher in the week between Christmas and new event --

:53:34.:53:38.

new year than in the previous year. Inter Amys demand has doubled. The

:53:39.:53:42.

A staff had to work incredibly hard to meet the demand -- in two

:53:43.:53:49.

A I was contacted to say that some people were not seen in the

:53:50.:53:52.

time they would expect, however I have heard from others who arrived

:53:53.:53:56.

at A expecting bedlam only to be seen within well under four hours.

:53:57.:54:01.

During last season's Christmas recess I spent the early hours of

:54:02.:54:05.

Christmas Eve in Western Hospital A with my then three-year-old.

:54:06.:54:10.

Like this year the Labour front inch frame Don McLean crisis and yet I

:54:11.:54:13.

saw incredible clinicians doing an incredible job within the required

:54:14.:54:17.

timelines. Moreover, an outpatient appointment is needed in the week

:54:18.:54:20.

between Christmas and New Year was easily arranged and kept. My

:54:21.:54:25.

personal experiences just one of millions experiences in the NHS each

:54:26.:54:29.

year but I highlight it because if we are to have an honest, factual

:54:30.:54:33.

debate about our health system we should caution against the emotion

:54:34.:54:38.

of individual experiences, for there will always be a least one that

:54:39.:54:40.

illustrates whatever point are seeking to make. Further into the

:54:41.:54:46.

hospital system, three of the four hospitals that serve the Wales

:54:47.:54:49.

constituency, have more beds available this year in the last week

:54:50.:54:56.

of 2016 and first week of 2017 than they did in the corresponding period

:54:57.:55:01.

the previous year. While occupancy last week in Taunton and Yeovil was

:55:02.:55:07.

81% and 82% respectively, it is true that occupancy in Bath was 93% and

:55:08.:55:12.

in Weston-Super-Mare last week it was 100%. Make no mistake, occupancy

:55:13.:55:17.

levels such as those are a cause for real concern. It is also important

:55:18.:55:24.

to note that whilst things are tight so far the trusts are managing.

:55:25.:55:29.

However, I know that for all four of those hospitals and particularly

:55:30.:55:33.

Western there are too many beds blocked by those who would be

:55:34.:55:37.

discharged if care at home could be arranged. The Government has made

:55:38.:55:40.

more money available for adult social care and given councils

:55:41.:55:43.

greater flexibility to increase council tax in the interim. Somerset

:55:44.:55:48.

County Council and our local NHS organisations are justifiably still

:55:49.:55:53.

very concerned. So I encourage that the government looks again at the

:55:54.:55:57.

local government funding settled meant for next year and adjust it

:55:58.:56:00.

and ensure the funding gap between urban and rural areas does not widen

:56:01.:56:06.

-- settlement. And secondly, funding for adult social care clearly and

:56:07.:56:09.

fully reflects the places in the country where the demographic is

:56:10.:56:13.

most top-heavy and where variety increases the cost of delivering

:56:14.:56:19.

that support. Finally, Mr Deputy Speaker, the challenge faced in

:56:20.:56:25.

local primary care. Local practices assured me that anyone requiring an

:56:26.:56:28.

emergency appointment is seen that day, however it is true that my

:56:29.:56:31.

constituents are too often expected to wait for a week or more if they

:56:32.:56:38.

require to see their regular GP. Quite understandably, for those with

:56:39.:56:41.

long-standing and complex health issues they expect to see the doctor

:56:42.:56:45.

they know so these weights are unacceptable. But it is wrong to

:56:46.:56:50.

connect these weights solely with funding. The greater challenge in

:56:51.:56:53.

Somerset is not the primary health care budget which has risen for each

:56:54.:56:57.

of the last three years, but our ability to recruit new GPs. The

:56:58.:57:03.

Secretary of State worked hard to bring more GPs into the system as a

:57:04.:57:07.

whole but now rural CCG is like Somerset will have to look at what

:57:08.:57:11.

initiatives could be developed to encourage new GPs to ply their trade

:57:12.:57:16.

in rural general practice. Furthermore we must listen to and

:57:17.:57:21.

support those responsible for our STPs. We have called again and again

:57:22.:57:26.

for politicians to keep our noses out of NHS planning. Now that we

:57:27.:57:32.

have and clinicians are at the helm the opposition dismiss that because

:57:33.:57:39.

it is expedient to do so. It has been written by people who know

:57:40.:57:43.

their craft and when I asked them if they would have written the plan as

:57:44.:57:47.

it is even if there were no resource constraints, they told me that they

:57:48.:57:51.

would. They say that the demand has changed. They tell me that the

:57:52.:57:55.

thinking over public health as changed and they tell me the

:57:56.:57:58.

clinical view of how and where people should recover after they

:57:59.:58:02.

have been in hospital has changed too. Things will change further yet

:58:03.:58:06.

over the years ahead. Some of the things the STP proposes are very

:58:07.:58:10.

challenging to me, Mr Deputy Speaker. Some will be unpopular with

:58:11.:58:14.

the community I serve but their analysis is based on an expertise

:58:15.:58:22.

which far outstrips mine, so unless I'm implored to reassert the

:58:23.:58:25.

supremacy of politicians in these matters, we have had enough of

:58:26.:58:28.

experts after all, we owe it to be clinicians empowered to design and

:58:29.:58:32.

run our local health care systems, to scrutinise of course, but also to

:58:33.:58:36.

support them. Moreover, they deserve to do that without the partisan

:58:37.:58:40.

hullabaloo being stirred up by those opposite today. Our inboxes give us

:58:41.:58:45.

a great feel for how things are, Mr Deputy Speaker. Our conversations

:58:46.:58:50.

with constituents, clinicians and patient participation groups like

:58:51.:58:54.

the one in Cheddar I will see tomorrow night shaped that the too.

:58:55.:58:58.

To claim that all is perfect right now is not true. But to claim a

:58:59.:59:04.

crisis is not true either. Our population and the practice of

:59:05.:59:07.

medicine are changing. This debate needs to happen. But not in a

:59:08.:59:12.

partisan funerary but in an honest, constructive, and supportive way

:59:13.:59:13.

instead. -- funeral stomach for I was going to talk about the cuts

:59:14.:59:27.

to health and social care funding to hospitals and health care in the

:59:28.:59:30.

south-west but all of the things I wanted to say have been made by

:59:31.:59:34.

owner stomach other honourable member is already. In keeping with

:59:35.:59:37.

previous speeches I have made recently I have decided not to

:59:38.:59:40.

repeat what has already been said but to scrub all of that and say

:59:41.:59:45.

something completely different. It is about the health consequences of

:59:46.:59:48.

loneliness in older people and the impact of funding cuts in NHS and

:59:49.:59:53.

social care systems on loneliness, and in turn the impact of old

:59:54.:59:56.

people's loneliness on the health care system. In the run-up to

:59:57.:00:03.

Christmas I was regularly blinking back tears on the Underground

:00:04.:00:06.

whenever I saw the advert is I'm sure many honourable member is will

:00:07.:00:11.

have seen from Age UK saying no one should have no one at Christmas and

:00:12.:00:14.

if you do not remember it it looked like this, which is the report I

:00:15.:00:18.

re-read again yesterday, no one should have no one by Age UK

:00:19.:00:22.

published in December last year about loneliness in old age. I found

:00:23.:00:29.

reading that report brought home to me just really how much loneliness

:00:30.:00:35.

affects people and how funding cuts which may appear small and

:00:36.:00:39.

insignificant can have a cumulative effect on older people. A

:00:40.:00:44.

constituent illustrated this to me recently when she came to talk to me

:00:45.:00:47.

about her worries for the older people she cares for. As a lowly

:00:48.:00:51.

paid care assistant she was not complaining about her pay, I am just

:00:52.:00:56.

observing that. She told me she regularly stays well beyond her low

:00:57.:01:00.

hours because she feels that the people she's working for need her.

:01:01.:01:03.

Partly because they have greater care needs than the time allows, but

:01:04.:01:08.

also because they are lonely. As I said, she wasn't complaining, but in

:01:09.:01:12.

my opinion starving social care of adequate funding means that people

:01:13.:01:19.

like my constituents are subsidising the health and social care system

:01:20.:01:22.

voluntarily, which she is willing to do, but it should not be left to

:01:23.:01:26.

chance like this. The Age UK report mentioned a survey they carried out

:01:27.:01:31.

of 1000 GP practices by their Campaign to End Loneliness in 2013,

:01:32.:01:37.

which found nearly 90% of GP practices than patients were coming

:01:38.:01:41.

in because they will only. The report also points out that funding

:01:42.:01:44.

has been cut and funding cuts mean that deals on -- meals on wheels,

:01:45.:01:50.

daycare centres, public toilets and community centres have been cut,

:01:51.:01:55.

closed or reduced in recent years. They point out that all of this

:01:56.:02:00.

decreases opportunities for older people to get out, to socialise, to

:02:01.:02:04.

take care of their health, to eat well, to exercise. One of which

:02:05.:02:11.

increases loneliness and isolation and damages their health. And what

:02:12.:02:16.

does that have to do with chronic serious illnesses? Age UK carried

:02:17.:02:20.

out an evidence -based review for their loneliness report and found

:02:21.:02:23.

out that chronic loneliness increases the risk of serious

:02:24.:02:27.

illnesses such as diabetes, stroke, depression and dementia, as well as

:02:28.:02:31.

I have already said, making it much harder for them to get out there to

:02:32.:02:34.

receive help, or do things that might prevent those conditions

:02:35.:02:37.

getting worse such as exercise and good diet. I pay tribute today to

:02:38.:02:42.

all the people across the country who give their time as volunteers,

:02:43.:02:48.

as staff, and as those who raise money for charities such as Age UK,

:02:49.:02:54.

nationally and locally, and in Bristol, Bristol ageing better, to

:02:55.:02:58.

do so much to combat loneliness in older people. If I may read one

:02:59.:03:02.

example from the Age UK report, I will read an example if I have time,

:03:03.:03:09.

Arthur's son was worried his health was deteriorating because of the

:03:10.:03:12.

many hours he spent alone in his flat in sheltered accommodation. He

:03:13.:03:16.

was unwilling to participate in group activities because of

:03:17.:03:19.

difficulties he had hearing. He had had a busy social life but most of

:03:20.:03:24.

the friends he had had died. Age UK introduced him to Paul who also had

:03:25.:03:27.

to retire early after an accident and was also feeling increasingly

:03:28.:03:32.

isolated and together they played dominoes, cribbage command would

:03:33.:03:34.

dissect the latest football match and reminisce about their time in

:03:35.:03:43.

the building trade, swapping funny stories of mishaps and adventures.

:03:44.:03:45.

Paul provided after with good company and a link back to the job

:03:46.:03:48.

he loved. Arthur has helped to restore Paul's sense of purpose and

:03:49.:03:50.

self worth. This example and many others in the report showed just how

:03:51.:03:55.

much work on loneliness can help to increase older people's health and

:03:56.:03:59.

reduce the costs on our health and social care system. So, what the

:04:00.:04:08.

CEOs, staff in my area have told me about cuts have on health care and I

:04:09.:04:20.

also want the Minister to tell me how he and the Secretary of State

:04:21.:04:23.

will lead the way to provide us with a fully integrated and fully funded

:04:24.:04:26.

health, social care and mental health care service. But I want all

:04:27.:04:33.

of us to read Age UK's report and follow the recommendations they make

:04:34.:04:37.

at the end for MPs amongst others. I will end on one. As a member of

:04:38.:04:42.

Parliament they have asked us, as well as to find out about loneliness

:04:43.:04:46.

among old people in our constituency, raise awareness,

:04:47.:04:49.

become an aged champion, encourage political parties to do more and

:04:50.:04:52.

take steps to put loneliness in later life on the government's

:04:53.:04:56.

agenda, so I hereby do this, and hold them to account for progress

:04:57.:04:59.

which I will continue to do, they have asked us to make the case for

:05:00.:05:04.

investment in local community resources to support sustainable

:05:05.:05:07.

long-term action to help lonely old people whatever they may be, I urge

:05:08.:05:11.

the government to take notice of that. I want to finish by saying

:05:12.:05:15.

they have asked as to support the work of the Jo Cox commission on

:05:16.:05:19.

loneliness. It is launching shortly. I would like one of us to take those

:05:20.:05:23.

words to heart. Thank you, Mr Deputy Speaker.

:05:24.:05:40.

