28/01/2016

:00:00. > :00:00.Commission. Mr Norman Lamb. Order, we will pause for a few seconds to

:00:00. > :00:10.allow the chamber to clear so that members are not walking in front of

:00:11. > :00:16.the honourable gentleman. Thank you. I beg to move that this house calls

:00:17. > :00:19.for the establishment of an independent nonpartisan comlission

:00:20. > :00:25.on the future of the NHS and social care, which would engage with the

:00:26. > :00:30.public, NHS, care workforces, experts and civil society, sitting

:00:31. > :00:35.for a defined period with the aim of establishing a long-term settlement

:00:36. > :00:39.for the NHS and social care. Can I take this opportunity to th`nk the

:00:40. > :00:44.Backbench Business Committed for granting time for this debate and

:00:45. > :00:48.for members on both sides of the house who have expressed interest

:00:49. > :00:55.and support in this motion. Can I also be clear that I move this

:00:56. > :01:01.motion, along with the honotrable member for Central Suffolk `nd North

:01:02. > :01:06.Ipswich, who sadly cannot bd here because of a sad family illness But

:01:07. > :01:12.also the honourable member for Leicester West. I have wantdd to be

:01:13. > :01:21.clear all the way through this that I make this case on a cross,party

:01:22. > :01:30.basis. This transcends narrow party politics. I sought the support and

:01:31. > :01:34.have been working alongside also Stephen Dorrell, the respected

:01:35. > :01:38.former Secretary of State for health from the conservative side `nd Alan

:01:39. > :01:46.Milburn, the former Secretary of State on the Labour side. I have

:01:47. > :01:56.felt, for a long time, that there is a very real existential thrdat to

:01:57. > :02:02.the NHS and the care system. It has been drifting in this direction for

:02:03. > :02:09.many years. It seems to me that we have had to get to grips with this

:02:10. > :02:12.before really seriously unattractive things happen to some of thd most

:02:13. > :02:20.vulnerable people in our cotntry. The motion addresses the situation

:02:21. > :02:24.in England, but the position in Scotland and Wales and Northern

:02:25. > :02:30.Ireland is essentially the same Everywhere faces the same

:02:31. > :02:34.demographic challenges and need to ensure our systems meet the needs of

:02:35. > :02:43.communities today, rather than what they were back in 1948. There is an

:02:44. > :02:49.enormous, I think, belief in the NHS in this country, one I hold very

:02:50. > :02:55.strongly. I think it engenddrs a sense of solidarity and a sdnse of

:02:56. > :03:00.decency of this country that we all commit together to ensuring people,

:03:01. > :03:06.regardless of their ability to pay, can get access to care when needed.

:03:07. > :03:12.It is a founding principle that has stood the test of time and should be

:03:13. > :03:21.sustained. And that is what this debate is about. It was a great

:03:22. > :03:27.liberal, Beveridge, who camd up with the proposition there should be a

:03:28. > :03:31.national Health Service and a great socialist, Nye Bevan, who

:03:32. > :03:37.implemented the National He`lth Service as Minister of Statd for

:03:38. > :03:40.health. It is fair to say that Conservative government since then

:03:41. > :03:47.has sustained the NHS and wd have always had our battles about funding

:03:48. > :03:52.levels, about reorganisation and structural reforms, but the NHS has

:03:53. > :03:57.been sustained with cross-p`rty support and I think it is ilportant

:03:58. > :04:04.that continues. It has stood the test of time. The Commonwealth fund

:04:05. > :04:09.in 2014 concluded that it w`s essentially the best system globally

:04:10. > :04:16.among the major economies that they looked at. Although it is worth

:04:17. > :04:24.noting the really important fact it did not score so well on outcomes

:04:25. > :04:31.and premature mortality. Those are, after all, important measurds which

:04:32. > :04:38.we should not be complacent about. I have made the case that there is an

:04:39. > :04:43.existential challenge to thd system and I believe it is time for what I

:04:44. > :04:51.call a new Beveridge report for the 21st century. Just consider these

:04:52. > :05:00.points. Does it still... Of course. I am very grateful. Isn't the key

:05:01. > :05:05.point he has made, which is how should consider, that all p`rties

:05:06. > :05:10.support the NHS and therefore, for one party to chart the future simply

:05:11. > :05:17.will not work. It is better therefore, which is why I stpport

:05:18. > :05:21.the motion, for there to be a cross-party commission, not a Royal

:05:22. > :05:24.Commission that kicks it into touch for three years, but a cross-party

:05:25. > :05:29.commission to bring people together to face what he describes as an

:05:30. > :05:33.existential challenge of he`lth in this country for the future? I am

:05:34. > :05:39.very grateful for that intervention. He puts the case absolutely. It is

:05:40. > :05:44.massively in the government's interests they respond positively to

:05:45. > :05:49.this, because any solution has to take with it public support and

:05:50. > :05:58.support across the political spectrum. Does it still makds sense,

:05:59. > :06:07.after the original design in 19 8, where the NHS was kept separate from

:06:08. > :06:11.the social care system, does it make sense to maintain that divide? Is it

:06:12. > :06:19.serving patients effectivelx? DFID in particular the big -- given in

:06:20. > :06:23.particular the big challengd of this century is people living with

:06:24. > :06:28.long-term chronic conditions, often multiple conditions, and often a mix

:06:29. > :06:32.of mental and physical health, and for those people, a divide between

:06:33. > :06:37.different organisations with different pools of money and

:06:38. > :06:42.arrangements does not it sedms to me make much sense and I think needs to

:06:43. > :06:48.be looked at. Too often, let me make this point and I will give way, it

:06:49. > :06:55.seems to be the system gives an impression of being dysfunctional. I

:06:56. > :07:04.give by way of example the fact that last October there were 160,000 dead

:07:05. > :07:09.days of people, where their discharge was delayed. This is

:07:10. > :07:13.predominantly older people, often people with dementia, stuck in

:07:14. > :07:16.hospital, sometimes long after they were ready to go home, to go

:07:17. > :07:23.somewhere closer to home. This is not good care. We are letting people

:07:24. > :07:29.down by keeping them in hospital longer than they need to be there

:07:30. > :07:33.and that makes it harder for them to become independent again. It went

:07:34. > :07:36.down a little in November btt it is still the second highest levels

:07:37. > :07:45.since they started recording the data on delayed discharges. I give

:07:46. > :07:48.way. He mentions the point `bout the relationship between the NHS and

:07:49. > :07:54.social care and the problem with having those separate. Does he

:07:55. > :07:57.acknowledged that in the five-year forward view there are several

:07:58. > :08:03.approaches to bring them together and parts of the country ard already

:08:04. > :08:07.working on further integrathon? Is it important those approachds press

:08:08. > :08:12.on and we see how they work and move as quickly as possible on that? I

:08:13. > :08:18.thank her for the interventhon and totally agree. I have always been a

:08:19. > :08:23.strong supporter of the forward view. Simon Stephens is a good

:08:24. > :08:28.leader and recognises the solutions to this challenge often lie beyond

:08:29. > :08:34.the NHS and some of the moddls that are being trialled are very

:08:35. > :08:37.interesting. I do not want hn any way in what I say today to be seen

:08:38. > :08:43.to be undermining the good work under way in what are called

:08:44. > :08:50.vanguards around the countrx. I will give way, but I am conscious I must

:08:51. > :08:54.make... On bed blocking, whdn I was leader of Croydon, it cost ?300 per

:08:55. > :09:02.night to keep someone in hospital, ?100 a night to provide a bdd in the

:09:03. > :09:09.local authority. I asked thdm to pay for our beds and save ?200 `nd they

:09:10. > :09:16.did. But that was ad hoc. Wd need an integrated approach. I totally agree

:09:17. > :09:21.on the last point and also on the substantive point that he m`kes The

:09:22. > :09:24.problem is they are ad hoc arrangements, they are good leader

:09:25. > :09:29.is doing something despite the system, not because of it. We have

:09:30. > :09:34.to mainstream this and align incentives through the systdm so

:09:35. > :09:36.everyone is focused on prevdnting ill-health and preventing a

:09:37. > :09:43.deterioration of health at getting people better as quickly as

:09:44. > :09:50.possible. Let me make this point and I will give way. As an example of

:09:51. > :09:55.the pressure the system is facing, and it is fair to say as a gentle

:09:56. > :10:02.challenge to the government, that this year we are not seeing the data

:10:03. > :10:08.on A pressures over the whnter period. It is slightly hidddn from

:10:09. > :10:13.view. I heard on Tuesday of this week all hospitals in Hertfordshire,

:10:14. > :10:17.north London, Bedfordshire, Northamptonshire, and

:10:18. > :10:21.Leicestershire, were on black alert. This is when hospitals are

:10:22. > :10:27.essentially completely fall, under enormous pressure. One of the key

:10:28. > :10:33.system leaders in that area had said that he had not seen anything like

:10:34. > :10:38.it for 20 years. This is a time when there is no epidemic. There is no

:10:39. > :10:43.severe weather. It is one of the mildest winters on record and yet we

:10:44. > :10:49.see hospitals under impossible pressure. I give way. Can I thank

:10:50. > :10:53.the honourable gentleman for giving way? I commend you for trying to

:10:54. > :10:58.bring parties together to h`ve this commission to look into this matter.

:10:59. > :11:04.But we are living in a devolved Great Britain. It is great to get

:11:05. > :11:08.the parties together in England how are you proposing to get Wales and

:11:09. > :11:14.Scotland and Northern Ireland to come together? My wife works for the

:11:15. > :11:19.NHS, she has worked for the NHS for 18 years in Wales and gets treated

:11:20. > :11:24.by the NHS in Wales but works for NHS England. How do you propose to

:11:25. > :11:30.get the whole of Great Brit`in to work with this plan? I thank him for

:11:31. > :11:35.the intervention. I made thd point I am focused on England because of

:11:36. > :11:38.health being a devolved responsibility and I make the point

:11:39. > :11:44.at the same pressures apply everywhere. The need for a process

:11:45. > :11:47.of this sort in Wales and Scotland and Northern Ireland is as strong as

:11:48. > :11:53.the case in England. I would encourage the debate to takd place

:11:54. > :11:56.in Wales as well and in a sdnse to overcome the clashes between parties

:11:57. > :12:01.to recognise something big hs going on and we need to work together I

:12:02. > :12:08.thank him for giving way. It was on the previous point about thd data.

:12:09. > :12:13.We had a debate last June about moving from weekly to monthly data

:12:14. > :12:19.and we were told the NHS wotld still know what was going on. We have a

:12:20. > :12:25.six-week delay in when that monthly data is published, which me`ns ten

:12:26. > :12:29.weeks. I did ask this at last health questions, I understand that people

:12:30. > :12:31.within the NHS can access d`ta. Why is it not shared with this place?

:12:32. > :12:46.The last data was November. I fundamentally believe in openness

:12:47. > :12:50.and I think it is good if everyone understands what is going on and

:12:51. > :12:55.there can be an informed debate 1 of my concerns is despite the way

:12:56. > :12:58.some of the very good policx positions that have been taken

:12:59. > :13:07.nationally, across the country too often, crisis management prdvails.

:13:08. > :13:12.Because areas are so focused on propping up acute hospitals, it ends

:13:13. > :13:18.up with more money being pulped into the acute hospitals and othdr parts

:13:19. > :13:23.of the system, the preventive parts, losing out, being cut back further.

:13:24. > :13:30.It becomes a vicious circle because the more you cut back on

:13:31. > :13:38.preventative care, general practice and social care, the more pressure

:13:39. > :13:42.you put on hospitals. You c`nnot escape from this. That is why we

:13:43. > :13:51.need the long-term solution I talked about. Seems to me that health and

:13:52. > :13:56.care is unique. Demand keeps rising. This is actually unusual whdn you

:13:57. > :14:09.compare it with police, schools so forth. It rises. We know th`t there

:14:10. > :14:17.are problems we are living through. The cost pressures keep going up. By

:14:18. > :14:26.2020, it is a well-established position that there will be a ? 0

:14:27. > :14:30.billion in the NHS funding. The health foundation has said hn social

:14:31. > :14:35.care the gap will be ?6 billion This is enormous and takes no

:14:36. > :14:41.account of the ?1 billion additional cost from the increasing minimum

:14:42. > :14:46.wage. The government has responded and identified that there whll be an

:14:47. > :14:50.extra ?10 billion for the NHS, leaving a ?20 billion shortfall

:14:51. > :14:59.That is based on scenarios set out in the foreword few. The scdnario

:15:00. > :15:02.involving a ?20 billion savhng involves efficiency savings which

:15:03. > :15:07.are completely unheard of in the history of the NHS and virttally

:15:08. > :15:11.anyone you speak to, it is not just people who refuse to accept the need

:15:12. > :15:20.for efficiencies, virtually everyone you speak to says to achievd

:15:21. > :15:26.efficiency savings of 3% is unachievable between now and 20 0.

:15:27. > :15:32.Extremely grateful to the honourable gentleman for giving way. Is it not

:15:33. > :15:38.the case that even though the NHS is under very great financial pressure,

:15:39. > :15:45.and we are trying to get catght from a pint pot, it the people -, it is

:15:46. > :15:49.the people who work in the service who are under pressure. The

:15:50. > :15:55.information that has come ott from across the service pays tribute to

:15:56. > :15:59.the fact that they work unddr enormous pressure. It is not just a

:16:00. > :16:03.financial issue, it is the fact that the staff around unprecedented

:16:04. > :16:15.pressure. That will not get any easier. It is a powerful pohnt and

:16:16. > :16:19.we know that staff are workhng under pressure. These assumptions about

:16:20. > :16:25.the funding gap also don't take into account the work that he and I have

:16:26. > :16:29.done together to make the c`se for equality of access for thosd who

:16:30. > :16:37.suffer mental ill-health. That is a historic injustice that needs to be

:16:38. > :16:41.met. He has led task force four NHS England and concluded that lental

:16:42. > :16:52.health will require an extr` ?1 2 billion per year by 2020. It's very

:16:53. > :16:56.hard to deny the justice of that cause and the right for people to

:16:57. > :17:02.get access in the same way dveryone else does to social care. I am

:17:03. > :17:10.conscious the Madam Deputy Speaker might get irritated with me so I

:17:11. > :17:14.should perhaps... For clarification, the honourable gentleman is doing

:17:15. > :17:17.just fine on timing and I appreciate he's taken a lot of interventions

:17:18. > :17:20.and people who intervene now that later in the debate their speeches

:17:21. > :17:29.will be shorter because thex've done so. The honourable gentleman is

:17:30. > :17:36.doing nothing wrong. I'm relieved. I sensed I might be getting in trouble

:17:37. > :17:42.so I will give way. Can we `gree in terms of the aggregate spend a chair

:17:43. > :17:50.of health and social care, which is higher in Wales, cutting social care

:17:51. > :17:55.might increase the total amount because undue pressure is ptt on the

:17:56. > :18:02.NHS who cannot relieve beds and it costs more overnight keeping someone

:18:03. > :18:07.in hospital. He is absolutely right. The point has been made that if you

:18:08. > :18:14.cut that the gap becomes evdn greater. There is no escaping from

:18:15. > :18:18.this. The brutal truth is the system is under substantial pressure.

:18:19. > :18:26.Consider this, the government needs to reflect on this. The Offhce for

:18:27. > :18:31.Budget Responsibility's analysis shows that between now and 2020 we

:18:32. > :18:38.are planning to spend a redtcing percentage of the GDP on he`lth At

:18:39. > :18:46.a time when demand is incre`sing dramatically, does that makd any

:18:47. > :18:49.sense? An analysis was done of all countries in the European Union and

:18:50. > :18:56.there were only five spending a lesser proportion on health than we

:18:57. > :19:04.do. The NHS is very good value for money but is under extraordhnary

:19:05. > :19:10.pressure. The picture he is painting is one of a very reactive approach

:19:11. > :19:17.to problems which are growing and I entirely support his call for this

:19:18. > :19:19.review because it seems to le as a responsible society we need a

:19:20. > :19:25.holistic, forward-looking, proactive approach. The commission made a

:19:26. > :19:31.number of good proposals. Some of them I agree with, some I do not. To

:19:32. > :19:35.what extent does he agree whth me on that point? I totally agree. I have

:19:36. > :19:42.agreed with every single ond so far. It is absolutely right. It goes to

:19:43. > :19:47.the point I made about crishs management. We are at risk of

:19:48. > :19:56.lurching from one crisis to another, propping up a system under

:19:57. > :20:02.unsustainable pressure. There are some great initiatives in

:20:03. > :20:06.Country, where volunteers working with GPs to address the problem of

:20:07. > :20:07.loneliness are helping to kdep people out of hospital. This sort of

:20:08. > :20:30.thinking could be more widespread. He might be about to come onto this

:20:31. > :20:32.but what I want to try and understand is the way that the

:20:33. > :20:34.commission and the output from the commission could help with some of

:20:35. > :20:38.the very difficult hospital reorganisations we face in our

:20:39. > :20:43.constituencies. How we can dnsure the balance that needs to bd there

:20:44. > :20:51.between acute services and care in the community, the right balance is

:20:52. > :20:59.struck. How will he help thhs? I agree with the intervention, the NHS

:21:00. > :21:07.has the status as a national religion. There is a danger that

:21:08. > :21:14.anyone who comes up with anx proposal that suggests any change to

:21:15. > :21:17.the NHS gets condemned from on high. That is the sort of politic`l point

:21:18. > :21:24.that can be scored against people in so doing. If we are doing this in a

:21:25. > :21:33.rational way and thinking long-term, about what this country needs, we

:21:34. > :21:41.need to give people the space, give government the space to think afresh

:21:42. > :21:48.about how to sustain this sxstem and guaranteed care. The point H was

:21:49. > :21:58.going to make is we have a choice. We either continue to drift into the

:21:59. > :22:03.system crashing or we take control, grasp the nettle and come up with a

:22:04. > :22:11.long-term solution. All parties should commit to this. The

:22:12. > :22:14.commission was established by the Labour government to look at the

:22:15. > :22:28.long-term sustainability of pensions in this country. He came up with

:22:29. > :22:32.proposals that led to reforl. It gave people the space to look at a

:22:33. > :22:39.very difficult challenge and come up with solutions. It is one model of

:22:40. > :22:41.how this should work. This hs not a Royal commission we are talking

:22:42. > :22:49.about which goes into the long grass. This is time-limited. I would

:22:50. > :22:54.suggest it is up to one year. There is the aim of coming up with

:22:55. > :23:02.solutions. It should engage with the public and patient groups. Staff

:23:03. > :23:06.often feel under intense prdssure and are not listened to by

:23:07. > :23:10.governments of all political persuasions. They should be

:23:11. > :23:18.centrally engaged in this together with unions and civic society. We

:23:19. > :23:24.should seek to come up with recommendations that can thdn be

:23:25. > :23:34.implemented, giving everyond the assurance that there is a long-term

:23:35. > :23:41.settlement. I want to raise something the commission should look

:23:42. > :23:49.at. It needs to look at the adequacy of funding. How much, as a society,

:23:50. > :23:53.are we prepared to pay to ensure we have a good and functioning health

:23:54. > :23:56.and care system? We need to look at the fact that at the moment funding

:23:57. > :24:05.comes through three different channels. The NHS, social c`re but

:24:06. > :24:11.also the benefit system. Dods that make sense? Should we be looking at

:24:12. > :24:18.that? We also need to look `t how we are spending money, are we spending

:24:19. > :24:23.it effectively enough and t`rgeting it at local people who need

:24:24. > :24:27.government help? We need to look at intergenerational fairness hn terms

:24:28. > :24:33.of where the money comes from, appoint very well made by the

:24:34. > :24:38.Cabinet Minister, David Willetts. We need to look at how we can give

:24:39. > :24:46.power to people to help thel self care. The point was made th`t

:24:47. > :24:50.projections about extra mondy that the system needs were based on

:24:51. > :24:54.people being engaged in thehr health. Self caring more

:24:55. > :25:01.effectively. That has not h`ppened as he proposed. He also said we need

:25:02. > :25:06.to look for the case for a dedicated health and care tax, with the

:25:07. > :25:15.ability for people to vary ht locally within their localities The

:25:16. > :25:21.problem is even protecting the NHS spending results in disproportionate

:25:22. > :25:25.cuts elsewhere, distorting sensible, rational decisions, and it seems to

:25:26. > :25:35.me that because this is an `rea which arises, there is a case for

:25:36. > :25:42.carving this out. I want to give other people the chance to speak.

:25:43. > :25:53.This proposal has very signhficant support. NHS survival, which now

:25:54. > :25:56.encompasses many groups, have strongly argued for this. Chief

:25:57. > :26:03.Executive is wrote to the Prime Minister to support the casd. The

:26:04. > :26:10.chief executive of the King's fund has written a very helpful blog

:26:11. > :26:15.making the case. Foyle Colldge is of surgeons, pathologists and

:26:16. > :26:21.anaesthetists have supported this -- Royal colleges. I urge the

:26:22. > :26:26.government to respond posithvely, to stop and think before rejecting

:26:27. > :26:30.this, to think this actuallx might be an enormous help to the

:26:31. > :26:36.government in resolving an intractable problem. This, ht seems

:26:37. > :26:40.to me, is the time for a 21st century Beveridge report to come up

:26:41. > :26:49.with the long-term settlement for the NHS and social care. Thd

:26:50. > :26:57.question is as on the order paper. Could I start by thanking the member

:26:58. > :27:00.and paying tribute to the work he carried out as a minister in the

:27:01. > :27:04.Coalition Government and his personal commitment to ment`l health

:27:05. > :27:10.services? I would also like to welcome his call for focus,

:27:11. > :27:14.cross-party agreement on wh`t is a long standing agreement if we are

:27:15. > :27:15.going to solve and create a health and social care service that is fit

:27:16. > :27:26.for purpose. One note of caution I would sound is

:27:27. > :27:33.that there is no shortage of commissions. We know we are a year

:27:34. > :27:37.from the Barca commission, the respected independent commission set

:27:38. > :27:46.up by the King's Fund that has laid out the problems we face st`sh Mac

:27:47. > :27:52.Barker. There will be hard choices if we are going to raise to 11% the

:27:53. > :27:59.share of GDP spent on health and social care, which many members

:28:00. > :28:03.would support. I would question whether we need a commission to

:28:04. > :28:11.carry that out, or whether what we need is a commitment from ldaders of

:28:12. > :28:16.all parties in England to come together to look seriously `t those

:28:17. > :28:21.proposals and try to get aw`y from the endless bickering in thhs place

:28:22. > :28:26.about the choices before us, that try to pretend somehow this is not

:28:27. > :28:30.going to happen because unldss we create these changes, we have to

:28:31. > :28:36.start thinking about plan B, what is the alternative? And what would be

:28:37. > :28:39.the consequences for all our constituents if we fail polhtically

:28:40. > :28:48.to reach an agreement about the challenges we face? I would ask .. I

:28:49. > :28:51.give way. The honourable lady is supporting a commitment but not

:28:52. > :28:58.quite a commission, but would a commission be a sign there was a

:28:59. > :29:02.commitment? I think sometimds in this place we can push things into

:29:03. > :29:08.commissions that we will thdn debate endlessly and come to no agreement.

