27/02/2017 House of Commons

health. I beg to move. The question is, as on the order paper. I call

the children of the health select committee. Thank you. Today's debate

on the supplementary Estimates and the financial position of health and

social care matters first and foremost because of the impact of

that financial position on patient care. I would like to start by

playing tribute to our health and care staff across the country and at

this particular time to note and thank those have who work in this

country from across the EU. The financial position is a great

concern. As a result of the wider academic downturn we're now in a 70

of the longest financial squeeze in the history of the NHS. Although the

Department of Health budget has of course been protected in relation to

many others, we cannot escape from the fact that over the last

parliament the average annual increase was 1.1%, far lower than

the increase in demand, and of course far lower than the historic

increase since the late 1970s of 3.8%. All of that is also in the

context of an extremely challenging position for social care. What we've

seen is a 10% real terms reduction in social care spending by local

authorities between 2009 to ten and 2014 to 15. All of this in the face

of an extraordinary increase in demand. Not only from a rising

population but because of our changing demographics. Just to put

this in context, over the decade 2015, there was a 31% increase in

people living to 85 and beyond. We estimate of the next 20 years we

will see a 60% increase in the number of individuals who rely on

social care. There has been an abject failure of governments over

the years to plan for this. This was entirely predictable. But we

absolutely can't keep ducking this question. Not only do we need to

address the immediate financial problems they've think health and

social care, we absolutely have to come together as a house to address

the problems for the future. Of course. I am grateful for you giving

way. It is not a uniquely British problem but also a global problem.

One of the things I've been trying to find out is where best is social

care delivered in the rest of the world and can we learn anything from

those countries. My honourable friend makes a very important point.

We are all looking forward to the publication of the House of Lords

report on the future sustainability because of course we have much to

learn from other systems. However, I would say, in welcoming that point

but also paid tribute to the Public Accounts Committee which publishes

today their report on the financial sustainability of NHS. We have also

seen the final position of trust is at the end of the last quarter, and

we know that 135 providers ended that quarter in deficit. We are on

course, just finish this then give way, we are on course for a

financial deficit of between ?750 million and 850 million in trusts. I

give way. I'm grateful forgiving way. In terms of the seriousness of

what we're talking about, she will know that over the past five we had

a down weight trend of falling death rates. New research shows that after

2011 that reverses and more people died in 2015 and 2014. With these

tests are coring in the context of a massive disinvestment in health and

social care, would you agree these cuts are likely to have been

implicated in that otherwise unprecedented rate in deaths? I have

seen the study to which you refer and I think it is something the

Department of Health needs to look at carefully. I give way to the

honourable gentleman. If you look at it in general terms, for example,

you have a situation where you have bed walking, the local authority

cannot deal with that because it does not have the order authorities.

If you look at worst to the National horrors of the whole have to find

cuts of 250 billion and creates an insoluble problem if we are not

careful. Thank you viewpoint. I think we should use the term delayed

discharges rather than bed blocking, because that term can leave older

people in that position feeling somehow as if they are to blame. But

I take the point that he is seeking to make. The estimates memorandum

before us today seeks a ?1.2 billion transfer to trap pop-up revenue from

the capital departmental expenditure limit. It also seeks a 23 million

transfer from domestic's Treasury reserve and ?58.5 million transfer

from other Government departments and ?6 million transfer to the

capital from other departments. I'm afraid again we are seeing an

unsustainable position here. That has been pointed out by the

controller general. I am following closely as ever, wise remarks. Does

she share my concern that if we are transferring money from capital to

revenue it means the sustainability and transformation plans, most of

which imply a certain level of capital investment to save revenue

long-term, will not be possible? I absolutely agree with my honourable

friend and I myself will be drawing on that later on. The point about

the rates to capital budgets over the years is that this is the third

year in which this has happened, that we have seen transfers from

capital to resource budgets, -- revenue budgets, we're talking about

keeping facilities up-to-date, essential repairs, rolling out new

technologies and putting off those and investments actually means they

cost more down the line. This is a false economy and simply an

unsustainable ongoing mechanism. I know the Department of Health has

indicated they would like see an end to this by 2020, but both the Public

Accounts Committee and the health committee have called on this to

stop immediately because we feel this is a false economy. As my

honourable friends pointed out, it is not only grades to capital

budgets but raids to across the sustainability and trust translation

fund. What we're seeing increasingly is that becoming all about propping

up the sustainability rather than putting in place essential

transformation. I give way. Thank you. She is making some excellent

points. In west Yorkshire the sustainability and transmission plan

plans to take about ?1.1 billion out of our health system over the next

four years. ?700 million from the NHS and ?400 million from social

care services. As a result, centres like Hill Street health centre are

set to close putting more pressure on overpriced accident and emergency

departments. Does she agree with me that this type of pressure coming in

and forcing even more pressure is on AMD departments gives the word

sustainability and transformation a bad name? I agree with the

honourable lady, absolutely. It is undermining public confidence in

sustainability and transformation. I will come to that in more detail

later. The financial position is starting to create a perfect storm

of delayed discharges, rising waiting times in accident and

emergency, rising so-called trolley waits the patients as they are

waiting to be transferred to the wards, and that has quite serious

implications for their safety within those departments. Unsustainable

levels of bed occupancy. We are increasingly hearing stories of not

only routine surgery but being cancelled but also of urgent surgery

and very worryingly to cases of urgent dialogical procedures

actually not taking place, and that resulting in the deaths of two

patients. This is extremely serious. I give way. Does she also agree that

when we look at to beating my via councils on the formulaic, we can't

just look at deprivation which tends to be highly weighted and is

important, in a more affluent area we have the problem of people living

longer and there being more demand for service because of that? My

friend makes an important point. It's not just about the overall

budget but also about distribution. And yes across this house we would

all agree that deprivation must be properly weighted. He is right that

one of the key drivers is actually the age and the need for services,

and it probably isn't adequately reflected in the way resources are

distributed. As I say, there is undoubted evidence of the impact on

the financial position now on patient care, and unfortunately, as

we see this whorl of hospitals having to cancel routine procedures,

that has a further impact on their ability to meet their financial

targets because of the reduction in cat in income. I hope ministers will

look at this not only as a short-term issue but all more

importantly to take a look at how we are going to sustainably farmed this

in the future. And also not also just to look at health and social

care in their separate silos, but to see them as a single system and

genuinely to look at how we are going to look at how we're going to

take this forward. I'm afraid if we don't address this problem we need

to be honest with our constituents about the consequences. People talk

about a collapse in the NHS, I don't believe that will happen. But what

we will see is a continuing deterioration in performance, with a

real impact on the quality of care, and putting lives at risk. And the

safety the Department of Health has proved prioritised is increasingly

in danger of slipping. It is essential to our patients. A number

of members have commented on sustainability and transmission

plans. In principle I think these are extremely important. Not only as

a way of acting as a road back for the five-year forward view, but as

asked being able to return to a much more logical way of planning for

integrated health and care, getting away from endless contracting rounds

to genuine planning. But Ford has undermined this is

inadequate planning. And crucially, inadequate funding. If we do not

have adequate funding for the transformation of services, we will

see these plans feel. They are being seen as a vehicle for cups, rather

than a vehicle for what they should be seen as. We have a genuine

opportunity to see this as a transformative process, but they are

being undermined by a number of critical points. Would my honourable

friend agree that what is missing is the bit that enables us to get the

money to move to the new system. There is no money for the

transition. I agree. She will know that we have seen not only cuts and

the closure of much loved community hospitals, but not only the loss of

these beds, but the local trust wanting to cut 32 acute beds at a

time when the occupancy is already running up to 94%. Communities can

genuinely see the changing this undermines this. They are planning

for port 40 man, rather than actual demand. I thank the honourable lady

for her point. I thank her to for her listening to me when I have

brought forward problems and talked me through the options. We need to

enable people to fully engage and have trust in the trusts involved.