The honourable member for Bristol West has spoken about loneliness

:05:41.:05:48.

which is a problem across the country and some great work is being

:05:49.:05:52.

done on that. Some colleagues have spoken about their personal and

:05:53.:05:59.

family experiences, like the member for Wells and the member for

:06:00.:06:02.

Chesterfield who have spoken about experiences both good and bad of the

:06:03.:06:07.

National Health Service. I have personal experiences both good and

:06:08.:06:10.

bad. Three years ago I spent Christmas Day night in A with my

:06:11.:06:16.

son he was five years old at the time and he had his appendix taken

:06:17.:06:19.

out first thing in the morning on Boxing Day, and had absolutely

:06:20.:06:25.

exemplary care and was home within two days, easily making up the

:06:26.:06:31.

quantity of sausages that he omitted to eat on Christmas Day with his

:06:32.:06:38.

tummy a closer last Christmas my grandmother, aged 100, was in

:06:39.:06:44.

hospital for several months and she had a much, much worse experience,

:06:45.:06:51.

and it was not the NHS at its best. We all, I think, have good and bad

:06:52.:06:58.

experiences to drawn and we hear from constituents as well about

:06:59.:07:03.

those good and bad experiences. It's important to recognise what the NHS

:07:04.:07:07.

does well and is doing well, and also where the system is failing, to

:07:08.:07:14.

focus on supporting the good and checking the bad. I can very much

:07:15.:07:18.

understand why this debate has been called the day, because there was no

:07:19.:07:23.

question that the NHS is under extraordinary pressure this winter.

:07:24.:07:27.

We've heard that it had the busiest week ever, last week. I will say I'm

:07:28.:07:33.

quite disappointed by both the tone of some of the contributions today

:07:34.:07:40.

and also, because it happens in the Chamber, the lack of proposals,

:07:41.:07:45.

rather than suggesting more money, but with no proposals for where that

:07:46.:07:52.

money comes from, which is fundamentally unhelpful, to suggest

:07:53.:07:55.

there should be more money but with simply no proposals about where it

:07:56.:07:59.

will come from. I am happy to give way. It's clear where the money

:08:00.:08:05.

comes from, we are asking for ?700 million to be brought forward from

:08:06.:08:10.

the better care for from 2019. It is already allocated. It is still quite

:08:11.:08:17.

a lot of money to be down. This is against the backdrop of less than

:08:18.:08:20.

two years ago, when the Labour Party was not committed to funding the NHS

:08:21.:08:25.

with money that it was asking for, which this Conservative Party chose

:08:26.:08:29.

to, so that is a rather shocking position that they are lying. I

:08:30.:08:35.

would like to seize this opportunity to say a very heartfelt thank you to

:08:36.:08:41.

all members of the NHS staff, nurses, doctors, allied health

:08:42.:08:45.

professionals, porters, Gera Systems and social services and particularly

:08:46.:08:52.

in Kent, -- care assistants, who are working extremely hard and dealing

:08:53.:08:55.

with this pressure at the front line. And also to the patients and

:08:56.:09:01.

their families who I know are being thoughtful and are making sure that

:09:02.:09:07.

they make best use of the NHS, so I thank them as well. We know that

:09:08.:09:13.

there is great variation in how the NHS is coping. As I speak I was told

:09:14.:09:21.

that the waiting time in Maidstone A is just 37 minutes, so Maidstone

:09:22.:09:27.

is coping well, but nearby, there is a weight of over four hours, so

:09:28.:09:34.

there is a variation and maybe people listening will divert where

:09:35.:09:37.

they are going. There may be a case for that and for greater

:09:38.:09:40.

transparency but that is for another day. The point we were talking about

:09:41.:09:48.

earlier, about money, there is no question that part of this is a need

:09:49.:09:52.

for more funding and for more staff, but the government is doing exactly

:09:53.:09:56.

that, giving the NHS more money, and also investing in significant

:09:57.:10:03.

increases in the workforce. Quite apart from that, money is not the

:10:04.:10:10.

whole answer. In part because, if the NHS continues doing all that it

:10:11.:10:14.

does in the way that it is, and without they level of change, we

:10:15.:10:18.

will find ourselves with a system that is unaffordable and which will

:10:19.:10:24.

be look -- using a level of GDP that would not have public support.

:10:25.:10:28.

Because we know that we have the situation of an ageing population,

:10:29.:10:33.

people living longer with complex, multiple conditions and costly

:10:34.:10:36.

treatment, high-cost treatments becoming available that people want,

:10:37.:10:40.

so the NHS itself recognises that it's not just about more money but

:10:41.:10:45.

about changing the way services are delivered, and that is actually

:10:46.:10:48.

happening and are being worked on at the moment. Earlier today I spoke to

:10:49.:10:54.

the chief executive of the hospital trust who is also the lead for Kent

:10:55.:10:58.

and Medway sustainability and transformation fund, the STP, which

:10:59.:11:07.

has come up several times today. What I saw from him and those around

:11:08.:11:14.

him is the coming together of NHS organisations intended to work

:11:15.:11:17.

closely together across central Medway, and the coming together with

:11:18.:11:21.

social services in a way that is so important, necessary and right, to

:11:22.:11:26.

work out how we can provide a better health service in a more sustainable

:11:27.:11:29.

way. Breaking down the barriers between organisations were it

:11:30.:11:34.

doesn't make sense that there's a shift between the NHS and social

:11:35.:11:37.

care in who is providing what, and looking at how we can moved care out

:11:38.:11:43.

of acute hospitals and closer to home, which we know is good for

:11:44.:11:48.

patients, it is exactly what the honourable member was hoping for for

:11:49.:11:54.

her father and what I hope of my grandmother as she knew the end of a

:11:55.:11:57.

light enable people to be looked after closer to home, increasing

:11:58.:12:03.

prevention and one that I feel strongly about, improving mental

:12:04.:12:06.

health care, which the Prime Minister has personally shown the

:12:07.:12:11.

lead she has taken on that since Monday, and I particularly value, in

:12:12.:12:17.

the light of the pressure on A, the commitment to psychiatric

:12:18.:12:22.

liaison in A which we know has helped people who go to A with

:12:23.:12:27.

mental health problems and looks after the people who need to be seen

:12:28.:12:31.

for physical health problems, and I welcome that in my area of Kent they

:12:32.:12:35.

are looking at having psychiatric liaison in rural A departments by

:12:36.:12:42.

2018, so bringing that world. There was important work going on at a

:12:43.:12:46.

local level. -- bringing that forward. I would encourage members

:12:47.:12:52.

opposite to, rather than perhaps knee jerk or even tear-jerker

:12:53.:12:55.

contributions that we have had from some members today, to take a longer

:12:56.:13:06.

view at the situation, to help have a more mature conversation about

:13:07.:13:11.

what the NHS needs, to talk about policies and concrete proposals

:13:12.:13:16.

rather than just more money for solving the problems, and, actually,

:13:17.:13:23.

to define what the NHS is doing at the local level, NHS and local

:13:24.:13:26.

authorities coming together for plans across their areas to have

:13:27.:13:30.

better care for patients in an affordable, sustainable way. Thank

:13:31.:13:39.

you, Mr Deputy Speaker. After four years of having responsibility for

:13:40.:13:42.

the National Health Service, the Secretary of State for Health has

:13:43.:13:45.

declared that we need to have an honest discussion of the public

:13:46.:13:50.

about the purpose of A departments, and we, who have seen

:13:51.:13:54.

his work from this House and have dealt his work on the front line

:13:55.:13:57.

know exactly what he means. He means, let me tell you why everyone

:13:58.:14:04.

else is to blame except for me. Earlier this week the Secretary of

:14:05.:14:08.

State told the UK that nearly one in three visits to A do not need to

:14:09.:14:14.

be made. This was his reasoning for weakening the target that every

:14:15.:14:18.

patient should be seen within four hours. That target only applies to

:14:19.:14:22.

you if your condition of your condition is serious and urgent

:14:23.:14:27.

enough. I find it staggering, the sheer hubris of those statements. He

:14:28.:14:31.

avoids accountability in this position. The danger that is

:14:32.:14:37.

inherent in both, first as an A specialist Doctor I have treated

:14:38.:14:41.

patients who have arrived in A with what seemed like minor

:14:42.:14:44.

complaints that develop into more serious and life-threatening issues.

:14:45.:14:49.

The Secretary of State, both in his words and his decision are saying

:14:50.:14:52.

that the people of the UK should self diagnose before heading to A,

:14:53.:14:57.

and that could have disastrous consequences, of which he would be

:14:58.:15:04.

responsible. What if, because of it, patients decide just to stay at home

:15:05.:15:08.

after that serious bang on the head that turns out to be a

:15:09.:15:12.

life-threatening bleak to the brain? What about that potentially

:15:13.:15:17.

deteriorating case of pneumonia that is not serious enough to warrant

:15:18.:15:22.

going to A, that results in somebody being severely septic and

:15:23.:15:27.

dying? As a citizen of this country and a patient of the NHS I find the

:15:28.:15:32.

Secretary of State's refusal to accept responsibility for the state

:15:33.:15:36.

of the A departments in this country deplorable. Instead, he

:15:37.:15:41.

blames patients for visits that do not need to be made. They do not go

:15:42.:15:48.

for fun. Patients go to A because they are ill and cannot get a

:15:49.:15:51.

doctors appointment is for two beach. We've heard from members on

:15:52.:15:54.

both sides of the House who have taken around young children to A,

:15:55.:15:59.

did they do so for fun because they felt there was a need for their

:16:00.:16:04.

child to treated? They go to the A because their GP does not have

:16:05.:16:07.

resources at their practice for something as simple as handing out

:16:08.:16:11.

crutches, in some cases. They go because there is something wrong and

:16:12.:16:15.

they are worried sick and simply desperate to speak to somebody about

:16:16.:16:21.

their health. No, I won't. Many now that they shouldn't be in A, but

:16:22.:16:25.

what other option is this government leaving them? Just calm it down.

:16:26.:16:32.

Let's not get into the habit of shouting at each other. Let's have a

:16:33.:16:41.

nice, sensible debate. They go to the A because their GP does not

:16:42.:16:45.

have resources. They go to A because there is something wrong and

:16:46.:16:48.

they are worried sick and simply desperate to speak to somebody who

:16:49.:16:51.

is a professional about their health. Many know they should not be

:16:52.:16:58.

in A I've had patients Sane, the elderly, saying, I am so sorry,

:16:59.:17:02.

Doctor, for wasting your time. But what other option is this government

:17:03.:17:08.

leaving them? This is what we are debating today. The Secretary of

:17:09.:17:11.

State wants an honest conversation. Well, let's have it. Let's talk

:17:12.:17:15.

about the impact of the current state of the NHS that he has been in

:17:16.:17:22.

charge of 44 years, and its impact on A departments and hospitals in

:17:23.:17:26.

this country. Let's talk about rock bottom staff morale. Let's talk

:17:27.:17:32.

about breakdown of staff managers. Let's talk about a rise in

:17:33.:17:36.

depression amongst staff, let's talk about the fact that waiting times

:17:37.:17:39.

are not the responsibility of patients. They are not to blame.

:17:40.:17:49.

They are those responsibility of the right honourable member, the

:17:50.:17:52.

Secretary of State for Health, and yet he blames the rise in waiting

:17:53.:17:56.

times on the number of people going to A since the target was set. I

:17:57.:18:01.

would say that it is the right and remember's responsibility to lead an

:18:02.:18:05.

NHS that can meet the needs of its people, and again, the Secretary of

:18:06.:18:09.

State pleads innocence. He says no other countries have such stringent

:18:10.:18:14.

targets, suggesting it is unfair that we have. I would say that the

:18:15.:18:19.

meeting of this target in particular, not water down but then

:18:20.:18:23.

fall, is what establishes the NHS as their best health service in the

:18:24.:18:29.

world, one that we can, should and would be proud of, under a Labour

:18:30.:18:34.

government. After all, the ability of emergency departments to meet the

:18:35.:18:37.

four our target is directly related to the health of the NHS itself.

:18:38.:18:43.