:29:09. > :29:17.I would say the urgency of this demands that leaders of all parties

:29:18. > :29:23.sit down together and agree it. I am grateful. I will not keep doing

:29:24. > :29:30.this, I promise. What I feel is there needs to be a process which

:29:31. > :29:35.everybody commits to. If it is a desire for the party leaders to

:29:36. > :29:39.cooperate together, every crisis that comes along, the tempt`tion to

:29:40. > :29:46.score political points will be too great and it will not happen. People

:29:47. > :29:50.need to be prepared to commht. I thank him for that clarific`tion. I

:29:51. > :29:54.agree, a process everyone c`n commit to is what we are looking for, we

:29:55. > :30:01.are not looking for a commission that will examine the probldms. We

:30:02. > :30:07.know the issues, they have been set out in stark terms. We have had an

:30:08. > :30:12.excellent commission in the King's Fund and independent Barker

:30:13. > :30:15.commission, setting out opthons What has always been lacking is the

:30:16. > :30:22.political determination to love this forward. I would join in a request

:30:23. > :30:26.to have any process that makes that happen, but not something that

:30:27. > :30:32.pushes it off for three years. The closer we get to an election, we all

:30:33. > :30:35.know the more challenging it will be to have a genuine political

:30:36. > :30:43.agreement. It needs to happdn as rapidly as possible. I am most

:30:44. > :30:46.grateful. I am not sure there is that big a difference betwedn my

:30:47. > :30:52.honourable friend and the rhght honourable gentleman but as well as

:30:53. > :30:59.getting everyone to focus on this issue now, it is also extrelely

:31:00. > :31:06.long-term. As with pensions, where we used to accept that it ndeded to

:31:07. > :31:09.be an all-party approach because of the length of time involved in these

:31:10. > :31:15.important decisions, so also it needs to be in the issue we

:31:16. > :31:20.discussed today. As well as getting everyone to focus on the issue, it

:31:21. > :31:24.is to get everyone to focus on the importance of agreement bec`use it

:31:25. > :31:31.is long-term. I thank him for making that point. I agree with hil. I

:31:32. > :31:34.would also say that we must in parallel with that process of

:31:35. > :31:39.looking at the long-term funding arrangements and settlement, we must

:31:40. > :31:44.get on here and now with ch`nges that need to happen in the

:31:45. > :31:50.short-term. I would like to touch on a few areas. The first is prevention

:31:51. > :32:00.and I agree with the honour`ble member for Norfolk that to cut money

:32:01. > :32:07.from public health is bad practice, simply because the challengds we

:32:08. > :32:13.face, and we look at the NHS budget, 70% goes on helping those who are

:32:14. > :32:17.living with long-term conditions. We know there are many problems brewing

:32:18. > :32:22.here and now for the future if we just take the issue of childhood

:32:23. > :32:28.obesity, an issue we discussed last week at length, with a quarter of

:32:29. > :32:34.the most disadvantaged children now leaving primary school not just

:32:35. > :32:38.overweight, but actually obdse. And the problems that is saving up for

:32:39. > :32:45.them, the personal cost to the children and the wider cost to the

:32:46. > :32:52.NHS when we consider alreadx almost 10% of the entire NHS budget goes

:32:53. > :32:57.towards treating type 2 diabetes. How is it we are not really grasping

:32:58. > :33:04.the nettle on this as an issue of urgent prevention in order to save

:33:05. > :33:10.money for the system? I givd way. Does she agree there is a

:33:11. > :33:16.relationship between child poverty and obesity and child poverty,

:33:17. > :33:20.indeed another problem with health that generates cost. If a p`rt of

:33:21. > :33:26.the problem of solving the dilemma of costs for health and sochal care

:33:27. > :33:29.is to look again at some of those demographic drivers. Indeed. The

:33:30. > :33:40.data from Public Health England is stark. Not only is there a large gap

:33:41. > :33:44.between, if you look at the index of multiple deprivation and incidence

:33:45. > :33:50.of childhood obesity, that gap is widening. As part of the strategy

:33:51. > :33:53.the government must aim to lower the overall levels of childhood obesity

:33:54. > :33:57.and to narrow the gap and look at measures that will help to do so. I

:33:58. > :34:04.thank the honourable gentlelan for making that point. The honotrable

:34:05. > :34:08.gentleman has referred to the need for self-care, a greater focus on

:34:09. > :34:13.how we support people to improve their health. We know that needs to

:34:14. > :34:17.be done and we know that thdre are mechanisms we can use if we raise

:34:18. > :34:22.money for the whole health or social care system, there are mech`nisms

:34:23. > :34:29.that also help to prevent ill-health in the future, for example, a sugary

:34:30. > :34:34.drinks tax that could leave money into a straight and public health

:34:35. > :34:40.budgets, to actually put pl`ce measures we know will help ,-

:34:41. > :34:43.straightened. We need to get on with prevention and we need more funding

:34:44. > :34:52.available to go into saving money for the future. Thank you for giving

:34:53. > :34:57.way. Might I say as chairman of the Select Committee what respect we

:34:58. > :35:01.have for you around this hotse. I would be interested to hear your

:35:02. > :35:11.view on the five-year forward view plan. I appreciate he has not been

:35:12. > :35:15.in the house very long, but when he uses the word you, he is not

:35:16. > :35:19.addressing the honourable l`dy, he is addressing the chair. I know he

:35:20. > :35:24.means his compliments are not the chair but the honourable lady, so he

:35:25. > :35:32.has to the honourable lady. I apologise profusely. We havd great

:35:33. > :35:37.respect for you also, of cotrse To go back to my initial questhon. The

:35:38. > :35:42.five-year forward view plan is already under way and is backed by

:35:43. > :35:46.and led by the former Labour adviser Simon Stephens. It is looking into

:35:47. > :35:54.reforming health and care sdrvices and is backed by funding thd NHS

:35:55. > :35:56.says it requires. Do you fedl setting up another body would

:35:57. > :36:06.benefit the NHS or a hindrance? I thank my honourable friend to

:36:07. > :36:10.referring to the forward vidw. Simon Stephens has referred to prdvention

:36:11. > :36:14.and social care as being unfinished business from the spending review

:36:15. > :36:19.and I think if we are going to make the five-year forward view deliver,

:36:20. > :36:27.we need to listen to his vidws and be mindful of the fact spending on

:36:28. > :36:31.social care actually saves the NHS money and we cannot separatd social

:36:32. > :36:36.care from the NHS and neithdr should we ignore his wise words on

:36:37. > :36:39.prevention and the importance of that in delivering the five,year

:36:40. > :36:46.forward view. But I thank the honourable gentleman. Is it not the

:36:47. > :36:50.case when Simon Stephens was in front of the Select Committde he

:36:51. > :36:55.identified a quarter of the 22 billion that was hoped to bd saved

:36:56. > :37:01.would have to come out of prevention and public health, and yet that has

:37:02. > :37:06.been cut? Indeed I remember that also and I agree that unless we deal

:37:07. > :37:12.with prevention and we up otr game and redouble our efforts on

:37:13. > :37:17.prevention, we will not achheve the savings required to deliver and

:37:18. > :37:22.close the gap. That is why H wanted to touch on that first. I think the

:37:23. > :37:30.other area we need to do more on here and now is a relentless focus

:37:31. > :37:36.on variation across the NHS. Because we do hear of examples wherd local

:37:37. > :37:41.systems do make it work. Thd NHS has a long history of failing to roll

:37:42. > :37:47.out best practice. I would like to touch on the NHS Confederathon s

:37:48. > :37:53.commission that has been published today and a report called growing

:37:54. > :38:01.old together. That gives a number of examples. Of really good pr`ctice

:38:02. > :38:06.where integrated practice is not only delivering better care for

:38:07. > :38:10.individuals but saving monex. The only depressing aspect of that is

:38:11. > :38:17.you have to ask why is that not happening everywhere? Rather than

:38:18. > :38:21.endlessly focusing on negathve in the NHS, let's try to focus more on

:38:22. > :38:29.the positive and facilitating that roll-out. I thank her for ghving

:38:30. > :38:32.way. She is talking about some of the work already done about problems

:38:33. > :38:39.of the health service and approaches to improve it. Does she share my

:38:40. > :38:43.concern there are big challdnges and a risk that the commission `s

:38:44. > :38:48.proposed could prove a distraction from getting on with so manx things

:38:49. > :38:54.we need to happen and getting on with the good proposals in the

:38:55. > :38:58.five-year forward view and could be unhelpful rather than helpftl

:38:59. > :39:02.despite its objective? I th`nk my honourable friend. If that were the

:39:03. > :39:07.case it would be a problem, but the two things could happen in parallel.

:39:08. > :39:14.I think we can work towards a consensus about funding at the same

:39:15. > :39:19.time as we focus on what nedds to be done in the here and now. Btt I

:39:20. > :39:25.agree if that were a distraction it would be a problem. Relentldss focus

:39:26. > :39:31.on tackling variation I think is one of the key is we need to continue

:39:32. > :39:37.with. The other thing I would touch on is evidence, that we need to

:39:38. > :39:43.follow evidence in health c`re, and when money is stretched, we must be

:39:44. > :39:48.careful we spend that money not only following the evidence, but also

:39:49. > :39:54.making sure we are not wasthng money in the system. I would cauthon the

:39:55. > :39:57.minister on the issue for example seven day services, something we

:39:58. > :40:02.have discussed the Health Sdlect Committee, that where there is

:40:03. > :40:07.evidence that for example GP surgeries are empty on a Sunday

:40:08. > :40:11.afternoon because there is not demand, in a financially stretched

:40:12. > :40:17.system, particularly if in parallel to that there are out of our

:40:18. > :40:23.services that we are being told are in danger of collapse because there

:40:24. > :40:29.is not the resources, or thd manpower, to man them both, we must

:40:30. > :40:34.be led by the evidence and be prepared to change what we `re

:40:35. > :40:38.doing, because when money is tight, we owe it to patients to focus on

:40:39. > :40:47.the things that will improvd their care. We must not delay changing

:40:48. > :40:51.where we know something that has been put in place with the best

:40:52. > :40:59.intentions could be having unintended consequences. I think we

:41:00. > :41:04.need to be clear about that. And follow the evidence on best practice

:41:05. > :41:08.can get the best outcome in a can get the best outcome in a

:41:09. > :41:17.financially stretched systel. Of course. If the government ddcides to

:41:18. > :41:21.make Saturday a working day alongside a regime where thdre is a

:41:22. > :41:26.couple who are doctors who can be sent without choice to diffdrent

:41:27. > :41:30.parts of the country to practise in hospitals and they only havd family

:41:31. > :41:35.time together at weekends, but now the Saturday will be a workhng day,

:41:36. > :41:42.it will make the situation impossible. Does she agree that

:41:43. > :41:48.needs to be looked at in case we see a further leakage of doctors will

:41:49. > :41:52.stop I have to declare a personal interest. One reason my daughter who

:41:53. > :41:57.was a junior doctor spent a year in Australia is because sometiles that

:41:58. > :42:02.are difficulties within married couples being able to work hn the

:42:03. > :42:06.same part of the country, or people in any relationship, it can be

:42:07. > :42:12.difficult sometimes. There hs more that can be done to help thd way

:42:13. > :42:17.junior doctors' lives, to hdlp their lives, in addition to the contract

:42:18. > :42:21.negotiation we have about money I do have a personal interest and it

:42:22. > :42:26.is probably best I do not comment further than that. I would like to

:42:27. > :42:35.draw attention to the role of the voluntary sector.

:42:36. > :42:44.I would like to pay tribute to the voluntary sector partners in my

:42:45. > :42:47.constituency. There is care across the constituency, a number of

:42:48. > :42:52.organisations making a real difference to people's lives and

:42:53. > :42:58.yet, very many of these organisations are coming under

:42:59. > :43:04.extreme pressure. I can givd examples of voluntary sector

:43:05. > :43:07.partners that have needed to close, sometimes for the want of vdry small

:43:08. > :43:14.amounts of money when they've been delivering enormous amounts of

:43:15. > :43:19.value. It was Elkan -- welcome commitment to look at making the

:43:20. > :43:31.arrangements for commissionhng voluntary partners. The resources

:43:32. > :43:36.are not there to fund them `nd I think we need to look at how we can

:43:37. > :43:46.best deliver value for our patients by supporting voluntary sector

:43:47. > :43:50.partners across constituenches. I would like those to be focused on in

:43:51. > :43:54.the here and now but in the long term we must look at funding. One of

:43:55. > :43:59.the challenges we face in this country, and I think it is `

:44:00. > :44:04.wonderful thing, almost all the funding for the health servhce comes

:44:05. > :44:09.directly from either taxation or national insurance. We are `lmost

:44:10. > :44:26.uniquely placed. There are only two Mac other countries. When wd say we

:44:27. > :44:30.spend 7.3% of our government GDP, only 1.5% additional is levdred in

:44:31. > :44:37.from the private sector. Thd choices in front of us are, are we going to

:44:38. > :44:42.expand the amount we raise, Top Of The Pops, personally, I do not

:44:43. > :44:47.support that and the Barker commission did not support ht

:44:48. > :44:53.either. They don't raise as much as people imagine and by the thme

:44:54. > :45:01.you've accounted for the bureaucracy, and the unintended

:45:02. > :45:10.consequences you often find, I hope we won't choose to go down that

:45:11. > :45:16.route, and I think the best way is to go through taxation. There is an

:45:17. > :45:20.issue of intergenerational fairness. We do need to look at that. But

:45:21. > :45:29.these are hard political choices and they cannot be ducked. The

:45:30. > :45:33.Democratic challenge we facd, that complexity, the alternatives are

:45:34. > :45:40.appalling and the alternatives are to abandon our older people, to mean

:45:41. > :45:47.that the pressures we face hn hospitals from those who cannot be

:45:48. > :45:53.discharged, those pressures are mounting. We can ignore thel no

:45:54. > :45:59.longer and I would call on the government to look carefullx at

:46:00. > :46:08.working with opposition partners to bring forward an agreement so that

:46:09. > :46:14.we can agree how we're going to do this, and make sure the mondy we

:46:15. > :46:22.spend is spent in the best hnterests of patients. It is a privildge to

:46:23. > :46:27.follow the honourable member, who is always open to discussion and debate

:46:28. > :46:31.and speaks with great experhence. I'm sure I speak for many mdmbers in

:46:32. > :46:37.this house in saying we are better for it. I support today's motion not

:46:38. > :46:44.because I think we can somehow take the politics out of the NHS and

:46:45. > :46:55.social care. Services used by millions of people, employed over 3

:46:56. > :47:01.million staff, they will always be the subject of political debate and

:47:02. > :47:06.in my view, rightly so. I stpport the motion because the NHS `nd

:47:07. > :47:13.social care face huge challdnges, bigger than at any point in our

:47:14. > :47:20.history, and I believe we mtst not ignore or downplay these ch`llenges

:47:21. > :47:31.and expect staff to struggld through. I agree that we nedd a new

:47:32. > :47:39.settlement and an independent commission involving public staff

:47:40. > :47:48.and exports could play an enormous role. Cross-party support is vital.

:47:49. > :47:56.I know as the former shadow minister that it is extremely diffictlt for

:47:57. > :48:00.front bench politicians to be open about what it will really t`ke to

:48:01. > :48:07.ensure care services are fit for the future, how much this will cost

:48:08. > :48:14.where the money will come from, and what changes are needed to lake sure

:48:15. > :48:21.our care services are it for the future. Your comments are lhkely to

:48:22. > :48:30.be leapt upon and end up as screaming headlines, but in the end

:48:31. > :48:35.it is not the politicians who suffer but the patients and familids and

:48:36. > :48:46.staff. There have been many important things that have `ddressed

:48:47. > :48:52.this. I want to pay tribute to the Commissioner, set up by the fund and

:48:53. > :48:58.from which many of my comments are drawn. What these initiativds have

:48:59. > :49:03.failed to achieve is genuind cross-party involvement and

:49:04. > :49:11.agreement. The commission bding proposed could create the political

:49:12. > :49:16.space we desperately need to agree a long-term settlement for thd NHS and

:49:17. > :49:25.social care, whichever partx or parties are in power. The nded for

:49:26. > :49:33.this is urgent. Given the btdget since 2010, staff have performed

:49:34. > :49:44.remarkably. The NHS is now struggling to meet many of hts

:49:45. > :49:51.waiting time targets. The 62 day cancer waiting time target has not

:49:52. > :49:57.been met for more than a ye`r. NHS finances are under acute prdssure,

:49:58. > :50:07.with a projected deficit of ?2 billion. The situation and social

:50:08. > :50:13.care is even worse. 400,000 less people are receiving care shnce 2010

:50:14. > :50:17.even though the population hs ageing. Many of those who gdt care

:50:18. > :50:24.are getting less support th`n they were. More than a million pdople who

:50:25. > :50:27.have difficulties in the very basics of daily living like getting up

:50:28. > :50:34.getting washed and going to the toilet now receive no formal or

:50:35. > :50:44.informal help at all. Last xear the CQC found one in five nursing homes

:50:45. > :50:47.do not have enough staff. The latest survey shows that the first time

:50:48. > :50:55.since it started collecting figures, more older people's care beds have

:50:56. > :51:00.closed than opened. Five of the largest care home providers predict

:51:01. > :51:05.significant failure within the next 12-24 months. Three of the larger

:51:06. > :51:09.home-care providers have already with drawn or signalled thehr

:51:10. > :51:15.intention to with draw from providing publicly funded c`re.

:51:16. > :51:23.These problems are not going away. The NHS sets out how they hope to

:51:24. > :51:27.close at in health spending that is estimated to reach ?30 billhon per

:51:28. > :51:35.year by 2020. This will reqtire efficiency savings of ?22 bhllion

:51:36. > :51:40.and an additional ?8 billion of real additional funding which thd

:51:41. > :51:45.government has committed to provide. But no health service in thd world

:51:46. > :51:51.has achieved efficiency savhngs of 5% in one year left alone fhve years

:51:52. > :51:58.in a row. And the Chief Executive of the NHS has repeatedly stressed very

:51:59. > :52:05.broad calculation is dependhng on social care receiving a decdnt level

:52:06. > :52:10.of funding, given cuts incrdase pressure on the NHS. I don't believe

:52:11. > :52:19.there is a decent funding sdttlement for social care. These reforms were

:52:20. > :52:24.never intended to address the current underfunding but to the cost

:52:25. > :52:34.to individuals. The Better Care Fund, which is welcome, and the 2%

:52:35. > :52:39.fund, will not fill the gap. It will be harder for areas with thd

:52:40. > :52:44.greatest need for social care to cover their costs because they raise

:52:45. > :52:52.the lowest amount from council tax. Our population is ageing. Ddmand for

:52:53. > :53:01.care will increase. The question we face is not whether the mondy will

:53:02. > :53:04.be spent, it is where the cost will fall, on collective provision

:53:05. > :53:08.through public expenditure or on those individuals and familhes who

:53:09. > :53:15.are unlucky enough to need care and support. There is no shortage of

:53:16. > :53:20.proposed solutions to this problem. The commission has called for

:53:21. > :53:25.changes to the national instrance system. These include removhng the

:53:26. > :53:32.exemption from national instrance for those past state pension age and

:53:33. > :53:38.raising the rate for those `bove the upper earnings limit. It also

:53:39. > :53:43.proposes restricting winter fuel payments to the least affludnt few

:53:44. > :53:46.costs of care are met by those above costs of care are met by those above

:53:47. > :53:59.state pension age who have the means to contribute. In a Guardian

:54:00. > :54:04.interview it was said there needs to be more flexibility between the

:54:05. > :54:08.current disconnected funding streams so that at times of need, everyone

:54:09. > :54:17.is guaranteed high-quality social care. I believe we must facd up to

:54:18. > :54:21.the vital question of interdst - of intergenerational fairness. The vast

:54:22. > :54:26.majority of older people have worked hard all their lives in paid

:54:27. > :54:31.employment and deserve support. They don't want to end up selling the

:54:32. > :54:36.family home to pay for care if they need it. But I know from my own

:54:37. > :54:40.family as well as my constituents that older people also worrx about

:54:41. > :54:46.their children and grandchildren and how they will be able to afford to

:54:47. > :54:50.pay their bills or go to college and university, let alone have the

:54:51. > :54:55.chance to buy their own homd. In my view we simply cannot ask the

:54:56. > :55:02.working age population to shoulder the costs required to fund the NHS

:55:03. > :55:08.and social care in future and I think many older people would agree.

:55:09. > :55:11.An independent commission whth proper cross-party support which

:55:12. > :55:16.genuinely involves and engages with the public, because after all they

:55:17. > :55:23.are the ones who fund the NHS and social care, could finally help us

:55:24. > :55:25.make progress on finding lasting solutions to these inevitably

:55:26. > :55:32.difficult and controversial questions. As the Barker colmission

:55:33. > :55:40.says, the challenges we facd, more people in need receiving fewer

:55:41. > :55:47.support, fewer people receiving publicly funded social care, care

:55:48. > :55:51.homes closing in the face of demand, homes leaving the publicly funded

:55:52. > :55:59.market. Individuals and famhlies unlucky enough to need high levels

:56:00. > :56:02.of care facing enormous bills, staff shortages leading to a rising

:56:03. > :56:07.neglect, as good people are delivering good care, firing --

:56:08. > :56:13.piling further pressure on the NHS and bleeding to declining standards

:56:14. > :56:18.of social care. That is not a future anyone would wish for their parents,

:56:19. > :56:21.themselves or their children, but it is upon us. It is time for

:56:22. > :56:40.politicians to act. When thank you. I would likd to

:56:41. > :56:50.congratulate the honourable member for arranging this debate. H broadly

:56:51. > :56:54.support the call for cross-party engagement in terms of securing the

:56:55. > :56:58.future for the National Health Service, though I think in ly speech

:56:59. > :57:03.today I will clarify that bdcause I think seeking cross-party stpport

:57:04. > :57:12.when it comes to the financhng of the National Health Service, the

:57:13. > :57:16.Right Honourable gentleman lake encounter difficulties, not least

:57:17. > :57:26.because of the contributions so far. There are profound challengds,

:57:27. > :57:34.pro-Marilyn because of the `geing challenges we face. -- Marilyn.

:57:35. > :57:42.I remember the intergenerathonal foundation launched in this

:57:43. > :57:46.Parliament a few years ago `nd it was only myself and the forler

:57:47. > :57:51.member for Dulwich who turndd up. At the time it was not much discussed

:57:52. > :57:56.and I know it now it is increasingly discussed, because we are doing the

:57:57. > :58:03.maths and realising we cannot afford the current system and we whll have

:58:04. > :58:08.to to discuss it at length. 1's approach to the financing of health

:58:09. > :58:12.and social care, you talk about broadly different philosophhes and

:58:13. > :58:16.approaches. I suspect more people will want to emphasise the need for

:58:17. > :58:22.personal responsibility and there will be some who will want to

:58:23. > :58:26.emphasise collectivisation `nd the like and that is why I suggdst

:58:27. > :58:32.discussing the financial settlement is possibly a road to nowhere. Where

:58:33. > :58:36.there is scope is to do with the structural organisation of the NHS.

:58:37. > :58:42.Where hospitals are located, what each hospital does, and I think

:58:43. > :58:47.particularly in a week wherd we have had another dreadful case of a

:58:48. > :58:53.failure of the system with regards to 111 and out-of-hours services, it

:58:54. > :58:58.is beholden upon us to disctss what is offered in the out of hotrs arena

:58:59. > :59:01.and how it is structured and web patients should seek appropriate

:59:02. > :59:10.care for themselves or indedd for their children -- and where

:59:11. > :59:16.patientss should go. We know we have an increasing demand problel, mainly

:59:17. > :59:22.driven by ageing and also bx obesity and driven by welcome advances in

:59:23. > :59:26.surgical practice, technology and drugs and also in the behavhour of

:59:27. > :59:32.generations in health seeking. I see in my clinical practice the passing

:59:33. > :59:38.of the stoic wartime generation and their attitude towards their own

:59:39. > :59:42.health, symptoms of pain, it is noticeably different to thehr

:59:43. > :59:48.children. With that will cole increasing demand upon health care

:59:49. > :59:54.services. If you put that in with this large cohort born betwden 945

:59:55. > :59:59.and 1955, you have an equathon that equals a significant deficit and on

:00:00. > :00:04.the subject of deficits, I have seen many faceless bureaucrats coming up

:00:05. > :00:09.with numbers about likely ddmand and shortfall. I would suggest to

:00:10. > :00:14.colleagues they are always wrong, they are usually under estilated.

:00:15. > :00:18.The 20 billion challenge I said was an under estimate of the likely

:00:19. > :00:25.demand and here we are talkhng about 30 billion, what's next? 40 billion?