She is right. It is not just the evidence available to others. It is

the evidence available to the communities and the idea that

consultation is a genuine process. We know, time and again, we have

reports which demonstrate that co-producing new services results in

much better service in the long run. It is not only the cups to trusts

themselves, but to CCGs. They are being asked to hold back ?800

million of the budget to offset deficits in trusts. This is about

patient care being cut back. We have seen cuts to NHS England and to

education in England. To have the idea that we have health services on

a sustainable footing is simply not true. I asked ministers to look at

this transformation and ask the Chancellor in the forthcoming budget

to address this urgently and give a lifeline to social care. As well as

announcing that lifeline, of which I hope he will give the better tear

fund more money, care cash fund, but I hope we will have a review of

sustainable future funding for health and social care. Rather than

as having this normal Contra confrontational debate, we want this

to all work together for the benefit of our constituents to have a

sustainable future for the NHS in social Kier. Care --. Could I pay

tribute to the cheer of the health committee for her work. If the

committees are united in our view that we need a new agenda for health

and social care and that it is at the forefront of government

thinking. It is unusual for three committees to agree so much. We are

clear that integration of health and social care is necessary. We were

looking at the first phase of the Better Care Fund. The head of the

NHS England said that there was no feel you're in the Better Care Fund.

If that does not undermine the challenges that we have with the

sustainability of on-board funding, I do not know what does. We do need

a long-term generational shift in how we deal with this. We cannot

just watch from crisis to crisis. The current funding situation cannot

go on. We looked very closely at the accounts. We lap up the accounts of

different government departments. We were disappointed that the NHS

accounts, we realised that they were within target only by a smoke and

mirrors approach and short one-off measures to make sure the balanced.

The Public Accounts Committee, of which he is a former member, the

Dave the department the yellow card. The put them on warning. They said

that this similar one-off measures would not be accepted and they would

receive a red card. The issued an unprecedented warning in these

accounts audited by the committee, laying out serious concerns. He

talked to the permanent secretary at the Department of Health to view has

concerns about these one-off measures. We would like to know how

it was by some miracle the department managed to get the books

to balance last year. First of all, there was ?2.14 billion set aside

for sustainable transformation. ?1.8 billion was used for hospital trust

deficits. The Department of Health did not notify the Treasury of an

additional ?417 million of national insurance receipts they had got.

They said it was a one-off reporting error. It does not rear car, I am

heartened to see. There was a one-off super dividend of ?100

million to the medical products agency, which the Department warns.

This helped it reach the final balance. The critical thing which is

becoming a long-term strategy, it appears, and I hope the Minister

will take this seriously and respond, we are seeing a trend of

capital funding pushed into revenue and the system capable in that way.

That is not sustainable. The Department of Health transferred

?915 million of capital. It shows the department will transfer about

?1.2 million of capital this year. More than ?250 million more than

last year. I will give way. I am interested in the PFI element of

capital funding. As our committee had a chance to look at that? We

have not directly, but we do know that the biggest revenue cost for a

hospital are stuffing. Then, it is financing a PFI deal. From

conversation I have had with auditors, the refinancing of these

deals can actually swamp the cost of potential savings. It is something

maybe ministers could go we look at further. There has been a lot of

technical work on this. If it could be spread out over a longer period

of time, for instance, that would reduce the day-to-day resource costs

for hospitals. The work I have done outside the committee rooms was

outside the remit of the committee. As the honourable gentleman said, if

we are looking at the transformation of the NHS, the sort of capital

expenditures are important to save money in the long. That could be

very short-sighted. If we look at how the trusts are managing in terms

of deficit, we see a trend. At the beginning of this financial year,

NHS England committed to us that they would produce a deficit not

exceeding ?580 million at the end of next month. It is now forecasting a

deficit of ?604 million. It is declining further to a deficit of

over ?800 million. That pledge does not amount to very much and it is

moving very much in the wrong direction. Through this financial

year, trusts have been overspending by about ?300 million per quarter.

If this continues, the overspend will be close to ?1.2 billion. Billy

is startling, the reality of the Department of Hill 's consolidated

course. I am picking a certain elements. We hear a lot of

discussion about how much money the government is putting into the NHS.

We had a committee hearing on January the love and support. On

that day there were anonymous briefings in the national press,

criticising himself and NHS England and defending himself and his

position in the committee. People do not want anonymous briefings. They

do not want to see an argument about the money. They want to know that

the people who are running the health service and those overseeing

it are actually committing to long-term patient care and the

long-term challenges of the future. Protecting the NHS England budget is

not the same as protecting the health budget. Health education is

being squeezed, as is NHS England. Funding has gone down 10% in the

last Parliament. This idea that tax precepts will make everything fine,

it is all money which could have gone somewhere else. It does not

solve this in the long-term. If we do not tackle this together, we will

have an unsustainable future. The is too much shifting money in the

budget from one place to another. It is not transparent to most people.

Very big numbers. I will give way. A very thoughtful speech. I want to

raise one point which is an issue not very often talked about, the

rise in physical attacks on staff within the NHS and the recognition

that protection in the budget deals with a lot of security issues. A lot

of those perpetrating those attacks are people with mental health

issues. We need to have the resources to deal with this.

Otherwise, it could be a situation which gets worse. It is important

that we protect staff. In the end, staff cost more than anything in the

NHS, but it is them who provide that care. I will touch on workforce

planning in a moment. I will give way for no. Some of those people who

have mental health problems, the Arab going to the A departments

and their views and problems are not being listened to. I get a lot of

that. And this a long-term system. In that

the support is the to stop the book going to any in the first place. I

will give way. Thank you for giving way. And thank you for the excellent

speech you are giving. I am really disturbed also when I hear from

Government about more money being put into mental health when just

received figures around Vale of York funding which will be cut, in a city

which has reeled challenges around mental health we are seeing the

budget drop, showing that services themselves are not catching up with

what the Government is insisting is trickling down into the system. The

honourable lady raises one of the real, puts a face on the real

challenge that many trusts and Commissioners are facing. They are

having to make choices about where they spend money and despite the

pledges, there is a squeeze on mental health funding. Growing

demand is outstripping the ability of the NHS to supply needs. This is

having a direct impact on patients. We're now seeing longer waiting

times for and I alert colleagues to our hearing on GP services in the

Public Accounts Committee. Any thoughts are welcome. They are

waiting longer to see specialists with the 16 week target being

reached and AMD targets are breached too often. We are seeing a real

challenge and NHS Improvement is a welcome body set up to encourage

best practice, and it is quite right that the NHS looks to perform as

efficiently as possible. But once again we are seeing improvements

mask what look like cuts. A 4% efficiency saving target is once

again being imposed, it was imposed last year by the then Chancellor of

the X. And it was acknowledged as particularly challenging. The

reality was everyone in this situation knew it was too

challenging but it was difficult for people to speak truth to power. We

see this over and over again. The head of NHS improvement was once at

that again acknowledged in our report that the 4% efficiency saving

required as part of the transformation programme are

challenging. We also see a worrying and real correlation between the

financial performance of trusts and their care emission quality rating.

Trusts that achieve lower quality rating had lower financial

performance. They had a net... We know that there is a real issue. I

want to touch on workforce planning before I draw to a close. We hear a

lot about the cost of locums. Very often I worry that in terms of some

of the national debate we end up fixating on smaller issues when we

need to look at the bigger picture. The cost of locums, we often hear

about high rates per hour or day. If someone is being paid several

thousand pounds a day for a shift that seems ludicrous. But the key

issue here is the sheer volume of locums needed. What happens eg is

the trust structures are set to meet the budget sent down to them by the

Department of Health. Tax money but not another. From the beginning they

are not set up well enough to meet demand. In order to meet the needs

of their population they have to buy in locums. This is not long-term

sustainable. We also see challenges in the middle of the last

parliament, a reduction in nursing places, we seen recently the loss of

the nursing bursary and we hope that does not see a writ loss of nurses

in the future. But in my own constituency I know how many women,

people, welcome that ability to better themselves and contribute. We

need figures for hammy people are going into nursing and whether the

people going into it will stay and work in our NHS. In Northumbria

foundation trust my local hospital trust, we have taken to training our

own nurses so that local people who want to germ the profession can.