It's simple, more people go to A when they have no other options are

:18:44.:18:49.

available. I thank My Honourable Friend Paul giving way. The issue of

:18:50.:18:55.

those options in A in my area of Cumbria is entirely down to the lack

:18:56.:18:58.

of GPs, and it was only going to become more acute with so many GPs

:18:59.:19:03.

reaching retirement age. But My Honourable Friend agree that this is

:19:04.:19:06.

something the government needs to tackle urgently? Without a doubt,

:19:07.:19:12.

yes. I wholeheartedly agree with my Right Honourable Friend and the

:19:13.:19:17.

point she has made about the lack of GPs and the problems that we shall

:19:18.:19:22.

see when three more retire. Three contacted me and my tooting

:19:23.:19:25.

constituency saying that they have been offered jobs that were

:19:26.:19:30.

subsequently retracted due to, and the reasons cited, financial

:19:31.:19:34.

pressures. The Secretary of State pleads innocence. He says that no

:19:35.:19:36.

other countries have such stringent targets. We should not be comparing

:19:37.:19:41.

ourselves to the worst, we should be leading as the best. The explosion

:19:42.:19:46.

of waiting times in this country are his failure and a sign of the

:19:47.:19:51.

dangerous erosion of one of the country's greatest institutions. As

:19:52.:19:54.

we saw last week when the British Red Cross at the be drafted into

:19:55.:20:01.

hospitals, our NHS is in crisis, yet instead of listening to doctors and

:20:02.:20:04.

fixing the systemic problems they have created, the government is

:20:05.:20:09.

repackaging the A four our target to take attention away from real

:20:10.:20:14.

challenges. The challenge of social care provision not being in place,

:20:15.:20:20.

prohibiting floats through A departments. Editing access to GPs

:20:21.:20:26.

across the country meaning that A is the only resort, and the chronic

:20:27.:20:30.

cuts in funding at local authority level. Doctors and nurses forced to

:20:31.:20:35.

miss breaks, as we have heard, working 14 hours, some of them

:20:36.:20:39.

without a break. Sleep deprived, unsafe to practice clinical work.

:20:40.:20:46.

And NHS staff do not feel supported, encouraged or motivated by this

:20:47.:20:49.

government. None of these things would be addressed by a watered-down

:20:50.:20:50.

four our target. Having spoken to the College of

:20:51.:20:58.

Emergency Medicine those working on the front line at all levels and

:20:59.:21:01.

those training junior doctors I would like to put forward questions

:21:02.:21:04.

for the Secretary of State. Why has the four-hour target been

:21:05.:21:09.

downgraded, who was consulted? Which body said it would be beneficial to

:21:10.:21:14.

patients, A staff across the trusts, how he defined the major and

:21:15.:21:17.

minor health problems? How will doctors and nurses magically know

:21:18.:21:22.

whether it is major or a minor health problem at first sight

:21:23.:21:25.

without proper assessment? Who is responsible if a seemingly minor

:21:26.:21:30.

condition is actually life-threatening? Shall it be he was

:21:31.:21:36.

Mac who will be responsible? How will this government explain that we

:21:37.:21:39.

will be going back to the days where patients could wait over 12 hours if

:21:40.:21:45.

they were not considered ill enough. The Secretary of State must

:21:46.:21:48.

recognise the impact of this systemic crisis on accident and

:21:49.:21:51.

emergency rooms across the country. In his words and decision to

:21:52.:21:56.

downgrade the target the Secretary of State does neither, instead

:21:57.:21:58.

placing blame on patients and putting patients at risk. Let me be

:21:59.:22:03.

straight, I've been an A specialist Doctor under a Labour

:22:04.:22:04.

government and Conservative government and there has been a

:22:05.:22:08.

change under this government and for sure it's not been for the better.

:22:09.:22:15.

Lucy Allan. Madam Deputy Speaker. There have been very many excellent

:22:16.:22:19.

and constructive contributions to this debate and I particularly

:22:20.:22:23.

welcome the valuable input from those who have real life experience

:22:24.:22:27.

in the NHS. I would particularly like to congratulate my honourable

:22:28.:22:35.

friend the member for Lewes and her excellent speech, and it was

:22:36.:22:38.

disappointing to see a member opposite behaving with such

:22:39.:22:42.

disrespect for a fellow member during that speech. Will owe a debt

:22:43.:22:47.

of gratitude to those on the front line and none of them would thank us

:22:48.:22:52.

for reducing this debate to an ill tempered party political act of

:22:53.:22:59.

posturing. I know there are many sensible members opposite who fully

:23:00.:23:03.

understand that no complex problem is ever solved just by increasing

:23:04.:23:07.

funding in response to ever-increasing demand. There are

:23:08.:23:13.

very strong members opposite who want to work in a constructive

:23:14.:23:19.

fashion with all members across the House to tackle the challenges that

:23:20.:23:24.

our NHS faces and I welcome that. The Right Honourable member for Don

:23:25.:23:28.

Valley is one such sensible member and she made a point earlier this

:23:29.:23:34.

week on BBC's radio for Westminster hour saying it is not even

:23:35.:23:38.

electrically advantageous to the Labour Party to treat the NHS in the

:23:39.:23:44.

way that the Labour Party so often does. We have just seen an example

:23:45.:23:49.

of that. I believe it is for the benefit of all our constituents that

:23:50.:23:54.

we all encourage a more constructive approach. I want to speak very

:23:55.:24:00.

briefly about the four-hour target. Four-hour targets were introduced

:24:01.:24:03.

for those with urgent health problems and I am sure that all

:24:04.:24:06.

members of this House agreed that it is those indeed who should get

:24:07.:24:11.

access to care as soon as possible, and not find that their needs are

:24:12.:24:15.

eclipsed by someone with a minor ailment just because targets must be

:24:16.:24:21.

met. The Secretary of State has spoken this week about his

:24:22.:24:25.

commitment to protect the four-hour promise for those who actually need

:24:26.:24:30.

it and he's absolutely right to say this. Because, today if we talk to

:24:31.:24:37.

those who work in our local Amys and I know lots of members do this

:24:38.:24:41.

regularly, they often say there are people going to A when they do not

:24:42.:24:47.

need to do so. -- A Clinicians expressed the desire to prioritise

:24:48.:24:51.

need rather than simply meet targets. As a constituency MP I

:24:52.:24:56.

fully understand that it can being friendly difficult to see a GP when

:24:57.:25:01.

you want to and it can be equally difficult to navigate a system of

:25:02.:25:05.

ringing at the right moment to get an appointment on the right day.

:25:06.:25:09.

However, it is not the answer to simply circumnavigate the system and

:25:10.:25:15.

turn up at A to get fast tracked irrespective of need. We should not

:25:16.:25:19.

be encouraging the expectation that whatever your element, no matter

:25:20.:25:23.

what the demands on A staff, if you go to A you will get seen

:25:24.:25:28.

within four hours. If people are going to A who do not need to be

:25:29.:25:33.

there why are we offering them a four-hour service when they do get

:25:34.:25:36.

there? When the minister sums up I should be grateful to hear more

:25:37.:25:40.

about what can be done to tackle this particular issue. Maybe he

:25:41.:25:44.

could mention what proposals there are four GPs in A, or what

:25:45.:25:48.

proposals there are around different mechanisms of triaging or managing

:25:49.:25:52.

expectations of our constituents. What matters most is that those in

:25:53.:25:55.

need get access to the appropriate treatment as soon as possible and

:25:56.:26:00.

that's what a target is for. It must be about safety and safety for those

:26:01.:26:07.

with critical and urgent health conditions. I would just like to add

:26:08.:26:14.

that we must never lose sight that our health and well-being is so

:26:15.:26:18.

often dependent on our lifestyle and with the right help and support we

:26:19.:26:21.

can all make the right choices to help us live healthy and help us

:26:22.:26:26.

live happy. Diet, stress management, sleep hygiene, exercise, alcohol use

:26:27.:26:30.

and smoking are key determinants in our physical and mental health and

:26:31.:26:36.

well-being. I would like to see much more emphasis on self-care and

:26:37.:26:39.

self-help, because we can all play our part. There is no amount of

:26:40.:26:45.

funding that will ever compensate for a lack of self-care. Yes, we do

:26:46.:26:52.

need a grown-up and honest approach to this incredibly important issue

:26:53.:26:57.

that matters to all of us here and to all of us who have spoken so

:26:58.:27:01.

passionately. I respect the passions of all members on both sides. What

:27:02.:27:07.

we have to avoid is falling into the trap that we have seen today where

:27:08.:27:12.

we let ourselves down, we let the House down and we actually do not

:27:13.:27:17.

benefit those we most wish to assist in the way we approach this debate.

:27:18.:27:24.

So, yes, let's keep on exploring a sensible and collaborative approach,

:27:25.:27:28.

as articulated so eloquently by the member for North Norfolk and

:27:29.:27:30.

particularly from our honourable friend from Totnes who echoed the

:27:31.:27:34.

sentiments of others, and she is also doing excellent work in this

:27:35.:27:40.

area of working together across the House. None of us, none of us should

:27:41.:27:44.

ever play politics with the NHS because the NHS matters far too much

:27:45.:27:53.

for simple games. Julia Chapman. Madam Deputy Speaker, it is a

:27:54.:27:57.

pleasure to follow the Honourable Lady for Telford, I have not heard

:27:58.:28:00.

has been before and I look forward to hearing many of her speeches in

:28:01.:28:04.

the future. I have to say that to imply somehow we are letting each

:28:05.:28:09.

other down, or the House, or our constituents by standing up and

:28:10.:28:12.

championing health services in our constituencies, I completely

:28:13.:28:18.

disagree with that. That is an essential part of our work. That is

:28:19.:28:23.

why many of us wanted to be elected to this place in the first place,

:28:24.:28:27.

particularly those of us like my honourable friend from Tooting who

:28:28.:28:31.

has such relevant experience in today's debate and I thought made a

:28:32.:28:35.

tremendous speech, and I listened with great interest to what she had

:28:36.:28:39.

to say. I think the front bench opposite ought to be doing the same.

:28:40.:28:43.

We have had a lot of debate about whether or not the NHS is in a

:28:44.:28:49.

crisis, or whether it is a humanitarian crisis, an ordinary

:28:50.:28:54.

crisis, the winter crisis. I looked up crisis and a crisis is a period

:28:55.:29:00.

of intense difficulty or danger. I would say that is a good description

:29:01.:29:04.

of where the NHS is today, a period of intense difficulty. That's what

:29:05.:29:11.

I'm seeing in my local hospital and that is what my constituents are

:29:12.:29:16.

coming telling me about. I've been an MP for nearly seven years and I

:29:17.:29:21.

track the things people come and talk to me about in my surgeries, I

:29:22.:29:25.

am sure many of us do and it is not hard to do. I have now every week

:29:26.:29:32.

somebody coming to see me, I'd about an experience at the hospital, or

:29:33.:29:36.

more and more often because of an experience in adult social care. --

:29:37.:29:43.

either an experience. That's not something that has occurred in the

:29:44.:29:46.

last few weeks, it has been growing over time. I would say the crisis we

:29:47.:29:51.

witness today is something that has been long predicted and that we have

:29:52.:29:56.

all felt happening over time. And that the Government has chosen, they

:29:57.:30:01.

made a decision, not to act to prevent the worsening of. That is

:30:02.:30:06.

why there is such anger on this side of the House. When a quarter of

:30:07.:30:12.

patients wait longer than four hours in A that is a crisis. I don't

:30:13.:30:18.

really care whether they are there with a minor ailment or a more

:30:19.:30:22.

serious problem, because four hours is too long. It's too long to wait.

:30:23.:30:28.

The fact people are there with minor ailments just tells you, it is a

:30:29.:30:33.

very clear demonstration of the problems that exist elsewhere in the

:30:34.:30:38.

system. When you can't get a G8 Dummett GP appointment or phone 101,

:30:39.:30:45.

you are more often than not directed to A when you phone 101. We need a

:30:46.:30:51.

selection of services available at a central point where if you need a GP

:30:52.:30:56.

you can see a GP, if you need to see a practice nurse you can do that. If

:30:57.:31:00.

you do need to be admitted you can be admitted. I will give way. In an

:31:01.:31:08.

effort to reassure her colleagues, it is a genuine question. What

:31:09.:31:15.

impact does she believe, this is the question I would have asked the

:31:16.:31:18.

honourable member for Tooting, what impact does she believe the 2004 GP

:31:19.:31:23.

contract has had on out-of-hours care, which seems to be the nub of

:31:24.:31:27.

many of the issues that have been discussed this afternoon. Well, do

:31:28.:31:32.

you know what I think about that? The GP contract was changed in 2004

:31:33.:31:37.

and I did not notice the kind of issues that we face today until far

:31:38.:31:45.

more recently. I'm not a scientist or a doctor, but I do understand

:31:46.:31:52.

cause and effect. I think it doesn't ring true to me to say that

:31:53.:31:56.

something that happened six years prior to the change in government

:31:57.:31:59.

can be blamed for something that's happening six years after the change

:32:00.:32:05.

in government. I'm not saying it has no consequence whatsoever, but I do

:32:06.:32:08.

think there has been ample opportunity to put measures in place

:32:09.:32:11.

that would have prevented us being where we are now. Her intervention

:32:12.:32:17.

leads quite nicely into the point I want to make about the Secretary of

:32:18.:32:22.