:00:26. > :00:29.The mental health issue, and I am glad there is a shadow minister for

:00:30. > :00:32.mental health because it suggests people are waking up to the demands

:00:33. > :00:39.for mental health. What I would like for mental health. What I would like

:00:40. > :00:45.to talk about, one, the hospital structure with essentially 09th and

:00:46. > :00:52.20th century buildings trying to deliver 21st-century care. @ll the

:00:53. > :00:56.staff, medical and management, are trying to do their best but to be

:00:57. > :01:01.blunt, it is not possible to deliver the best care in all hospit`ls we

:01:02. > :01:08.have and in all locations wd have. Of course, I will give way. To some

:01:09. > :01:13.extent is it a failure to engage with the public, to underst`nd how

:01:14. > :01:18.much 21st-century medicine has changed? People who have a heart

:01:19. > :01:24.attack do not go to casualtx, they are taken to a heart unit where they

:01:25. > :01:30.have an angioplasty, becausd people do not understand the paramddic

:01:31. > :01:35.ambulance has everything thd old A used to have. Of course the

:01:36. > :01:41.honourable lady is right and can I say that tomorrow I will work as a

:01:42. > :01:46.doctor. I am very proud to be working as a doctor tomorrow. It is

:01:47. > :01:51.something I have been opened about throughout my time here and I will

:01:52. > :01:56.continue to practise in medhcine for the foreseeable future and H would

:01:57. > :02:00.encourage her to face down hnternal critics as well as ill informed

:02:01. > :02:09.external critics in the Scottish Daily Mail. The honourable lady is

:02:10. > :02:12.right, I have tried in my own area, because I stood for election calling

:02:13. > :02:17.for the closure of my local hospital for the very reason I did not want

:02:18. > :02:20.my constituents going to an ill-equipped hospital or thhnking

:02:21. > :02:27.the hospital provided the c`re it did not. I have sought to educate my

:02:28. > :02:42.local public about the need for a 24-hour and Chios Sweet and 24-hour

:02:43. > :02:47.strike unit -- angio suite. We have made progress particularly hn stroke

:02:48. > :02:53.care. In London and Manchester they have consolidated the services which

:02:54. > :02:57.is why people are surviving. This is why morbidity is improving for

:02:58. > :03:03.survival of stroke because patients are taken to appropriate unhts and

:03:04. > :03:07.cared for and the appropriate intervention can be applied within

:03:08. > :03:12.the appropriate time. This hs sadly not possible across the country

:03:13. > :03:17.only in areas where difficult decisions about reconfiguration have

:03:18. > :03:23.taken place. Oncology is another area. There is a belief that somehow

:03:24. > :03:29.cancer outcomes are to do whth late diagnosis and primary care. Forgive

:03:30. > :03:34.me, that is not the whole story The quality of cancer care when you

:03:35. > :03:39.reach the hospital, the del`y in receiving radiotherapy, this is

:03:40. > :03:44.having a profound impact on cancer outcomes. I would suggest if you

:03:45. > :03:50.consolidated oncology services to fewer sites you would get bdtter

:03:51. > :03:56.clinical outcomes. Moving to out of hours, I remember when I turned up

:03:57. > :03:59.here I said I would scrap ott of hours as currently constituted and

:04:00. > :04:06.most looked at me and thought, our slightly nuts? No. Having done many

:04:07. > :04:12.sessions in the primary card out of hours arena I realised that the

:04:13. > :04:17.acutely unwell, there was a potential to delay their care in a

:04:18. > :04:22.way that could have an adverse impact and also lead to somdone s

:04:23. > :04:31.death. I suspect the case wd heard about was Tuesday -- was it Tuesday,

:04:32. > :04:34.Wednesday? This is an example. It is not possible I believe to properly

:04:35. > :04:43.assess a sick child via the telephone. You can go some way to

:04:44. > :04:47.doing it with an adult becatse an adult can express themselves more

:04:48. > :04:51.accurately. With a child yot have to see them, you have to see the mother

:04:52. > :04:56.and the mother's response towards the child to assess how acutely

:04:57. > :05:01.unwell they are. With all the best intentions, if you have a tdlephone

:05:02. > :05:09.service, and it was no diffdrent under NHS Direct. The medic`l

:05:10. > :05:13.profession got frustrated whth that. If you have these services, these

:05:14. > :05:19.instances are sadly going to happen because if you tighten up the

:05:20. > :05:23.protocols, what happens is because the symptoms of sepsis, thex can be

:05:24. > :05:28.many other things other than sepsis and if you tighten the protocol you

:05:29. > :05:34.flood the service with more people worried a child has sepsis, when it

:05:35. > :05:39.is not back common for sepshs to develop. -- not that common. I would

:05:40. > :05:44.revisit the out of hours settlement will stop you could get awax with

:05:45. > :05:48.having fewer doctors on in anti-social hours, looking `fter the

:05:49. > :05:52.housebound and the terminally ill. Those who can be visited by the

:05:53. > :05:59.doctor, that list is compildd by GP practices. You do not get a visit

:06:00. > :06:03.unless your practice says you're entitled to visit because of your

:06:04. > :06:08.diagnosis. I would place thd resources for that, I would put each

:06:09. > :06:12.doctor may be in the future in urging care centres, but for now I

:06:13. > :06:21.would put them in casualty, sifting through. Doctors are taught to

:06:22. > :06:27.triage and diagnose. No othdr health care professionals are in the same

:06:28. > :06:30.way. The best thing to do is to put your most experienced person at the

:06:31. > :06:39.front end because then the proper triage can take place. I appreciate

:06:40. > :06:43.my honourable friend giving way On out of hours, in my constittency,

:06:44. > :06:48.the borough has a GP led system which I believe is brilliant. I have

:06:49. > :06:53.encouraged the Secretary of State to visit it as one that can be rolled

:06:54. > :06:59.out. My question would be, while I appreciate the idea of a colmission,

:07:00. > :07:04.if we having guards, we alrdady have out-of-hours services such `s the

:07:05. > :07:12.one lead from Teddington Melorial Hospital tonight, that I believe is

:07:13. > :07:16.the right standard, what extra can a commission to that we cannot do

:07:17. > :07:25.without a commission? The intervention allows me to elaborate

:07:26. > :07:29.more. A couple of years ago I had a meeting with the honourable member

:07:30. > :07:35.for Lee because the polls s`id we were going to win the electhon and I

:07:36. > :07:40.said to him, you are going to have this problem, Andy, we have these

:07:41. > :07:45.hospitals, we know some of them are not fit for purpose and maybe we

:07:46. > :07:50.have too many because health care has changed. 80% of care delivered

:07:51. > :07:55.is for chronic conditions, why not have a cross-party commission where

:07:56. > :08:01.all the parties share in thd political pain of deciding which

:08:02. > :08:07.hospitals should be retained as acute hospitals, delivering 24-hour

:08:08. > :08:13.stroke and surgical intervention and the like, and having more community

:08:14. > :08:20.hospitals with urgent care centres attached, and at the time hd looked

:08:21. > :08:24.at me and said, maybe, and lade no commitment. My point was for those

:08:25. > :08:30.colleagues in marginal seats, it is difficult to come out and s`y what I

:08:31. > :08:34.said in my constituency, whhch is the local hospital current

:08:35. > :08:39.settlement is not in the best interest of constituents. It is hard

:08:40. > :08:44.to do that in a marginal se`t. By having a cross-party commission we

:08:45. > :08:49.could share the pain. All of the Royal colleges, particularlx

:08:50. > :08:55.paediatricians and obstetricians, know that staffing in some hospitals

:08:56. > :09:01.is not ideal. It is difficult to provide the level of care wd know we

:09:02. > :09:07.can deliver. How do you get to that point? I thought a couple of years

:09:08. > :09:14.ago having the parties and dxperts in a room would be one way of trying

:09:15. > :09:20.to go from approximately 200 to approximately 100. This is hn

:09:21. > :09:25.England and Wales. I hope that answers the honourable Lady's

:09:26. > :09:33.question. Of course. I wonddr, thinking in my own constitudncy you

:09:34. > :09:37.have hospitals that have grown organically and are not far apart,

:09:38. > :09:41.but what is happening in my constituency is an increase in

:09:42. > :09:45.modern community hospitals, what people would have called cottage

:09:46. > :09:49.hospitals. When the honourable member talks about management of

:09:50. > :09:56.chronic diseases and being ` large number of patients, we need to take

:09:57. > :09:59.back closer to the public. Ht is the specialised things that shotld be

:10:00. > :10:03.centralised. The public would accept that, provided they do not have a

:10:04. > :10:08.sense of their hospital disappearing, provided they are

:10:09. > :10:16.aware that other services are coming closer to them. I am in agrdement.

:10:17. > :10:20.We are making a habit of thhs! I had public meetings in which people

:10:21. > :10:23.turned up against my position but when they understood what I was

:10:24. > :10:28.trying to do was provide more services closer to home, but they

:10:29. > :10:31.would have to travel further to get acute care perhaps, they understood

:10:32. > :10:37.it and accepted it and becale broadly supportive. I am under no

:10:38. > :10:43.illusions about the difficulty of this. However, the national Health

:10:44. > :10:49.Service, if there is one go`l we should seek, it is better clinical

:10:50. > :10:52.outcomes. At the moment the clinical outcomes are not as good as they

:10:53. > :11:00.should be. The common wealth fund report made that clear. Part of the

:11:01. > :11:07.problem, it is where the care is currently being delivered. The

:11:08. > :11:12.junior doctors strikes that have been paused, consultants' contracts,

:11:13. > :11:17.nursing contracts, these wotld be made easier if we had a strtcture

:11:18. > :11:23.that was more easily start. It would be easier to avoid the situ`tions of

:11:24. > :11:26.doctor husband and wife teal is being spit if you had bigger

:11:27. > :11:32.hospitals with bigger staff to provide cover. We need to

:11:33. > :11:36.concentrate first upon the structure of health care. And indeed social

:11:37. > :11:43.care. I am conscious I have not spoken about it. Of course ht should

:11:44. > :11:47.be integrated. But the structure of health care, let's concentr`te on

:11:48. > :11:53.that first as a cross-party approach and then I think subsequent to that,

:11:54. > :11:58.maybe we can have a debate `bout finance. I suggest that will be a

:11:59. > :12:02.harder nut to crack as opposed to hospitals, which I think thdre is

:12:03. > :12:06.broad consensus we are in it for the same outcome, which is people

:12:07. > :12:13.recovering from illnesses, being treated appropriately when they have

:12:14. > :12:15.operations, and everybody in this country leading long and he`lthy

:12:16. > :12:25.lives, irrespective of means. It is a pleasure to participate in

:12:26. > :12:30.this debate and I thank the honourable member for bringhng it

:12:31. > :12:37.forward. He has a passion for this subject and whenever the qudstions

:12:38. > :12:41.relate to it, we take great account of what he says. It is good to have

:12:42. > :12:54.him leading off on the subjdct matter. All the other members who

:12:55. > :13:02.spoke before sat on the sochal care committee. We have some knowledge of

:13:03. > :13:09.the subject matter. Can I ptt on record my thanks to the honourable

:13:10. > :13:20.gentleman, he has very kindly let me go first. I thank him for a letting

:13:21. > :13:27.me come first. In this debate so far, those who have not spoken will

:13:28. > :13:33.bring a wealth of knowledge to the debate, and I want to add a little

:13:34. > :13:43.contribution in relation to northern Ireland. This year marks thd 10th

:13:44. > :13:48.anniversary, since that revhew has been the Coalition Government and

:13:49. > :13:54.the Conservative majority government attempting to shift direction and

:13:55. > :13:59.introduce that. They're tryhng to make it versatile and cope with

:14:00. > :14:05.increasingly demand. In my constituency we have one of the

:14:06. > :14:19.largest growing numbers of those elderly people. The challenges of

:14:20. > :14:25.finance are making it more difficult. These are challenges that

:14:26. > :14:35.will be around for awhile and will need to learn how to address this as

:14:36. > :14:38.the democratics become older. We can perceive these challenges. Ht is

:14:39. > :14:45.encouraging to see the government recognising that and we look forward

:14:46. > :14:51.to the Minister's contributhon. I just want to say we are encouraged

:14:52. > :14:56.when you're on your feet because of the real interest you have hn the

:14:57. > :15:05.subject matter. The importance of an integrated system is widely accepted

:15:06. > :15:19.and we seem developments in Northern Ireland. The care programme was

:15:20. > :15:28.carried on by the health minister. They are assessing as a focts and

:15:29. > :15:34.strategy. There is a potenthal to save the NHS and social card system

:15:35. > :15:40.a lot of money in the long run. I would suggest the Minister light

:15:41. > :15:45.want to note that there is `n example of what we can do and what

:15:46. > :15:48.we are doing, something to take on board. I believe there is a

:15:49. > :15:55.potential to save a lot of loney in the long run and to ensure the

:15:56. > :16:03.social care experience is one they can benefit from. With the financial

:16:04. > :16:10.challenges of austerity, thdse are ideas we need to come up with to

:16:11. > :16:16.ensure that we modernise and offer a first-class service. Whether you

:16:17. > :16:26.like it or not, it is part of the system.

:16:27. > :16:36.We need to turn this into rdality. Social care needs to be on `

:16:37. > :16:39.sustainable path financiallx. We need to maintain a world-cl`ss

:16:40. > :16:49.social care and health systdm and make sure the pressures are properly

:16:50. > :16:54.understood. It is crucial to provide patients centred approach. With care

:16:55. > :17:04.and caution it is possible to do more with less. There are examples

:17:05. > :17:08.of how we can modernise. Thd public sector can deliver results. Health

:17:09. > :17:12.and social care need to be seen as equal partners, provided with the

:17:13. > :17:21.necessary resources to deliver high-quality services. We are living

:17:22. > :17:27.in tough times financially, and whilst funding is always desirable

:17:28. > :17:32.the success should be judged on the results. Social care is important in

:17:33. > :17:42.its own right. The government Association claims there is a lack

:17:43. > :17:49.of proportionality. Additional sources from the Better Card Fund

:17:50. > :17:56.will not be available until 201 . Is it possible to look at a shorter

:17:57. > :18:07.timescale? The problems we face are not down the road. There nedds to be

:18:08. > :18:27.a greater effort from the government to address this. We should seek to

:18:28. > :18:33.make these reforms. Yellow lac I rise to support the motion `nd I

:18:34. > :18:46.hope to explain why. I should first explain my interest as a licensed

:18:47. > :18:50.medical practitioner, but I commend those who work there. And I think

:18:51. > :18:56.people appreciate there are those engaged still in medical pr`ctices,

:18:57. > :19:03.in practice of all sorts, it makes us relevant and current and gives us

:19:04. > :19:18.authority, where it comes to talking on areas of expertise.

:19:19. > :19:26.An important part of the pe`ce, if we are to consider the entirety of

:19:27. > :19:35.health and social care then we need to consider it, I think it has been

:19:36. > :19:38.ignored. Nobody fully publicly understands what public health is,

:19:39. > :19:43.there is no definition of it, it means many things to many dhfferent

:19:44. > :19:53.people. Some of us believe ht is rather more old-fashioned, that it

:19:54. > :20:05.was to do with a vision before 974. It pervades all evidence and needs

:20:06. > :20:08.to be addressed head-on. We need to insure we meet some of the

:20:09. > :20:18.imperative is that apply to health in this country, which should be

:20:19. > :20:34.focused pretty much exclusively on health care outcomes. I think the

:20:35. > :20:39.right outcome, these are absolutely where we must be room awesolely

:20:40. > :20:48.focused on those, the story is not a particularly good one. The

:20:49. > :20:53.Commonwealth fund is quoted selectively, reported by those who

:20:54. > :21:00.want to pay that our system -- say that our system is the best there

:21:01. > :21:04.is. I trained in the NHS and worked in the NHS and I would be rdliant on

:21:05. > :21:08.it. I defer to nobody in my admiration of the National Health

:21:09. > :21:13.Service and all it stands for but I think it is naive to supposd it is

:21:14. > :21:17.perfect in all respects. I suspect that is what lies at the he`rt of

:21:18. > :21:24.this motion as we look to the future. The very distant future The

:21:25. > :21:27.Commonwealth fund goes on to say that outcomes in this country are

:21:28. > :21:32.not good and I think our people deserve better. I want outcomes in

:21:33. > :21:39.this country to be among thd best in Europe, not in the lower qu`rter as

:21:40. > :21:45.is the case too often with common forms of disease. We are betraying

:21:46. > :21:49.those who put us here if we demand any less than that and I thhnk this

:21:50. > :21:56.motion is relatively modest because it tries to work out how we square

:21:57. > :21:59.the gap towards the end of this decade and in the minds of those who

:22:00. > :22:05.have written this, we are worried about this issue, that is something

:22:06. > :22:10.that will apply in five years, we are not perhaps looking forward to

:22:11. > :22:15.improving where we are at the moment. There is too much t`lk of

:22:16. > :22:20.marking time. There is a concern about this gap in funding which

:22:21. > :22:26.makes us think what we have is good enough, at frankly, it is not. We

:22:27. > :22:31.need to improve the health service right across the peat is to ensure

:22:32. > :22:41.the outcomes approximate thd very best in Europe, and not the very

:22:42. > :22:47.worst. The honourable Lady, the member for Leicester West, lentioned

:22:48. > :22:51.the Barker report. It was useful, I don't necessarily agree with all the

:22:52. > :22:55.conclusions, but she producdd some figures which were useful. She

:22:56. > :23:01.pointed out the spending on health in this country is less than some of

:23:02. > :23:09.the countries with which we can be compare, reasonably. She suggests

:23:10. > :23:13.that by 2025 we need to spend a great deal more of our national

:23:14. > :23:21.health on wealth and social care and I agree with her. She suggests 1-12

:23:22. > :23:31.percent. That is probably rdasonably modest. Question will be how we deal

:23:32. > :23:41.with that. 30 billion does not come close, even if we stand still. The

:23:42. > :23:48.question is how on earth we close that gap, whether we do it hn

:23:49. > :23:56.general taxation, or as applies in France. I suspect there is `

:23:57. > :24:03.consensus in this house that some of the options we can discount

:24:04. > :24:11.immediately. It is important the commission examines all opthons

:24:12. > :24:21.even if it is not palatable for a variety of reasons, neverthdless, we

:24:22. > :24:29.need to examine all options if we are going to be doing this for the

:24:30. > :24:36.long term. My honourable frhend was right to focus on structure. This is

:24:37. > :24:40.something that is necessary in my opinion. There is a need for

:24:41. > :24:49.cross-party discussion. It hs all very well talking about the NHS is

:24:50. > :24:54.state in general. I know from my personal experience when th`t is

:24:55. > :24:57.translated into the specific of a member of Parliament's own

:24:58. > :25:02.constituency, though my honourable friend is terribly brave in the

:25:03. > :25:12.description he gave, for many members it becomes extraordhnarily

:25:13. > :25:15.difficult. It is the local that inspires people, they would love to

:25:16. > :25:21.have local services they iddntify with. When it comes to talkhng about

:25:22. > :25:26.the NHS estate, we're talking about change. Sometimes it is gre`t

:25:27. > :25:30.locally because it means a new hospital, art often it means there

:25:31. > :25:39.is a perception of loss and people feel that very acutely. One of the

:25:40. > :25:48.first things I did was introduced a bill called the build -- thd bed

:25:49. > :25:53.block built. It was designed to promote community hospitals. I had

:25:54. > :25:59.four in my constituency at that time. I felt each one of thdm was

:26:00. > :26:09.under threat and I was a strong advocate for them. The bill was

:26:10. > :26:17.designed to promote them. It drifted into the sand but it remains

:26:18. > :26:22.relevant. At the higher levdl, we must talk about whether we `re the

:26:23. > :26:28.right size for district Gendral hospitals, whether we should have

:26:29. > :26:39.these across the country, f`r more than in France, with an exalple

:26:40. > :26:43.being gastroenterology. Thex have produced reports around this,

:26:44. > :26:48.pointing out in many district general hospitals you're not

:26:49. > :26:55.guaranteed to have out of hours endoscopy services availabld to you.

:26:56. > :26:59.I put it to the house that hn the 21st century, not being surd that

:27:00. > :27:06.you're going to be scoped is simply not acceptable. That will translate

:27:07. > :27:11.into worse outcomes for a rdlatively common set of conditions. It seems

:27:12. > :27:18.to me that the only way we can achieve better outcomes is to think

:27:19. > :27:22.about whether we need to move towards regional and subreghonal

:27:23. > :27:27.specialist centres rather than continue with the pretty and is --

:27:28. > :27:33.pretend that we can mirror those services.

:27:34. > :27:41.People talk about stroke and heart attack and the same applies. It is

:27:42. > :27:45.simply not the case you will get the same treatment regardless of the

:27:46. > :27:49.hospital you go to. This is professionally driven and it is the

:27:50. > :27:54.specialist to say we need to increasingly is rationalise and the

:27:55. > :27:57.day of the general is coming to a conclusion. To get that levdl of

:27:58. > :28:04.specialisation we need crithcal mass. The only way to achieve that

:28:05. > :28:10.is having a smaller number of clinical cathedrals, large centres

:28:11. > :28:15.offering specialised servicds geared towards improving those outcomes.

:28:16. > :28:24.The downside is obviously where the cuts come. Right sizing the NHS

:28:25. > :28:30.estate means some will gain and some will lose in this process. Hn terms

:28:31. > :28:34.of the immediacy of services. Nobody wants to travel miles in order to

:28:35. > :28:40.access services. We get complaints all the time on this issue. There is

:28:41. > :28:45.a process of education to go through for the public and they need to make

:28:46. > :28:51.a choice, they either have hmmediacy of service, just down the road, to

:28:52. > :28:55.an institution that will give sub optimal care, or they have better

:28:56. > :29:01.outcomes of the sort they mhght achieve good sub regional cdntre.

:29:02. > :29:04.Part of the work of the comlission the right honourable gentlelan

:29:05. > :29:11.suggests to the house we have will be that process of education, which

:29:12. > :29:18.is one reason his 12 months is ambitious. I would not want to have

:29:19. > :29:22.a commission that reports of five, ten years' time, but I think he will

:29:23. > :29:28.have to be realistic how long this takes if it is going to be `n

:29:29. > :29:33.iterative process. We need better step up and down care which lies at

:29:34. > :29:38.the heart of unblocking acute centres. It is important to look

:29:39. > :29:42.again at this. The reason community hospitals went out of favour

:29:43. > :29:47.slightly was because of the cost that related to the services they

:29:48. > :29:52.gave and the reason was the case mix was wrong. Too often it was a

:29:53. > :29:57.convenient way of relieving social pressures and admitting people

:29:58. > :30:02.stands a stanza be for medical reasons to a medical bed whdn those

:30:03. > :30:07.people in facts needed soci`l care and it always comes back to social

:30:08. > :30:13.care. If you put social card people into what remains a medical bed it

:30:14. > :30:20.becomes impossibly expensivd and that is why it did not add tp. The

:30:21. > :30:24.onus is on practitioners and controllers of those places, to

:30:25. > :30:31.ensure the case mix is corrdct and if you do that, community hospitals

:30:32. > :30:35.become effective and efficidnt. I thank the honourable gentlelan. One

:30:36. > :30:42.issue we have come across in Coventry when we talk about blocking

:30:43. > :30:46.and this is another factor, people cannot be discharged from hospital

:30:47. > :30:51.until they have a social worker outside, normally employed by the

:30:52. > :30:56.local authority. Beds blockdd again and it is an additional cost. That

:30:57. > :31:01.is something commission shotld look at. I think the honourable gentleman

:31:02. > :31:05.is right and it comes back to the issue of integrating health and

:31:06. > :31:13.social care around which we have to say has been some progress. Can I

:31:14. > :31:18.this point make clear that despite the fact what is intended as a

:31:19. > :31:24.nonpartisan initiative, I fdel very strongly that without a strong

:31:25. > :31:30.economy, we will not make progress. Improvement requires the sort of

:31:31. > :31:34.economy we aspire to, not one that has been sustained in Greecd, Spain

:31:35. > :31:38.and Portugal and if you look at those countries whose health care

:31:39. > :31:43.systems I do not think were comparable to our own beford their

:31:44. > :31:46.respective crises and see what has happened subsequently, as their

:31:47. > :31:50.governments have struggled to control the situation, made huge

:31:51. > :31:56.cuts, that is something we need to be aware of, something we h`ve

:31:57. > :32:00.avoided in this country and without strong economy, frankly talking

:32:01. > :32:07.about improving public servhce across the board, in partictlar this

:32:08. > :32:13.one of health care will be pretty pointless, since there will not be

:32:14. > :32:17.the resources to sustain wh`t we have at the moment let alond the 12%

:32:18. > :32:28.suggested by Kate Barker in her report. I would like to givd credit

:32:29. > :32:32.to ministers for sustaining the Stevens plan. We have heard

:32:33. > :32:35.contributions as to why the plan might not be sufficient but

:32:36. > :32:42.nevertheless finding that sort of money at a time of austeritx is a

:32:43. > :32:46.huge achievement. We need to acknowledge that. I was protd to

:32:47. > :32:55.stand on a manifesto that stpported the 8 billion spend, which `llows

:32:56. > :32:58.that leads to have a servicd that is sustainable, notwithstanding my

:32:59. > :33:01.fears for the future and thd inadequacy of plans at this point to

:33:02. > :33:07.take us through to the end of the decade and beyond at a time when

:33:08. > :33:14.local government funding is being cut, so the pressure on sochal

:33:15. > :33:18.services that was not antichpated by Simon Stephens applies. And we have

:33:19. > :33:23.pressures on the public health budget as well. Those things

:33:24. > :33:28.together mean we have a defhcit by the end of this decade that needs to

:33:29. > :33:35.be addressed and beyond that, looking at 2025 and beyond `s Kate

:33:36. > :33:39.Barker has done, we need to determine how we will find dxtra

:33:40. > :33:43.funds she feels are necessary, not withstanding the dispute about

:33:44. > :33:47.whether the funds might comd from, the sort of thing that might be

:33:48. > :33:53.examined by the right honourable gentleman's commission, when it is

:33:54. > :33:58.set up. Can I mention some small points on public health? Among my

:33:59. > :34:02.distinguished medical colle`gues, I think I am the only one with a

:34:03. > :34:06.postgraduate qualification hn public health, and has done a job with

:34:07. > :34:12.significant public health input in it. I have a soft spot for this

:34:13. > :34:20.discipline and I hope I unddrstand some of what it is. Healthy lives,

:34:21. > :34:26.healthy people has been in ly view a success. It has set public health on

:34:27. > :34:31.the right track. It has handed back to local government a functhon that

:34:32. > :34:36.arguably it should never have lost. It has set up Public Health England

:34:37. > :34:41.which in large part has dond a good job. I suspect the minister, who

:34:42. > :34:47.will be answering shortly, will have fallen off his stool when hd read

:34:48. > :34:52.the King's Fund report, which said the same thing, that public health

:34:53. > :34:55.appears to be on the right track in this country and the changes

:34:56. > :35:01.introduced in the government White Paper five years ago have l`rgely

:35:02. > :35:06.been successful. However, there is no room for complacency, as I'm sure

:35:07. > :35:10.the minister will agree, particularly where we have health

:35:11. > :35:15.care indices such as teenagd pregnancy, which although it has

:35:16. > :35:20.improved, nevertheless is along the worst in Europe. We do slightly

:35:21. > :35:26.better than Bulgaria, Romanha, Slovakia. Nobody would be s`tisfied

:35:27. > :35:30.with that I hope. While we have indices as disastrous as th`t, there

:35:31. > :35:35.is no room for complacency. One worry what has been happening in the

:35:36. > :35:39.past months is we appear to have changed from a model which health

:35:40. > :35:43.care is pretty much funded through general taxation, that is to

:35:44. > :35:50.National Insurance and incole tax, to one partly funded by loc`l

:35:51. > :35:57.taxation, with all that means in terms of cuts when it comes as to

:35:58. > :36:04.hard times. In my view the public health interventions, having bits

:36:05. > :36:08.shaved off them, are not discretionary, they are essdntial

:36:09. > :36:13.parts of health care. We can come up with figures as to why we nded to

:36:14. > :36:19.invest in health care. Publhc health investment by and large savds money

:36:20. > :36:22.in the long-term, but the potential for public health interventhon and

:36:23. > :36:27.prevention services to have an impact on lives is truly enormous.

:36:28. > :36:35.Very little of that will happen overnight and therefore it will not

:36:36. > :36:39.show up within an electoral time frame. If we set up a commission

:36:40. > :36:48.that will look at health care in the long-term, we need to focus on

:36:49. > :36:54.public health and ensuring ways in which resources into public health

:36:55. > :36:59.are maintained and sustained. They are not discretionary, they are an

:37:00. > :37:04.essential part of what we should do for health care in this country

:37:05. > :37:10.though I accept when it comds to making economies, it will always be

:37:11. > :37:13.tempting to shave away at those services rather than cut an acute

:37:14. > :37:21.service that is more obvious to the general public. In conclusion, I

:37:22. > :37:24.support the motion. I congr`tulate the honourable gentleman for

:37:25. > :37:28.bringing it forward and he hs right to say with the national religion of

:37:29. > :37:36.ours, the NHS, party politicians meddle with it at their perhl. That

:37:37. > :37:41.is why, if we accept there `re huge challenges in the long-term, going

:37:42. > :37:45.beyond 2020, it is important we have a national debate so we can address

:37:46. > :37:53.difficult issues we have discussed today around the estate, how we pay

:37:54. > :37:57.for health care, and also tried to gain that usually impossibld goal of

:37:58. > :38:05.getting some level of cross,party consensus. I would like to join

:38:06. > :38:09.everyone else in congratulating my right honourable friend in securing

:38:10. > :38:14.this debate on what is one of the biggest questions we face as a

:38:15. > :38:20.country, Parliament and polhtical class, how we square the circle in

:38:21. > :38:26.an ageing population and put the NHS on a sustainable financial footing.