Knowing they can work in that local trust which has such a great

reputation and is leading the way in terms of financial and medical

changes we need to see. I agree. My own hospital does the same in health

care assistants. The challenge is without that bursary payment, how

many people will it put off. We did clear answer from the Minister about

what analysis was done about the impact on the workforce of that

change. That amount of money is relatively small compared with the

challenges and problems of not being able to provide a health service if

we don't have enough nurses in place it may well be a false economy. I

will give way. I thank you for giving way. The early figures that

have come out from NHS England suggest a 23% Jock drop in

applications, and that is a significant change. The key thing of

course is how that figure comes through the pipeline at how we

filled the gap. It would be helpful while the minister is on his feet at

the end of the debate today, if he could talk about what analysis the

Department of Health has done about the impact of Brexit and any changes

that may herald for our workforce, because a high percentage of fat NHS

workforce are from Europe. We are hearing the right sounds from

Government but yet no action about securing this future of those

European resident citizens who are currently resident in the UK. If he

is able to give us any comfort on that it would be very welcome. I'm

heartened that so many members are here today to discuss this important

issue and also this is another committee we've been working with is

the procedure committee to try to ensure we can discuss the financial

details of estimates in the house rather than just the general

principles. I have obviously strayed into a general principles to but

hopefully basing that in the actual figures. It is an edifying for the

public to have anonymous briefings and public argument. It does not

wash. We need to be on top of this so that we are holding the

Government's feet to the fire and making sure every step of the way

they know we are watching the budget and won't let them get away with

raiding the capital budget to fund the accounts. I will give way one

final time. She is making a very interesting speech. But one of the

things we should make much more use of is pharmacies. Especially in

order to try to take some pressure off the GPs. Secondly, to ask GPs to

go into pharmacies and be located there. He makes a good point. I

visited a local pharmacy a few weeks ago and saw first-hand the work they

do. To help ease pressure from GPs, where people are waiting from

appointments, and her any. I knows minister has taken a keen interest

in pharmacies but nonetheless there is a cut to their base budget. While

we were on that point, that base amount of money allowed pharmacies

to with certainty employment of spa to allow them to do those

appointment with patients. If they are just rely on revenue income they

were not sure if they could maintain the salary and a solid base of

funding was very important in a constituency like mine where, for

all sorts of regions, culturally and linguistically and convenience wise,

people will find their local fireman see more readily than they will find

their GP. The minister has things to answer on that point as well. But

can I say I was heartened when a group of us recently crossed party

met with the Prime Minister. She shoe polish there was a need to look

at the long-term issues around health and social care. She has made

a pledge that her adviser will meet with cross-party MPs to look at

this. I hope this heralds a change of attitude. We will see no more

bickering. We will see a concerted effort to ensure we future proof our

NHS and make sure it is a beacon to the world that we believe it is. It

will be obvious to the house that a great many people wish to speak this

evening. Of course we have plenty of time, but it is limited. If

honourable members take a self-denying ordinance and speak for

no more than nine minutes, then everyone who has indicated they

would like to speak will have an opportunity to do so. I hope not to

have to put on a formal time limit because nine minutes is actually a

very long time. If you can't say it in nine minutes then you have to go

away and practice! I know that no practice is needed here. Let's be

clear. Estimates are a serious business, they must be realistic.

Parliament every year votes on how much can be spent and if access is

needed you have to go back to the house, so getting the estimates

right is critical. The challenge I have with these estimates is that

they are based on assumptions for which I can find very little comfort

for being realistic. We look at what is assumed and as my honourable

friend has said there is an assumption that demand will go down.

As the population increases and as immigration increases, it seems that

is unrealistic. It seems to me that the Government needs to look long

and hard at the assumptions it has made, I for 1am not convinced it has

got it right. We also need to look at what this estimate is assuming in

terms of negatives. It is assuming that we can still keep on course if

we reduce public health spending. If you start reducing that which will

prevent the need for NHS intervention, which is the most

expensive form of intervention, are you really going to save money? It

seems to me you are not. The other assumption that is being made with

these estimates is that central administration will be cut. Given

the complexity of what is going on at the moment with 44 coming on

board we hope because they are in concept a good idea although I have

concerns about delivery, I am concerned that overall these

estimates are not based on realistic assumptions which the Government and

the ministers will need to seriously address. As my honourable friend who

leads the select committee, the Public Accounts Committee, has said,

and indeed my honourable friend for Totnes, you must take into account

when you make these estimates what you need for both health and social

care. Because if you cut health spending on social care or don't

adequately fund it you will increase spending within the NHS.

Underpinning all this is actually having measurements in place across

the whole system as was indicated so that you actually know what the full

scope of the demand is, you measure the results of the resource you put

in our, and what the outcomes are for the population as a whole. We

talk about measures around accident and emergency and the NHS. We talk

about waiting times. We talk about. The targets set are around reducing

waiting times will no one looks at the impact on care, an GPs, on

social care. We need it seems to me to look very carefully if an

estimate is to be right, as a whole system of measurement. I thank her

for giving way. She makes powerful points. Would she agree with me, my

local District Hospital had winter preparing less for a 5% uplift, they

had a 20% increase in demand. I had the exact same thing in social care

whether social care providers are telling me people are older and

earlier. We have increased demand across-the-board because of that. I

thank her for that helpful example. She is writing what you says. So, if

we look at the whole measurement system, it seems to me, and this was

acknowledged in one of the Public Accounts Committee sessions by the

Department of Health, that there is a limited measurement and that there

probably should be more. When I challenged the individual concerned

as to whether the Government would be looking at it he stood from one

foot to the other and could not give much of an answer. It seems to me

the estimates have to be based on proper measurement of need, of what

is actually operationally put into practice, and of the outcome for the

patient, and that is not there. We'll is only to look at the

differences between the NHS and social care in how the money is

allocated. The NHS, we have ring fencing will stop social care, we

don't. But the the two are linked that linked that means that unless

we look at the way each of those pots are managed, no matter how much

is in them, we give rise to problems for the future. Social care by

comparison is not ring fenced and while I'm sure a role great for for

the extra money is, they don't go far enough. The first Chang of money

may cover the living wage and the ability of local authorities to

increase the precept by 3% is welcome. But as my friend the leader

of our select committee said, that is taxpayer money.

Does she shear my concern about the 3% precept? It seems it is going

from general taxation onto property -based tax. It will disadvantage

communities that are worse off. That is a very fair point. He is

absolutely making the rate case. Many of the facilities here to

provide social care graph feeling because there is not an individual

to ensure that some of the care homes are alive and well. I am down

to just three in our constituency that is totally inadequate. We both

have constituencies with a large proportion of elderly people. Is

there not a double whammy because people who are over 85 came to stay

in hospital for longer. We are looking after them well, but need to

look after them better, but the daily in going from hospital to

social care is very costly and I do not think the estimates to take

proper account of that. My honourable friend makes a very good

point. The cost is not adequately taken into account. If you look at

the way the government measures outcomes, they are predicated on a

span of the population and predicated on the number of births

and the length of life. Because there are different areas, the lakes

of my constituency in Devon, where people live longer, is that we have

a lower number of live births. People tend to move into the area

when they are order. So there are basic fundamental flaws in the way

government and not just this government, this has gone on for

years, estimate the need for within a Navy. One of the biggest

challenges is in that regard. I will move on. Information is expected to

be the solution to all of our problems. There is no transition

funding so that is not allowable. There are not many pooled budgets.

These plans assume recruitment for individuals but we cannot recruit

will in the future. It does not take will in the future. It does not take

into account the training we will need. We are looking at the

population getting older, we need more specialist nurses. It has been

agreed by the experts, but has not been put into practice. There are so

many issues which will impact on this that I have my doubts that this

was the way forward, in terms of reducing cost. I am concerned that

this integration model, while welcome, has not been thought

through and the barriers to it being successful have an implication that

it will be an unbudgeted cost. My concern is that there is no evidence

for this option that the demand will decrease. There is no evidence that

integration is going to deliver savings. It seems to me that the

estimate can it really be sound. The real cost estimate is needed. My

final closing comment, what we have failed to address is at peace of

social care which is paid for privately. I will look at the report

briefly and the act, because we are looking at how the taxpayers money

is to be shared out between these two systems, but we should never

forget that social care is means tested, as opposed to the NHS, which

is free at the point of the envelope. If you do not take into

account that savings are required, then we will find on the NHS is

simply too great on the system to succeed than for the system, the new

system, to be valid. The select committee is currently undertaking

an enquiry into social care. The report has not been published yet,

so anything I say is my own so anything I say is my own

reflection, as opposed to directly to do with the findings. I hope it

will not be too long before we can provide the report with regard to

the immediate issues within social care. We will then look at the

longer term issues. We have taken expert analysis from many connected

parties. From people with an the care system and key providers. It is

not surprising to me to have heard what I have heard because

unfortunately, as an MP, we only get the tip of the iceberg of problems

which occur. The number of feelings end social care have undoubtedly

increased in the last two or three years. I look at fundamentally what

is happening. A council which is having to cut its budget on social

care is often doing that by going to the private sector and going out to

agencies. Replacing that with the service which the council used to

provide. Undoubtedly, the way the services our Kilvert, often people

are not travelling up and causing even more problems for patients in

the long-term. It is not surprising that the cheer of the hills select

committee said there was a 7% cut in real terms in social care in the

past seven years. Central government plans have been reduced by 57%.