State. I hadn't intended to speak today but I was so frustrated

:32:23.:32:29.

listening to him on the Today Programme trying to blame anybody

:32:30.:32:33.

but himself. He has a pattern. The first thing he does is he will blame

:32:34.:32:39.

the Labour government, in government until 2010, and then his party since

:32:40.:32:44.

then. He blames Labour, he will blame Labour for anything he

:32:45.:32:47.

possibly can. He will find something that happened at some trust and say

:32:48.:32:51.

that's why this has gone wrong today. But if that doesn't work, if

:32:52.:32:55.

he can't evidence that, he will say that particular trust is a basket

:32:56.:33:00.

case, it is the trust's fault, it's the local managers, local commission

:33:01.:33:03.

not organising themselves right, it is their fault. If that doesn't work

:33:04.:33:08.

he blames the public and he says you're going to the wrong place, you

:33:09.:33:11.

are accessing your care in a way I don't think you ought to, or call

:33:12.:33:15.

them frequent flyers, or there will be a problem that is the public's

:33:16.:33:19.

fault. They don't look after themselves properly, but clearly

:33:20.:33:24.

their fault. If that doesn't work he blames the local council. That, I

:33:25.:33:31.

think, is probably the worse thing that I've heard him do, blamed the

:33:32.:33:35.

local authority. My local authority,... In a minute... They

:33:36.:33:41.

have prioritise local Amaq social care but the pressures are not going

:33:42.:33:48.

away. -- prioritised social care. They are running out of things to

:33:49.:33:54.

cut. We are just closing our Central library in Darlington. We are making

:33:55.:33:58.

hideous cuts and I don't know where the next round is going to come

:33:59.:34:04.

from. I give way to the honourable gentleman if he still wishes to

:34:05.:34:08.

intervene. I thank the Honourable Lady for giving way. It is incumbent

:34:09.:34:12.

upon us all, I am sure she would agree, to discuss the future of our

:34:13.:34:16.

NHS and health services responsibly. Can she not surely accept that when

:34:17.:34:20.

the Secretary of State is talking about where people go for their

:34:21.:34:23.

services, it is not a matter of blaming people's we ought to move

:34:24.:34:27.

away from this blame culture. There is a benefit in trying to educate

:34:28.:34:33.

people that if perhaps their illness is not best served at A and is

:34:34.:34:37.

best served elsewhere that they ought to realise they should go

:34:38.:34:40.

elsewhere and that helps all of us, both the people who are seeking the

:34:41.:34:44.

services and the people who are giving them.

:34:45.:34:49.

Why doesn't he tell his honourable friend, the Secretary of State,

:34:50.:34:55.

this? He is the one blaming people, not me. I would welcome a programme

:34:56.:34:59.

of explaining to people and making it easier for the public, including

:35:00.:35:03.

myself, in helping us decide where it is we ought to go when we need

:35:04.:35:08.

assistance. The solution, though, that the

:35:09.:35:11.

government seems to have come up with around watering down the

:35:12.:35:16.

target, even members on the government side don't seem to be

:35:17.:35:21.

able to agree or explain exactly what change, or even if there is a

:35:22.:35:25.

change, to the four hour target, they don't seem to be able to

:35:26.:35:29.

explain exactly what that is. The other solution they have come up

:35:30.:35:30.

with is to close a A It is something the local

:35:31.:35:48.

community will not accept. Part of the reason we do our jobs is to give

:35:49.:35:52.

a voice to that local community. So far, in that STP process, they have

:35:53.:35:58.

been completely shut out. We would not have even known what was

:35:59.:36:03.

contained in that plan, had it not been leaked by Hartlepool Borough

:36:04.:36:07.

Council on their website. That is quite a shocking way to conduct a

:36:08.:36:16.

local dialogue. Having started about three years ago, we had the better

:36:17.:36:21.

health programme across the region where my constituency is. I was

:36:22.:36:25.

shocked to find out in response to Parliamentary questions that local

:36:26.:36:30.

health managers have spent ?4.6 million on this process. ?4.6

:36:31.:36:36.

million that could have been spent, and should have been spent, on

:36:37.:36:40.

providing front-line health services to my constituents, and has been

:36:41.:36:45.

spent on a consultation on whether or not to downgrade A I could

:36:46.:36:49.

have spent that money a lot, lot better. I could have given the

:36:50.:36:54.

answer to what the local population thinks about this proposal, because

:36:55.:36:59.

they are very, very angry and upset about it. It is right that we

:37:00.:37:04.

express that anger and disappointment, outrage and fears

:37:05.:37:09.

for safety, in this House. Many people today have spoken about their

:37:10.:37:14.

families and their relatives. The Member for Chesterfield, the Member

:37:15.:37:18.

for Workington, spoke about their fathers. My dad I'd in 1994, and he

:37:19.:37:26.

had a heart condition -- died. He was 48 and I was 20. One of the

:37:27.:37:31.

things I have done since then is take a very keen interest in cardio

:37:32.:37:37.

health and services for people with heart disease. I was shocked to find

:37:38.:37:43.

that before 1997, it was not uncommon for people to die waiting

:37:44.:37:47.

for heart treatment, often people would be waiting to 18 months for

:37:48.:37:50.

heart treatment. This party in government changed

:37:51.:37:57.

that. We changed that. We made it a matter of weeks. We have saved

:37:58.:38:02.

countless lives as a consequence. And so, when people say that the

:38:03.:38:08.

Labour Party did not do a good job with the NHS, or members opposite

:38:09.:38:11.

try to imply that we somehow have this fake do we eyed sentimental

:38:12.:38:18.

attachment to the NHS but they are completely wrong to do so. We will

:38:19.:38:24.

fight for the NHS. We did create it, but we also did a good job running

:38:25.:38:29.

it in government. We saved lives, cut waiting times, put in targets,

:38:30.:38:33.

it made a difference, it was better for patients, and it will never be

:38:34.:38:41.

any other case stated in here or outside.

:38:42.:38:43.

I am afraid that it is rather unfair on those that have waited all day

:38:44.:38:47.

and have not yet spoken. But some people have taken way over seven

:38:48.:38:52.

minutes, and I'm afraid that I now have two reduced the time limit to

:38:53.:38:58.

five minutes. I would like to pay tribute to all

:38:59.:39:04.

those that work in our National Health Service. And welcome this

:39:05.:39:09.

important debate. I hear the Secretary of State not blaming but

:39:10.:39:14.

looking for solutions. And actually, I think that's more what we should

:39:15.:39:18.

be about. I have called for an honest debate about the National

:39:19.:39:21.

Health Service since I came to this place, because it is 70 years old

:39:22.:39:28.

next year. Actually, if it is going to get to 100, we need to look after

:39:29.:39:32.

it. But I want to start with the positives. My own hospital, West

:39:33.:39:38.

Suffolk Hospital, has seen a 20% increase between Christmas and New

:39:39.:39:42.

Year in the number of patients admitted. Those patients have been

:39:43.:39:46.

poorly, very poorly, which was a point made earlier in the House.

:39:47.:39:54.

They made a resilience plan for 5% uplift in patient numbers, and

:39:55.:39:57.

actually, they have coped spectacularly.

:39:58.:40:04.

People coming into A, and I point to the honourable member for tooting

:40:05.:40:07.

who is no longer there, they have people coming in with ingrowing

:40:08.:40:13.

toenails, and with dry skin. And it is important that we do something

:40:14.:40:18.

about making sure we see the poorly as people in the most appropriate

:40:19.:40:21.

way, and use was also is most effectively.

:40:22.:40:28.

My constituency is the second oldest constituency, by age, in the

:40:29.:40:37.

country. An ageing population:, comb morbidity

:40:38.:40:42.

The allocation of resources as we go forward is important. But my

:40:43.:40:52.

hospital has been one of the most resilient in the east, at 85%, and

:40:53.:40:57.

its resilience is in most part due to its fantastic staff. West Suffolk

:40:58.:41:10.

Hospital has been innovative. In January, it will be doing a bridging

:41:11.:41:14.

care service with the councils, improvement will come through

:41:15.:41:17.

prevention and integration, and not always by shouting for more money.

:41:18.:41:22.

The honourable member for Faversham, mid Kent, stated that it is good

:41:23.:41:27.

integration that we need, good working in Suffolk needs to be

:41:28.:41:32.

copied. STPs, as the honourable member for Wales and Central

:41:33.:41:35.

Ayrshire said, they need to be looked at as a force for good, and I

:41:36.:41:39.

would urge the party opposite, don't knock it, work with it. A clinician

:41:40.:41:44.

led. That is what everybody was asking for. We can't have

:41:45.:41:53.

everything, we never can. We need an honest conversation. With rising

:41:54.:41:57.

expectations, an ageing publishing, the private sector has been in use

:41:58.:42:01.

in the NHS since 1948. If we are going to get more bang for our buck,

:42:02.:42:06.

we may be should look at parts of the private sector, in order to

:42:07.:42:11.

enhance what we get through these critical periods. Yes, certainly.

:42:12.:42:20.

She is absolutely right on the need for a grown-up debate about

:42:21.:42:23.

integrating, and about learning from best practice. But she share my

:42:24.:42:31.

concern that as the party opposite fans the flames of indignation, all

:42:32.:42:35.

they are doing is proving yet again that they are either unwilling, ill

:42:36.:42:42.

equipped... ? I would agree in that since we last

:42:43.:42:46.

debated this on November 23 with the opposition, apart from asking for

:42:47.:42:52.

700 million to be brought forward, actually, there is very little

:42:53.:42:55.

tangible other plans that are being put forward. And it is important,

:42:56.:43:00.

and this is everybody we are talking about, so slinging bows and arrows

:43:01.:43:04.

across this chamber is not going to get us to the solution that we need.

:43:05.:43:09.

If it's about money, how come some areas do better than others? It is

:43:10.:43:12.

about the allocation of resources and good leadership. There are three

:43:13.:43:19.

letters about good health care I've had, a resident in my constituency,

:43:20.:43:24.

the GP on the 28th October, the consultant on the 8th of November,

:43:25.:43:30.

operated on on the 29th, that was actually at my District General

:43:31.:43:33.

Hospital that use the private facility locally in order to enhance

:43:34.:43:36.

that patient experience. We need a long-term solution, I am

:43:37.:43:42.

pleased that the Prime Minister has spoken about tackling the

:43:43.:43:44.

difficulties of mental health, something that the honourable member

:43:45.:43:48.

for North Norfolk has championed, and with me shares a mental health

:43:49.:43:53.

trust. I am pleased to see another 49,000 people being treated for

:43:54.:43:57.

cancer, something that I came to this place to champion. Another

:43:58.:44:04.

822,000 people being treated, seeing specialist cancer patients. We have

:44:05.:44:09.

seen huge increases in demand, and we need to actually admit that we

:44:10.:44:13.

can't just carry on. Advances in drugs, co-morbiditys and an ageing

:44:14.:44:19.

population, we need to understand what is wrong, and we will do that

:44:20.:44:24.

by better data throughout the system. The Richmond group wrote in

:44:25.:44:29.

support of my Private members Bill that information held in health care

:44:30.:44:32.

records has a huge potential to provide better care, improve health

:44:33.:44:39.

service delivery. Paramedics have asked me for better access to data

:44:40.:44:42.

to understand that when they find someone on the floor what measures

:44:43.:44:45.

they are on and what beneficial treatment they can give them. GPs

:44:46.:44:50.

want their information to flow through the system, to help social

:44:51.:44:52.

care and to help the hospital sector. Pharmacies need to be able

:44:53.:44:57.

to read and write, and social care need to look at somebody's pathway.

:44:58.:45:02.