:38:27. > :38:31.My grandfather was editor of the British Medical Journal frol the

:38:32. > :38:37.point at which the NHS was founded to the 60s. I suspect if he was

:38:38. > :38:41.around, he would consider the challenges the NHS faces now to be

:38:42. > :38:49.unrecognisable to his gener`tion of medics. It is right my right

:38:50. > :38:54.honourable friend is pushing us to try to sketch out solutions on a

:38:55. > :39:00.cross-party basis. You could say he and I tested the virtues and

:39:01. > :39:05.pitfalls of cross-party working to destruction, some would say unfairly

:39:06. > :39:11.perhaps, to self-destruction, in the last government, but notwithstanding

:39:12. > :39:17.that experience, I think thdre are issues, pensions, long-term

:39:18. > :39:22.infrastructure, investment, Europe, decarbonising the economy, the NHS,

:39:23. > :39:27.none of these issues are susceptible to single parliament, singld

:39:28. > :39:33.government, single party solutions. All strength to his elbow in setting

:39:34. > :39:39.up this commission. I hope the government will look kindly upon it.

:39:40. > :39:43.I would like to dwell on ond aspect which I hope will be a subjdct of

:39:44. > :39:49.real examination in the comlission and that is the role of mental

:39:50. > :39:55.health in the NHS. We have come a long way. I remember standing there

:39:56. > :39:59.eight years ago shortly aftdr becoming leader of my party, asking

:40:00. > :40:08.Gordon Brown a question abott mental health. I was listening to hn almost

:40:09. > :40:13.shocked silence. It was considered to be a novel, brave thing to do, to

:40:14. > :40:17.raise mental health. If you consider how the debate is advanced, it is

:40:18. > :40:24.fantastic. There have been loving debates here, where a number of

:40:25. > :40:27.colleagues have spoken openly and movingly for the first time about

:40:28. > :40:31.their own struggle with mental health. As a society, the mddia

:40:32. > :40:38.talks now more comfortably `bout mental health. A barrage of

:40:39. > :40:45.celebrities have lent their weight to doing so. The debate, retro,

:40:46. > :40:49.awareness of mental health hs a major challenge affecting one in

:40:50. > :40:55.four citizens, which has bedn transformed in recent years, a

:40:56. > :41:01.wonderful thing. We lifted the lid, the taboo, the slight foot shuffling

:41:02. > :41:05.embarrassment that overshadowed mental health. That has been lifted

:41:06. > :41:11.and that is a great step forward. I am proud of some of the things we

:41:12. > :41:15.managed to do in the previots parliament, in the coalition, to

:41:16. > :41:19.push the agenda forward and putting mental and physical health of the

:41:20. > :41:31.first time on the same legal footing, introducing for thd first

:41:32. > :41:33.time waiting times standards which existed for physical health issues

:41:34. > :41:41.for a long time, and many other steps forward. My concern is there

:41:42. > :41:45.is a growing gap opening between the rhetoric around mental health and

:41:46. > :41:51.the reality of what is going on on the ground. You will get a gap

:41:52. > :41:56.because rhetoric is easier to deliver then change on the ground.

:41:57. > :42:02.There will always be a time lag between the debate and policy,

:42:03. > :42:08.prescriptions alter. That pdrcolates down to the ground. The gap is

:42:09. > :42:14.getting dangerously wide. Not only is it very bad for the many

:42:15. > :42:18.patients, with mental health conditions, who have not bedn

:42:19. > :42:22.properly treated. I think if we do not address it soon and follow up

:42:23. > :42:28.the rhetoric with action, there will be cynicism about what the political

:42:29. > :42:31.classes have meant over the past years as we have gone on thhs

:42:32. > :42:38.journey in talking more openly about mental health.

:42:39. > :42:47.The scale of the problem is worth repeating. It is worth illustrating

:42:48. > :42:53.the scale of the challenge with a couple of facts. Mental health makes

:42:54. > :42:58.up 23% of what is in elegantly called the UK disease burden. The

:42:59. > :43:06.majority of people with mental health conditions still go

:43:07. > :43:10.untreated. Just less than a third of those with mental ill-health end up

:43:11. > :43:15.accessing treatment. If that was the case for any physical health

:43:16. > :43:27.condition it would be considered to be a Dickensian state of affairs. I

:43:28. > :43:37.do hope the cross-party comlission, that can really look at mental

:43:38. > :43:45.health, really is absolutelx critical. In doing so I would like

:43:46. > :43:57.to invite the Minister to focus on three issues. There is a blockage

:43:58. > :44:09.which is preventing the rhetoric translating. Last year, arotnd the

:44:10. > :44:12.time of the budget, just before the election, I announced on behalf of

:44:13. > :44:21.the Coalition Government transformation fund of substantial

:44:22. > :44:27.size, ?1.4 billion to transform the service within the service, namely

:44:28. > :44:33.adolescent services. It was the most ambitious blueprint ever set out by

:44:34. > :44:42.any government to transform and fund properly mental health servhces It

:44:43. > :44:51.divides up as a quarter of ?1 billion to be invested per xear

:44:52. > :45:07.Over the last year, it has not been that much but ?143 million. There

:45:08. > :45:15.can be perfectly exploitabld teething problems, it was announced

:45:16. > :45:19.in the spring, but I really hope the minister today and the commhssion as

:45:20. > :45:24.it conducts its work will m`ke sure that not only our future reforms

:45:25. > :45:29.properly delivered, some of which I will come to, but also the previous

:45:30. > :45:35.commitments are delivered and funded info. If that has not been delivered

:45:36. > :45:40.over the last year it needs to be made up for in future years between

:45:41. > :45:44.now and the end of this Parliament. That was the first point of three

:45:45. > :45:54.points I just briefly wanted to make. The second is, the importance

:45:55. > :46:02.in all areas of health of prevention, the need for better

:46:03. > :46:14.prevention was one of the kdy findings, yet there has been little

:46:15. > :46:20.mention of any engagement. H know that the campaign and policx group

:46:21. > :46:25.have shown that local authorities spend just 1% of their publhc health

:46:26. > :46:33.budgets on the prevention of mental ill health, ?40 million out of a

:46:34. > :46:40.total of ?3.3 billion. Yet dverybody knows this, even if we are not

:46:41. > :46:53.clinical experts, intervening early to improve mental health involves so

:46:54. > :47:00.much cost to society, half of those with mental problems have sxmptoms

:47:01. > :47:03.by the age of 14. 75% of chhldren and young people who have a mental

:47:04. > :47:10.health problems don't get access to the treatment they need. Wahting

:47:11. > :47:19.times are far too long. Waiting time is two months. There are no waiting

:47:20. > :47:24.times in children's and adolescent mental health services. As we are

:47:25. > :47:30.trying to revolutionise the approach to mental health the waiting time

:47:31. > :47:34.standards that have already been announced that need to be

:47:35. > :47:41.extrapolated to other parts of the service. If we want to put the NHS

:47:42. > :47:46.on a financially sustainabld footing, many honourable melbers

:47:47. > :47:49.have spoken about the need to reconcile social care and hdalth

:47:50. > :47:53.care but we also need to understand the lack of prevention and darly

:47:54. > :48:02.intervention of health problems is one of the biggest drivers for

:48:03. > :48:06.inflated costs on the NHS btdget. To put the NHS on a sustainabld footing

:48:07. > :48:12.it is essential that the colmission looks at this. The arguably the most

:48:13. > :48:21.important and technocrat Ric Wee complex issue is the one about the

:48:22. > :48:30.formula, the mechanism by which mental health is funded. Thd problem

:48:31. > :48:44.is that for as long as anyone can remember, mental health trusts have

:48:45. > :48:52.been funded by block grants and others paid on the outcome basis.

:48:53. > :49:04.That is deeply unfair, it mdans at any time, any Chancellor nedding to

:49:05. > :49:11.make savings, the easiest thing to do is shave off the money from the

:49:12. > :49:23.block grant. That is precisdly what has been happening. However much

:49:24. > :49:28.welcome impetus has been put on them, the basic mechanism for

:49:29. > :49:37.funding them constantly discriminates against mental health

:49:38. > :49:42.trusts. The honourable gentleman is suggesting a tariff for mental

:49:43. > :49:46.health whereas it has been obvious taking evidence in the health select

:49:47. > :49:50.committee that the tariff c`n also work against having more colmunity

:49:51. > :49:57.care. I met a paediatrician who did I'd reach work and having rdduced

:49:58. > :50:04.admissions, the hospital pulled it. Be careful what you wish for. I

:50:05. > :50:16.think the issue is moving from a block to an outcome based formula.

:50:17. > :50:22.You can then decide how it hs administered but the fundamdntal

:50:23. > :50:28.principle, that they are aw`rded for their outcomes, rather than an

:50:29. > :50:38.arbitrary amount of money, hs the fundamental point. Mental hdalth

:50:39. > :50:40.budgets are at risk of being raided to pay for the unsustainabld

:50:41. > :50:49.deficits in mental health. Health commission spent 12% on mental

:50:50. > :50:56.health. In 2015-16, that fell. There was a transfer of money frol mental

:50:57. > :51:01.health to acute trusts. That is completely the wrong directhon of

:51:02. > :51:07.travel. In 2012, to address this problem, the Coalition Government

:51:08. > :51:11.announced they would pilot ` new approach to mental health ftnding

:51:12. > :51:25.through what they call care clusters. Adults receiving care are

:51:26. > :51:41.assigned this based on the care of the people. Each cluster is given a

:51:42. > :51:55.local price. It is fearfullx complex and yet the evidence is alrdady

:51:56. > :52:05.there that transferring that already has yielded results. Recent research

:52:06. > :52:10.has found mental health trusts operating under block contr`cts had

:52:11. > :52:15.more emergency readmission hs than trust operating without a block

:52:16. > :52:18.contracts. The National clinical director for mental health has

:52:19. > :52:24.agreed and she says that block contracts do not facilitate access

:52:25. > :52:29.to evidence -based care such as those set out in new mental health

:52:30. > :52:35.access standards and another organisation has been very critical

:52:36. > :52:40.of block contracts, where they have said despite the introduction of the

:52:41. > :52:47.care clusters, most local agreements still rely on simple block contracts

:52:48. > :52:56.and we believe Locke payments do not work in the interests of patients.

:52:57. > :53:05.Notwithstanding the decision in principle to shift the systdm away

:53:06. > :53:11.from the punitive effects, still 35 out of 62 NHS trusts are providing

:53:12. > :53:15.mental health services using those block contracts. For give this

:53:16. > :53:22.detour but I think the devil is in the detail, if we want to close the

:53:23. > :53:26.gap between the progressive rhetoric which has occupied the publhc and

:53:27. > :53:31.political debate about ment`l health and the need to get on and push the

:53:32. > :53:37.system in a radically different direction. Not only because it is

:53:38. > :53:43.the right thing to do to end the discrimination, and it is

:53:44. > :53:45.discrimination, against pathents with mental health issues, who

:53:46. > :53:51.suffered in silence alone and untreated for generations, but also

:53:52. > :53:57.because if we don't do that and make some of these fundamental changes

:53:58. > :54:02.then spiralling costs which are placed onto the shoulders of the NHS

:54:03. > :54:12.will continue. It is a vital element in meeting the cross-party

:54:13. > :54:16.commission's mandate to arrhve at a new cross-party consensus on placing

:54:17. > :54:26.the NHS on a sustainable long-term footing. I'm grateful to be able to

:54:27. > :54:30.speak in this important deb`te, and I speak as a nurse still working in

:54:31. > :54:39.the NHS, though not as much as I would like to. I come to thhs date

:54:40. > :54:47.to welcome sentiments but w`nt all sides to work towards more

:54:48. > :54:52.cross-party settlement. I'm very nervous about setting up a

:54:53. > :54:57.commission and I will touch on why because much of that work h`s been

:54:58. > :55:08.done already, and we need to roll back the solutions and not discuss

:55:09. > :55:15.them. I speak as a nurse and not a politician, and my feeling `nd the

:55:16. > :55:19.feeling of a number of my colleagues is it has been an interventhon by

:55:20. > :55:27.politicians over decades in a series of governments that have got the NHS

:55:28. > :55:35.to where it is now. Health care professionals and managers have been

:55:36. > :55:41.allowed to get on with their job, and if they had we would not be

:55:42. > :55:46.where we are now. There is no way that if you spoke to one single

:55:47. > :55:51.health care professional th`t they would agree that it should be as

:55:52. > :55:56.divided as it currently is. If we had been allowed to get on with our

:55:57. > :56:02.job, many years ago, that g`p would be smaller than it was todax. That

:56:03. > :56:06.gap was created when the NHS was invented all those years ago, there

:56:07. > :56:11.was a natural gap between what was health care and social care, and it

:56:12. > :56:17.was compounded by the nurse's act in 1949 which set out the view of what

:56:18. > :56:22.a nurse dead as opposed to what social care did. Over time with the

:56:23. > :56:29.invention of various bodies and structures, national or loc`l, those

:56:30. > :56:34.rigid boundaries of what has been termed health care and what is

:56:35. > :56:38.social care have grown stronger Funding streams have emerged where

:56:39. > :56:43.the funding has been protected, where the funding has been ring

:56:44. > :56:48.fenced, where it has been increased over time, whilst social care has

:56:49. > :56:51.not had that luxury, mainly being given to local authorities who have

:56:52. > :56:58.merged it with other projects, not ring fenced it, and as we h`ve heard

:56:59. > :57:10.so eloquently from many honourable members, that has been a foolish

:57:11. > :57:12.approach because the preventative work has been cut and it is the NHS

:57:13. > :57:26.that picks up the price for that. During my training we were taught

:57:27. > :57:34.analytic model of care that the physical care can not be separated

:57:35. > :57:38.from the emotional, spiritu`l and psychological care but when you

:57:39. > :57:42.practise in the real world, you are forced into separating physhcal care

:57:43. > :57:48.for mental health, from sochal care. When I worked as a nurse on a ward,

:57:49. > :57:53.we would never question, is this the nurse's role, should someond else be

:57:54. > :57:57.doing this? If I was bathing a patient, getting a patient tp in the

:57:58. > :58:05.morning, walking them in thd grounds to get fresh air, there was never a

:58:06. > :58:10.notion of is this the nursing role, is this health care? It was looking

:58:11. > :58:15.after a patient as a whole. When you are bathing, feeding someond, you

:58:16. > :58:20.are not just feeding them, xou are looking at if they have takdn their

:58:21. > :58:25.medication, are they eating? Are they more confused? Is therd an

:58:26. > :58:31.infection brewing? It is not just about ticking boxes and sayhng the

:58:32. > :58:35.patient is fed, they have h`d medication, it is about holhstic

:58:36. > :58:41.care. The systems in place today very much do not allow you to

:58:42. > :58:48.practise that. That is one thing in the hospital where you have the

:58:49. > :58:53.freedom to take on what is deemed as a social role. In the community you

:58:54. > :58:57.have no choice. What you sed today is an elderly patient may bd

:58:58. > :59:03.struggling to stay at home, who has maybe five visits a day frol five

:59:04. > :59:08.separate people, five different people tomorrow. The nurse will go

:59:09. > :59:13.into may be administer medication, and someone else will come hn to

:59:14. > :59:19.make a cup of tea, heat up their meal. There is no continuitx, no

:59:20. > :59:24.holistic care, and that is because health budgets are run by the NHS

:59:25. > :59:30.and social care budgets by the local authority. It is nobody's f`ult it

:59:31. > :59:38.is the way it has emerged. H welcome the work done by the NHS in the

:59:39. > :59:41.forward view. I welcome the work of the Barca commission, which has not

:59:42. > :59:50.only identify this, but comd up with solutions and said that funding must

:59:51. > :59:54.be ring-fenced and combined -- Barker. We cannot continue with

:59:55. > :00:03.separate health and social care funding. If we do, it is a false

:00:04. > :00:10.economy to have separate budgets. We are doing nothing for patients,

:00:11. > :00:15.doing nothing for carers because of the constant divide. While H welcome

:00:16. > :00:21.the notion of a commission `nd cross-party working, I am ndrvous we

:00:22. > :00:27.will do work done already. H am seeing fantastic work in my local

:00:28. > :00:33.CCG, making sure the local `uthority and health services working together

:00:34. > :00:40.in a combined way. We hear luch about how hard it is to get social

:00:41. > :00:44.care packages and often that is why elderly patients, those who need

:00:45. > :00:48.care packages, are stuck in hospital. It is not always because

:00:49. > :00:54.of funding, it is because wd cannot get people to do the jobs, because

:00:55. > :00:58.there is no actual reward for going in and having 15 minutes to make a

:00:59. > :01:03.cup of tea when you know if you had half an hour with the patient and

:01:04. > :01:07.helps them with their medic`tion, and helped them by making a cup of

:01:08. > :01:12.tea and ensuring they drink it, how rewarding that would be, but because

:01:13. > :01:16.of the system that is not h`ppening. My nervousness about the colmission

:01:17. > :01:25.is we will undo recommendathons we no need to be carried out. @nother

:01:26. > :01:30.year down the line, we will be left with the divide between health and

:01:31. > :01:35.social care. My other nervotsness is a national one size fits all will

:01:36. > :01:40.not work. What works in my rural community will be different to what

:01:41. > :01:49.is needed in a London borough. I welcome the idea where local CCGs

:01:50. > :01:51.identify what is needed to lerge health and social care and will

:01:52. > :02:02.coordinate what will work bdst in that place. I urge other politicians

:02:03. > :02:07.to try to take a step back `nd let professionals take a lead on that.

:02:08. > :02:10.We have identified the problems and many of the solutions, we are

:02:11. > :02:16.committed to joint funding, let s get on and do it. Our role `s

:02:17. > :02:21.politicians is to lobby if the funding is not coming through to

:02:22. > :02:26.enable health care professionals to get resources they need, but also to

:02:27. > :02:31.identify examples of good practice, that could be rolled out in other

:02:32. > :02:37.areas where maybe it is not working well. Our job is not to constantly

:02:38. > :02:42.debate the issue. We know the issue and the solutions, we need to get on

:02:43. > :02:48.with it. I welcome comments made by the honourable member for Bracknell.

:02:49. > :02:52.I do not dismiss the need for a commission, I think a commission

:02:53. > :02:58.about health and social card is a great idea but the timing is wrong.

:02:59. > :03:01.It has missed the moment. Wd need a cross-party debate about structure

:03:02. > :03:07.of the NHS and having speci`list units and may be fewer of them, but

:03:08. > :03:12.going back to the cottage hospital. That is the problem in terms of

:03:13. > :03:16.getting people out of hospital and preventing them from going hnto

:03:17. > :03:23.hospital in the first place, where they have holistic care to dnable

:03:24. > :03:28.them to stay at home, it is a step between being at home and bding

:03:29. > :03:32.admitted. We have moved awax from that and that has been to the cost

:03:33. > :03:40.not just of patients, but those of us who have worked in health care. I

:03:41. > :03:45.do not want to go over word said this afternoon. I support

:03:46. > :03:50.cross-party working. We need to take NHS out of the game of political

:03:51. > :03:54.football and I welcome that. I welcome every comment today. I do

:03:55. > :04:00.not think anyone has said hdalth and social care should not be combined.

:04:01. > :04:05.But my fear is another commhssion will delay the good work th`t is

:04:06. > :04:10.starting but it is to be carried on. I thank the honourable gentleman for

:04:11. > :04:19.bringing this forward, and H hope we will not stand here in five years

:04:20. > :04:23.still debating it further. Ht is a pleasure to follow the honotrable

:04:24. > :04:28.member. We have heard from doctors this afternoon, so good to hear from

:04:29. > :04:32.someone who worked as a nurse in the NHS and I'm sure keeps closdly in

:04:33. > :04:37.touch with it from the commdnts she has made. I agree with the

:04:38. > :04:44.honourable lady that there hs much good work that happens in dhfferent

:04:45. > :04:49.parts of the UK in providing health and social care, but we know from

:04:50. > :04:53.the data and outcomes that ht is not uniform. There are doctors `nd

:04:54. > :04:59.nurses and health professionals who are willing to rise to the challenge

:05:00. > :05:04.of putting public health on the same standing as treatment and to provide

:05:05. > :05:07.innovation in providing mental health services. Like all

:05:08. > :05:13.professions, I am afraid thdre are some not so willing to embr`ce

:05:14. > :05:16.change. They may be stuck in a way of working that maybe isn't

:05:17. > :05:22.providing the outcome is thd patients want. I would say before I

:05:23. > :05:29.get into the main part of mx speech, she quite rightly gave the dxample

:05:30. > :05:35.of where for many people in the communities who are in need of

:05:36. > :05:40.social care, they have not one visit, not two, maybe five visits

:05:41. > :05:47.from different people who fdel they have a role to provide for those

:05:48. > :05:51.individuals. When I listened to that, it took me back eight years,

:05:52. > :05:58.when I shadowed community m`trons in my constituency. I spent tile going

:05:59. > :06:02.on rounds with them and finding out what they did. The communitx

:06:03. > :06:07.matrons, their posts were created so there could be better links between

:06:08. > :06:13.the hospital and support in the community. Each community m`tron had

:06:14. > :06:18.a caseload of patients who had to have at least five different

:06:19. > :06:23.conditions that prevented them getting the most out of thehr daily

:06:24. > :06:30.lives. Some were pensioners and some were not. What those women did, once

:06:31. > :06:34.I shadowed in my constituency, they were the person who held together

:06:35. > :06:41.what was happening in the GP surgery and in the hospital. If one patient

:06:42. > :06:45.had a fall and ended up in @, people at A would look to see who

:06:46. > :06:50.the community matron was, they would be on the phone to them and before

:06:51. > :06:57.they had treatment, they wotld work them to look after outside. Sadly,

:06:58. > :07:02.all these years later, the community matrons now do not exist. Wd have to

:07:03. > :07:08.address the fact that some of the good ideas that have been whthin the

:07:09. > :07:12.NHS for whatever reason, because of political footballs, sometiles they

:07:13. > :07:17.start good work and within xears they are gone. Part of this motion

:07:18. > :07:23.today is not about saying somehow we should stop what is happening, that

:07:24. > :07:27.somehow the commission will paralyse us from carrying on with thd good

:07:28. > :07:33.work happening in the NHS, `nd there are good parts around the forward

:07:34. > :07:39.view. But five years when it comes to these services is a blink of an

:07:40. > :07:46.eye. We need to think about ten years, 20, 30 years, 40 years. What

:07:47. > :07:49.can we do today to think about what the NHS and social care shotld look

:07:50. > :07:58.like in 50 years? That is the challenge. And why the commhssion

:07:59. > :08:01.enables us, to take some of the political football out of the debate

:08:02. > :08:09.and allow us to move forward together. I give way. To put on

:08:10. > :08:18.record, I was out visiting ` GP surgery last Friday, in a

:08:19. > :08:21.constituency that borders mhne, and there are community matrons out

:08:22. > :08:28.there. When I was there, thd community matron on duty prdvented a

:08:29. > :08:32.90-year-old man from being ` two to hospital because she was able to

:08:33. > :08:36.fast track a social care referral and get help to him on Frid`y

:08:37. > :08:43.afternoon, or else he would be admitted the whole weekend. That was

:08:44. > :08:46.to highlight my point, that a national roll-out does not `lways

:08:47. > :08:51.fit with what is happening locally and there is still good work

:08:52. > :08:55.happening at local level. I hope I have not given the impression there

:08:56. > :09:00.is not good work happening. I had a case with our district nursd,

:09:01. > :09:04.supporting treatment and care in the home for people who have problems

:09:05. > :09:10.with their legs and they nedd bandaging. For a short period, those

:09:11. > :09:13.patients were incredibly nervous because they heard maybe it would

:09:14. > :09:17.not happen any more and thex would have to go to the surgery to have

:09:18. > :09:22.that treatment. Fortunately, it did not work out like that. It was the

:09:23. > :09:28.stress that caused those people a problem about the future of their

:09:29. > :09:34.treatment. We can talk about things that are working in constittencies,

:09:35. > :09:39.we can point to good practice. It is a frustration in health and other

:09:40. > :09:43.areas that best this is not the driver for good practice evdrywhere,

:09:44. > :09:48.and I do not know why we kedp reinventing the wheel on thhs. We

:09:49. > :09:57.have to look at bigger issuds. That is why commend the right Honourable

:09:58. > :10:05.and honourable members' members for securing the debate today. We have

:10:06. > :10:09.an important role. It is holding the government to account and shining a

:10:10. > :10:15.light on problems the country faces and where we can offer solutions

:10:16. > :10:20.that are not just about one term of a parliament. This debate hdlps to

:10:21. > :10:23.fulfil the role of highlighting an ongoing generational problel and

:10:24. > :10:31.proposing a path to finding a solution. The UK is an ageing

:10:32. > :10:35.society, a society growing older. Looking around the chamber, I am

:10:36. > :10:49.tempted to say put your hand in the air if you are under 50! Two, three,

:10:50. > :10:54.four. Five! The Right Honourable member for Sheffield Hallam says a

:10:55. > :11:00.majority, did you say majorhty? I think a minority under 15. We are

:11:01. > :11:06.here as politicians and as citizens. With families and living in

:11:07. > :11:13.communities that we seek to discuss the politics and policies that will

:11:14. > :11:17.touch their lives. Today, Society is growing older, and that brings a lot

:11:18. > :11:22.of joy with it. We often talk about things that are bad but there is joy

:11:23. > :11:25.about living longer. It is not uncommon to meet older people who

:11:26. > :11:30.are great-grandparents and xet they are active enough to look after

:11:31. > :11:34.their great-grandchildren. The current generation of older citizens

:11:35. > :11:40.share problems of previous generations. There is still poverty.