Councils have tried to provide social care, but they have not been

able to protect it completely from the cuts. On top of that, not only

is the money going down, but the number of elderly people going to

require care is going up. On top of that, there is the Care Act, in

principle a great piece of legislation. Welcome measures, in

terms of trying to reward those properly for the excellent work they

do in social care, the entries in the minimum wage puts additional

burdens on the system. There was a very good article about social care

yesterday in which the council leader said the doing more for less,

something they have become very good at. But no, they have to admit they

are doing less for less. We should not blame councils for not being

able to provide a standard service. Even if every council did their

best, there would still be problems with the system. I asked the

Minister affair was a crisis. He did not want to use that word, but he

said the system was under stress. That was the words he used. I think

we would recognise this case is very obvious for all of us to see. 1.2

million people estimated getting the care daily choir. That is 40% higher

than it was in 2010. We got evidence from people who said that they were

not getting the care Lee got in the past when the needs we are

increasing. People pulling out of contracts. Contracts not been

delivered property -- properly for the councils. People actually paid

for care actually subsidising local authorities. This did not seem fear

fear too many people. At the same time, you have the 27% turnover in

the south. You are getting people leaving with long-term experience

and there are much more demands on training. These are problems we

learned about in our evidence. We learned about in our evidence. We

come to one of which I hope they will reflect on. This was some of

the very compelling evidence that we received as part of that enquiry. In

the short-term, the government have done things. They brought in the

council tax precept. I brought in the fact that local authorities have

taken up on that. There are problems, of course, the fact that

it raises more money for some local authorities than it does for others.

The better clear from, which was meant to stabilise, is rather

backordered into the system. The new homes burnt his welcome, but that

causes problems for smaller district councils. He suddenly find the

budget position fundamentally altered. Going back to the article,

you have got a situation where government simply was not thinking

through in the longer term. They are moving money around in the system

without giving real thought to the end result. There was a lack of

thinking and funding between health and social care. There was not

really any understanding of what was happening to the money at the end of

the line. Local authorities are facing very difficult choices and

having to make decisions on the cuts that are being pressed onto them.

These are some of the issues we have and we will reflect on in the report

which will produce. The link between which will produce. The link between

health and social care is vitally important. It will be interesting to

see what comes out of the idea of the two being devolved together. Not

only the idea of discharging, but that there is nobody in the system

for preventative social care. The funding is for people in the highest

need. People not getting the attention in the early stages means

they are more likely to end up in hospital and more likely to end up

with long-term problems. We need longer-term arrangements. We need to

respond to the theatre no, because that is also important. There are

some people who if we do not deal with the here and now, there will be

some people who will not be around to see the long-term benefits. We

went to Germany and they told us that 20 years ago, they solve this

problem coming. We sat down with the cross-party committee and agreed on

long-term systems. That is what they decided to do. It has stood the test

of time for two decades. They have increased the social insurance

allowance. This has got cross-party agreement and virtually no public

opposition. This is not just funded by the taxpayer. There are private

contributions in it, as well. It is just an example. We need to sit down

a cross-party basis and work out solutions which stand the test of

time, regardless of what government is in power at the time. Does he

agree that fundamentally the issue is that countries in Europe, such as

Germany and France, they are spending a great deal more money

through either the system he described in Germany, or somehow we

are going to have to close that gap. It is highly likely the difference

in mortality and outcomes generally in this country is related to the

amount of money which is put into the system?

It is something we need to reflect on. But it is not simply a question

of public funding. There is an issue about where we get the Private

funding from, I don't think anyone has argued to us so far that the

whole of it can be publicly funded. How do we raise the Private money?

Should it be from individuals who near need care at that point or

should we ask people to pay more into some sort of insurance system,

and how do we putting more money from the public sector? Can we rely

on local authority funding alone, particularly if that is coming from

business rates when business rates are not going to grow at the same

percentage in future as the number of people who want social care? Can

I pass over to my, the honourable member? It is my pleasure to join

him on that visit with other members will stop does he feel it was all

the more pertinent that his example of the German system in that 20

years ago they too had a system funded by local authorities, prior

to changing to social insurance in 1995, and find that system was not

fit for purpose and they discovered that 20 years ago, moved to this

system, which as he says has cross-party support, and is a

long-term sustainable solution? I just want us to have a process which

gets us to a similar position. If local authorities remain part of the

funding solution I don't think we can assume that the increase in

business rates and council tax will keep pace with the level of demand

will come in. Finally, I know you are trying to encourage us to keep

within a time limit, what I would say is... The honourable gentleman,

as chairman of the select committee, I don't apply the time limit so

strictly to him. I better not stray too far. Health and social car

working close together, of course. Let's see how Manchester develops.

It will be interesting to look at that. But the other thing that came

out of this it is not a panacea, it will not solve all the problems. I

in I agree with the chair of the select committee, they are going to

need some pump priming to make them effective, they have been done

properly in every area with full cooperation. If they are done

properly and looked at how we can better plan for the future, I think

they will make an important contribution. But in the end we have

to recognise this process will take time, it will need upfront funding

to make it work, and wheels have to recognise that there are big

differences in health and social differences in health and social

care, not merely in culture but in the funding arrangements. Health is

provided free at point of use and social care isn't and probably won't

be after any changes will stop they will be different funding

arrangements. There is fundamentally different accountability. Social

care is accountable to local councillors. Health is accountable

to the Secretary of State. If you want to the problems this creates,

see the evidence last health minister gave to the select

committee. I think it shows it isn't all quite worked out in Government

in a way you could pull a switch tomorrow and get it all operating

smoothly. I would say we have a lot of work to do in that direction and

I'm sure the local Government select committee will consider all the

evidence and produce reports on this range of issues. Thank you. It is a

pleasure to follow the honourable gentleman. I think it is worth

putting on the record, notwithstanding some of the issues

which have already been drawn to your attention, the increase in

money the Government is committing, the extra 10 billion by 2020, the

extra doctors, nurses in the system, the near eradication of mixed sex

wards and a huge reduction in hospital infections. I note also

that health spending in England is almost 1% higher than the OECD

average. I think it is worth putting that on the record. I'm sorry to

intervene so early. Would he agree with me that the OECD average is

probably a specious camp heiress and since it will consign countries like

Mexico and Turkey and former Eastern Bloc countries which, laudable

though they may be, are not countries which most people in this

country would worth would wish to be compared in terms of health

economies? I think that's a fair point. In the course of my remarks I

will outline some areas where some more spending is necessary. I want

to start by focusing in on an individual case, not from my

constituency, which I think highlights many of the issues that

have been raised so far this evening. It concerns a 98-year-old

lady, admitted to a hospital on the 22nd of January. She unfortunately

died in that hospital on the 31st. It was made clear to the hospital on

the 25th of January that the nursing home she had come from, she had been

in the residential part, had nursing facilities which were able to take

her back and deal with the deterioration in her health. In

spite of the hospital being made aware of that on the 25th of

January, no action was taken to remove her back to that nursing

home, which resulted in an extra six days of staying in that hospital.

The relatives which drew this true case to my attention asked me to

raise the following two points. First, they thought it wasn't good

enough that the hospital concerned did not have a good knowledge of the

fact that the nursing home this lady came from had nursing facilities in

addition to residential facilities she had come from, which would have

been able to care for her and free up a hospital bed. Secondly, they

were also disappointed that because her period in hospital spanned a

weekend they were told by several of the nursing staff that no doctor was

available to make a decision to move her back to the nursing floor of the

home which she had come from, which is where she had always wanted to

end her days. I think that story illustrates some of the issues which

I know ministers are aware of in terms of making sure the knowledge

of what residential and nursing facilities are available in the

community to elderly people that come into hospital, and also the

issue of weekend cover so that appropriate decisions can be taken.