Patient outcomes should be the thing that we are all talking about, but

:45:03.:45:08.

we have to make decisions. At the centre of all this, we need to

:45:09.:45:11.

support those colleagues who are working above and beyond at this

:45:12.:45:16.

current time, and we need to behave in a grown-up, responsible way as

:45:17.:45:28.

they are, caring for our NHS. That an organisation is highly rated

:45:29.:45:35.

as the Red Cross would say what they have is shocking. It points to be

:45:36.:45:39.

hot of the government's did provide a reliable, properly resourced,

:45:40.:45:41.

national Health Service free at the point of need. It should be a source

:45:42.:45:45.

of shame for this government. The reports last week that patients died

:45:46.:45:48.

on trolleys and corridors, one having waited 35 hours is shocking.

:45:49.:45:56.

Could this be the face of the NHS in 2017 under the Tories? It seems it

:45:57.:45:59.

is will stop Health Secretary responded by suggesting that the

:46:00.:46:02.

four hour target should only apply to the most urgent cases, and that

:46:03.:46:08.

it was estimated that 30% of agents in ten won shouldn't be there. He

:46:09.:46:14.

should hang his head in shame. -- in A In Cheshire and Merseyside, the

:46:15.:46:21.

NHS has defined savings of ?1 billion. Nearly a third higher than

:46:22.:46:33.

the original 9 million forecast. I would be interested to hear why this

:46:34.:46:38.

curious request has been made. Patients in Wirral West are

:46:39.:46:40.

concerned about the impact of these savings or cuts will have in general

:46:41.:46:46.

practice will stop by our rights to be concerned. The biggest financial

:46:47.:46:49.

squeeze in the history of the NHS 's puddings services at risk. --

:46:50.:46:52.

putting. And NHS manager from my constituency

:46:53.:47:09.

has written to me saying that STPs are pushing for a redesign of

:47:10.:47:14.

services. Primary care and scale, the real punch line is there is no

:47:15.:47:18.

funding to make these changes. They go on, locally there is talk about

:47:19.:47:21.

and accountable care organisation for West Wirral, meetings being held

:47:22.:47:27.

on almost a weekly basis to create a road map to do this with no money to

:47:28.:47:34.

do it with. Having fragmented services, they are now making

:47:35.:47:40.

services use what pitiful resources they have to try to put it all back

:47:41.:47:43.

together again. I truly despair there will not be an NHS this time

:47:44.:47:48.

next year. What a stark warning, a damning indictment on the

:47:49.:47:51.

government's you. The Secretary of State should address the crisis by

:47:52.:47:54.

giving the NHS funding they need to make up for the crisis of the

:47:55.:47:59.

government's making about access to GP appointments, failure to train

:48:00.:48:05.

enough nurses, I have long been aware of the Tory's gender for the

:48:06.:48:09.

privatisation of the National Health Service, seen in the 2012 act, which

:48:10.:48:17.

opened it up to the private sector, and allowing NHS hospitals to give

:48:18.:48:21.

half their beds to private patients. I believe that this and previous

:48:22.:48:25.

Tory government seek to move us to a two tier system, where those that

:48:26.:48:29.

can afford it, paid private health insurance, and the rest are left

:48:30.:48:36.

with a bargain basement NHS. Since the Thatcher period, this has been

:48:37.:48:39.

shown. We appear to be reaching the end game. The government is cutting

:48:40.:48:42.

the supply of health care in the Babic sector to create demand in the

:48:43.:48:48.

private sector. -- in the public sector. It is an entirely different

:48:49.:49:02.

concept, and in the process of trying to transfer us to that two

:49:03.:49:06.

tier insurance -based model, did you not pause to think about the human

:49:07.:49:10.

suffering he would unleash in the process with patients waiting for

:49:11.:49:13.

hours on trolleys, anxious relatives waiting helplessly as they watch

:49:14.:49:20.

what's happening, and stressed out day in, day out. Now is the time for

:49:21.:49:24.

a decision. The government can review and it is not too late. It

:49:25.:49:27.

can face the facts and admit to itself that actually engage people

:49:28.:49:31.

would a state managed, state funded, National Health Service free at the

:49:32.:49:37.

point of use, paid for, created by the Labour government after the

:49:38.:49:41.

Second World War, the envy of the word, the government should swallow

:49:42.:49:44.

its ideological pride and say, OK, we get it, we will fund the NHS,

:49:45.:49:49.

anything else is a betrayal of all the NHS stands for.

:49:50.:49:53.

Madam Deputy Speaker, thank you for calling me to speak. I believe we

:49:54.:49:59.

need to look afresh at the entire health and social care pathway which

:50:00.:50:02.

is why I'm delighted to contribute today. From visiting the pharmacist

:50:03.:50:07.

to attending a GP appointment, to spending time in hospital, be it at

:50:08.:50:12.

A or preplanned, and being able to reside beforehand and afterwards at

:50:13.:50:16.

home or in a care home, we need to find the most efficient and

:50:17.:50:20.

dignified way to treat and look after people. We must avoid using

:50:21.:50:25.

one treatment centre as a default option, despite it not being the

:50:26.:50:29.

best for the individual or for the financial purse, because it is the

:50:30.:50:32.

only one which is available due to difficulties with individual

:50:33.:50:37.

funding, opening hours or lack of accessibility to a better form of

:50:38.:50:42.

provision. We must also, Madam Deputy Speaker, be encouraged to

:50:43.:50:45.

speak freely about the pressures in the system and to provide ideas. For

:50:46.:50:50.

years it frustrated me that anyone who thinks aloud with ideas which

:50:51.:50:54.

can change health and social care for the better is denigrated as

:50:55.:50:58.

seeking to harm it when the opposite is true. To this end I listened with

:50:59.:51:04.

interest to be interviewed the Secretary of State gave to Radio 4

:51:05.:51:08.

on Monday morning. It struck me as measured and thoughtful as to new

:51:09.:51:12.

ideas. I was particularly interested by the ideas as to how we could

:51:13.:51:16.

deliver more capacity in the GP system because an increasing number

:51:17.:51:21.

of people attending A are either accident victims or needing

:51:22.:51:26.

emergency treatment. They did, however, need some form of medical

:51:27.:51:30.

intervention as the Secretary of State mentioned. It was thoroughly

:51:31.:51:33.

depressing to read the Secretary of State's words taken out of context.

:51:34.:51:38.

I hope he will continue to think outside the box and that all inside,

:51:39.:51:43.

insiders has will recognise the benefits of him doing so. Talking

:51:44.:51:46.

about ideas, I suggest the following for each of the treatment centres in

:51:47.:51:50.

the health pathway. Pharmacists, in the event we have too many clusters

:51:51.:51:54.

of pharmacies, I agree with the need to ensure they are spread out across

:51:55.:51:57.

the country with the money saved being recycled. At the same time,

:51:58.:52:03.

can we find ways to help pharmacies deliver more interventions in order

:52:04.:52:08.

to free up capacity at GP surgeries. We must do more to signpost patients

:52:09.:52:13.

to pharmacist before going to their GP. A recent report costed common

:52:14.:52:18.

ailment treatment in community pharmacies at ?29 per patient. Four

:52:19.:52:23.

GP practices that treatment cost rises to ?82 and four A ?147.

:52:24.:52:28.

Treatment results across all three were equally good regardless of

:52:29.:52:31.

where they were treated. The research estimated 5% of GP

:52:32.:52:42.

consultations for common ailments could be managed by community

:52:43.:52:44.

pharmacies equating to more than 18 million GP consultations which could

:52:45.:52:46.

be diverted. Turning to GPs, I was buoyed by the suggestion by the

:52:47.:52:49.

Secretary of State that more GPs must be placed in A departments

:52:50.:52:55.

and care homes. The new NHS requirement of GPs undertaking

:52:56.:52:58.

weekly ward rounds in care homes is the right at the thinking to prevent

:52:59.:53:01.

emergency treatment in our hospitals. I welcome GPs operating

:53:02.:53:05.

on Sundays but practically we surely just need one surgery per area being

:53:06.:53:10.

opened. I don't believe all GPs operating over seven days is a good

:53:11.:53:14.

use of scarce resources, in the same way government funding of two

:53:15.:53:17.

pharmacies across the road from each other is also not a good use of

:53:18.:53:21.

scarce resources. I have long taken the view that we need to find ways

:53:22.:53:31.

to free of our GPs so they might focus on patients who need them the

:53:32.:53:34.

most. Because it is free there are too many wasted or cancelled GP

:53:35.:53:36.

appointments. If there was a cost for unjustifiably keeping to an

:53:37.:53:38.

appointment it might demonstrate how precious this resource is in the

:53:39.:53:42.

same manner that an NHS dentist would charge for a missed

:53:43.:53:46.

appointment when I was younger. Turning their forger A, some of

:53:47.:53:50.

these reforms are about pharmacies and GPs but I designed to ensure

:53:51.:53:54.

patients are only attending A if they have had an accident or it is

:53:55.:53:58.

an emergency. Clearly this is not the case for some who are now

:53:59.:54:02.

attending. We are also facing a demand on hospital places due to the

:54:03.:54:07.

need to reform the way we look after an ageing population. Time does not

:54:08.:54:11.

allow me to talk about social care, so important in my constituency, but

:54:12.:54:15.

the delivery by the government of more social care funding before

:54:16.:54:18.

Christmas was welcomed however it is crucial to question the operating

:54:19.:54:22.

model in social care. The NHS benefits from a national funding

:54:23.:54:25.

programme, social care is largely the responsibility of local

:54:26.:54:28.

authorities and local rate players like payers in areas where

:54:29.:54:32.

retirement may be high but employment and council tax receipts

:54:33.:54:36.

are not. We have to think radically to ensure we get the best out of our

:54:37.:54:41.

health and social care system. To do so will not only make resources

:54:42.:54:44.

stretch further but deliver the innovation which will improve the

:54:45.:54:47.

lives of the sick and infirm who are most in need of our care. Two days

:54:48.:54:58.

ago the Health Secretary read out a statement in this chamber on the

:54:59.:55:02.

crisis in our NHS and his answer to his Government's failure to meet A

:55:03.:55:06.

waiting time targets is to downgrade those targets rather than seeking to

:55:07.:55:11.

take any action to treat the Mall is at the heart of our NHS. The Health

:55:12.:55:17.

Secretary heaped fulsome praise on our hard-working and dedicated NHS

:55:18.:55:22.

staff, praise they richly deserved but it will ring hollow with many of

:55:23.:55:27.

them. I speak from years of experience working in the NHS as a

:55:28.:55:31.

clinical scientist. Having worked with staff of all grades, skills and

:55:32.:55:37.

experience. The simple truth is that NHS staff are demoralised. As I said

:55:38.:55:42.

two days ago, the reason they continue to work with care and

:55:43.:55:46.

compassion is in spite of, not because of, any action taken by this

:55:47.:55:50.

Health Secretary. Since that statement I have been inundated with

:55:51.:55:55.

health service staff wanting to tell me their stories of how the service

:55:56.:56:00.

they were once proud to work in is now in perpetual crisis, of the

:56:01.:56:05.

strain of wanting to do their best for their patients but being

:56:06.:56:09.

prevented from doing so because of short staffing, because of

:56:10.:56:13.

overcrowding, because of delayed discharge, and because of

:56:14.:56:17.

underfunding. Of the e-mails they get from ministers demanding to know

:56:18.:56:21.

what they're going to do about failing to meet targets, and then

:56:22.:56:25.

listening to the very same ministers telling the public that the NHS

:56:26.:56:30.

doesn't have a problem. Health managers are saying that we have a

:56:31.:56:35.

perfect storm of ageing patients needing more care just at the time

:56:36.:56:39.

when social care has been cut to the bone leading hospitals to pick up

:56:40.:56:45.

the pieces. An Aimi doctor at Manchester Royal Infirmary said to

:56:46.:56:48.

me crisis is the new normal and it has become usual to have ten

:56:49.:56:53.

patients waiting in the corridor -- A Doctor. In my own constituency

:56:54.:56:58.

of Heywood Andy Little. Michael Middleton the hospital that serves

:56:59.:57:01.

my constituency has been the subject of a damning report revealing

:57:02.:57:05.

appalling neglect in maternity care and leading to the avoidable deaths

:57:06.:57:09.

of mothers and babies. Pennine acute trusts have the highest number of 12

:57:10.:57:15.

hour A waits in October and the second-highest number of cancelled

:57:16.:57:18.

urgent operations in November. In December it was forced to divert

:57:19.:57:23.

ambulances 14 times in total, one of the highest figures in the country.

:57:24.:57:28.

Social care across Greater Manchester races collapse and this

:57:29.:57:31.

is borne out by the delayed discharge figures for Greater

:57:32.:57:36.