:11:41. > :11:44.Loneliness is common as those living longest outlive their lifethme

:11:45. > :11:50.companions. And as families no longer living close-knit

:11:51. > :11:54.communities. This generation is different, they are less

:11:55. > :11:57.deferential, and rightly so. They expect more from life. They are not

:11:58. > :12:04.waiting for the Grim Reaper, they have lives to lead. Many will live

:12:05. > :12:09.30, 40 more years in retirelent as not so long ago that was half a

:12:10. > :12:15.lifetime. This generation ddmands more and are less likely to accept

:12:16. > :12:19.what the state offers and ltmp it. If options for retirement, living

:12:20. > :12:24.arrangements, social care is not to their liking, they will voice their

:12:25. > :12:29.protest. They do so as a generation who overwhelmingly own their homes

:12:30. > :12:31.and want to remain independdnt within four walls to call their own

:12:32. > :12:41.as long as possible. Less than one year on from the

:12:42. > :12:48.general election, none of those big long-term projects facing the NHS,

:12:49. > :12:53.in particular the integration of social care are any closer to being

:12:54. > :12:58.resolved. We know that the NHS has always been an election isste and we

:12:59. > :13:04.should not apologise for th`t or expect that to change in thd short

:13:05. > :13:07.term. In the last election `nd the one before, this problem of funding

:13:08. > :13:15.social care so family do not lose their homes have been electhon

:13:16. > :13:21.issues. I recall in 2010 Conservative billboard with a

:13:22. > :13:28.tombstone and a message. Gordon wants 20,000 when you die, do not

:13:29. > :13:33.vote for Labour's death tax. I'm not going to sound pure than thd driven

:13:34. > :13:41.snow on this, our party has upped the ante with these issues, but

:13:42. > :13:51.today, one in ten of the public can face bills of ?110,000 for social

:13:52. > :13:55.care. It makes a deal of ?20,00 deferred pretty attractive. This

:13:56. > :14:07.administration has deferred the introduction of a from 2016 to 020,

:14:08. > :14:10.I'm not going to spend time on the merits of the proposal, suffice to

:14:11. > :14:18.say they are complex and rely on local authorities, creates different

:14:19. > :14:23.thresholds and ceilings for contribution. But not an duly

:14:24. > :14:29.penalising those who save for a lifetime, these are not easx

:14:30. > :14:34.decisions. They will not be solved by a five-year plan. The ch`llenge

:14:35. > :14:38.remains to put in place are social care funding system that is clear to

:14:39. > :14:44.people of different income levels, that can be embraced by all parties,

:14:45. > :14:49.and crucially, successive governments of different colours.

:14:50. > :14:53.For these reasons I believe this motion is right today. We nded an

:14:54. > :14:58.independent commission for those big long-term decisions we need to make

:14:59. > :15:02.and the same problem applies to some of the other challengers colleagues

:15:03. > :15:06.have raised facing the NHS. Securing long-term funding for the NHS when

:15:07. > :15:11.successive governments are Rebalancing Britain income `nd

:15:12. > :15:15.expenditure to reduce and eliminate the deficit, meeting the long-term

:15:16. > :15:19.challenge of democratic change, of the rising sophistication and cost

:15:20. > :15:27.of new medical technologies and pioneering treatments, and while at

:15:28. > :15:31.the same time the potential for new treatments is unlimited but the

:15:32. > :15:37.budget to meet them are not. Add to that, as we look at the way we

:15:38. > :15:42.devolved services, we need to think about where we devolve, where is the

:15:43. > :15:46.accountability? Where are the checks and balances that the quality is

:15:47. > :15:51.there but also value for money is there as well? As a relativdly new

:15:52. > :15:54.member of the Public Accounts Committee I can see we have not got

:15:55. > :16:01.the structures in place to lake sure those providing services have the

:16:02. > :16:12.accountability structures to make sure they are transparent. When I

:16:13. > :16:18.was first elected, half the buildings used by the NHS predated

:16:19. > :16:27.the existence. Financial prdssures led to a backlog. The Labour

:16:28. > :16:39.government did invest in a record amount. One of the jobs I w`s most

:16:40. > :16:43.proud to hold was that as a public health minister. Part of providing

:16:44. > :16:47.better buildings in the comlunity was to move the services out of

:16:48. > :16:54.hospitals closer to where pdople work, particularly where eqtality

:16:55. > :16:59.was so evident. To make surd the most vulnerable, the least `ssertive

:17:00. > :17:03.could see within the communhty the services that they should bd taking

:17:04. > :17:14.the opportunity to get available to them. We need consensus. Whhlst

:17:15. > :17:20.those buildings were welcomd, not least by NHS staff and patidnts the

:17:21. > :17:25.funding has remained contentious. If we are going to plan sustained

:17:26. > :17:28.investment in the future we need a consensus that gives future

:17:29. > :17:34.government and this governmdnt the courage to make big decisions of

:17:35. > :17:40.this kind. Only a truly inddpendent commission will begin to unpick the

:17:41. > :17:49.real costs and pinch points facing the NHS. There are real, hard

:17:50. > :17:52.choices about meeting the ftture of social health and care. I bdlieve

:17:53. > :17:56.the commission has a role to play in involving staff and the public. We

:17:57. > :18:04.need a grown-up discussion outside of this place and inside. Btt we

:18:05. > :18:09.need to involve the public `nd staff in the challenges ahead and help

:18:10. > :18:12.them make the decisions as well but also in making the decisions

:18:13. > :18:19.understand the responsibilities they might have to play in supporting a

:18:20. > :18:24.new NHS social care service. I believe it will be a worthwhile

:18:25. > :18:26.investment if it can achievd a new social contract between parties and

:18:27. > :18:33.the British people that provide a new secure base for the futtre of

:18:34. > :18:40.health and social care. It hs about change. There is no comparison to

:18:41. > :18:47.the NHS that was created 60 years ago. Our job is to face up to change

:18:48. > :18:54.but to help people face change and cope with it as well becausd it can

:18:55. > :19:02.be frightening. It is about a better and stronger NHS, but let us have a

:19:03. > :19:07.smarter NHS as well. I hope my own front bench and the Minister will

:19:08. > :19:19.respond positively to this proposal. Thank you. It is an honour to follow

:19:20. > :19:21.the Right Honourable lady. H think every single contribution in this

:19:22. > :19:29.debate has made some excelldnt points. I speak in favour of this

:19:30. > :19:40.motion. My first contribution in this Parliament, I said let's use

:19:41. > :19:44.the five years of this parlhament is set up social care for the next 30

:19:45. > :19:50.years. Why did I believe it then and do I believe it now? It is

:19:51. > :19:53.insubstantial part due to mx own experience representing staff since

:19:54. > :20:01.2010 and being involved in the community before that. What we saw

:20:02. > :20:06.in the last Parliament, in Stafford, was a tremendous coming togdther of

:20:07. > :20:10.people from all parties in order to protect our health services and

:20:11. > :20:17.respond to the very serious problems that we had and to make proposals to

:20:18. > :20:25.the government, to argue with the government, to oppose some of the

:20:26. > :20:33.things they propose but also support the health services in our `rea It

:20:34. > :20:36.was a great privilege to be part of that, to see people come together,

:20:37. > :20:44.put aside their differences and work together. I know that happened in

:20:45. > :20:52.other constituencies but in Stafford, I was very grateftl for

:20:53. > :20:59.that. Another reason I am so in support of the commission or a

:21:00. > :21:08.commitment of bringing us together is there are important issuds to

:21:09. > :21:14.decide. My honourable friend talked about this issue of specialhsm and

:21:15. > :21:22.general is. Made some incredibly important points. What I wotld also

:21:23. > :21:29.say is there is a danger of going to march down the specialist route To

:21:30. > :21:33.think everything must be spdcialist. In the last count we had 62

:21:34. > :21:40.specialities and some of thd colleges want to go even further. In

:21:41. > :21:49.cardiology they want to splht it up further. I hope that might not be

:21:50. > :21:53.the case. In Norway it was pointed out they had just over 20

:21:54. > :22:02.specialities. It was a more generalised system. Whereas I do

:22:03. > :22:08.agree that specialities need to be concentrated, we must not c`st out

:22:09. > :22:13.general medicine. We must not cast out those who would like to work in

:22:14. > :22:17.a more localised setting, bdcause for many people that can be more

:22:18. > :22:22.satisfying, seeing the broad range of health rather than an

:22:23. > :22:31.increasingly narrow part of health care. Would he agree that one

:22:32. > :22:39.solution might be to develop further GPs with specialist interest models,

:22:40. > :22:48.which was started but has ndver found its place in the NHS. That is

:22:49. > :22:55.an excellent point. I declare an interest, being married to `n MP but

:22:56. > :23:00.I think -- to a GP but I thhnk it is extremely important. Perhaps

:23:01. > :23:05.specialism of general is on, that might be a contradiction in terms

:23:06. > :23:10.but the idea it is possible to be someone who says I want to

:23:11. > :23:16.concentrate on practising mx medical career in a smaller place. H have

:23:17. > :23:22.the knowledge to know where the limits of my competence are and when

:23:23. > :23:31.to refer onwards. That is why I welcome this motion. I will suggest

:23:32. > :23:38.boundaries to it. The points being made about not going overall

:23:39. > :23:47.grounds, not making it to broad are very valid. The bulk of it has done

:23:48. > :23:55.some tremendous work. I would like to say there are other revidws going

:23:56. > :24:02.on. The maternity review is incredibly important, and I made a

:24:03. > :24:10.submission, because you havd this contrast on someone wanting the best

:24:11. > :24:22.possible care, and on the other hand they want to be as close as possible

:24:23. > :24:32.to home. In some cases, that can work for a limited number of women,

:24:33. > :24:44.but 30% will be able to go hnto those units. 70% will go further

:24:45. > :24:49.afield. The largest unit is in Liverpool, the largest as 4400. Is

:24:50. > :25:06.there something to learn from the model? I'm hoping the report will

:25:07. > :25:11.show us that and give us a path I welcome the government's colmitment

:25:12. > :25:15.to fund the five-year plan. That was a major step. It was not an easy

:25:16. > :25:29.step but it was extremely ilportant and I welcome the fact it h`s been

:25:30. > :25:34.increased since the election. To achieve ?20 billion of savings is

:25:35. > :25:43.something nobody has ever m`naged and we are seeing problems with

:25:44. > :25:47.that. I was lobbied yesterd`y by community pharmacists, seeing cuts

:25:48. > :25:52.in the funds which may result in the closure of pharmacies in thd future.

:25:53. > :26:02.Reform is needed but the government needs to look very carefullx at that

:26:03. > :26:08.money, I cheered a meeting `nd this money, I cheered a meeting `nd this

:26:09. > :26:23.additional money coming through was really welcome and should plug some

:26:24. > :26:27.of the gaps in this service. I want to focus on two areas, the first is

:26:28. > :26:35.integration and the second hs finance. At the moment the two

:26:36. > :26:44.hospitals serving my constituents are basically flop. This is at a

:26:45. > :26:52.time when we've not had a m`jor epidemic. -- basically full up.

:26:53. > :26:56.We've something like 170 beds in the Royal store cost little with

:26:57. > :27:00.patients who should be out of hospital but cannot go out `nd in

:27:01. > :27:08.the county is that all something like 30 beds. It becomes more

:27:09. > :27:10.difficult for accident and dmergency departments to meet their t`rgets.

:27:11. > :27:23.They are doing a great job. To show how hard people are working

:27:24. > :27:26.in a hospital which went through some difficult times this thme last

:27:27. > :27:31.year. Because it shows just what we were

:27:32. > :27:35.talking about, just shows the people who are working long shift, putting

:27:36. > :27:38.patient first, Taize are in Stoke the County Hospital and indded

:27:39. > :27:43.hospitals in all our constituency, up and down the country.

:27:44. > :27:46.So, there is that to look at. The clear problem we have in getting

:27:47. > :27:50.people out of hospital, as people have said this is something that was

:27:51. > :27:56.a worry ten years. It is sthll there today. We haven't fixed it. That is

:27:57. > :27:59.a reason real reason for integration, something the

:28:00. > :28:03.Commission needs to look at, the look at where things are working and

:28:04. > :28:07.say let us get this right across the country. I think the supported

:28:08. > :28:13.housing review mentioned in the opposition debate yesterday is

:28:14. > :28:17.critical, because if a lot of this funding for supported housing goes,

:28:18. > :28:24.through changes to housing benefit, then we will see a greater problem,

:28:25. > :28:30.we will see more pressure on Accident Emergency, and inpatient

:28:31. > :28:34.services. I think I would also very much endorse what members h`ve said

:28:35. > :28:39.about community matrons or district nurse, they perform a vital role,

:28:40. > :28:45.just this last week, I remelber my wife talking about the work of the

:28:46. > :28:50.district nurses in Stoke-on,Trent and how the work is valuabld and

:28:51. > :28:52.appreciate, yet there are not that many available, particularlx over

:28:53. > :28:58.the weekend. That means a lot of juggling round, when that I can go

:28:59. > :29:03.out, and see her patients. So, members have talked honourable

:29:04. > :29:07.MEPs have talked a lot aboutent investigation from more knowledge

:29:08. > :29:11.than me. I would make the point this commission needs to look at best

:29:12. > :29:18.practice, I want to spend more time on financing, I think it is right

:29:19. > :29:23.that a commission, should look at all options, but I have to say, that

:29:24. > :29:28.I have looked at this careftlly over a up in perof year, and -- ` number

:29:29. > :29:32.of year, I don't think we h`ve too many option, I tend to a degree with

:29:33. > :29:35.the, and -- a number of year, I don't think we have too manx option,

:29:36. > :29:38.I tend to a degree with the Barker commission, and I quote "Thdre

:29:39. > :29:43.should be a ring-fenced budget for NHS and social care" and it rejects

:29:44. > :29:48.new NHS charges on a broad scale and private insurance op suns, hn face

:29:49. > :29:54.of public funding. Now, why do I come to that? I come to that because

:29:55. > :29:57.I don't think there is any other way in which the volume of extr`

:29:58. > :30:03.resources needed is going to be raised. At the moment, and H stand

:30:04. > :30:10.to be corrected on this, but we probably spend 2-3% less of our GDP

:30:11. > :30:15.on health than France or Germany. And this could amount to solething

:30:16. > :30:21.like ?35-45 billion a year, additional money we need to raise

:30:22. > :30:25.and spend. I have to say, the NHS is a very efficient system, but given

:30:26. > :30:29.the efficiency, with which ht operate, think what would bd

:30:30. > :30:34.possible if we were to do, to come up with that extra 2-3% of ` share

:30:35. > :30:37.of national a income, such `s our neighbours in France and Germany do.

:30:38. > :30:42.I am not talking about the 08% of the US. In my view that is too much

:30:43. > :30:46.and a huge am of money is w`sted in the US system and it doesn't

:30:47. > :30:53.necessarily achieve the right outcome, particular for people who

:30:54. > :30:58.are uninsured, although that is changing, or in the lower income

:30:59. > :31:02.groups. It is here we will run-in to problems with political problem and

:31:03. > :31:07.that why it is so important, it is put into a cross-party, non,party

:31:08. > :31:11.commission. Because in our fiscal system we lump together manx

:31:12. > :31:16.different things and we call them public expenditure, but in fact

:31:17. > :31:21.what is call public expenditure is made up of different categories of

:31:22. > :31:26.spending. There is spending on state functions such as defence, policing

:31:27. > :31:31.and I would add education, then there is spending much more or

:31:32. > :31:34.individual,/which the biggest categories are pennion, welfare and

:31:35. > :31:39.the National Health Service. We are coming to a situation where we talk

:31:40. > :31:45.about it all as though it is, ta, and in politics, so often t`x is bad

:31:46. > :31:49.and yet this spending, the spend, the two things don't make sdnse in

:31:50. > :31:54.other countries such as Gerlany the latter forms of expenditure, the

:31:55. > :31:57.more personal ones are often provided more through incomd based

:31:58. > :32:02.social insurance. Now, in the UK we started on that system more than 100

:32:03. > :32:07.years ago with National Instrance. Over the past 50 years we h`ve

:32:08. > :32:11.allowed it to become less rdlevant except when it comes to eligibility

:32:12. > :32:16.for state pension and certahn benefits. As a result of thhs, of

:32:17. > :32:21.course. Just on the point of finance. I know talking to ly local

:32:22. > :32:26.council leaders that becausd there is always, for the last few years

:32:27. > :32:29.there has been a cap on how much they can raise the council tax by

:32:30. > :32:33.they haven't been able to r`ise it to pay for social care, and when you

:32:34. > :32:38.talk to residents, they would be more than willing to pay for that if

:32:39. > :32:43.it was ring-fenced for soci`l care and it meant there were mord home

:32:44. > :32:50.helps and services availabld. I welcome the announcement of that 2%

:32:51. > :32:53.ring-fence, for social care, because the NHS has had to pick up the bill,

:32:54. > :33:00.because social care has not been able to be properly funded.

:33:01. > :33:07.I think my right honourable friend is right. Staffordshire council last

:33:08. > :33:11.year raised it by 1.9% but ring-fenced it for social c`re. This

:33:12. > :33:15.I believe they are looking `t doing the same and taking advantage of the

:33:16. > :33:22.Government's welcome propos`l. Of course. Yes. I think the honourable

:33:23. > :33:26.gentleman for being so generous my concern about the 2% precept is that

:33:27. > :33:31.areas that are wealthy will get an awful lot more money than areas in

:33:32. > :33:36.are poor, and in fact that will increase health inequalities. I

:33:37. > :33:40.wonder whether he would consider looking like combining tax `nd

:33:41. > :33:43.National Insurance, National Insurance has become an anolaly

:33:44. > :33:48.people pay it when they earn little and that I stop paying it when they

:33:49. > :33:56.retire, even if they are very wealthy. I wonder whether something

:33:57. > :34:00.more radical should be lookdd at. I believe national insurance hs a very

:34:01. > :34:06.good thing, and I will expl`in why. I understand, I fully accept what

:34:07. > :34:11.the honourable lady says, btt let me argue the case for National

:34:12. > :34:15.Insurance if I may. She may disagree with me by intervention or other

:34:16. > :34:21.ways. So, we have allowed jtst to pick up much thread National

:34:22. > :34:24.Insurance to become press rdlevant except for the various

:34:25. > :34:30.eligibilities. It has becomd viewed by the Treasury as another form of

:34:31. > :34:34.raising funds and indeed thdre was a consultation or proposal of merging

:34:35. > :34:39.tax and nags avenue insurance something I would oppose, bdcause my

:34:40. > :34:43.perception is that our constituents still see National Insurancd as

:34:44. > :34:47.something different from income tax, being their contribution to the NHS,

:34:48. > :34:53.pensions and welfare and indeed the nags after insurance money raised,

:34:54. > :34:56.although it's a fiscal ficthon, still goes towards the NHS, about 60

:34:57. > :35:03.billion a year, far less th`n we spend on the NHS. It is still there.

:35:04. > :35:08.That perception is in part true But national, our constituents don't see

:35:09. > :35:11.it in the same way as incomd tax, that was particularly the c`se when

:35:12. > :35:16.Gordon Brown raised National Insurance, in order to put

:35:17. > :35:19.additional money into the NHS. He, and I think rightly, viewed that as

:35:20. > :35:23.the best way for raising additional money for the NHS. It was something

:35:24. > :35:27.that was more acceptable th`n putting a couple of pence on income

:35:28. > :35:31.tax. So I believe, and I will come to my conclusion on this, that the

:35:32. > :35:35.best and indeed personally the only way, but obviously a commission

:35:36. > :35:41.needs to be very broad minddd in its view, to ensure that we can finance

:35:42. > :35:44.NHS and social care properlx in the long-term, is through progrdssive

:35:45. > :35:50.income based national insur`nce with a wider base, as Kate Barker said,

:35:51. > :35:54.applying to people, not to stop when they retire, and indeed not to stop

:35:55. > :35:58.at the upper National Insur`nce him, which it does at the moment with

:35:59. > :36:03.only 1% over that. By broaddning the base some national insurancd it

:36:04. > :36:06.should be possible to keep the percentage rates reasonable for all

:36:07. > :36:12.while paying for the servicds needed. In conclusion, what I would

:36:13. > :36:17.say is I welcome this motion, I welcome the proposal for cross-party

:36:18. > :36:22.work, whether a commission, or whatever, but I would also plead it

:36:23. > :36:25.be fairly focussed, not covdr ground that has been well covered, and

:36:26. > :36:30.probably better than we could, covered elsewhere, on the ddtails of

:36:31. > :36:34.health care, but look at integration, and most important of

:36:35. > :36:41.all, future finance for the next 20 or 0 years.

:36:42. > :36:46.It is always a pleasure to follow the home for Stafford. He is a great

:36:47. > :36:57.defender of the NHS, locallx and nationally. And I want to start by

:36:58. > :37:02.congreat lating the member for north Norfolkings the member for Leicester

:37:03. > :37:06.West, she was a good shadow minister, and the honourabld member

:37:07. > :37:11.for Central Suffolk and North Ipswich, who can't be here. He was

:37:12. > :37:16.an assiduous minister and a member of the Health Select Committee. And

:37:17. > :37:21.so it is with great difficulty, and I suppose a bit of sadness that I

:37:22. > :37:27.want to say I don't actuallx support the motion, I know it comes with

:37:28. > :37:34.great heavyweight backing, from public figure, and MPs and dx-former

:37:35. > :37:39.minister, but I don't feel hn my view, that this is something that

:37:40. > :37:43.would take the debate forward. And sometimes, we feel that when we set

:37:44. > :37:48.up a commission it is almost like kicking something into the long

:37:49. > :37:52.grass, and this word commission feels as though that is what we are

:37:53. > :37:57.doing, because this issue h`s been going on for a long time, and as I

:37:58. > :38:02.see it, it is a lack of polhtical will that is failing to drive the

:38:03. > :38:06.changes forward. We have had the evidence, there has been a pilot

:38:07. > :38:12.scheme that was set up by mx right honourable friend the member for

:38:13. > :38:19.Leigh in 2009 in Torbay. Thd integrated care trust is opdrating,

:38:20. > :38:22.and the the former Secretarx of State Steven door re, and a very

:38:23. > :38:27.good chairman of the Select Committee I served on, I don't know

:38:28. > :38:32.whether you have seen his interview in the House magazine on thd 22nd.

:38:33. > :38:37.He said, what is the oldest quote from a health minister saying how

:38:38. > :38:49.important it is to join up health and social care services? The answer

:38:50. > :38:54.that came back was Dick account crossman. I want to touch on what

:38:55. > :38:59.some honourable members havd been saying about cross-party support.

:39:00. > :39:04.And unless I have been in a different planet or a bit lhke Bobby

:39:05. > :39:10.in Dallas if members can relember, I have woken up and it is all a dream,

:39:11. > :39:16.Select Committee, on a cross-party Select Committee, on a cross-party

:39:17. > :39:25.Select Committee, producing many reports I will touch on and we. .

:39:26. > :39:29.And we came up with a number of conclusions that members ard talking

:39:30. > :39:33.about now, that we should look at. In our report on public expdnditure,

:39:34. > :39:37.we said very little of the loney spent by the NHS on people with

:39:38. > :39:41.long-term conditions is spent in an integrated way, and this me`ns

:39:42. > :39:45.significant amounts of monex is wasted.

:39:46. > :39:51.Our report on commissioning, the NHS commissioning word should work

:39:52. > :40:01.closely with Loke commissioning bodies to facilitate budget cooling.

:40:02. > :40:05.Social care, the 12th report of 2010/12. This has been an ahm of

:40:06. > :40:13.successive Governments and has not been properly achieved. And our 11th

:40:14. > :40:16.report, in 2012/13 on public expenditure of health and social

:40:17. > :40:21.care. Health and wellbeing boards and clinical commissioning groups

:40:22. > :40:25.should be placed under a duty to demonstrate how they intend to

:40:26. > :40:28.deliver a commissioning process which provides integrated hdalth,

:40:29. > :40:35.social care, social housing service, in their area.

:40:36. > :40:38.Evidence of 30% of admissions to the acute sector are unnecessarx or

:40:39. > :40:42.could have been avoided if the conditions had been detected and

:40:43. > :40:47.treated earlier through an integrated health care, health and

:40:48. > :40:50.care system. And then our sdventh report, of 2013/14. Public

:40:51. > :40:57.expenditure on health and social care. Fragmented commissionhng

:40:58. > :41:02.structures inhibit the growth of truly integrated service. Otr second

:41:03. > :41:06.report of 2014/15. Managing the care of people with long-term

:41:07. > :41:09.commissions. In many cases, commissioning of service for

:41:10. > :41:13.long-term commissions remains fragmented and that care centred on

:41:14. > :41:21.the person is remote from the expense of many. An integrated

:41:22. > :41:27.approach is necessary to relieve pressure on acute health. Mx

:41:28. > :41:31.honourable members, we have sat through that evidence. I know it is

:41:32. > :41:34.real, Madame Deputy Speaker because it will be on the Select Colmittee

:41:35. > :41:39.website. Pages and pages of evidence of where

:41:40. > :41:44.we can get things right. In particular, our report on social

:41:45. > :41:47.care said the government has sign up to the idea of integration but

:41:48. > :41:50.little accuse sun has taken place, the committee does not belidve that

:41:51. > :41:55.the proposals in the Health and Social Care Bill will simplhfy the

:41:56. > :41:59.process. And we call for a single commissioner, with a single pot of

:42:00. > :42:03.money, who will bring together the different pots of Monday and decide

:42:04. > :42:09.how resources will be deploxed. One of the things that we dhd on

:42:10. > :42:14.our, as part of the health `nd social care evidence inquirx was to

:42:15. > :42:21.visitor bay, and many members haven't mentioned Torbay, btt there

:42:22. > :42:24.we have seen integrated card in action, Mrs Smith, it could be any

:42:25. > :42:30.one of our constituents has one point of call. She makes ond

:42:31. > :42:35.telephone call, and it goes, and she has a seamless, social care, up to

:42:36. > :42:39.the Health Service and back again. The workers there are upskilled

:42:40. > :42:42.they are able to help Mrs Slith going through the whole service

:42:43. > :42:45.What they did was work together the Local Authority and the loc`l

:42:46. > :42:48.hospitals so when Mrs Smith was unwell, and had to go to hospital

:42:49. > :42:55.she was tracked through the whole system.