So the beds are not taken up unnecessarily within hospitals.

Couple of weeks ago I sat down with a number of social care providers

within Bedfordshire, covering both residential and domiciliary care,

and I asked them what they thought it was they actually needed in order

to attract enough people into the care profession. The chairman has

just told us there is a 27% turnover and I learned they cannot always

attract the calibre of people they would like. In terms of domiciliary

care, I was told very clearly that the ability to offer a 16 to ?18,000

a year salary rather than paying people on an hourly basis when they

provided care, would go a long way to attracting the right sort of

people into this profession. This domiciliary care provider was one of

the better ones in my area, and paid 30p a mile for travel costs. All of

us as members of Parliament get paid 45p a mile when we travel in our

constituencies, and I find it an affront that there is this division

between different rates for travel within the public sector. Social

care staff do an incredibly important job and it is not right

that they are lucky to be offered 30p a mile when members of

Parliament are offered 45p a mile. I am not just asking for local

authorities to put it up to that straightaway in terms of what they

pay, we have to be realistic. We have to actually decide that that

comes with a price tag which has to be provided through taxation. I

fully recognise that point. But a salary to ?16,000 to ?18,000 over

and above this Barony rates of pay which don't include travel time and

that travel paid for at a miserly rate compared with what other people

get in the public sector, I think would go a long way. In the

estimates before us today, one of the issues which has not been

highlighted so far is the revaluation of the NHS litigation

costs and increase of some ?8 billion which is a fairly large

figure. It is worth focusing on that because litigation costs mean and

thing is, firstly that patients do not have the right quality of care

first time around and secondly that it is money going out of the door of

the NHS, often to lawyers, which could better be used to doing the

job correctly first time. In that regard, I make no apologies for

again drawing the house's attention to the getting it right first time

initiative, which seeks to embed quality of clinical care across the

NHS. Something which quite often I find we don't seem to focus

sufficiently on within this house stop the variability in terms of

infection rates, in terms of rates of revision surgery requires very

significant across the NHS, and if we could raise the quality of

clinical care to the level of the best across the NHS we could that

litigation amount down very substantially. I was very pleased to

join a meeting held a couple of weeks ago on the manifesto for a

healthy and health creating society, led by the former permanent

secretary of the Department of Health and other colleagues in the

House of Lords and indeed others. Although this may seem quite a

long-term approach to the acute problems we are facing today, and

the chair of the local Government select committee is right to say we

need action now, because not everyone will be around in the

longer term, but nonetheless I think it is incredibly important that we

take seriously a lot of the ideas within this report in terms of

trying to reduce the strains on the NHS and create a healthier

population in the years to come. There are already some very good

examples of that, the Saint Paul's way transformation project in

popular in the east end is already doing sterling work and the well

north initiative supported by Public Health England is focusing on ten

cities in the North of England which have poor health outcomes, bad

levels of health and health inequality. It is all about creating

what they called vibrant and well-connected communities where you

deal with issues like debt, jobs, training, poor housing and

loneliness, an issue many of us are determined to carry on working on.

This sort of long-term preventative work to increase the health

resilience and increase the health of society is absolutely firm under

mental to all the issues we are talking about tonight. In terms of

the sustainability and transformation plans, in having

spent time with both GPs and hospital staff in the past couple of

weeks, I observed that clinicians in hospitals often pointed to the work

that they thought should have been done by GPs and had not and when I

spent time with GPs it was pointed out to me that they were doing quite

a lot of work that in the past they would have expected hospitals to

undertake. And I think that as sustainability and transformation

plans move forward there would be some merit in making sure that in

time they do turn into accountable care organisations so we can get a

proper join up between the different parts of the system, so that that

sort of finger-pointing between different parts of the system

becomes a thing of the past. The last area I want to talk about

quickly is just the issue of beds. Was I totally understand the

Government focus to shift more care to the community, the fact that we

have a thousand fewer beds than five years ago while the occupancy rate

has gone up from 84 to 87% and sometimes operating theatres are

remaining idle, is something I would like reflected on.

Sadly, it has the feel of rearranging the debt chairs on the

Titanic. Bringing this matter before the House today highlights the

extensive range of issues facing the NHS. From my involvement in health

issues in West Lancashire, from individual constituencies' cases to

the commission of multi-billion pound contract, it is a microcosm of

the issues that the multitude of bodies within the NHS need to start

finding answers for. In West Lancashire, my constituents can wait

up to a week by telephone conversation with a GP to assess

whether they actually need an appointment and then a further wait

for that appointment. Is it any wonder people turn to AMD and minor

injuries units? While clinical experience at the top is laudable

and to be welcomed, there is a shortage of GPs, there is also lost

capacity because of the time GP spent on clinical commissioning

groups governing bodies. Where as in the case of West The Lancashire,

they have handed community health and urging cares services contracts

to private providers, especially threatening the future of the NHS

tossed there by removing services and essential financing turnover.

The chair of the CCG is a local GP who spent three days a week on CCTV

business under five further GPs with executive lead responsibilities.

Besides the loss of capacity, there are also the financial

considerations of GPs being remunerated for their work on the

governing body. Now the GB owning over ?100,000 for a three-day week

alongside a cheap accountable officer also an approximately

?100,000 a week. There is also a fundamental lack of direct

accountability of clinical commissioning groups which I

understand is the responsibility of NHS England. So we have got GPs

handing out contracts to private providers in the face of significant

and substantial local opposition in West Lancashire and no is for

meaningful accountability about how those GPs are spending taxpayers

money. My constituents did not get to vote on whether Gale -- on who

represents them on the CCG. The question also arises whether NHS

England and NHS improvement have enough resources to deal with the

increasingly complex contracts and structures they are supposed to

supervise within the NHS. Threats to the smaller acute trusts besides

coming from local GPs also come from the sustainability and

transformation process. The name of which is being increasingly becoming

a misnomer. These plans were quietly generated by small groups of people

without the involvement of both the those who need their services or the

public representatives of their public representatives both local

and national. Some of us have missed strategic health Authority. I would

be very interested to hear from the ministers if the process will

actually provide capital resources to enable hospital trusts to develop

transformational change projects. Increasingly, NHS improvement and

NHS England cannot agree on these currents eight of NHS finances. NHS

forecast for this financial year has worsened each financial quarter.

Currently quarter three is standing at the deficit of 873 million was

NHS England appears confident that the final deficit figure will be no

more than 580 million. I took a deeper look at the figures. The

figures for NHS trusts quarter three figures and a huge question over

those deficit figures appears when you look at the sustainability and

transformation fund money the government has given trust.

Admittedly, trusts only have the allocated funding if the trust trees

certain financial targets at the end of the financial year. If they do

not, this extra funding will disappear like snow in July. The

system deficit could be even greater. In fact, much greater. It

is not just the Department of Health's funding of the NHS that has

a consequential impact on services, we are witnessing savage cuts to

local authority budgets. Lancashire County Council is the provider of

social care and despair is personally close to being bankrupt

in the next five years based on the current funding projections. We talk

about health and social care absolutely as if they are

intertwined these days. Yet the government allows this competitive

existence between the two services to continue. ASBOs systems seek to

survive financially, each body makes decisions to minimise their area of

expenditure. -- ASBOs systems. Hospitals urgently seek to discharge

a medically fit patient. I have a great fear that as each day passes,

the struggle for survival due to the ever tightening financial structures

imposed by government and a lack of any solutions means that patients

are actually getting lost. Organisational for and financial

considerations mean that patients are a distant third on the priority

list. I do not know if creating chaos and turmoil within the system

is part of a longer term strategy to lead us to a new health care system,

one of private providers and health insurance. The Secretary of State

will have to answer that one. What I see from the estimates provided for

the transfer of money between budgets is that this is not just

tinkering at the edges, sorry, this is just tinkering at the edges of a

system that needs to be properly financed. Not shoving a few pennies

in the left hand while taking away pounds and pounds from the right

hand. Our NHS, our constituents deserve so much better.