Manchester, which doubled in the year to October. Greater Manchester

:57:37.:57:40.

asked for ?200 million for social care in the Autumn Statement, but

:57:41.:57:45.

this issue was not even referred to. Some C Greater Manchester's devolved

:57:46.:57:48.

health care system as a solution, but even the chief officer John

:57:49.:57:53.

Rouse, says while devolution can help close working, it is not magic

:57:54.:57:58.

dust. I want to remind the Health Secretary about the NHS Constitution

:57:59.:58:04.

for England, which was updated in October 2015, which establishes the

:58:05.:58:08.

principles and values of the NHS in England. It sets out rights to which

:58:09.:58:13.

patients, public and staff are entitled and pledges, which the NHS

:58:14.:58:18.

is committed to achieve. And enshrined in the Constitution is the

:58:19.:58:23.

patient's right to be cared for in a clean, safe, secure and suitable

:58:24.:58:27.

environment and the right to be protected from abuse and neglect,

:58:28.:58:32.

not an A corridor. Patients and the public have a right to be

:58:33.:58:36.

involved in the planning of health care services and in changes in the

:58:37.:58:39.

way health care services are provided and in decisions to be made

:58:40.:58:44.

affecting the operation of the services. And for NHS staff, one of

:58:45.:58:48.

the pledges is to engage staff in decisions that affect them and the

:58:49.:58:53.

services they provide. And yet I seek precious little evidence of

:58:54.:58:57.

staff or patients or the public having any input at all into the 44

:58:58.:59:01.

sustainability and transformation plans covering the regions England,

:59:02.:59:11.

which appear to have been drawn up behind closed doors and are shrouded

:59:12.:59:14.

in secrecy. Yet their impact on health care could be huge. But where

:59:15.:59:17.

is the public involvement? Patients are being failed under this

:59:18.:59:19.

Government's watch and their rights to save care are being neglected.

:59:20.:59:29.

All that is asked is the occasional flurry of warm words yet the junior

:59:30.:59:33.

doctors dispute showed his real attitude towards NHS staff. Aneurin

:59:34.:59:39.

Bevan said no government that this, hopes to destroy the NHS can expect

:59:40.:59:45.

the support of the people. That is from his essays. Sadly I think the

:59:46.:59:48.

current secretary has managed to achieve replacing the fear. Thank

:59:49.:59:57.

you, Madam Deputy Speaker. I want to start by paying tribute to our

:59:58.:00:00.

hard-working staff in the NHS and those in the care sector. The best

:00:01.:00:05.

way to help Dummett thank those health and care staff would be to

:00:06.:00:07.

give them the resources they need to do the job we want them to do. I

:00:08.:00:12.

welcome the contributions made by honourable member is today,

:00:13.:00:15.

particularly the moving contribution by my honourable friend for

:00:16.:00:18.

Chesterfield who told us about the personal catastrophe for him and his

:00:19.:00:22.

family when his father was sent home from a pressured A sadly to die

:00:23.:00:26.

from an aneurysm. My honourable friend from Workington was also able

:00:27.:00:30.

to tell us about the happy death her father had with the end of life care

:00:31.:00:34.

at the local Community Hospital. I want to mention the Honourable Lady

:00:35.:00:37.

for Central Ayrshire, the Honourable Lady for Totnes, who emphasised the

:00:38.:00:40.

complexity and verity of patients needing care in the winter months.

:00:41.:00:45.

We should remember that in terms of the scale of pressures facing the HS

:00:46.:00:50.

-- frailty of patients. Both honourable members supported the

:00:51.:00:53.

four-hour target of the A as a barometer of the wider pressures in

:00:54.:00:58.

the NHS guy a measure of managing the frail and convex patients. My

:00:59.:01:05.

Right Honourable friend urged the government not to give the NHS of

:01:06.:01:10.

Donaghy oppression of giving up on the four-hour target. It sends the

:01:11.:01:18.

wrong message. There was a concern that parents might be discouraged

:01:19.:01:22.

from taking their children to A Honourable member is opposite have

:01:23.:01:25.

quoted Simon Stevens and Chris Hopson in support of claims on NHS

:01:26.:01:28.

funding and I would like to update them because in the House this

:01:29.:01:32.

afternoon Simon Stevens said on NHS funding: we got less than we asked

:01:33.:01:36.

for. The Government are stretching it to claim the NHS got more. Simon

:01:37.:01:41.

Stevens said it doesn't help anybody to pretend there are not financial

:01:42.:01:46.

gambles. Chris Hopson of NHS Providers said: we do not believe

:01:47.:01:53.

the NHS has all the money it needs and the NHS is not sustainable on

:01:54.:01:56.

the current funding. I want to turn to the pressures caused by social

:01:57.:01:59.

care. The crisis in our hospitals has been made much worse by the

:02:00.:02:02.

government's continued failure to fund social care properly. The care

:02:03.:02:08.

crisis is caused by insufficient funding in the face of growing

:02:09.:02:12.

demand. Government ministers have ignored warnings from a wide group

:02:13.:02:17.

of doctors and from leaders and professionals in the health and care

:02:18.:02:21.

sectors. They fail to produce a Singleton any other extra funding

:02:22.:02:23.

for social care in the autumn settlement. Then they told us extra

:02:24.:02:28.

funding was made available for social care in the local government

:02:29.:02:31.

funding settlement but this was not the extra funding needed from

:02:32.:02:36.

central government. What ministers did was shift the burden onto

:02:37.:02:41.

council taxpayers. This was made worse by the fact the ?240 million

:02:42.:02:46.

adult and social care grant was actually money recycled within local

:02:47.:02:48.

government budgets from the New Homes Bonus, and one third of

:02:49.:02:55.

councils will be worse off as a result of this settlement. My own

:02:56.:02:59.

local authority Salford will have ?2.3 million less in its budgets.

:03:00.:03:05.

This is not a boost to social care. What health and social care leaders

:03:06.:03:08.

have pleaded for was for ministers to bring forward funding to address

:03:09.:03:13.

the current crisis in social care and that is what we have in our

:03:14.:03:17.

motion today. This would provide some breathing space, and breathing

:03:18.:03:21.

space is needed because the lack of social care means that thousands of

:03:22.:03:25.

older people are stuck in hospital waiting for a care package in their

:03:26.:03:29.

own home. That was the most common cause of delayed discharges due to

:03:30.:03:33.

social care. More than a third of the record 200,000 delayed Dummett

:03:34.:03:39.

delays reported were due to a lack of social care. Being stuck in

:03:40.:03:43.

hospital can affect patient morale and patient mobility but also

:03:44.:03:47.

increased the patient's risk of hospital acquired infections. We

:03:48.:03:49.

know the major impact is the knock-on effect on people in A

:03:50.:03:55.

waiting for a bed for an emergency admission. Health ministers like to

:03:56.:03:57.

blame local authorities for the lack of social care but there are

:03:58.:04:01.

problems with that. When NHS Chief Executive Simon Stevens was asked by

:04:02.:04:05.

the DCLG committee chair in a recent Caerau on social care what extra

:04:06.:04:09.

resources would be needed if every local authority performed as well as

:04:10.:04:13.

the best local authority on delayed discharge, he said: even happen

:04:14.:04:19.

Dummett having sorted that out if we have a the gap between the

:04:20.:04:23.

availability of social care and the number of frail older people it will

:04:24.:04:26.

show up as extra pressure on them, their families, carers and of course

:04:27.:04:32.

the NHS. Of course we want to get to the position with a best practice in

:04:33.:04:35.

tackling delays is spread across the country but ministers have to start

:04:36.:04:38.

to reflect on what their government has done through the cuts they have

:04:39.:04:43.

inflicted on local authority budgets. Figures from the Local

:04:44.:04:46.

Government Association show the hardest hit local authority has had

:04:47.:04:51.

cuts of 53% to its budget in the last five years. The average cut is

:04:52.:04:56.

39%. Now the budget cuts for Surrey were at the lower end of the budget

:04:57.:05:01.

cuts at 29%. Even so, the Cabinet member for social care in Surrey,

:05:02.:05:05.

has talked in a letter to the Guardian about the issues the local

:05:06.:05:10.

authority faces. He said: the Care Quality Commission is not the only

:05:11.:05:12.

organisation with worries about inadequate adult social care funding

:05:13.:05:18.

and the impact on already clocked up hospitals. He said while the social

:05:19.:05:22.

care precept was a welcome move it falls many millions of pounds short

:05:23.:05:26.

of what is needed now, let alone in the next two decades. I suggest the

:05:27.:05:31.

Health Secretary and Chancellor talked to social care leaders to

:05:32.:05:37.

understand the needs they see in local communities and the impact of

:05:38.:05:41.

local social care on NHS hospitals. Ministers have been warned about the

:05:42.:05:47.

impact of cuts on social care but ignored those warnings. The Royal

:05:48.:05:50.

College of Emergency Medicine has said emergency care is on its knees,

:05:51.:05:54.

mainly due to a lack of investment in both social and acute health care

:05:55.:06:00.

beds. The BBC has reported that last week there were 18,000 trolley waits

:06:01.:06:05.

over four hours. That is people waiting on a trolley in a hospital

:06:06.:06:11.

corridor and there were 485 cases where patients waited over 12 hours.

:06:12.:06:16.

My honourable friend raised the issue we don't know the figures

:06:17.:06:20.

waiting stomach for patients waiting on corridors, all been treated and

:06:21.:06:23.

waiting on a chair due to lack of trolleys. The figures don't tell us

:06:24.:06:27.

all about the misery for patients and for their family members waiting

:06:28.:06:32.

with them. Last night a senior A consultant said on ITV that patients

:06:33.:06:36.

can be left with absolutely no dignity during these weights. He

:06:37.:06:41.

said: we have got patients with severe illnesses on chairs receiving

:06:42.:06:45.

drips, antibiotics, medications and patients with cardiac problems on

:06:46.:06:48.

chairs because there are no trolleys for them to go on to. The senior

:06:49.:06:54.

doctor talked about patients who are left unable to move off their

:06:55.:06:58.

trolleys or stuck on chairs. And he talked about a lack of shutters and

:06:59.:07:02.

blinds, which means that patients can be left in full view of others

:07:03.:07:06.

while they are being treated. He also reported patients who were

:07:07.:07:11.

incontinent in front of relatives and strangers because hospital staff

:07:12.:07:14.

could not reach them in time. He said: patients have no dignity left.

:07:15.:07:20.

That is what it can lead to. What would we feel if that was our

:07:21.:07:27.

relative? This situation may get worse with the expected cold weather

:07:28.:07:32.

with more major incidents being declared and many hospitals on black

:07:33.:07:39.

alert. Downgrading the four hour waiting

:07:40.:07:45.

time targets for A misses the point. As we have discussed in this

:07:46.:07:51.

debate, that for our target is a proxy for patient safety. It is

:07:52.:07:55.

miserable for a sick patient to lose their dignity through being

:07:56.:07:59.

incontinent during a trolley weight in a hospital corridor. But it is

:08:00.:08:03.

also miserable and frightening for a vulnerable patient to be discharged

:08:04.:08:06.

in the middle of the night to a cold home without a care package. That is

:08:07.:08:10.

why in our motion today we repeat the call for the government to bring

:08:11.:08:14.

forward ?700 million of funding promised to social care in 2019 to

:08:15.:08:18.

how the NHS and social care systems cope with extra pressures this

:08:19.:08:22.

winter. We also call for a new improved settlement for the NHS and

:08:23.:08:27.

social care in the budget in March, so that we avoid this crisis in the

:08:28.:08:31.

future. Staffing emergency departments are at the shop end of

:08:32.:08:38.

saving lives. A staff are so directly in the front line of that.

:08:39.:08:44.

Care staff with a working in caring homes, make a huge difference to the

:08:45.:08:47.

lives of millions of older and vulnerable people. People with

:08:48.:08:53.

disabilities, and people with mental health conditions. Though should be

:08:54.:08:57.

the best jobs in the UK. But without the right investment in the funding

:08:58.:09:00.

they need, those people doing those jobs feel undervalued and

:09:01.:09:04.

overstretched. I urge members to vote for this motion tonight.

:09:05.:09:13.