:42:56. > :43:01.One of their concerns were what would happen under health and social

:43:02. > :43:07.care. There are concerns thhs integrated system would not work. I

:43:08. > :43:11.have seen work and another `rea another visit we went to was in

:43:12. > :43:15.Denmark and Sweden to look `t integrated care. In Denmark we saw

:43:16. > :43:21.the most fabulous building where elderly people could have c`re. GPs

:43:22. > :43:30.visited and it looked more like a hotel than actually a home. What

:43:31. > :43:33.they said was we are looking at your system, at this point we ne`rly fell

:43:34. > :43:43.off our chairs because we thought we were going to Denmark to look at how

:43:44. > :43:47.their system works top. I'm just wondering, she talks about these

:43:48. > :43:51.different initiatives and the need for political will, the conclusion

:43:52. > :43:57.is that none of these things which she talks about happen. The

:43:58. > :44:03.political world has not been there because of the acute partis`n

:44:04. > :44:06.environment wheel working. Does that not make the case what you need a

:44:07. > :44:11.process which the Government buys into which will actually deliver

:44:12. > :44:16.change in a defined period of time that all parties can commit to? I'm

:44:17. > :44:24.grateful for that interventhon and I will say this. The structurd had

:44:25. > :44:29.that purpose. The Government has a responsibility to reply to that and

:44:30. > :44:34.if he waits until the end of the speech he will see where I `m

:44:35. > :44:41.heading with this. I agree with this idea that something needs to be put

:44:42. > :44:44.together. Madame Deputy Spe`ker like to see things taken forward and it

:44:45. > :44:50.is what the Honourable membdr of Stafford said. It may be th`t the

:44:51. > :44:54.Honourable member has a good role to play to put together all of these

:44:55. > :45:01.and take it forward but at the end of the day it is political `nd it is

:45:02. > :45:05.a matter of the Government ,- for the Government of the day to look

:45:06. > :45:12.at. I want to move on to thd man of my local hospital and authority --

:45:13. > :45:15.manner. We have a settled community in Walsall and we have one local

:45:16. > :45:20.authority dealing with the local hospital. There is that work which

:45:21. > :45:24.is carried out between the local authority and the hospital `nd they

:45:25. > :45:28.can talk things through and the difficulties arose when there were

:45:29. > :45:35.difficulties in Staffordshire Hospital and we had to take on more

:45:36. > :45:40.services when the a and D closed and extra maternity services were taken

:45:41. > :45:43.on. Taking patients on from different areas was much more

:45:44. > :45:48.difficult. The relationships were not built up that they can be built

:45:49. > :45:53.up and I'm sure they will. We know that the workers in the health

:45:54. > :45:57.service to work very hard and extremely well together to dnsure

:45:58. > :46:00.that those relationships ard there. If they work for one local `uthority

:46:01. > :46:09.then I'm sure they can work for others nearby. It is interesting,

:46:10. > :46:18.the Honourable member for North Norfolk has used Alan Milburn and

:46:19. > :46:23.Stephen Dorrell, if I was bding cruel I would say the secretary of

:46:24. > :46:30.state failed and why did thdy not do something about it, but I think

:46:31. > :46:33.there is a way forward on this which many members have alluded to the

:46:34. > :46:38.myriad of reports that have come out. The King 's fund produced a

:46:39. > :46:45.report, the Nuffield trust produced a report and many universithes have

:46:46. > :46:52.produced reports. Lots of words and more action. My only diffictlty is

:46:53. > :46:56.the accountability structurd. I am not sure who they report to and

:46:57. > :46:59.there is no obligation for the Government to respond to thhs in the

:47:00. > :47:06.way they would respond to the health select committee. I do want to touch

:47:07. > :47:14.slightly on the matter of money We did have a reorganisation at a

:47:15. > :47:24.minimum of ?2 million and I would say and counselling, I would say the

:47:25. > :47:28.if the Government can sit down and see what flows into the Tre`sury,

:47:29. > :47:34.that has an enormous impact on all of us and the Mrs Smith's the world.

:47:35. > :47:41.That is why as the Government said in their evidence to our second

:47:42. > :47:44.report in 2014, the ambition of achieving integrated health and

:47:45. > :47:53.social care services by 2017 had been given a turbo-charged. The

:47:54. > :47:56.minister giving evidence sahd by 2015 the whole country will be

:47:57. > :48:01.starting to see a significant change. It may be something that the

:48:02. > :48:11.health select committee could look at and produce a new report or even

:48:12. > :48:14.the commission or whatever the commitment the Honourable mdmber for

:48:15. > :48:19.North Norfolk and his colle`gues can extract from the Government. We have

:48:20. > :48:23.the evidence Madame Deputy Speaker, we have the care trust, we have the

:48:24. > :48:31.pilot and in the Government 's own turbo-charged words, we havd the

:48:32. > :48:34.will hopefully. Finally I'm not persuaded that a commission will

:48:35. > :48:42.actually bring about change that is so desperately needed for all of us.

:48:43. > :48:49.It is an honour to follow mx honourable friend the member of

:48:50. > :48:50.staff at who made some very good points and drew reference to the

:48:51. > :49:00.Barker reports. Ash might Stafford. Although I am sure we don't all

:49:01. > :49:07.agree with everything in thd report, it is something good to be talking

:49:08. > :49:09.about. To follow the Honour`ble member of Walsall South, I'l a

:49:10. > :49:14.member of the health select committee so it is good to hear

:49:15. > :49:18.about her experiences as a lember of that committee and to reflect what I

:49:19. > :49:22.may be to do with my fellow members to make sure we are effective in

:49:23. > :49:29.driving on the agenda of integration of health and social care. H would

:49:30. > :49:33.like to thank the Honourabld member of North Norfolk, Leicester West and

:49:34. > :49:39.Suffolk Central for calling this debate. Sitting here today has been

:49:40. > :49:43.a very good conversation, wide-ranging but a very good

:49:44. > :49:46.conversation, a productive conversation about the future of the

:49:47. > :49:57.health service and social c`re. There have been interesting

:49:58. > :50:03.contributions from other melbers. I share the Honourable member of North

:50:04. > :50:07.Norfolk's desire and aspiration to take politics out of the NHS and out

:50:08. > :50:13.of discussion about the health service and social care. Thdre are

:50:14. > :50:17.most certainly situations rtnning up to election where there are very

:50:18. > :50:26.unhelpful scaremongering calpaigns on all sides about what is going on.

:50:27. > :50:29.The reality is... I would agree with that point she is making and we do

:50:30. > :50:36.need to look at this in the long term and whoever is making those,

:50:37. > :50:38.whether it is us or the Govdrnment in an election campaign, talking

:50:39. > :50:42.about death taxes and all of that is not helpful because we need a

:50:43. > :50:46.cross-party view on this because it is something that would be `

:50:47. > :50:55.long-term measure and will cost money. There is no way getthng out

:50:56. > :50:59.of that. He may want to hear more of what I have to say before hd

:51:00. > :51:03.entirely agrees. We share the view on the scaremongering point about it

:51:04. > :51:10.being unhelpful, but what I'm going on to say, in a health systdm which

:51:11. > :51:21.burns ?135 billion of taxpaxers money every year which employs .3

:51:22. > :51:24.million staff and has over ` million users, there is no way this cannot

:51:25. > :51:30.be political. This just is political. Also it is no bad thing

:51:31. > :51:34.it is political because it leans there is a debate about it `nd out

:51:35. > :51:43.of the debate we get better and since and it gives the publhc a

:51:44. > :51:46.choice. Coming specifically to the question of the commission proposed,

:51:47. > :51:49.one thing that concerns me `bout it is there does not appear to be a

:51:50. > :51:55.consensus amongst those who supported about what this commission

:51:56. > :51:58.should be about. This afternoon I've heard proposals that it shotld be

:51:59. > :52:04.about the future funding settlement but also that it should be `bout

:52:05. > :52:11.public health, about the structure and configurations of the NHS, about

:52:12. > :52:13.the future of mental health and the health services and preventhon and

:52:14. > :52:21.integration of health and social care. If the commission is to be as

:52:22. > :52:24.effective in the proposed one-year and lead the something concrete it

:52:25. > :52:29.cannot possibly be as wide-ranging as all of those areas. I worry that

:52:30. > :52:34.those involved in the commission will spend a huge amount of time

:52:35. > :52:37.working out and disagreeing amongst themselves what the commisshon is

:52:38. > :52:47.actually looking into Amat hn its process would be enormous -, looking

:52:48. > :52:52.into it, and that in its. Introduce a of brainpower and resourcds to put

:52:53. > :52:58.in to the discussion of the future which would be an opportunity cost

:52:59. > :53:03.which is one concern I have about the post commission. To the extent

:53:04. > :53:07.that it might focus on the future funding for the long term of health

:53:08. > :53:10.and social care, I do think that is important and is something that

:53:11. > :53:18.should be given a huge amount of attention to, we need to look

:53:19. > :53:23.further out. If anything it is going to be political. Questions `bout

:53:24. > :53:28.what amounts we should spend as a society, what amount of GDP per

:53:29. > :53:31.person and how should it be funded, with taxes or charges, copaxments,

:53:32. > :53:38.these are important questions but they are all political. There are

:53:39. > :53:43.questions of value so it wotld be incredibly difficult to takd the

:53:44. > :53:47.politics out of that. It wotld be wrong in fact to come to a consensus

:53:48. > :53:50.because we need to have a ddbate about it and we need to dis`gree

:53:51. > :54:00.about it and give the public a choice. Just as the current funding

:54:01. > :54:05.settlement through to 2024 the NHS -- 2020, for the NHS and th`t ?

:54:06. > :54:11.billion it would be getting in the Parliament was put to the ptblic in

:54:12. > :54:16.the last general election as an overall package as what levdl should

:54:17. > :54:23.taxation be, overall spending and the depth of the deficit. In the

:54:24. > :54:27.same way a future funding should be put to the public at a future

:54:28. > :54:33.election. It is not something that should be agreed by insiders through

:54:34. > :54:37.some commission, if it is going to move quickly as is suggested,

:54:38. > :54:43.between now and the next eldction, that is a very warring proposal It

:54:44. > :54:49.is something that should be decided by the public. Does the Honourable

:54:50. > :54:54.member believes that the public would be happier with a confused and

:54:55. > :54:59.disagreed choice and argue choice between parties rather than an

:55:00. > :55:06.agreed and long-term choice that is putting real priorities and written

:55:07. > :55:11.undertakings in front of thdm? The public would be given a chohce, does

:55:12. > :55:15.that mean we will have a debate about Europe in the upcoming

:55:16. > :55:20.referendum? That is something voters have voted for in the last dlection.

:55:21. > :55:28.We should respect the voters and the choices to them that they c`n take a

:55:29. > :55:31.view on. I understand some points and I've heard a lot of

:55:32. > :55:36.contributions about all aspdcts of health but for this motion, and for

:55:37. > :55:43.the central parts being abott funding, the truth is tell le where

:55:44. > :55:47.any political party in the last 40-50 years has put before the

:55:48. > :55:51.electorate a very clear fralework about what the state will p`y out of

:55:52. > :55:57.the pool funding we get frol national insurance or incomd tax and

:55:58. > :56:01.what people will add on top based on their income or assets to ftnd the

:56:02. > :56:05.future of social care, we h`ve never had that proposition becausd it is

:56:06. > :56:09.not within the mix of a gendral election and the bustle and back and

:56:10. > :56:17.forth that a debate allows to happen and we politicians are to blame for

:56:18. > :56:20.that. I agree it is difficult in the election cycle to think further

:56:21. > :56:24.ahead but I don't think it hs impossible. What we saw in the last

:56:25. > :56:29.parliament was the NHS coming up with a five-year forward vidw which

:56:30. > :56:33.at the time of supported by all major political parties, with that

:56:34. > :56:37.experience it is possible to go ahead and come up with further

:56:38. > :56:40.long-term views. As I said darlier a debate would actually be helpful

:56:41. > :56:50.rather than a consensus being aimed for. This is exactly the sort of

:56:51. > :56:55.thing which researches and think tanks will be looking into. I just

:56:56. > :56:59.want to highlight one particular point about the fact this is

:57:00. > :57:10.political. The Honourable mdmber of North Norfolk mentioned NHS survivor

:57:11. > :57:15.which on their website has lots of clinicians being involved in this

:57:16. > :57:18.discussion. But that said, the founder of the organisation was also

:57:19. > :57:26.according to the website thd person who initiated a petition calling on

:57:27. > :57:30.the Secretary of State to rdsign. When he called on that as an example

:57:31. > :57:35.of a body lobbying for this commission, but it is clearly very

:57:36. > :57:39.political, there is no way of taking the politics out that. But H will

:57:40. > :57:42.happily give way to him. I `m grateful to the honourable lember

:57:43. > :57:49.for give away. I totally sh`re her view that the politics should not be

:57:50. > :57:53.taken out of health, as othdrs have said, we spend such a subst`ntial

:57:54. > :57:59.amount of money it is right it should be subject to political

:58:00. > :58:03.debate. But as others have said particularly the honourable members

:58:04. > :58:10.for Leicester West and Don Valley, we don't ultimately, in the partisan

:58:11. > :58:12.environment we work within, confront the really difficult issue, they

:58:13. > :58:18.keep being put off. This is the whole problem. However much in their

:58:19. > :58:23.she describes a perfect democratic situation in which the issuds are

:58:24. > :58:27.debated and resolved, they `re not resolved. We remain drifuling into

:58:28. > :58:31.crisis because we are not confronting it.

:58:32. > :58:36.I think he May makes an important point about the need to confront and

:58:37. > :58:39.look at the long-term futurd funding settlement. I just don't thhnk a

:58:40. > :58:43.commissioner necessarily thd right way to do it. The fact we are having

:58:44. > :58:51.a conversation about it now and here in this House is in its own right a

:58:52. > :58:57.good thing I would say. I will briefly give way. I thank

:58:58. > :59:03.her, does she not agree with me that NHS England is a nonpartisan group

:59:04. > :59:08.and the five year forward vhew is exactly you know, nonpartis`n and as

:59:09. > :59:11.looked a all a aspect, the role of a political party is whether to decide

:59:12. > :59:16.that or not. Too often the politicians are making the decision

:59:17. > :59:21.and not the NHS. . I agree with her, I think the five year for S`turday

:59:22. > :59:26.view was a landmark dock -- forward view was a landmark dock yot'll It

:59:27. > :59:32.set out a plan for the future, supported by political partx, the

:59:33. > :59:38.more it can be encouraged and enabled to have that autonoly, the

:59:39. > :59:42.better for those organisations. Another of the proposals for this

:59:43. > :59:46.commission was that it should focus on theent nation of health `nd

:59:47. > :59:51.social care. -- the end intdgration. We have talked about it tod`y, it is

:59:52. > :59:54.in many ways in progress, m`ny different models being pursted and

:59:55. > :59:59.it is one of the important features of the five year forward vidw. One

:00:00. > :00:06.thing I am wary this commission might come up with, if it looks is a

:00:07. > :00:09.one-size-fits-all model for that. One-size-fits-all is not a good

:00:10. > :00:13.idea. One of the good things that is going on at the moment is the

:00:14. > :00:18.development of different model, whether it is the model in lan chess

:00:19. > :00:22.e the local vanguard to my constituency down the road, they are

:00:23. > :00:27.looking at different ways of doing it. That is healthy. Each area

:00:28. > :00:32.should work out to bring it together. What we should do and

:00:33. > :00:35.government should do is enable support, encourage that to love

:00:36. > :00:42.forward around be bolder but not necessarily put on a a isle template

:00:43. > :00:48.of how it should be done. Interested as I am in health care. I al mindful

:00:49. > :00:52.of the problems of the NHS, that a national level, the outcomes

:00:53. > :00:58.challenges, I have two trusts in my constituency, which are in special

:00:59. > :01:05.measures. I have a 100-year,old grandmother who right now is in in

:01:06. > :01:11.Acute Hospital but needn't be in there if the system were working

:01:12. > :01:14.better. So, there are many problems as well as many strengths to the

:01:15. > :01:19.Health Service. Because of that I think what we should be doing is

:01:20. > :01:22.supporting and focussing on how the NHS and the social care can get on

:01:23. > :01:29.with the things that are in the pipeline. There have been m`ny

:01:30. > :01:33.allusions this afternoon to the recent reports there have bden, and

:01:34. > :01:40.evidence of best practise, which is already known but not being done

:01:41. > :01:45.enough across the. Is. Many experiment, beyond experiments are

:01:46. > :01:47.going on, the development of the vanguard, integrated care

:01:48. > :01:53.organisation, all that good stuff happening needs to get on whth it.

:01:54. > :01:59.The shift of care out of hospitals, especially more primary card, and we

:02:00. > :02:02.need to be making sure as pdople who can hold the Government to `ccount

:02:03. > :02:07.that the funding is following that shift of care. That is something

:02:08. > :02:11.that concerns me, let us kedp an eye on that. The shift wards parity ofs

:02:12. > :02:18.seem for mental health and the funding for it. That needs to

:02:19. > :02:21.happen. Improving quality through transparency, technology, ddveloping

:02:22. > :02:25.a learning culture in the NHS. A Gratzer focus on outcomes. Ht is

:02:26. > :02:32.happening but we need more of it to happen. A particular concern of mine

:02:33. > :02:37.which is morale of the workforce and the terrible levels of

:02:38. > :02:40.demoralisation among the NHS workforce, where junior doctors for

:02:41. > :02:45.instance have said round 80$ of them don't feel valued by the

:02:46. > :02:48.organisations they work in that is similar for other members of the

:02:49. > :02:51.health care works force. Th`t is an enormous problem. If I was to call

:02:52. > :02:54.for a commission on anything, I would call for a commission looking

:02:55. > :03:01.into what is going on with the workforce? Why is the workforce so

:03:02. > :03:04.down beat and demoralised? Because that is something fundament`l but

:03:05. > :03:12.specific that I think something could be done about. Overall the NHS

:03:13. > :03:15.needs to get on with, with `chieving the productivity opportunitx that

:03:16. > :03:20.was identified and committed to by the NHS itself, in the five year

:03:21. > :03:24.forward view. There are manx people who have raised their scepthcism

:03:25. > :03:28.about the ability of the NHS to make in the region of 20 billion of

:03:29. > :03:33.efficiency improvements in the coming years. But for it to do that,

:03:34. > :03:37.it needs to be bold, it needs to make the most of the potenthal of

:03:38. > :03:43.technology, reduce the enorlous amount of wastage we know is in the

:03:44. > :03:46.Health Service. Deal with, get over the problems of patients not being

:03:47. > :03:52.discharged or coming to hospital unnecessarily. Join up with the

:03:53. > :03:55.social care system round thd NHS. Address the shortage of nursing beds

:03:56. > :03:59.which is an acute problem in my constituency, and one of thd major

:04:00. > :04:04.reasons why patients are in hospital when they don't need to be. I want

:04:05. > :04:08.to see all these things happen at a greater pace, a greater scale, with

:04:09. > :04:12.greater boldness. And that will require the energies of the NHS and

:04:13. > :04:18.the NHS and social care system to be directed at doing that. I think not

:04:19. > :04:22.being distracted by a commission that is potentially very wide ranges

:04:23. > :04:25.on all the subjects that have been mentioneded to include. I wdlcome

:04:26. > :04:32.the conversation we are havhng today, and that we are having a

:04:33. > :04:35.conversation with which feels a lot less party political than m`ny

:04:36. > :04:40.conversations about the NHS and we are talking about the long-term as

:04:41. > :04:44.well as the near future, but I don't support the Commission that the

:04:45. > :04:53.honourable member has proposed. Thank you. I am grateful to you

:04:54. > :04:57.I congratulate the right honourable member, the member for North

:04:58. > :05:03.Norfolk, my honourable friend, the member for Leicester West, `nd other

:05:04. > :05:11.members that have been involved in getting the debate today. I think we

:05:12. > :05:15.have had thoughtful pieces on both sides of the House, and havhng

:05:16. > :05:21.different views op that. I reflect on what the honourable membdr, the

:05:22. > :05:29.member for Faversham, and mhd Kent has just said, and I am grateful to

:05:30. > :05:35.be able to follow on after her, but I also, I am of the belief that this

:05:36. > :05:40.commission would also, although in principle sounds like a good idea

:05:41. > :05:45.would be a distraction from other thing, I do reflect back, I think my

:05:46. > :05:52.honourable friend the member for Walsall South made the point about

:05:53. > :05:59.what was different in 2009. There was also the opportunity in 201 ,

:06:00. > :06:04.just after the Coalition Government was formed, for a round table to be

:06:05. > :06:09.held across party, round table, something that my right honourable

:06:10. > :06:14.friend the member for Leigh proposed, and was rejected by the

:06:15. > :06:21.coalition, at the time. And it really gets down to what many people

:06:22. > :06:24.have already been saying about the difficulty of taking politics out

:06:25. > :06:30.of, out of the debate of thhs nature. It is down to polithcal

:06:31. > :06:36.Will. I wanted to really talk abott a few

:06:37. > :06:42.points in particular, I think it was the member for Bracknell who made

:06:43. > :06:46.the point and again coming from different perspectives but H

:06:47. > :06:52.fundamentally agree with hil, about having different ideological

:06:53. > :07:00.perspectives. I just wanted to focus for a moment, on the 2012 hdalth and

:07:01. > :07:08.social care act, and the honourable member for Stafford. Sat on two bill

:07:09. > :07:14.committees with him. He onlx bodies the word honourable gentlem`n, but

:07:15. > :07:20.you know, at the time, on this side of the House we made real efforts to

:07:21. > :07:25.explore, and to provide the evidence base about the implications of what

:07:26. > :07:33.would happen with the act, `nd I am afraid many of them have cole true.

:07:34. > :07:37.And it comes from the basis that the Government and at that time the

:07:38. > :07:41.Coalition Government have a different view of how both the NHS

:07:42. > :07:47.and I would suspect, although I can't recall if that is acttally on

:07:48. > :07:54.the record, about how they should be funded. So we believe absolttely

:07:55. > :07:58.passionately and we fought the General Election on this basis, as

:07:59. > :08:03.a, on a number of other isstes of course. We believe in a publicly

:08:04. > :08:08.funded NHS, funded through general taxation with the NHS as a preferred

:08:09. > :08:14.provider. The health and social care act which we committed to rdpeal,

:08:15. > :08:19.because we believe the basis for the act through Section 75 of the act

:08:20. > :08:23.which come pels all providers to put that contracts out to tender is

:08:24. > :08:31.wrong. -- compels. We have been proven it has been wrong. The first

:08:32. > :08:35.year... Thank you for giving way. We do support a publicly funded NHS,

:08:36. > :08:39.but it has been Labour Partx policy to recognise and social card that we

:08:40. > :08:42.think people should make a contribution. The problem is we

:08:43. > :08:47.can't come to a defined space where we can all agree what is a

:08:48. > :08:51.reasonable contribution. We have to be up front about these things,

:08:52. > :08:54.because accuse eventually wd need a system, particularly when it comes

:08:55. > :09:00.to social care where we havd to look at other models in the way we are

:09:01. > :09:07.going to provide the servicd, what is going to be expected is people to

:09:08. > :09:13.finance them. With my honourable friend. I think to pretend we could

:09:14. > :09:16.get to that conclusion on a cross-party basis would be `n

:09:17. > :09:22.illusion. An absolute illushon. I needs to happen but I think we come

:09:23. > :09:28.from completely different perspectives and that needs to, if I

:09:29. > :09:38.could continue my points on this. The bill, now the act, in its first

:09:39. > :09:43.year put out ?16.8 billion hn public money to tender 40% of that went to

:09:44. > :09:50.private health care companids. That we could track because it w`s on a

:09:51. > :10:00.public website which was taken down, so we couldn't be monitored. Care UK

:10:01. > :10:04.won 49 contracts worth ?110 million. The association of donations to

:10:05. > :10:12.different political parties is again on the record. ?5 million h`s been

:10:13. > :10:19.wrapped up, in in competition lawyers funding. In my own

:10:20. > :10:22.constituency in Oldham. My community trust who provides our ment`l Health

:10:23. > :10:28.Services says the time and loney that have been wrapped in up

:10:29. > :10:32.competing for termeds had an increase. It is a distraction, that,

:10:33. > :10:36.and having a commission, getting away from the central points is a,

:10:37. > :10:44.would be a distraction, and as I say, we come from very very

:10:45. > :10:48.different ideological perspdctives. Given what my honourable frhend has

:10:49. > :10:51.said about the impact of legislation in the last Parliament, does she

:10:52. > :10:55.believe a commission would be worse, would have a more adverse ilpact on

:10:56. > :10:59.the lock term future of the Health Service than that legislation, which

:11:00. > :11:05.is based top old way of doing things.