Thank you. It is a pleasure to speak after the honourable member. She has

made some interesting points about fundamental reform. There is no

doubt that members of both side of the House alludes to this, we are

having this debate, setting up some background against huge demand and

in many way decreasing supply, particularly in the area of adult

social care which is where I am going to restrict my comments to in

that this is, I have been very interested to take part in the

inquiry on social care and the select committee which the cherub is

said to earlier in his remarks. -- the chair. 33% increase in the

population of people aged 80 and over the last ten years, 100%

projected increase of that population over the next 20 years,

50% increase in the 60,000 over over the next 20 years, interestingly

enough, only a 4% increase in the numbers of people of the population

of this country below 65 over the next 20 years which is in dynamic of

who is going to provide the care needed for all these people who are

getting older. The other area we have not touched on in adult social

care, those with learning disabilities. Increasing very

rapidly and is due to increase again over the next 20 years, more

profound challenges for our health and adult social care services.

Against the backdrop of decreasing supply provision, understandably,

when you look at everyone is going to take part in making sure the

books are balanced. Reducing the deficit from a a year in 2010 to

around ?68 billion this year is no mean feat. We have to understand

that there is no bottomless pit, we have to make difficult decisions in

where our spending is allocated to. Local authorities have borne the

brunt of this, 37% reduction in overall spending, 25% after council

tax increases. Adult social care accounts for around 33% of local

authority discretion or spend. It is inevitable that this is going to

come into focus when local authority managers try to balance the book.

Other competing pressures, around the National Living Wage, that is

soaking up a lot of the action money that is being allocated into this

area. It is not just about local authorities, it is the providers as

well but are under huge pressure. 59% of care homes in this country

are losing money, below profitability is threshold. Some of

those homes are closing and providers sometimes are returning

contracts to local authorities. Other elements as well in what we

recall a well functioning health and social care service, other

reductions such as community nurses, 28% reduction in community nurses

which again can provide key services to stop people going into the health

and social care system. In my constituency, simple things like

sitting services or local dementia clubs, they have all closed, or been

reduced over recent weeks and months which puts more pressure on the

system. The discharge, has an impact on the NHS, something members know

far more about than I do, Simon Stephens when he came to give

evidence to committee, estimated at ?2 billion on extra spent on the NHS

because of delayed discharges. There is an impact on whole system. The

government has responded to a great extent, ?2 billion more in 2010. The

adult social care preset, Betty care funding, adding 3.5 to ?4 billion by

2020 but I think there is no doubt that all the evidence we have heard

from a number of different sources, there is a one to ?2 billion

shortfall in the system for investment that we need at the

moment. We do need a cross-party conversation. I am happy to give

way. On that issue of the shortfall, does he agree with me that time has

come for us to bite the bullet and increase social care funding? Doing

that in the short would provide the financial headroom to achieve the

meaningful reconfiguration of services through the STB 's that

will reflect the changing health prior to the Democratic? He makes a

strong point. -- demographics. I'm sure this is in the Chancellor's

budget calculation is on the 8th of March. In the short term, to plug

the gap, we need some more money. In the longer term, we need to have a

cross-party, across the House conversation on how we solve this

problem and select committee has been an excellent forum so that on

this issue and many others as the chair mentioned in his remarks, we

went to Germany to see their system. It was very enlightening. It was

particular say that in 1995 when they moved one system to another,

they made from a local government funded system which just did not

work, they clearly saw this coming before we did. They moved to a

social insurance system. I think in Germany they are more used to that

system, they have similar systems in place for health, pensions, employer

and insurance and accident insurance, it works very well, it is

cross-party. Around 1.175% of salary contribution, it is a bit like auto

enrolment. It is mandatory. When people need care, they have a pot to

call on. It is independently assessed so big at the level of

prisoners and that suits their needs. They can go to family members

to look after those people do these times which again I think as a

social benefit as well as being clearly a sustainable system that

works in the longer term. It is one of the things that we should look

at, it is not the only thing that I reiterate and I new member still be

same on both side of the House, we should look at this cross-party in a

way that is sustainable for the long-term. I'm very happy to give

way. I am very much enjoying his speech. Will he agree with me that

the current way we fund local government does not help? My own

constituency that has got a lot of over 85, the demographics are not

properly reflected and the challenges of coastal communities

face are not reflected? He makes a very good point. The evidence we

have seen that the current method of funding adult social care do not

correlate to those in those those areas. This is what we need to look

at and take a strategic look at it. Just on that point, see the

government now is moving towards a different way of funding towards

2020. A key part of that is the fact that we look at a new fair funding,

how it is allocated, absolutely critical that need is first and

foremost and cost rivals so it is need and cost delivering the

services. We get a fair and transparent system. One other thing

to mention, in terms of the early point about adult social care and

disabilities, one of the most enlightening examples of we saw in a

way to deliver this in a different way is rather the look at this from

a single viewpoint was the village shared lives concept where people

look after each other, co-workers and people in need of the car. A

fantastic and inspirational scheme. I shall touch on a few small points,

such as how domiciliary care is charged, how people are accessed for

their financial assessments are different in domiciliary care than

they are in residential care and I think there is some money in the

system they're potentially. It doesn't make much sense to me that

the government fund one thing one way and another thing another. There

is money to be taken out of the system, or people could contribute

potentially if there are houses were taken into account for the

assessment for domiciliary care. The second point is code terminal city.

There are so many different services provided by so many different ages.

It is working really well in Sheffield where all the agencies

work together very effectively but in my area it is completely

different and a mishmash of different providers, different

geographical areas which is difficult when to provide a joined

up service. With those remarks I will conclude in pass on to provide

a joined up service. With those remarks I will conclude in pass onto

another honourable member. Often, Mr Speaker, the NHS estimates to be a

rather perfunctory affair but this year we are entitled to ask what on

earth is happening to our NHS and social care system? Can be any

longer afford the extraordinary complacency of this government. As

an opposition MP I sometimes worry that either by design or simply

collect -- neglect we will finally fulfil many of our worst fears, that

the Tory party is destined to destroy the NHS. I don't think I

need any lectures on cross-party dialogue from the party of the death

tax and the ?8 billion financial fib. In Birmingham we have seen 28

million of cuts to the budget for social care, bringing the service to

its knees. Elderly people being treated like cattle, lying around on

trolleys, waiting in corridors, dispatched from hospital in the

middle of the night. Everywhere we look we see our hospitals, GPs and

social care services collapsing under the strain. The Secretary of

State is quite happy to flex his muscles when it comes to bullying

junior doctors but it is always someone else's fault when it comes

to resources, management and administration of the NHS. There was

a time when the deal was simple, in return for the red box and

ministerial salary ministers took responsibility. The buck stopped

with them. But no more. I have lost track of how many parliamentary

answers begin with the words the department does not collect that

data centrally, or it would not be cost-effective to provide

information in that format. Basically ministers don't know don't

want to know and don't want us to know what is really happening. They

are no longer presiding over a genuinely national Health Service,

whether it is the postcode lottery that characterises the provision of

IVF, with Clinical Commissioning Group is ignoring guidelines and

making up their own criteria as they go along, or children's dentistry,

where there is a growing crisis and the heavy reliance on hospital

emergency surgery because of the lack of provision and monitoring of

proper dental services for children. All this government wants to do is

hide behind and blame others for their shambolic decisions. The

latest disaster is the business rates revaluation, which imbibing is

estimated will see a rise for the Queen Elizabeth you HP Hospital from

2.8 million two 6.9 million a year. Talk about robbing Peter to pay

Paul. And yet ministers from the DC LG and health haven't even met to

discuss this problem. I do know that private hospitals get an 80%

reduction because they are registered as charities. In my own

constituency of filioque we have been fighting a battle to save a

centre for several years, we have had stop/ go consultations, money

wasted, explanations and excuses that vary from month to month,

consultations announced and then scrapped, and now we have the

sustainability and transformation plan that sadly, as has been

acknowledged, has turned into a secret strategy, drawn up by

non-elected bureaucrats, from which the public and their elected

representatives have been largely excluded. It seems that Katie red is

now caught up in this fiasco and with its contract scheduled to

finish on the 31st of next month we still don't know what is happening,

although if rumours are true more money that ought to be spent on

health care in the Birmingham is about to be siphoned off to rescue

bankrupt neighbours. Only the other week I discovered that the contract

for South Maple GP services is to be counselled, apparently it is no

longer cost-effective. Not cost-effective to provide GP

services to the sick and elderly, only under this secretary of state

could the NHS have come to this. I will give way. In my own remarks I

spoke about a cross-party consultation. If we have this kind

of con so -- the conversation I can easily point to the fact that

between 20112014 there was a 8.6% drop on health spending in Wales

under a Labour administration while there was a 4% increase in England.