Matt Lund deputies beaker, I am pleased to follow the honourable

:09:14.:09:20.

lady, and be able to close this debate. I would like to thank all 34

:09:21.:09:24.

honourable members for their contributions, some of which mostly

:09:25.:09:29.

on this side of the House have managed to rise above party politics

:09:30.:09:33.

and make some constructive comments. I would like to start by joining my

:09:34.:09:39.

right honourable friend the Secretary of State by thinking the

:09:40.:09:44.

2.7 million staff working in our NHS and social care system. As the prime

:09:45.:09:50.

Minster said earlier, we recognise they have never worked harder to

:09:51.:09:57.

keep patients safe with a A working hard to see patients.

:09:58.:10:03.

Regrettably through 5.5 hours of debate and criticism from the

:10:04.:10:08.

benches opposite, we have heard little if anyway of providing

:10:09.:10:15.

solutions to the challenges which we acknowledge our A face. The

:10:16.:10:19.

opposition have again touted more funding as their only answer to

:10:20.:10:24.

solve public sector challenges. In fact, the party opposite has

:10:25.:10:29.

repeatedly pledged raising corporation tax eight times,

:10:30.:10:32.

promising an unspecified amount from an unspecified source, this will not

:10:33.:10:36.

help our NHS, and it will not fool the public.

:10:37.:10:41.

There is a lot to do to protect the system and ensure a sustainable

:10:42.:10:45.

future. What it is this government which has plans in place to get

:10:46.:10:48.

through this extremely challenging period, and sustain the NHS for the

:10:49.:10:55.

future. The shadow Secretary of State, the Member for Leicester

:10:56.:11:00.

South, spoke for close to around three quarters of an hour without

:11:01.:11:03.

making a single suggestion of what could be done to solve the problem

:11:04.:11:09.

that are facing the NHS. Not one. He should have stayed to listen, he may

:11:10.:11:12.

have done, and I apologise if I didn't pay enough attention to his

:11:13.:11:19.

presence, but the Member for Doncaster Central that asked

:11:20.:11:23.

specifically for community pharmacists to be paid for providing

:11:24.:11:27.

minor ailment services, and I'm pleased to be able to tell the right

:11:28.:11:30.

honourable lady that that is exactly what we are doing, and my honourable

:11:31.:11:34.

friend the Minister for community health was discussing this only this

:11:35.:11:38.

morning in Westminster Hall, and I regret to say not a single Labour

:11:39.:11:42.

member was present to hear what he had to say.

:11:43.:11:48.

Surely the House wants to hear the Minister after this long debate.

:11:49.:11:57.

With courtesy, Minister. Thank you Madam Deputy Speaker. We

:11:58.:12:01.

have heard a number of comments from opposition members, and I am pleased

:12:02.:12:04.

to say they were outnumbered in this debate by members of the government

:12:05.:12:11.

backbenchers. Rehearsing tired phrases to mislead the public over

:12:12.:12:13.

alleged increasing independent provision within the health service.

:12:14.:12:20.

And also, misrepresenting what my right honourable friend the

:12:21.:12:22.

Secretary of State was saying in his remarks about A targets, but I

:12:23.:12:29.

would, having said that, like to pay tribute as the honourable lady did

:12:30.:12:35.

to the honourable gentleman from Chesterfield, who I can't see in his

:12:36.:12:39.

place, but he is, and the honourable lady for Workington, who both showed

:12:40.:12:45.

considerable personal courage in explaining the circumstances around

:12:46.:12:49.

the deaths of each of their fathers, and I think they did so in an

:12:50.:12:53.

entirely honourable and sensible way. I am grateful to them for

:12:54.:12:57.

sharing that. I would also like to congratulate my honourable friend,

:12:58.:13:02.

the Member for Faversham and Mid Kent, for managing to get her son

:13:03.:13:06.

into hospital to have his appendix treated on Boxing Day. Clearly, as

:13:07.:13:10.

she said, that service was working well.

:13:11.:13:15.

The opposition sought to adopt a posture of moral high ground in this

:13:16.:13:19.

debate, and I have to say that the honourable lady for Dewsbury, who

:13:20.:13:24.

challenged members on this side as to whether they had visited

:13:25.:13:27.

hospitals over the Christmas period other than on official visits, and

:13:28.:13:32.

it was completely punctured by the honourable Member for Lewes, who

:13:33.:13:34.

pointed out she was doing a night shift between business and New Year

:13:35.:13:39.

in her role as a nurse, not on an official visit.

:13:40.:13:42.

We have had some impressive contributions, and I would like to

:13:43.:13:48.

thank the chairman of the select committee, who was supportive of a

:13:49.:13:55.

new nuanced target for A, and for her calm and generally constructive

:13:56.:14:00.

comments. And my right honourable friend, the Member for Chelmsford,

:14:01.:14:03.

for his support for the success of regime in Essex, and pointing out

:14:04.:14:09.

that it is not closing any of the three A departments in the

:14:10.:14:14.

hospitals there. Also, my honourable friend, the Member for Crawley, who

:14:15.:14:17.

made a thoughtful speech welcoming the opening of an assessment unit in

:14:18.:14:21.

Crawley to believe pressure on the unis nearby. -- A

:14:22.:14:35.

Of course, we do recognise on this side, and in government, that our

:14:36.:14:40.

NHS faces pressures, both the immediate pressures of the colder

:14:41.:14:43.

weather and the wider pressures of an ageing and growing population.

:14:44.:14:47.

There were nearly 9 million more visits last year to our A when

:14:48.:14:56.

compared to the year before the four hour commitment was made. More than

:14:57.:15:10.

2 million a A compared, I won't give way, the

:15:11.:15:13.

honourable lady didn't give way, I have a short time. When compared to

:15:14.:15:18.

when the party came into office in May, 2010, in 2015-16, there were

:15:19.:15:26.

2.4 million more A attendances, and this is in the context of a much

:15:27.:15:34.

busier NHS overall. The NHS is delivering 5.9 million more

:15:35.:15:39.

diagnostic tests, 822,000 more people seen by a specialist for

:15:40.:15:43.

suspected cancer, and 49,000 more patients starting treatment for

:15:44.:15:48.

cancer every year, compared to the year before we came into office also

:15:49.:15:51.

it is therefore the case that a government of any colour would be

:15:52.:15:54.

faced by the same problems, but it is this government that is committed

:15:55.:15:58.

to funding the NHS's plan for a sustainable future. Had we followed

:15:59.:16:08.

Labour's and, the NHS would have 1.3 billion a year less, equivalent of

:16:09.:16:12.

13,000 fewer doctors or 30,000 fewer nurses. We remain committed to the

:16:13.:16:19.

vital for our accident and emergency promise for those patients who need

:16:20.:16:23.

to be there. We're proud to be the only country in the world to commit

:16:24.:16:28.

to all patients that we will sort out any urgent health need within

:16:29.:16:34.

four hours, only three other countries, New Zealand, Australia,

:16:35.:16:37.

and Canada, have similar national standards, but none of these are as

:16:38.:16:44.

stringent as ours. Today, it is the Conservative Party

:16:45.:16:50.

that is the party of the NHS. This is why we pledged more than

:16:51.:16:57.

Labour did, and why we are delivering more funding with a

:16:58.:16:59.

higher proportion of total government spending going into

:17:00.:17:05.

health in each year since 2010. Funding for the NHS will rise in

:17:06.:17:11.

real terms by ?10 billion by 2020-21, compared to 2014-15, front

:17:12.:17:16.

loaded with ?6 billion delivered by the end of this year as the NHS

:17:17.:17:21.

asked for. It was this government that

:17:22.:17:25.

established an independent NHS with an independent chief executive. It

:17:26.:17:29.

was this NHS which came up with its own plan, and we were the only party

:17:30.:17:35.

to back it. Madam Deputy 's Beagle, we agree

:17:36.:17:39.

that the NHS and social care are facing huge pressures, and there is

:17:40.:17:44.

more for us as a government to do, but I can say to the House -- Madam

:17:45.:17:49.

Deputy Speaker, we enter winter with a more comment of planned than ever

:17:50.:17:52.

before. We have confidence the plans are in place to cope with both the

:17:53.:17:59.

current pressures we face, winter, A, and delayed discharges, and

:18:00.:18:01.

also to sustain the future of the system. I would like to conclude by

:18:02.:18:08.

saying a huge thank you to the 1.3 million staff in the NHS, and the

:18:09.:18:13.

1.4 million people who provide social care. They are the ones who

:18:14.:18:17.

continue to make this possible. We are aware of the pressures they are

:18:18.:18:21.

under, especially during winter. We have increased the number of doctors

:18:22.:18:25.

and nurses as my right honourable friend the Secretary of State said

:18:26.:18:30.

earlier, especially in A We have launched plans to recruit more, both

:18:31.:18:33.

doctors and nurses. Without them we would not have a national health

:18:34.:18:37.

service that provides such a high level of care.

:18:38.:18:46.

Opinions say iMac. On the contrary, no.

:18:47.:18:55.

The ayes have it. The question is that the original words stand part

:18:56.:19:06.

of the question, as many of that opinions say aye. On the contrary,

:19:07.:19:08.

no. Clear the lobby! Order. The question is that the

:19:09.:20:29.

original word standard part of the question.

:20:30.:20:32.

Tellers for the noes, Christopher Pincher at.

:20:33.:31:45.

The ayes to the right, 209. The noes to the left, 295. Their eyes to the

:31:46.:32:16.

date, 209. The noes to the left, 295. Then nose have it. Then nose

:32:17.:32:29.

habits. The question is that the proposed words be added. Those of

:32:30.:32:36.

that opinion they ayes. On the contrary, no. I think their eyes

:32:37.:32:43.

have it. The question as amended to be agreed.

:32:44.:32:52.

We now come to point of order, Margaret Greenwood. If people wish

:32:53.:33:03.

to have a conversation, they should go somewhere else. The honourable

:33:04.:33:09.

lady is making a point of order. Thank you. The Minister told a House

:33:10.:33:16.

there were no Labour backbenchers, in actual fact he has inadvertently

:33:17.:33:20.

misled the House because I spoke in the debate and was a member that

:33:21.:33:27.

lack and the Member for Google spoke in the debate. I just wanted to set

:33:28.:33:32.

the record straight. I understand her point of order. I understand why

:33:33.:33:39.

she wishes to make the point. It looks as if the Minister would like

:33:40.:33:42.

to say something to that point of order. I am very grateful for

:33:43.:33:50.

complete clarity with their eyes. There were two members present in

:33:51.:33:55.

interventions but made no speeches interventions but made no speeches

:33:56.:33:59.

or substantial contributions from Labour members present. I am sure

:34:00.:34:05.

the House are thankful to the Minister or clarifying what he said

:34:06.:34:09.

in his speech and to the honourable lady for clarifying higher position.

:34:10.:34:17.

The matter is now closed. -- her position. We come to motion number

:34:18.:34:20.

three on local government. The division is deferred until

:34:21.:34:39.

Wednesday next. We come to motion number four on local government

:34:40.:34:44.

Minister to move. The question is as the order paper, many of that

:34:45.:34:50.

opinion say aye. The contrary, no. The ayes have it. The ayes have it.

:34:51.:35:02.

Petition, Mary Craig. Thank you very much. Rise to make a petition 2000

:35:03.:35:07.

residents of Wakefield on the future of the health centre in my

:35:08.:35:14.

constituency, whose GP service is at threat of being withdrawn, a very

:35:15.:35:20.

important issue for my constituents. I urge the government and Wakefield

:35:21.:35:24.

clinical commissioning group to take all necessary steps to ensure King

:35:25.:35:30.

Street health centre remains open and has current contracts for GP led

:35:31.:35:34.

services extended to allow Wakefield residents continued access to health

:35:35.:35:35.

care. Petition, the future of King Street

:35:36.:36:01.

Health Centre, Wakefield. Petition. My petition comes from

:36:02.:36:12.

dozens of residents in Salford. The humble petition of the residents

:36:13.:36:18.

of Salford showing that they would prefer the inhabitants of some boats

:36:19.:36:22.

moored on the River Avon to refrain from staying for long periods of

:36:23.:36:26.

time. Your petitioners pray that your honourable house ask Her

:36:27.:36:30.

Majesty 's government to consider the opinions of local residents and

:36:31.:36:34.

boat owners in this. Petition, boat moorings on the River

:36:35.:37:01.

Avon. I beg to move this House to an

:37:02.:37:05.

allergen. The question is that this House do now adjourned.

:37:06.:37:10.