:11:06. > :11:12.I thank the honourable gentleman for his intervention. As I menthoned to

:11:13. > :11:16.my honourable friend, we cole from different perspectives, to think

:11:17. > :11:21.that my right honourable frhend from Walsall said this had been looted in

:11:22. > :11:26.the 60, to think now, just ` few months after we had, we havd been

:11:27. > :11:33.having the debate about health and social care, something sudddnly

:11:34. > :11:39.changed, I think, I, I would respectfully say what has changed?

:11:40. > :11:43.So, again a distraction awax from what we really need to be h`ving our

:11:44. > :11:48.eye on the ball, in terms of what is happening in health and sochal care

:11:49. > :11:54.at the moment. We know that the decisions have been made for example

:11:55. > :11:59.round staffing, and training, have really put in jeopardy our workforce

:12:00. > :12:04.plans and we know as a consdquence one of the reasons that we have got

:12:05. > :12:12.the financial issue, three out of four trusts now in deficit, and I

:12:13. > :12:15.think it is about ?840 millhon deficit, total deficit. That is

:12:16. > :12:24.going to be running up to a billion by the end of the year.

:12:25. > :12:30.Isn't there a danger with the approach is advocating that we can

:12:31. > :12:34.continue to have a go at thd Government and say how awful

:12:35. > :12:38.everything is an the pressure on staff and the deterioration of

:12:39. > :12:47.services, a lot of that is happening, but is it better to try

:12:48. > :12:52.to achieve a solution rather than waiting there will be a dechsion by

:12:53. > :13:04.the Government to make a decision on the funding necessary. As I teased

:13:05. > :13:07.him last week when we were `t a radio five interview, so saxs the

:13:08. > :13:11.minister who a few months ago was saying something differentlx. Please

:13:12. > :13:16.do not want anybody to be under any illusion that we should not be

:13:17. > :13:23.thinking of planning for 30,40 years hence, it is not what I'm s`ying

:13:24. > :13:26.that's all, try to pretend coming from such different ideologhcal

:13:27. > :13:32.perspectives and I've given you one example of how different we have few

:13:33. > :13:45.things in terms of the 2012 health and social care act. If I could

:13:46. > :13:49.refer Honourable members soleone who chaired the committee in thd last

:13:50. > :13:53.Parliament undertook an enqtiry looking at the effect of

:13:54. > :13:58.international health systems, it is on my website for everybody to look

:13:59. > :14:03.at, we were concerned about in terms of both quality and in terms of

:14:04. > :14:09.equity in access and equity in health comes, we know there is a

:14:10. > :14:15.vast difference in both of those so the enquiry showed quite

:14:16. > :14:17.conclusively that where there is competition, privatisation or

:14:18. > :14:24.marketisation, health equitx worsened. It'll so revealed that

:14:25. > :14:28.there is no compelling eviddnce of competition privatisation or

:14:29. > :14:32.marketisation improves qualhty. There is some evidence that it

:14:33. > :14:38.impedes quality and increasds hospitalisation rates and mortality.

:14:39. > :14:43.This is peer-reviewed review of review evidence. This is not a

:14:44. > :14:48.one-off study, it is the strongest type of evidence that shows that

:14:49. > :14:53.marketisation, privatisation that we have just been talking about worsens

:14:54. > :15:04.health equity, worsens the puality of care. Again we need to bd looking

:15:05. > :15:13.across with a forward view 30-4 years hence on how we continue to

:15:14. > :15:16.fund the NHS and social card. This is a distraction, a distraction from

:15:17. > :15:28.the crisis that we have at the moment. Weights are up 30-40% since

:15:29. > :15:36.2015, standards again are down and goes on and on. Mental health cuts,

:15:37. > :15:41.600 million cuts to help trtsts what has changed in the last few

:15:42. > :15:49.months? Delayed discharges reflecting that the care crhsis 3.6

:15:50. > :15:58.billion taken out of the budget for social care in the last Parliament,

:15:59. > :16:03.that'll be 4.3 soon. This increase will not make the differencd and we

:16:04. > :16:09.know, the member for Leicester said since 2010, half a million fewer

:16:10. > :16:15.older people and disabled pdople have received state funded support.

:16:16. > :16:21.In my own constituency, I w`s doing when regular door knocks and I'm not

:16:22. > :16:29.on a door and an elderly lady in her 70s open the door and she s`id, she

:16:30. > :16:33.presented me with a pack of medicines, she said I don't know

:16:34. > :16:36.what I have to do, she had never met before, she was dishevelled in her

:16:37. > :16:42.dressing gown and this was ` woman who clearly needed our help stop she

:16:43. > :16:47.was on her own and didn't know what medication to take. I managdd to get

:16:48. > :16:51.somebody but how often is this happening up and down the country?

:16:52. > :17:00.It is in a crisis and a rock concern. There are many exalples

:17:01. > :17:03.around the country were using a care coordinator, having a singld point

:17:04. > :17:08.of contact is not only provhding better care for individuals but also

:17:09. > :17:12.saving money for the whole system in avoiding admissions and allow people

:17:13. > :17:16.to come home early. We should focus on the good and how we can sure that

:17:17. > :17:24.is available in a more coordinated way. I totally agree. Again it was

:17:25. > :17:29.one of our recommendations `nd a manifesto pledge. I thought what she

:17:30. > :17:35.said in her speech earlier was absolutely spot on, I agree. As I

:17:36. > :17:43.say, getting back the distr`ctions, we need to look at the issud of

:17:44. > :17:46.funding and resources and I want to come onto something the Honourable

:17:47. > :17:52.men fought on the said on this basis. We know in real terms growth

:17:53. > :17:58.in spending in last Parliamdnt it was the lowest in the history of the

:17:59. > :18:05.NHS, less than 1%. If you compare that to 6% in the 97-2009 pdriod, it

:18:06. > :18:11.is a percentage of GDP around 7 5%, slipping below the European Union

:18:12. > :18:19.average. We are now towards the bottom which is where we st`rted in

:18:20. > :18:25.97. We haven't even spoken `bout devolution, the devolution offered

:18:26. > :18:29.to greater Manchester, when the current collective social hdalth

:18:30. > :18:34.care and economy is 10 billhon, there is no talk about conthngency

:18:35. > :18:41.if there is a flu pandemic for example. It is an absolute disgrace.

:18:42. > :18:49.To sum up Mr Deputy Speaker, I do agree with the member for Totnes on

:18:50. > :18:54.an evidence -based, that is what has been lacking, and evidence ,based

:18:55. > :18:59.decision, I have provided this in terms of what we need to do around

:19:00. > :19:06.the system. We look to resotrce we look to find around and improved

:19:07. > :19:09.quality and equity. There are vast disparities across the country and

:19:10. > :19:16.the terms of outcomes for dhfferent groups. We should be repealhng the

:19:17. > :19:25.social health care act. We should make sure the NHS is a prefdrred

:19:26. > :19:32.provider. Would you mind, I have had a lot and I've being pressed by the

:19:33. > :19:39.Deputy Speaker. Go on then. Just on the comments about repealing. My

:19:40. > :19:45.frustration as an NHS emploxee, there has been too much reform and

:19:46. > :19:48.reorganisation, reinventing the wheel, my plea is please do not make

:19:49. > :19:55.any more changes in terms of the structure. I totally agree. Again I

:19:56. > :20:00.was the chair of the trust `nd a former consultant. I totallx agree

:20:01. > :20:03.on what we committed to in the run up to the election is to repeal

:20:04. > :20:07.without a reorganisation but we thought we did the things in a

:20:08. > :20:14.better way to integrate health and social care which would havd, sorry

:20:15. > :20:18.wouldn't have needed that reorganisation. We need confidence

:20:19. > :20:21.that the system is thereford of us. Our parents, our children and it

:20:22. > :20:34.should be based on people and not profit. We now stop up to 14

:20:35. > :20:41.minutes. I also was in the debate on the 2nd of June last year and I

:20:42. > :20:45.remember expressing my shock at the violence happening across the two

:20:46. > :20:50.dispatch boxes, I thought of just leaving the chamber, it did not seem

:20:51. > :20:56.like a useful debate and thdn I thought no, let's tackle thhs. I did

:20:57. > :21:04.make the comment that regardless of the differences in how politicians

:21:05. > :21:09.would do the NHS, people and the public absolutely believe in the

:21:10. > :21:12.NHS. I think it has been a fantastic debate today because people have

:21:13. > :21:22.brought different views, different outlooks that have brought them in a

:21:23. > :21:30.convoy -- calm way. The challenges of increasing demand due to age and

:21:31. > :21:34.multi-mobility is not just north and south of the border but is `cross

:21:35. > :21:37.the developed world. We havd the challenge of not having enotgh

:21:38. > :21:40.doctors, we're seeing that hn primary care and secondary care and

:21:41. > :21:46.again that is throughout thd nations of the United Kingdom. In Scotland

:21:47. > :21:48.there are some challenges wd don't have, we don't have the

:21:49. > :21:54.fragmentation that came frol the health and social care act, indeed

:21:55. > :22:03.we got rid of trust back in 200 . We have gone therefore to geographical

:22:04. > :22:06.boards. There is no longer ` barrier between primary and secondary care

:22:07. > :22:12.which people use the picturd cross. What has gone active cinch @pril

:22:13. > :22:15.last year is the joint integration. They ran in a theoretical w`y free

:22:16. > :22:21.year that the vast majority went live last year in the last will go

:22:22. > :22:24.live in April this year. Th`t is actually putting the pot of money

:22:25. > :22:29.into a joint space where he`lth and social care work together, break

:22:30. > :22:32.down the barriers and realise there is no benefit to sticking this

:22:33. > :22:38.person in a bed because it hs my bed, your bed, who is paying for it.

:22:39. > :22:44.What person money in has often been the biggest problem. You cannot

:22:45. > :22:48.develop integration if an actual fact what you are developing is

:22:49. > :22:52.fragmentation, competition `nd that is why we have not gone down the

:22:53. > :22:56.route of outsourcing the prhvate providers because it wastes an awful

:22:57. > :23:04.lot of money, an awful lot of effort and we have people who are competing

:23:05. > :23:09.instead of core operating. We have different systems, we have free

:23:10. > :23:12.personal care and the level has been increased to allow sticky more

:23:13. > :23:20.complicated people at home. That is quite important. -- allow us to

:23:21. > :23:23.keep. Since June last year what we have needed is a national

:23:24. > :23:26.conversation, whether you are a committee or a commission, ht is

:23:27. > :23:31.important that the public and the staff are involved as well `s the

:23:32. > :23:37.people who have written all of these reports. The Kings fund, thd

:23:38. > :23:44.Nuffield trust, whoever, thdre is a way of these together. Actu`lly

:23:45. > :23:49.picking out the good bits to get a shave. Ours is looking towards 030,

:23:50. > :23:56.that is a piece of work will working at at the moment. We did a piece of

:23:57. > :24:01.work which started in 1112 which was vision 2020, looking five ydars

:24:02. > :24:05.forward and what was the sh`pe and where we wanted to be which

:24:06. > :24:11.identified the number one problem to be integration. When we talk about

:24:12. > :24:15.the money that is was going to be political, where it comes from and

:24:16. > :24:20.my comments on national instrance is that at the moment national

:24:21. > :24:24.insurance is bizarre. It st`rts when people and 7000, it stops when

:24:25. > :24:27.people retire when they might be incredibly wealthy. It bears no

:24:28. > :24:32.relationship and I don't thhnk people see it as national hdalth

:24:33. > :24:35.insurance which is how it started. That is a political decision, where

:24:36. > :24:43.the money comes from and whdre it is put. To actually get some khnd of

:24:44. > :24:48.shared view of where NHS England and indeed for the nations want to be in

:24:49. > :24:53.2030, could be a useful piece of work. I agree with the membdrs who

:24:54. > :24:56.expressed anxiety of just khcking it into the long grass. That is quite

:24:57. > :25:01.important and I certainly don't think it needs to stop any piece of

:25:02. > :25:06.work going forward. To medi` provides a place that can come. One

:25:07. > :25:10.of the things in Scotland ddveloping quality measures is actuallx

:25:11. > :25:13.bringing in groups of peopld together for an annual confdrence.

:25:14. > :25:16.I'm a great believer to get people in a room, maybe not always a room

:25:17. > :25:21.like this, maybe a more corporative room but people saying this is all

:25:22. > :25:26.we found difficult, this is how we fix it, this is where we ard stuck,

:25:27. > :25:31.I see you solve that. One of the projects and Nicola Sturgeon has

:25:32. > :25:36.taken forward is what is called once for Scotland, it is not eternally

:25:37. > :25:43.going through local projects, local experiments and never get shared.

:25:44. > :25:47.That is a huge waste of energy and only talk about the money, the

:25:48. > :25:51.Government have committed to 10 billion which has been welcomed

:25:52. > :25:59.More than 2 billion of that has a ready: the deficit and that increase

:26:00. > :26:00.is focused on NHS England when funding is described in the

:26:01. > :26:06.Department of Health responsibilities. The other

:26:07. > :26:11.responsibilities are actually facing a cut which is described as 3

:26:12. > :26:19.billion which means the Kings trust Nuffield trust and the actu`l

:26:20. > :26:25.increases for an half billion so not the headline figure. Five-ydar

:26:26. > :26:30.forward has been mentioned `nd that asked for a billion but it `lso

:26:31. > :26:36.identified 22 billion that had to be found which is fairly eye w`tering

:26:37. > :26:40.would like to suggest. Two of the things identified with that was

:26:41. > :26:48.obviously a change in how pdople work... She is talking a lot of

:26:49. > :26:53.sense as she always does. The five-year forward view actu`lly set

:26:54. > :26:57.out three scenarios. It didn't ask for 8 billion, that is the narrative

:26:58. > :27:03.that has developed but actu`lly the efficiency assumptions of which the

:27:04. > :27:09.8 billion or 10 billion or whatever you want to call it has been based

:27:10. > :27:13.are unimaginable. 2-3% at ldast through the period between now and

:27:14. > :27:21.2020, every knows it will not be delivered. I thank you for that

:27:22. > :27:25.intervention. Even not recognising that no one has gotten to those

:27:26. > :27:32.levels of efficiency savings, a big chunk of that is prevention. More

:27:33. > :27:36.than 5 billion is identified as not having people coming to hospital and

:27:37. > :27:49.not having people get sick. Public health has been cut by 200 lillion,

:27:50. > :27:52.which is 3.9%. People think that of the less alcohol, less prevdntion

:27:53. > :27:58.but public health should be much bigger than that. I underst`nd these

:27:59. > :28:05.to be a Cabinet committee in this place. We should have that feeling

:28:06. > :28:09.into all decisions to ensurd our directors of Public health `re

:28:10. > :28:15.involved strategically and local governments. What shape your town

:28:16. > :28:23.centre is will to note if it is car -based or active transport. Whether

:28:24. > :28:27.you flog off the playing fidlds all will interact with help.

:28:28. > :28:34.I think that comes down to we talk about fixing the roof when the sun

:28:35. > :28:37.is shining. But when the window come in that is what what you fix, then

:28:38. > :28:42.the door comes off the hingds that is what you fix. That is wh`t

:28:43. > :28:47.secondary care is. It's the national illness service, we are responding

:28:48. > :28:51.to people, who are already hll, we are as was mentioned developing more

:28:52. > :28:55.complex and more expensive treatments that allow us to keep

:28:56. > :29:01.people alive. I think that this needs to be recognised. People talk

:29:02. > :29:04.about the catastrophe of agding I have mentioned this before. I would

:29:05. > :29:08.like members to focus on wh`t the alternative to ageing is. Pdople

:29:09. > :29:13.used to say age doesn't comd alone and it is terrible. In the field I

:29:14. > :29:17.worked in, not everybody gets old. It is something that we shotld

:29:18. > :29:20.value, because wisdom comes with that, a sense of community comes

:29:21. > :29:26.with that, but we therefore need to be ready to develop the service

:29:27. > :29:31.that are round people. That means not always just patching up at the

:29:32. > :29:35.end. We need more intermedi`te care to allow step up and step down beds,

:29:36. > :29:39.we are work worken that in Scotland. Particularly we need to focts on

:29:40. > :29:44.primary care as the member for Stafford said. That is the real

:29:45. > :29:49.generalism. That is the person who is able to diagnose, becausd they

:29:50. > :29:53.have known someone over manx year, and GPs are on their knees `nd again

:29:54. > :29:58.that is UK-wide. It is a huge pressure. Because of the deland and

:29:59. > :30:02.because of the complexity. @nd with the, within that, of course, is the

:30:03. > :30:05.lack of mental Health Service, because they have been ignored for

:30:06. > :30:12.such a long time. That is bdginning to change. We do have a waiting

:30:13. > :30:16.time, target for CAMHS in Scotland. It is challenging to meet it but we

:30:17. > :30:19.have doubled the number of staff within that, that is somethhng

:30:20. > :30:25.obviously we hope eventuallx to see improving. But the thing is that we

:30:26. > :30:30.need to be actually looking broader than that, the honourable mdmber for

:30:31. > :30:36.Oldham and saddle worth, not very good at everyone having two name, I

:30:37. > :30:39.find one a challenge for 650 people, but we share sitting on the health

:30:40. > :30:44.policies is and we have been taking evidence on health impact of

:30:45. > :30:48.increasing child poverty, which we a are already seeing is and wd are

:30:49. > :30:54.going to see more of. I think that we need to recognise that every

:30:55. > :30:57.decision we made feeds into whether or citizens are healthier, both

:30:58. > :31:02.physically and mentally or less healthy. That is welfare, that is

:31:03. > :31:05.particularly housing, one of the biggest impacts on health. The

:31:06. > :31:09.member for Stafford mentiondd the impact of the debate we had

:31:10. > :31:12.yesterday on supported care, if we lose supported care in the

:31:13. > :31:17.community, you are never gohng to get people out of hospital. So I

:31:18. > :31:23.would like to make a plea, `s did in my maiden speech, in this place we

:31:24. > :31:27.would put health and wellbehng, meaning mental health across all of

:31:28. > :31:31.our policies and measure our decision against them. Far too many

:31:32. > :31:39.decisions are made in a broken up narrow way, without looking at the

:31:40. > :31:44.ramifications on everything else. Thank you. It was a pleasurd to

:31:45. > :31:50.follow the honourable lady for Central Ayrshire. Can I start by

:31:51. > :31:53.congratulating the honourable gentleman for North Norfolk on

:31:54. > :31:57.securing this debate today. Can I thank all the honourable and right

:31:58. > :32:01.honourable members who have contributed to the debate. H think

:32:02. > :32:07.it has been an important debate and a very well-informed one as well.

:32:08. > :32:10.Mr Deputy speaker, many members have raised this seriousness of the

:32:11. > :32:15.financial challenge facing our health and care system. Thex are

:32:16. > :32:21.right to do so. Many members have been right to say that we nded a big

:32:22. > :32:26.honest national debate about what excellent care services look like,

:32:27. > :32:31.and how we might pay for thdm. I have been the Shadow Secret`ry of

:32:32. > :32:36.State for Health now for just four month, in that time it has been

:32:37. > :32:41.obvious to me that the NHS `nd care system in our country is facing

:32:42. > :32:46.unprecedented challenges. Hue hospital deficits, care home

:32:47. > :32:50.providers on the brink of f`ilure, older people in hospital, bdcause

:32:51. > :32:56.they can't get the support they need at home, more critically ill people

:32:57. > :33:00.waiting longer than ever before for ambulances, and large chunks of the

:33:01. > :33:05.workforce so demoralised thdy want to up sticks and leave for the

:33:06. > :33:12.southern hemisphere. Now for many people who use the NHS, this picture

:33:13. > :33:15.may sound unfamiliar. For the majority, the NHS still provides

:33:16. > :33:19.excellent care, and it is ilportant to recognise that, and to thank the

:33:20. > :33:24.thousands of dedicated staff, who ensure that happens.

:33:25. > :33:31.But for many others, the system fails them. And the risk is that it

:33:32. > :33:35.starts to fail more and mord people as time goes on. Mr Deputy Speaker,

:33:36. > :33:40.when I was asked to do this job I knew that the NHS and care system

:33:41. > :33:44.was under pressure. I knew that demographic change and the larch of

:33:45. > :33:50.technology, both in and of themselves good thing, were places

:33:51. > :33:55.demands on a system designed for a different century. As a constituency

:33:56. > :34:01.MP, I visited isolated older people, many feeling like prisoners in their

:34:02. > :34:06.own home, surviving with thd help of a meagre care package or thd support

:34:07. > :34:10.of family and friends if thdy are lucky. As a local authority

:34:11. > :34:13.councillor I saw the soaring demand for adult social care, and the

:34:14. > :34:19.woefully inadequate budget to deal with it. Demand which is growing,

:34:20. > :34:25.because of our ageing popul`tion, but also because of advances in

:34:26. > :34:30.medicine which enables babids which may not have previously survived all

:34:31. > :34:34.to not only survivor into childhood but adulthood. On a person `h level

:34:35. > :34:41.I know in my own family my grandmother spent the last few years

:34:42. > :34:47.of her life in and out of hospital on an almost weekly basis, driven as

:34:48. > :34:52.much by crises of loneliness, as by a deterioration of her COPD. And I

:34:53. > :35:00.knew that my other nan was forced to sell her own home to pay for her own

:35:01. > :35:05.care, when she developed vascular dementia, meaning all but ?23,0 0 of

:35:06. > :35:09.a ?140,000 estate disappeardd. All of these things I knew before I

:35:10. > :35:13.became the Shadow Secretary of State. But it is only been when I

:35:14. > :35:18.have visited hospital after hospital, up and down the country,

:35:19. > :35:24.in the last few months, that my eyes have really been opened.

:35:25. > :35:30.The image of frail,ledly people perched alone on beds in emdrgency

:35:31. > :35:34.admissions united, or in rehabilitation wards is the abiding

:35:35. > :35:36.picture which stays with me following my first four months in

:35:37. > :35:43.this job. It made me feel uncomfortable, as a

:35:44. > :35:49.childless, 40-year-old woman, I ask myself would that be me in 40 years'

:35:50. > :35:54.time? Was it the best place to be? Was it the best we as a country

:35:55. > :36:00.could do? The image may havd been uncomfortable but the numbers say it

:36:01. > :36:06.all. One in four hospital bdds occupied by people with demdntia.

:36:07. > :36:12.Half of all people admitted to hospital aged over 65. Over 300 000

:36:13. > :36:19.people aged over 90, arriving at A by ambulance every year.

:36:20. > :36:24.When we get older, and it whll come to all of us hopefully, hospital

:36:25. > :36:28.will sometimes be necessary, but it shouldn't become the norm. H know

:36:29. > :36:32.that we have to address this problem, the system needs to be

:36:33. > :36:36.redesigned, so that it gets the right sort of support, to pdople at

:36:37. > :36:39.the right time, and in the right place, to prevent problems from

:36:40. > :36:45.escalating. But we have to be honest, and say

:36:46. > :36:50.there is a price tag attachdd to this. Yes, there are still savings

:36:51. > :36:54.that can be made, ways to m`ke the system more efficient and ldss

:36:55. > :36:59.wasteful, but there are simple underlying pressures that c`n't be

:37:00. > :37:06.wished away. Every day that goes by, there are more and more olddr people

:37:07. > :37:12.living with more complex, m`uvenl tipple conditions. Some say family

:37:13. > :37:16.members need to step up to care for elderly relatives. Others s`y that

:37:17. > :37:22.is unrealistic. Every day that goes by as well, new drugs and treatments

:37:23. > :37:29.become available. At not in significant cost. It may be tempting

:37:30. > :37:33.to brush these uncome forth fortable truths couner carpet but we can t,

:37:34. > :37:37.we would be failing generathons to 23078 if we or two do so.

:37:38. > :37:42.Uncomfortable truths doner the carpet. That brings us to establish

:37:43. > :37:47.an independent, nonpartisan commission to establish what a

:37:48. > :37:52.long-term financial settlemdnt for the NHS and social care system might

:37:53. > :37:54.look like. I understand the superficial

:37:55. > :38:00.attraction of this. I have been stopped on the street, and hn the

:38:01. > :38:01.gym, by people I have EWLIND I understand the superficial

:38:02. > :38:04.attraction of this. I have been stopped on the street, and hn the

:38:05. > :38:07.gym, by people I have never met before, saying, "Why can't the

:38:08. > :38:10.politics be put to one side, when it comes to the NHS? " I understand

:38:11. > :38:14.that sentiment. Politicians aren't always the most popular bunch of

:38:15. > :38:19.people out there and too often we are seen to be advancing our own

:38:20. > :38:27.parties's interests and not those of the public. But for me, I think the

:38:28. > :38:32.question of how we fund elddrly care going forward is the most ddeply

:38:33. > :38:37.political question our country face, over the next decade.

:38:38. > :38:43.Its political, because it is about who pays, and who benefits.

:38:44. > :38:49.While the NHS is a universal taxpayer funded system, fred at the

:38:50. > :38:55.point of use, social care provision is a mixed bag. Those with loney pay

:38:56. > :39:01.for it themselves, those without, rely upon councils to provide what

:39:02. > :39:06.support they can. It has bedn a make do and mend approach to sochal care

:39:07. > :39:11.in recent time, but our changing population means that is no longer

:39:12. > :39:17.an option. I spoke about my nan earlier, a woman of limited mean,

:39:18. > :39:19.who experienced catastrophic care costs, because she developed

:39:20. > :39:25.dementia. My family is not a rich famhly. We

:39:26. > :39:29.are not a poor family either. We are like many families, up and down this

:39:30. > :39:33.country. When I was growing up, my dad decided to take us on a two week

:39:34. > :39:38.holiday to Spain each year, instead of paying into a pension. Hd has

:39:39. > :39:43.never bought a brand-new car in his life but he never let his children

:39:44. > :39:50.go without either. The costs of care which fell upon my nan, and my

:39:51. > :39:56.family fell randomly. Is it right that a woman of limited means who

:39:57. > :40:00.dies of dementia at 85, passes nothing meaningful on to her family?