Would you be better having a constructive conversation that how

we take the NHS of the front page of the tabloids and try and work out a

solution together. It is always desirable to have that conversation

when the Tories are in power but when Labour is in power then we talk

about death tax regimes and funding bids. The argument always changes

when they are responsible. As I was saying, Mr Speaker, they are about

to withdraw the contract for South Maple GP services. I found out not

when the Clinical Commissioning Group, who it turns out have been

ruminating on this since November, told me, but when I was contacted by

anxious constituents who had just found out they were being given

eight weeks to find a new GP. Many of them are elderly people. Some

have long-term conditions and rely on regular medication that they are

dismissed, as if they don't matter. The loss of their GP services is

treated like the closure of a local hairdresser or a petrol station.

They are told they should shop around. Apparently the CCG thinks

there are enough GPs in the area, enough at any rate to satisfy their

little diagrams and tables on their secret little plans. Reducing demand

for acute care is one of the governments plans ease pressures in

the NHS. Exactly how do we achieve that by closing walk-in centres and

GP surgeries? Isn't that the fastest route to the already overstretched a

and E departments? It is not just the estimates which are at issue

here, it is a proper long-term plan for the NHS and social care. This

secretary of state has failed us. His stewardship is a disaster and

rather than accept more of it this house should be calling for a motion

of censure. This is a government and secretary of state who are presiding

over the steady dismantling of the country's greatest peacetime

achievement. It is a total disgrace. Thank you, Mr Speaker, I would like

to start by paying tribute to the many thousands of health and social

care workers that support day to day some of the most vulnerable people

in our society. Today what we are talking about is how we make the

books balance. The NHS five-year forward view identified that if the

trajectory of health care spending continued at the same rate as just a

couple of years ago, an extra ?30 billion would be needed by 2020. It

was also stated in the forward view that over ?20 billion could be

identified in savings and efficiency measures over that time period. That

is why the government is allocating an additional ?10 billion by 2021,

and we can quibble whether it is 8 billion 10 billion, but what must be

recognised is that it is NHS England that ask for the ?8 billion and this

government is delivering that. What hasn't happened yet is to some

extent the other side of the bargain, finding the savings of ?22

billion. Perhaps it was never possible. Perhaps the timescale over

which has to be delivered was too short. Next year we will be

celebrating 70 years of the NHS and to change the way it works in less

than five years is probably too big and ask. There are not many areas of

the NHS where -- there are many areas of the NHS where savings are

being made changes are happening but it does take time. I would like to

use a couple of examples to illustrate where savings can be

made. It may be costs upfront, but it is long-term savings. Prior to

being elected to this place I spent a lot of time and energy promoting

diagnostic tests that could be carried out at patient bedsides or

in GP surgeries or even in the patient's home and possibly in

community form as well. This type of testing is used extensively in

Scandinavia and other European countries and we are definitely

lagging behind. I feel that if we adopted such tests more widely there

are many savings to be made. More importantly it is better for the

patient and surely that should be the key determinant. Let me talk

about one example. The point of care test that measures a protein, fast.

The protein is raised when someone is suffering from a bacterial

infection but it is not raised if the infection is caused by a virus.

Without this test patients may be prescribed unnecessary antibiotics.

This is not good for the patient or the NHS budget. In some instances

patients are admitted to hospital unnecessarily. All that is needed is

a type of test that I am talking about, which is a small device and a

drop of blood. I know from personal experience that it's such tests were

readily available for GPs to carry out within their surgeries all the

patient's home, it would have saved a five-day hospital stay for my

mother. That is savings to the health service and it would also

have been better for my mother to be kept at home at that time of her

illness. We cannot continue to do what we have done and expect to have

different outcomes. I will give way. I would like to thank the Honourable

lady for giving way, she talks a lot of sense. Would she also agree that

the NHS should make the mistakes of the past by going down the route of

more disastrous PFI deals. She may know my local CCG is currently

developing a business case to bulldoze Huddersfield Royal

Infirmary, replace it with a small plant care unit, moved everything to

Halifax, including A, but come forward for ?280 million for this.

If they don't it from the main funds they

are going to go down a PFI route and the trust is actually already being

crippled because of the disastrous PFI at Halifax which cost ?64

million to build and will eventually cost ?774 million because of a

disastrous PFI. I thank my honourable friend for those very

pertinent comments and I actually did my training as a biomedical

scientist at Halifax General Ho spital Royal Infirmary in Halifax so

I know the area very disastrous PFI agreements. Today we are debating

health and social... On the point that the honourable lady was making

about tests which are not being deployed and which could save money

if they were, I have for long been concerned that yes, we need to make

sure we don't go down more disastrous PFI agreements. Today we

are debating health and social... On the point that the honourable lady

was making about tests which are not being deployed and which could save

money if they were, I have long been concerned that don't are at risk of

ovarian who are at risk of which is definitive, but which nevertheless

helps in the early identification of a cancer, which if it is early

identified, can actually with a CAA 125 test, which isn't definitive,

but which nevertheless helps in the early identification of a cancer,

which if it is early identified, can actually save does she agree with me

that one of the things that we need from the top on clinical issues like

this is to ensure that short-term savings decided by an individual CCG

do not put a patient's health at NHS on clinical issues like this is to

ensure that short-term savings decided by an individual CCG do not

put a patient's health at the topic of prevention

and screening could take up another whole debate but you make a very

good point there. The two are linked, and yet funded in different

ways. Too often budgets, these budgets, are only casted in the two

are linked, and yet funded in different ways. Too often budgets,

these budgets, are only casted in from back to me. I recently met a

young man who if we take treating some stroke patients as another

example, there was quite a new technique now available called

mechanical from back to me. I recently met a young man who was to

be near one of the few centres in the UK that carried out this

procedure when he had a massive stroke. That is if you he was in.

But he can now lead a full life instead been disabled for the rest

of his life and possibly being dependent on fortunate in this

situation he was in. But he can now lead a full life instead of being

disabled for the rest of his life and possibly being dependent on

social this procedure cannot yet be rolled out across the country due to

limited funding to train specialists to carry out and the procedure

itself. What are the patients who don't get that procedure and other

similar procedures? That is a respectable personal cost

It's far too slow to spread new and best practise.

Locally, in my efficiency, a Vanguard site. Whether it one of its

actions is ward rounds in residential nursing homes. There is

already strong evidence to show this is reducing hospital admissions for

these elderly people. Yet, this is not rolled out quick huff to other

areas. So, I don't believe that throwing more money at the NHS and

social care is the answer. If we want different results, we need to

do things differently. And that's what sustainability and tan

formation plans aim to do. I have read the Derbyshire plan in

department. There is little information about how the plan will

be implemented. My concerns are around work balance, capacity in the

community and stakeholder buying. I hope I am wrong, because better

integration and bold action is what is really needed. Mr Speaker, it is

important that we do not shy away from the hard and difficult

decisions that lie ahead. It is a real pleasure to follow the

honourable lady and I think she's made a characteristically well

informed and thoughtful speech. Mr Speaker, you don't need to be a

brain surgeon to have worked out that the NHS and care system is

currently under enormous pressure. Anyone who has recently visited a

hospital, sought a GP's appointment or tried to arrange support for an

elderly relative will tell you the whole system is struggling.