Thank you, Madam Deputy Speaker. In the previous parliament, we took

:37:11.:37:19.

action to empower local doctors, surgeons and clinicians to look at

:37:20.:37:24.

how hospital services were going to be provided, to think about the

:37:25.:37:34.

optimum weight to provide these services and ever-changing

:37:35.:37:35.

circumstances, namely demographics, and other changes that are taking

:37:36.:37:42.

place in our society. That was the right step to take, rather than

:37:43.:37:46.

promote civil servants in Whitehall making these decisions, we wanted to

:37:47.:37:51.

make sure that the people at the coal face of providing these

:37:52.:37:56.

services, people who were providing services to our constituents, people

:37:57.:38:00.

with medical expertise, people who have dedicated their lives to

:38:01.:38:02.

improving the care and safety of others that they were empowered to

:38:03.:38:09.

make these decisions. I stand by that decision that we took, and I

:38:10.:38:13.

want to tell the Minister this evening some of the practical

:38:14.:38:17.

problems that have ensued in Shropshire as a result of that

:38:18.:38:23.

devolution of power. I want to raise it with the

:38:24.:38:27.

Minister, because I believe in this process, and I want to ensure that

:38:28.:38:32.

it is retained and protected for future programmes in the future. In

:38:33.:38:36.

Shropshire, we have two orbitals, one in Shrewsbury, one in Telford.

:38:37.:38:43.

-- two hospitals. They look after all the people throughout the whole

:38:44.:38:47.

of Shropshire and mid Wales. I'm not going to go into all of the

:38:48.:38:52.

specifics with the Minister here this evening, because as he will

:38:53.:38:59.

know, I and the other Shropshire MPs have briefed him repeatedly over the

:39:00.:39:02.

last few days, weeks and months about this process. I would like,

:39:03.:39:08.

however, Madam Deputy Speaker, to thank, with genuine heart-throb way,

:39:09.:39:20.

the health workers in Shropshire... Have been able to dedicate

:39:21.:39:36.

themselves and to persevere despite many problems and obstacles in their

:39:37.:39:40.

way in coming up with these proposals for a reconfiguration of

:39:41.:39:48.

A services in Shropshire and mid Wales. A decision has been achieved

:39:49.:39:54.

after three years, and ?3 million of taxpayers money being spent on this

:39:55.:39:59.

process, a decision was achieved. And that decision was going to go to

:40:00.:40:04.

public consultation. Unfortunately, it has been blocked by Telford CCG

:40:05.:40:13.

and Telford Council. Telford CCG have been part of this process from

:40:14.:40:18.

its inception, and they were consulted throughout, but at the

:40:19.:40:23.

11th hour when the decision did not go the way they thought it would,

:40:24.:40:27.

all the way that they wanted it to do, they decided to a man to vote

:40:28.:40:34.

against the proposals. Although they were party to the whole methodology

:40:35.:40:41.

and process. In addition to Telford CCG voting against these changes,

:40:42.:40:46.

Telford Council, an esteemed body no doubt, but a body with I would argue

:40:47.:40:52.

limited medical experience, has decided to threaten the programme

:40:53.:41:01.

with a judicial review, if they dare allow the public to have this final

:41:02.:41:06.

public consultation. Of course, in a democracy, Telford

:41:07.:41:11.

Council has the right to challenge things. Of course, in a democracy,

:41:12.:41:15.

Telford Council may even have the right to use taxpayer money to

:41:16.:41:20.

instigate a judicial review come about what the Minister must

:41:21.:41:27.

remember and retain from our own experience is these two parties were

:41:28.:41:32.

part and parcel of the whole process from its inception. And I have a

:41:33.:41:37.

real and genuine concern going forward about the integrity of this

:41:38.:41:43.

process if we do not back the local clinicians and doctors. I give way

:41:44.:41:49.

to my hard-working neighbour from Telford.

:41:50.:41:51.

I think the honourable gentleman for bringing forward this debate, and I

:41:52.:41:54.

have to say that I have tried also to get a similar it entitled debate.

:41:55.:42:00.

Will he agree with me that the Telford clinicians have an absolute

:42:01.:42:03.

right to express their views just the same way as the Shropshire

:42:04.:42:06.

clinicians do, and the fact they did not come up with the same view is no

:42:07.:42:11.

indication that the Shropshire clinicians came to the wrong view?

:42:12.:42:16.

As I alluded in my earlier speech, of course they have the right to do

:42:17.:42:20.

so, and may I take this opportunity of acknowledging the work that my

:42:21.:42:24.

honourable friend has done since she became a member of Parliament to

:42:25.:42:31.

campaign for Telford, and also to campaign very strongly and

:42:32.:42:35.

effectively on this issue, but without being overtly political, and

:42:36.:42:39.

without adversely personalising this like some other people have done so.

:42:40.:42:44.

And I will come onto talking about the CCG a little bit later. My

:42:45.:42:50.

concern, I have to say, is, and I will reiterate this, we all put our

:42:51.:42:53.

cards on the table. We all went along with this process. This

:42:54.:42:59.

decision could have gone against Shrewsbury. Ultimately, they have

:43:00.:43:02.

decided that they want to have an urgent care centre in Telford, and

:43:03.:43:08.

they want the main A service to be provided by Shrewsbury. It could

:43:09.:43:12.

have gone the other way. That could have been for Telford. We would have

:43:13.:43:17.

lost out. But at the end of the day, it shouldn't be about winning or

:43:18.:43:20.

losing, and this is the biggest problem. My honourable friend from

:43:21.:43:24.

North Shropshire has talked about the pillow fight that has existed

:43:25.:43:27.

between Shrewsbury and Telford ever since he became an MP. Certainly,

:43:28.:43:33.

over the last 11 years, I have lost more sleepless nights over it than

:43:34.:43:37.

anything else, the constant fighting between Shrewsbury and Telford over

:43:38.:43:41.

hospital services. At the end of the day, we are one county, we are one

:43:42.:43:45.

county, and we must fight collectively as one county for all

:43:46.:43:51.

of the people of Shropshire. And of course, our friends from across the

:43:52.:43:54.

board in Wales, I give way to my honourable friend.

:43:55.:44:00.

I congratulate you for this debate. He is absolutely right. The

:44:01.:44:04.

bickering between trees breathe and Telford has opened my nearly 20

:44:05.:44:13.

years in Parliament. I thoroughly back FutureFit. We will get a ?300

:44:14.:44:22.

million emergency care centre for my rule areas, but we will also gain

:44:23.:44:30.

with care centres Imrul areas. What is utterly is spreading is the

:44:31.:44:39.

indecision we have had. -- rural. I very much hope the end of this

:44:40.:44:45.

debate will give us a clear recommendation for a decisive

:44:46.:44:47.

mechanism to deliver the will of the local commissions.

:44:48.:44:52.

I couldn't agree with my right honourable friend more. I would like

:44:53.:44:54.

to pay tribute to him in the work that he has done on this over the

:44:55.:45:01.

last few years. In order to continue, I would like the Minister

:45:02.:45:06.

to intervene to ensure that the process allows for a decision. In

:45:07.:45:13.

our case, what happened is that all the members of the Shropshire CCG,

:45:14.:45:19.

six numbers of the Shropshire CCG, voted for the proposals. All the

:45:20.:45:23.

members in Telford voted against. It was

:45:24.:45:35.

The local two CCGs cannot come to an agreement, so I would like to hear

:45:36.:45:56.

from him on that. I would like to appeal to constituents from the

:45:57.:46:00.

whole of Shropshire and mid Wales to lobby Telford Council and others.

:46:01.:46:06.

Let's start to get behind, as my right honourable friend said, let's

:46:07.:46:09.

start to get behind the concept of all of us working together to lobby

:46:10.:46:15.

the government more effectively for more resources, rather than fighting

:46:16.:46:21.

one another in a rather parochial way as to where these services are

:46:22.:46:26.

going to be. Let's not forget how close these hospitals are to one

:46:27.:46:30.

another. We're not talking about 50 miles, we're not talking about 30

:46:31.:46:36.

miles or 20 miles, somebody may correct me if I'm wrong, but I think

:46:37.:46:42.

they are only 13 miles apart. 13 miles apart, these two hospitals. We

:46:43.:46:47.

ought to think about how to improve and modernise the provision of

:46:48.:46:51.

health care for all of the people of Shropshire and mid Wales going

:46:52.:46:55.

forward. And listening to the proposals of these medical experts

:46:56.:47:00.

who have done so much work to put these proposals forward. I give way

:47:01.:47:06.

very quickly. A quick point, and I thank our

:47:07.:47:09.

honourable friend for bringing this debate forward. I represent

:47:10.:47:22.

constituents in Powys in Wales, who are without a General Hospital,

:47:23.:47:24.

relying heavily on Telford and Shropshire. Shropshire is at the top

:47:25.:47:42.

end of my constituency. I urge consideration for my constituents.

:47:43.:47:45.

I thank my honourable friend for that intervention. He is absolutely

:47:46.:47:48.

right. My honourable friend from just a cross the border, we almost

:47:49.:47:59.

think of him as a solo paean, almost. Not quite. He does so much

:48:00.:48:05.

to represent his constituents in Wales, and by the way, have two

:48:06.:48:09.

already travel rather long distances to get to the Royal Shrewsbury

:48:10.:48:12.

Hospital. My honourable friend may correct me if I'm wrong, but I think

:48:13.:48:16.

some of his constituents from the extreme west of his constituency

:48:17.:48:26.

already take over an hour to get to A services in Shrewsbury. Some are

:48:27.:48:32.

even further away from Shrewsbury would be an acceptable for his

:48:33.:48:36.

constituents. I give way very briefly for the last time.

:48:37.:48:41.

I come from a peripheral position, but to congratulate the member onto

:48:42.:48:46.

Cubist Dabiq. The importance of getting this right has an impact

:48:47.:48:50.

further west. If the issue is resolved, it would impact on my

:48:51.:48:57.

District Hospital in Aberystwyth. It is important this issue is

:48:58.:48:59.

addressed. I completely concur with the

:49:00.:49:01.

honourable gentleman. I am grateful for his intervention. I would like

:49:02.:49:06.

to end because I want to give as much time as possible for the

:49:07.:49:09.

Minister to answer these questions by saying, let's not forget that if

:49:10.:49:17.

we get this right this could potentially result in an investment

:49:18.:49:23.

of ?300 million into the NHS and Shropshire. I don't know about my

:49:24.:49:28.

colleagues, I know my honourable friend from North Shropshire has

:49:29.:49:32.

been an above Parliament longer than I, but I certainly don't remember a

:49:33.:49:36.

time in my 11 years as a member of Parliament where we have had such an

:49:37.:49:42.

investment in the local NHS. If we get this right, we could see an

:49:43.:49:47.

investment of ?300 million in Shropshire in order to implement

:49:48.:49:54.

these changes. There is more work to be done in terms of securing this

:49:55.:49:57.

money. More work will have to be done in innovative ways, both

:49:58.:50:01.

locally and nationally to secure all of the funding, but if we don't sort

:50:02.:50:07.

ourselves out, we are going to be further hind. Other areas in the

:50:08.:50:16.

United Kingdom, who are going through this process -- behind, in a

:50:17.:50:22.

more cordial and mutually effective way of going to jump the queue.

:50:23.:50:27.

Shropshire will be left right at the end. That's something I am not heard

:50:28.:50:33.

to see happen. Finally, Madam Deputy Speaker. Telford Council would have

:50:34.:50:39.

you believe, obviously, that as part of this programme, clearly, women

:50:40.:50:43.

and children services have to be moved from Telford to Shrewsbury,

:50:44.:50:52.

because the main A will have to have women and children services

:50:53.:50:57.

next to the main A provider at the Royal Shrewsbury Hospital. They say,

:50:58.:51:03.

and this is an important point, because the services were moved from

:51:04.:51:06.

Shrewsbury to Telford a few years ago, such a move would lead to the

:51:07.:51:12.

waist of ?28 million, and they repeatedly talk about that through

:51:13.:51:16.

the local media. No, no, no. It is not a waste. The building will be

:51:17.:51:23.

used for other purposes, and all of the equipment already in that

:51:24.:51:28.

building, which is easily moved will be moved to the Royal Shrewsbury

:51:29.:51:33.

Hospital. So I refused any proposals that there has been a waste of the

:51:34.:51:38.

?28 million because of the changes that will take place. I give way,

:51:39.:51:42.

finally, to my honourable friend. Subtitles will resume on

:51:43.:54:17.

'Wednesday In Parliament' at 2300.

:54:18.:55:37.

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