Inadequate funding, a workforce crisis and a failure to reshape

services quickly enough to meet the needs of our ageing population means

that the men and women who care for our loved ones are simply running to

standstill. This winter, we have seen the front-pages of national

newspapers, covered by images of frail older people, stuck on

trolleys in hospital corridors. And a poorly toddler led on plastic

chairs, pushed together to make and create a bed. Mr Speaker, if you

happen to watch BBC Two on a Wednesday night in January or

February, you would have seen the documentary Hospital, which showed

the reality of people working on the front line and taking really

difficult decisions about patients, beds and operations in a big and

busy hospital. It was captivating viewing and left me, as a

politician, feeling sad and frustrated that we are failing to

create the conditions in which the NHS can thrive. Many of the current

problems plaguing our health and care system relate to a lack of

money. It's not the only problem, but it's a major one. Whilst the NHS

budget has inched up in recent years, it has been outstripped by

rocketing demand. Next year, NHS funding per head of the population

will fall in real terms. Social care Budgets have been slashed, meaning

that the support available to the elderly and disabled in the

community has been reduced. And even with the changes that the Government

have made to the better care fund and the social care present, the

Local Government Association still predict a shortfall of ?2.6 billion

by the end of this Parliament. We cannot escape the fact that our

population is growing and we are ageing. It is a fact that there are

now more people retired in the UK than there are children in our

schools. And as the decades pass, medicine advances, we keep more

babies alive who are born with complicated medical conditions, we

successfully treat more and more people who have cancer. We perform

ever more complex operations, which can give people many happy years of

life, but which contribute to the fact that as we age, many more of us

have underlying frailties and multiple health needs. This isn't a

situation that has come about overnight. And it's one that every

recent Government has had to manage. But this Government isn't managing

it and that's the difference. This Government has had its head in the

sand. Between 1997-2010, the last Labour Government increased real

term spending on the NHS by an annual average of 5.7%. The

equivalent figure for the coalition Government was 0.8%. The lowest

increase of any Government since World War II. And the figure for the

present Government is 1.75%. The Government might talk a good game on

NHS spending, but the truth is, we are in the middle of a decade of au

ter ritty. Add to that a slash and burn approach to local Government

and the social care services it is responsible for and it is little

wonder we find ourselves in the current predicament. What now? As

the chair of the Health Select Committee has said, we have to be

honest about the scale of the challenge. When it comes to NHS

spending, this year is meant to be the year of plenty. The one year in

this Parliament when there is a relatively significant increase in

available funds. But these funds have already been used to pay off

the debts from last year. Money which is meant to be used to repair

buildings and buy new equipment is in effect being used to pay

salaries. Funds to transform services are being used to deal with

the flow of people arriving at A Hospitals are likely to end this

year in deficit again. More clinical commissioning groups are

overshooting their budgets. NHS England is struggling to stay within

their spending limits for specialised services. So called

efficiency savings really equate to freezing staff pay. People who work

in the NHS and care system need to be honest about their ability to

cope. The junior doctors were last year and it is now time for others

to do the same. NHS managers need to be honest about the time it will

take to transform services and the funding that transformation

requires. You can't close hospital beds if services in the community

aren't already up and running and have been proven to reduce the

demand for in-patient care. So, we need to be honest, but we also need

action. The Government needs to provide direct support to local

authorities with funding for social care in the Budget. How the

Government pays for this is obviously for the Government to

decide, but it cannot continue to shove partial, so-called solutions

on to local Government and wash its hands of the problem. If it doesn't

address the long-term problems in social care, it will simply leave

the NHS to pick up the pieces. But even if Government is persuaded of

the case for additional funding, we also need to think carefully about

where that money would be best spent. It's tempting to say simply

put it back into the things that have been taken away, the more

comprehensive care packages, provide social care to a wider group of

people, look at the cuts to community, health nurses, look at

the cuts in mental health trusts. I think it's more complicated than

that. This current short-term fix of taking money out of the capital

budget to prop up revenue is the wrong thing to do. New scanners are

less likely to need repair than old ones. Cutting waiting times and

improving outcomes. Well designed, well maintained buildings can

improve productivity and constituency. Compare the new cancer

centre to the buildings at the Princess Alexandra Hospital in

Harlow. You wouldment believe you're in the same country. We should

invest in new step down care facilities for people well enough to

come out of hospital, but for whom care in the home is yet to be

arranged. There is also a massive need to

invest in staff and build careers which people aspire to. This will

take time as well as money. Perhaps we do need to consider new roles in

community health services which provide holistic care to older

people in the home. Perhaps we need more GPs who are paid to dedicate

time to residential homes, spotting problems amongst the elderly would

otherwise end up in a hospital addition. Perhaps the social care

workforce needs a re-think. I never forget the conversation I had a

senior A nurse who told me that the half term holidays always result

in more older people coming into hospital because the mums who do the

part-time zero hours jobs in home care were looking after their

children instead. I fundamentally feel that the whole system needs to

focus on how we provide care in the broadest sense to older people. The

one in four people in hospital beds with dementia, the three in four

people in care homes with dementia as well. We should focus on the real

weekend effect. The one where if you happen to be in hospital on a Friday

night you are unlucky to make it out until Monday lunch time at the

earliest. Why do doctors talk about how it takes three minutes to admit

a patient but three days to discharge one? Mr Speaker, I will

end by saying this, the Government maybe absorbed by the complex task

of trying to take us out of the European Union, but if it doesn't do

something to address the scale of underfunding in the NHS and care

system, the public will not forgive it. We need real answers to the real

problems and we need it urgently. Thank you, Mr Speaker. It is a

pleasure to follow the honourable member for Lewisham East. She will

not be surprised to know that while I agree with some of the points she

made I don't agree with all of them. In the time I have I want to cover a

few points. I don't want to repeat much of the excellent statements

that many members have made across this House. But the time I do have I

want to go over just a few issues. Because while I do welcome the

Government's extra funding and the ?6 billion this year in particular,

with the changes in national insurance contributions, pension

contributions, the costs of running the NHS are going up all the time.

That extra money is being swallowed up without it necessarily going to

front line staff. I do particularly agree with the honourable member for

Newton Abbott, when she said that in an estimates debate we shouldn't

just be talking about the money that we need to spend, but we also need

to look at the demand and the type of services that we need to fund,

because there's no doubt that demand for the NHS services and social care

is increasing. So even by providing extra funding, we are just really

standing still in terms of the services that we are providing. We

know there's an increase in numbers across the country. We know, as has

been said by others, there are new treatments which need providing and

we know that patients are changing. In years gone past they would have

been admitted with one illness, treated and go home. Now when they

are admitted they are many illnesses which are not sod easy to treat.

That is why discharges are often delayed. If you look at the data

provided, we know there's around a 7% increase in terms of demand for

services across the board. A 7% increase in the number of ambulance

calls made. A 3% increase made in the number of A visits. We know

that the Tuesday after Christmas was the busiest day in the history of

the NHS ever. And that takes extra money to be able to deliver. That we

know for diagnostic tests there is a 6% increase. We know that cob

sulant-led treatments are up -- consultant-led treatments are up by

6%. Demand is rising. The extra money is welcome, there's no doubt

about. That but it's not actually dealing the level of service that is

required. But one point I would like to make

and this is just a plea, as someone who still works in the health

service and still sees and works with colleagues across the NHS nstz

on a regular basis. While there is a lot of pressure that the services

are under and there's a lot that we can be concerned about, there is

some amazing work that's going on in our NHS. And I welcome the NHS

England's announcement only last week that it's going to start to a

fund General Secretary ond stem-cell transplants. We had debates in this

place about how important that is to those patients whose first

transplant actually fails. We know there'll be new treatments for

kidney disease and for high per tension. All are really welcomed

announcements. We must recognise there is some great work happening

there on the front line. I'm particularly pleased that the

Government once again, the Department of Health gave ?1

million, I would love ?1 billion, ?1 million to the British Heart

Foundation to provide defibrillators up and down the country. That will

make a tremendous difference when we know that 12 young people a week die

in this country from cardiac arrest. There's work, ground-breaking work

in cancer care. In my old hospital, the Royal Marsden in London we are

making strides in Cancer Research which are not just innovative in

Europe but making world-wide break throughs. We are often leading the

field in research on a global level and it is something we should be

extremely proud of. Now, in response to the Health Select Committee's

report, the Government made a number of recommendations in how to tackle

some of the problems facing the NHS and facing social care. And I just

want to touch on two of them. The first was to try and arrive at a

type of financial discipline in the health service because for years

now, there have been problems in terms of financial mismanagement. I

know, as someone who has worked in the health service, how

heartbreaking it is to see money being squandered. We have talked

about the PFI deals here, which have touched many parts of the country.

There was the IT system which cost billions of pounds which never saw

the light of day, which was suppose to move us from paperless records to

a paperless system. Today, the NHS is spending huge money still on

paper notes and storage, off-site storage facilities that hospitals

are having to pay for to keep patients' recordses.

to the, mainly imposed on social care, for those patients who don't

get that procedure and other similar procedures? That is a respect for

personal cost to the wasted opportunity and it cost the NHS

millions of the pay structure for staff and improve productivity was