:40:01. > :40:06.When a wealthy man, who dies of a heart attack, at the age of 60 does?

:40:07. > :40:11.What about those who plan their financial future, having invested in

:40:12. > :40:17.expensive tax advice, to avoid the costs of care? It is my view that

:40:18. > :40:22.these are deeply political questions. In order to adeqtately

:40:23. > :40:27.fund the NHS and care systel in the future, the truth is that a

:40:28. > :40:32.political party needs to be elected to Government, having stood on a

:40:33. > :40:38.manifesto that sets out hondstly and clearly, how we pay for elddrly

:40:39. > :40:43.care, and how we manage in ` fair and transparent way the rishng costs

:40:44. > :40:49.of new treatment, new drugs, and new technology.

:40:50. > :40:54.No matter how well researchdd. How well intentioned, how well reasoned

:40:55. > :41:00.the recommendations from an end commission, someone, at somd point

:41:01. > :41:03.will have to take a tough ddcision. When I think about the cross-party

:41:04. > :41:09.work that has been done on this in the past, I think I can also be

:41:10. > :41:13.forgiven for being cautious. Take the decisions that took place

:41:14. > :41:18.between my predecessor, the Right Honourable member for Leigh and the

:41:19. > :41:23.then Conservative and Liber`l Democrat opposition prior do the

:41:24. > :41:28.2010 election. Just weeks ott from the election, the Conservathves

:41:29. > :41:32.pulled the plug on those talk, and acquisitions of death taxes were

:41:33. > :41:37.suddenly being hurled round. So much for the grown up debate to `nswer

:41:38. > :41:43.the difficult questions. Take also the cross-party attempt in

:41:44. > :41:49.the last Parliament, which led to some of the proposals on capping the

:41:50. > :41:52.cost of care. These proposals were in the Conservative party's

:41:53. > :41:58.manifesto, but were swiftly kicked into the long grass just wedks after

:41:59. > :42:03.the election. I am not sure that attempts to take the politics out of

:42:04. > :42:11.inherently political decisions have worked. Even if we take somdthing

:42:12. > :42:15.straightforward, a new runw`y for example, an understood commhssion

:42:16. > :42:23.hasn't exactly led to consensus on how to proceed. It has just led to

:42:24. > :42:28.more delay. As the Nuffield Trust has said, experience shows that ends

:42:29. > :42:35.commissions into difficult hssues can have little impact if their

:42:36. > :42:38.recommendations do not line up with political, local or financi`l

:42:39. > :42:42.circumstances. How we pay for elderly care is one of the lost

:42:43. > :42:47.difficult decisions facing our generation. The truth is it will

:42:48. > :42:51.require political leadership, a political party needs to own the

:42:52. > :42:56.solutions and be determined to make the case for them. I am not ashamed

:42:57. > :43:00.to say that I want the Labotr Party to leave this debate. I want us to

:43:01. > :43:05.build on some of the excelldnt work that has already been done hn this

:43:06. > :43:10.area, and particularly the work of Kate Barker and the King's Fund

:43:11. > :43:19.I want us to spend time, thd Labour Party, talking to people up and down

:43:20. > :43:22.the country but the kind of health and care service they want to see.

:43:23. > :43:25.To have a frank and honest discussion to see what some of the

:43:26. > :43:32.options to pay for the servhce might be. I have to be honest and say it

:43:33. > :43:38.was a profoundly political decision to cut the amount of money `vailable

:43:39. > :43:44.for councils to pay for adult social care. I say journey to the

:43:45. > :43:49.honourable member of North Norfolk that he stood at the dispatch box

:43:50. > :43:53.and defended the cut his government were making the social care. He

:43:54. > :43:58.dismissed many of the warnings that my honourable friend the melber for

:43:59. > :44:04.Leicester West made when shd was the shadow chemist about delayed

:44:05. > :44:16.discharges and reductions in other vital services like meals on wheels

:44:17. > :44:21.and home productions. It is not right to pretend we don't h`ve

:44:22. > :44:32.fundamental differences on this Any attempt at a consensus must begin

:44:33. > :44:35.without the knowledge meant... Particularly as I wasn't in at the

:44:36. > :44:38.very beginning of her remarks, most gracious of her. I have been

:44:39. > :44:42.listening very carefully to what she has to say and she's making a very

:44:43. > :44:48.powerful case and then she came over all partisan she now except that the

:44:49. > :44:56.fundamentals to spending on health care as well as public finances

:44:57. > :45:00.will she accept the Governmdnt has had to make them extremely difficult

:45:01. > :45:08.choices in order to get that economy back on track? I'm grateful to the

:45:09. > :45:11.Honourable gentleman. I accdpt difficult choices have had to be

:45:12. > :45:14.made but some of those choices have impacted enormously on some of the

:45:15. > :45:23.most vulnerable people in otr society. He wasn't in for the

:45:24. > :45:31.beginning of my debate when I recognised, my speech when H said I

:45:32. > :45:37.wanted to tackle it. I want a solution that delivers the change

:45:38. > :45:42.that is needed. The public dye view are crying out for in this debate.

:45:43. > :45:45.They understand the pressurds created by rising demand and new

:45:46. > :45:51.technologies and they want to be treated like adults. To suggest that

:45:52. > :45:57.this can all neatly be sewn up by an independent commission with the

:45:58. > :46:01.politics taken out of it sotnds attractive but I worry it jtst won't

:46:02. > :46:05.deliver. For the millions of people who depend on our NHS and social

:46:06. > :46:10.care system, I agree with the Honourable gentleman for North

:46:11. > :46:17.Norfolk, we cannot afford to have another parliament where we failed

:46:18. > :46:22.to grasp the nettle. I don't whose repose of has good intentions but I

:46:23. > :46:29.fear -- know his proposal h`s, but I fit is not the answer. This has been

:46:30. > :46:31.a great afternoon, I have thoroughly enjoyed listening to all of the

:46:32. > :46:37.speakers and we have had thd debate I hope people outside with

:46:38. > :46:39.appreciate. Can I start by thanking the Right Honourable gentlelan and

:46:40. > :46:44.his colleagues will bring forward the debate and as always th`nk him

:46:45. > :46:49.for his contribution for thd role I am now in. I want to thank `ll

:46:50. > :46:53.Honourable members and right honourable members, who werd

:46:54. > :46:56.encouraged to remain involvdd in active medicine which brings an

:46:57. > :47:03.extra dimension when we havd these debates. If we have time I will

:47:04. > :47:08.cover a comments from each. What I would like to do is respond briefly

:47:09. > :47:13.to the debate to what it saxs here and deal with that briefly. And then

:47:14. > :47:20.make some remarks that colldagues have that out and then some, and

:47:21. > :47:25.structure. The sustainability of the NHS and social care whether

:47:26. > :47:29.financial operational is a comedian commitment to the Government. We

:47:30. > :47:32.don't believe there is a nedd to launch an independent commission

:47:33. > :47:42.into the future. The NHS and wider health system needs to examhne to

:47:43. > :47:44.see what has to be done. Part of the purpose in making NHS England

:47:45. > :47:50.Independent is to examine the circumstances of its financds and

:47:51. > :47:54.project into the future. It did so independently, it came up whth a

:47:55. > :47:57.figure uniquely, the Conservative Party in the last election let that

:47:58. > :48:02.commitment and has been abld to carry it on into the Governlent

:48:03. > :48:09.That is very important for the House to recognise at the beginning. I'm

:48:10. > :48:14.very grateful to the Ministdr for giving way so graciously. I just

:48:15. > :48:18.wanted to challenge him on the suggestion that NHS England came up

:48:19. > :48:22.with a figure and the Government met it because that is not actu`lly what

:48:23. > :48:29.happened. He painted NHS England three scenarios. The scenarho that

:48:30. > :48:33.the Government has met and which both my party at his party stood the

:48:34. > :48:38.election on is based on asstmptions that are heroic in their sc`le. They

:48:39. > :48:48.have never been met in the history of the NHS. If I may say, so Miss

:48:49. > :48:51.Stevens came up and said it needs ?22 billion worth of efficidncies

:48:52. > :48:59.and we have met the challenge and that even more than 8 billion in, it

:49:00. > :49:03.be ten by 20 20. I understand the pressures in the sister and I

:49:04. > :49:10.appreciate his art. The fund said in their report in 2014 that btsiness

:49:11. > :49:14.is not sustainable but this is not mean the NHS is fundamentally

:49:15. > :49:19.unsustainable. Simon Stephens recently said the NHS has a huge

:49:20. > :49:22.work to do to ensure a lean of service is as efficient as ht can be

:49:23. > :49:29.which in my assessment, people are entirely up for. He said recently in

:49:30. > :49:32.a headline terms that ?23 bhllion is a big number but when you think

:49:33. > :49:37.about the practical examples and do the economic analysis, we h`ve some

:49:38. > :49:47.pretty big opportunities in front of us. We know the challenges there,

:49:48. > :49:52.nobody denies it but we need to put to the political parties at the last

:49:53. > :49:57.election the challenges, we were elected and I will speak about that

:49:58. > :50:06.in a second. In a moment if I may make some progress. What NHS England

:50:07. > :50:10.produce was developed by thdm alongside Public Health England

:50:11. > :50:15.monitors and Care Quality Commission, the NHS Trust ddvelop

:50:16. > :50:18.that authority and the Government backs the plan as a number of

:50:19. > :50:21.colleagues have mentioned, ht needs a strong economy to do this. And

:50:22. > :50:27.without trespassing into other areas. Again that is the me`ns that

:50:28. > :50:30.could debate in this countrx. The public are not just us to m`ke a

:50:31. > :50:35.judgment on the delivery of one particular service however ht is. It

:50:36. > :50:39.is about whether they think that those who are promoting thehr views

:50:40. > :50:43.on the political service actually have the economic background to be

:50:44. > :50:48.able to deliver. That questhon is also conference of the answdr that

:50:49. > :50:51.the last election. We have the responsibility for carrying forward.

:50:52. > :50:58.The loot we could put the money into it and we have done so. -- people

:50:59. > :51:02.believed. He said he believds that the Government has met the

:51:03. > :51:09.challenge, does he think in terms of funding the NHS and social care that

:51:10. > :51:12.it is job done? I've said wd have met the challenge that was put

:51:13. > :51:16.before us in terms of supporting what NHS England said, we h`ve done

:51:17. > :51:21.that through the financial commitments we have made. Wd worked

:51:22. > :51:28.hard on the spending review on what social care would need, the

:51:29. > :51:31.Chancellor came at the ?2 bhllion plus the ?1.5 billion from other

:51:32. > :51:38.resources, 3 billion extra by the end of 2020. We have put thd

:51:39. > :51:41.financing that we believe whll allow the delivery of health and social

:51:42. > :51:49.care over the next two years. It is a big but, it is not just about the

:51:50. > :51:51.resources but how it is spent. Most colleagues in speaking about the

:51:52. > :51:56.debate have spoken about variability. How best practhce is

:51:57. > :52:00.not always available elsewhdre, we have to make sure that it comes in

:52:01. > :52:13.and is not just about resources and how things are done. It is not the

:52:14. > :52:19.case though that the idea of seven-day week 8-8 GP practhce was

:52:20. > :52:24.not included in the NHS England estimate and therefore that has been

:52:25. > :52:27.added on top and will the Mhnister commit to taking the evidence from

:52:28. > :52:34.the pilot studies on whether that is a good use of money? We had this

:52:35. > :52:38.discussion last week and I will of course that very hard at thd

:52:39. > :52:43.evidence, whether it is the evidence from greater Manchester where

:52:44. > :52:47.somebody working is effective or whether it is places where that is

:52:48. > :52:51.not currently the case, we have the wait and see in relation to that.

:52:52. > :52:54.The spending review showed our continued commitment to join up

:52:55. > :52:58.health care by confirming ongoing commitment to the better care fund,

:52:59. > :53:04.again the integration process is extremely important in relation to

:53:05. > :53:10.this. It is clear that in tdrms of the general argument about what

:53:11. > :53:12.should be done, a commitment was made, it was based on indepdndent

:53:13. > :53:18.assessment of what was requhred and it required a government prdpared to

:53:19. > :53:21.make difficult decisions and a strong economy and we got that

:53:22. > :53:29.responsibility and that so we are in relation to that. If I may just deal

:53:30. > :53:34.with some remarks set by thd Right Honourable members. It is a

:53:35. > :53:39.conversation, a really good conversation, I think it more debate

:53:40. > :53:46.about health have the flavotr of the discussion this afternoon the public

:53:47. > :53:51.might be happier about that. The Honourable lady from central

:53:52. > :53:54.beverages said her preferred method is bringing people in the s`me room

:53:55. > :53:57.but perhaps not this room, but there are rooms in this place to have that

:53:58. > :54:02.conversation, that is indeed what the honourable lady and the

:54:03. > :54:09.honourable chair of the health select committee does an irregular

:54:10. > :54:11.basis. This place can provide opportunities of the discussions

:54:12. > :54:16.that are at the heart of anx cross-party discussion on what we

:54:17. > :54:21.want to do so we should not neglect on what we can do. It has bden a

:54:22. > :54:28.good conversation today. I `m with the honourable lady from Lewisham

:54:29. > :54:34.East that fundamentally I al shy of the idea that we can just ptt this

:54:35. > :54:38.to others and with one bound we are free. I do understand the

:54:39. > :54:41.sentiments, the sentiment and someone is trying, if not the

:54:42. > :54:45.politics out of it but the heat of the politics out of it to allow the

:54:46. > :54:57.conversation we need to havd but it still requires at the end of the day

:54:58. > :55:04.a process. I believe the honourable lady in time, that the procdss is

:55:05. > :55:08.discussed. We come to concltsions within our own party about what we

:55:09. > :55:12.can do, we offer it in a sensible way to the electorate and I agree

:55:13. > :55:15.with those who said there h`ve been times when we have will been guilty

:55:16. > :55:20.of the most ridiculous adverts. In the last general election I was in

:55:21. > :55:23.the last minute of a margin`l constituency and either piece of

:55:24. > :55:27.paper which was our last-minute leaflet and I'm locked front doors

:55:28. > :55:31.and said that I knocked on doors and said I can hand you this whhch is

:55:32. > :55:36.nonsense and give you 20 seconds on why you should vote for Davhd

:55:37. > :55:42.Cameron tomorrow and they l`ughed and said: then. I had my 20 seconds

:55:43. > :55:46.so we all know we are guiltx of having material produced in the cold

:55:47. > :55:51.light of day that we would not. In relation to health we need to be

:55:52. > :55:57.careful. My concern is the debate went on, whether or not the

:55:58. > :56:00.commission proposed can bear the weight of the many different things

:56:01. > :56:03.we would like to cover. The honourable lady of the chair of the

:56:04. > :56:10.select committee on my honotrable friend wanted it done rapidly. My

:56:11. > :56:15.honourable friend the member for Sutton Coldfield intervened to say

:56:16. > :56:23.it had to be longer term. So which is going to be? My honourable friend

:56:24. > :56:26.from Totnes also spoke about the problem of variation in the system

:56:27. > :56:36.and that is not to do with resources. No commission can have

:56:37. > :56:42.the directive in that way. The honourable member for Leicester West

:56:43. > :56:46.again as always in a very thoughtful and sensible contribution in

:56:47. > :56:49.relation to this did recognhse the problem of politics and agrdeing in

:56:50. > :56:56.this, I think she was right to do that. It is very difficult for the

:56:57. > :57:00.over lady or any member on the other side to talk about the introduction

:57:01. > :57:04.of private medicine. If I dhd stand here and say cast-iron that the

:57:05. > :57:09.Conservative Party and the Government believes in a tax funded

:57:10. > :57:12.health system free at the point of delivery, if I deviated frol that

:57:13. > :57:17.for a moment on the roof wotld fall in. There are constraints. We have

:57:18. > :57:26.to be thoughtful about how we deal with those responsibilities.

:57:27. > :57:33.How we could deal with thesd problems of reviews of wherd

:57:34. > :57:39.hospital premises might be, and there again, got into that problem

:57:40. > :57:43.of politics. It is a Bray one of us who, when approached by pathent or

:57:44. > :57:47.doctor, perhaps with a vestdd interest to keep a physical bit of

:57:48. > :57:51.bricks and mortar, save our hospital, say, do you know what the

:57:52. > :57:56.this may not be the best thhng. That is a difficult problem and that was

:57:57. > :58:00.also alluded to, my friend the member for South West Wiltshire No

:58:01. > :58:05.commission can get us over that sort of problem. The honourable

:58:06. > :58:08.gentleman, my right honourable friend the member invited md to see

:58:09. > :58:13.integration work in Northern Ireland and I would be keen to do so. The,

:58:14. > :58:16.my right honourable friend the remember for South West Wiltshire

:58:17. > :58:22.made the point about public health, prevention is not just about the

:58:23. > :58:25.public health budget. There is significant resource going hnto pub

:58:26. > :58:30.luck health. It is what we `re trying to do with the shift for

:58:31. > :58:35.prime secondary to primary care to make sure people are seen e`rlier.

:58:36. > :58:41.The honourable lady made thd point about making sure we keep pdople

:58:42. > :58:45.longer, well longer and instead of seeing the NHSes in as lookhng after

:58:46. > :58:49.the the ill, what it can do beforehand. The right honourable

:58:50. > :58:55.gentleman the member for Shdffield Hallam, spoke prince pip about

:58:56. > :58:59.mental health. I am in the role I know what the Coalition Govdrnment

:59:00. > :59:03.as a whole did in relation to mental health. Picking up a trajectory that

:59:04. > :59:08.had been disappointingly low but we are well on track. But I do want, if

:59:09. > :59:13.I may, just to gently correct something that is slightly coming

:59:14. > :59:18.into the narrative, which it was going fine until six months ago and

:59:19. > :59:22.it has come off the rails a bit now. It hasn't, it wasn't all sorted

:59:23. > :59:28.during the coalition, and I do reject the charge it is all rhetoric

:59:29. > :59:34.and not delivery. It is. We are making sure that CCGs do spdnd the

:59:35. > :59:40.money they get ass an incre`se in resource, on mental resourcd, we are

:59:41. > :59:47.tracking it for the first thme. That 1.25 billion for children and young

:59:48. > :59:53.people's mental health which was a significant delivery, is now ?1 4

:59:54. > :59:57.billion for children around young people's mental Health Servhces and

:59:58. > :00:01.it will be spent on that by 202 . We are dealing with issue of mdntal

:00:02. > :00:07.health tariffs as well and laking sure that goes in. We want to have

:00:08. > :00:10.the waiting times and access times for children and young people's

:00:11. > :00:14.mental health services as wdll. I would encourage him to see `t least

:00:15. > :00:20.in this part of my portfolio, that what I am seeking to do is to build

:00:21. > :00:24.on what the right honourabld gentleman and my right honotrable

:00:25. > :00:27.friend did in my role, rathdr than suddenly think it has all come to a

:00:28. > :00:32.halt and talk in that manner. It hasn't. There is one or two things

:00:33. > :00:38.we are having to repair a bht by Perry natal mental health and we

:00:39. > :00:43.have put more resources into that. The conversation has been advanced

:00:44. > :00:48.by consensual discussion and we will certainly carry it on: I thhnk he is

:00:49. > :00:53.being oversensitive. I went, I bent over backwards to say I think it is

:00:54. > :00:59.understandable that there always a lag of time between rhetoric and

:01:00. > :01:03.delivery, all I would urge him, in the most consensual cross-p`rty

:01:04. > :01:07.non-finger pointing way, is there is a real, real delay now betwden

:01:08. > :01:13.pilots which were started b`ck in 2012, and the paucity of thd number

:01:14. > :01:16.of mental Health Trusts who have placed their financial arrangements

:01:17. > :01:23.on the new non-block arrangdments. That that needs to be lock looked

:01:24. > :01:28.into. I accept that, from 2012 to 2015 was a period where I al not

:01:29. > :01:33.sitting where I am. I am gl`d we have sorted this out. But, the the

:01:34. > :01:39.coalition's involvement and commitment to this has been immense,

:01:40. > :01:42.I am proud to take it on in the way I am doing. My honourable friend the

:01:43. > :01:49.member for Lewis brought her experience into this and spoke about

:01:50. > :01:54.the integration of budgets, in terms of the social health, social care

:01:55. > :01:59.and expenditure of local authorities and the NHS. This is crucial.

:02:00. > :02:02.Integration for me, is not getting two group groups of people sitting

:02:03. > :02:06.down in the same room every few months and having a discusshon, I

:02:07. > :02:11.think it can't be done without a combined budget. I really don't

:02:12. > :02:14.think it can do that. So long as you have a perverse incentive for one or

:02:15. > :02:19.the other it is not going to work. We are making progress on this, we

:02:20. > :02:23.have clear plans to get this done by 2020. We will follow it with a score

:02:24. > :02:27.card, we will find out wherd we are. But the Holy Grail we have `ll

:02:28. > :02:30.spoken about for too long, we are sort of more along the way than

:02:31. > :02:35.anyone has been before. I think that is not a bad place to be. Btt we

:02:36. > :02:38.have to make sure, and a lot of it is about relationships. It hs not

:02:39. > :02:42.just about the organisations being in the same room, unless people are

:02:43. > :02:46.really talking to each other, and have a real sense of what c`n be

:02:47. > :02:53.done collectively, then, we are not going to get anywhere. But `lso my

:02:54. > :02:56.honourable friend's heartfelt plea, leave us but from time to thme is

:02:57. > :03:02.something echoed by virtually everybody in the public sector I

:03:03. > :03:06.have been involved with in the last 30 year, they which we would decide

:03:07. > :03:14.to let them do what they want to do. I am sure this Government h`s

:03:15. > :03:19.absorbed that lesson. The honourable lady from the Don Valley, sorry

:03:20. > :03:23.forgive me, right honourabld lady, I will get all these right, once I

:03:24. > :03:28.have been here for a few ye`r, I will get these distinctions right.

:03:29. > :03:33.But again speaks from a poshtion of experience and great success. And

:03:34. > :03:38.again, made the point that the Commission couldn't, she spoke again

:03:39. > :03:42.of the suck susses and failtre we know within the system, --

:03:43. > :03:45.successes, and talking about that how the Commission could look at

:03:46. > :03:49.that. Again, I am not sure ht could bah bear the weight. She addressed

:03:50. > :03:54.the political issue, and how difficult some of those werd, and

:03:55. > :03:59.forgive me, she then made an intervention on her honourable

:04:00. > :04:03.friend, the lady from the honourable lady from Oldham and Saddleworth

:04:04. > :04:07.which exemplifified the point. There are difficult political challenges

:04:08. > :04:12.within parties as well as across the floor. Noticed the challengd that

:04:13. > :04:16.was made. I have to say to the honourable lady who spoke whth

:04:17. > :04:22.passion aboutst commitment of her party to a publicly funded taxpayer

:04:23. > :04:26.funded NHS, no deviation from the line, it is simply not true. It

:04:27. > :04:32.suits her to say it but it hs not true. Let me quote from The New

:04:33. > :04:36.Statesman of 27th January 2015 in an article under a headline Labour

:04:37. > :04:41.can't escape its Blairite p`st on the NHS, so it should stop crying

:04:42. > :04:43.privatisation. Said during hts paragraph, ticle under a he`dline

:04:44. > :04:46.Labour can't escape its Blahrite past on the NHS, so it should stop

:04:47. > :04:48.crying privatisation. Said during its paragraph, speaking abott Alan

:04:49. > :04:51.Milburn. "Services won of the many reminders not so longing a hn the

:04:52. > :04:53.new Labour years the Labour Party was driving through massive reforms

:04:54. > :04:57.in the NHS and did not shy `way from private money in doing so." There

:04:58. > :05:00.are variations on a theme even for the honourable lady. I think she

:05:01. > :05:03.protested about the public nature of the NHS perhaps a bit too mtch, of

:05:04. > :05:07.course. Grateful to the minister. Hd didn't

:05:08. > :05:13.challenge me on that partictlar point. Does he accept we stood for

:05:14. > :05:16.on a platform where the NHS was the preferred providerment we h`ve

:05:17. > :05:22.learned from the evidence, `s others have said, how important it is that

:05:23. > :05:28.the policy driving the NHS should be based on evidence, now we h`ve the

:05:29. > :05:33.evidence, that an internal larket, an market tied or private thed

:05:34. > :05:37.health system, as this Government seeks to fulfil does not help in

:05:38. > :05:42.improving quality or releashng ebbing the I in health care, that

:05:43. > :05:45.was the platform. Well, the platform has clearly stunningly succdssful

:05:46. > :05:49.and I am not embarrassed behng reminded about the Labour P`rty s

:05:50. > :05:53.NHS platform at the last eldction which did not succeed, for one

:05:54. > :05:56.reason or another the public did not believe the stories that were run

:05:57. > :06:00.about us and the NHS or thehr competence to handle it. I happen to

:06:01. > :06:04.believe that as we know, thd amount of private sector involvement in the

:06:05. > :06:10.NHS is very small, and I am not quite sure I accept her description

:06:11. > :06:14.of how it has turned out, btt it is an example of how careful wd have to

:06:15. > :06:17.be, in dealing with this and not pretending to the public we are

:06:18. > :06:22.something we are not, and that our opponents are something thex are

:06:23. > :06:25.not. My honourable friend the melber for

:06:26. > :06:28.Stafford who speaks with grdat ex pressures from the work he has done

:06:29. > :06:31.with the NHS, again spoke about best practise, he wanted to see this

:06:32. > :06:35.commission, but again, added yet more pressure with the sort of

:06:36. > :06:40.things it would be doing and considering. And I make the point

:06:41. > :06:45.that a commission may be ond point in time. I know it would be designed

:06:46. > :06:50.to look ahead, but inevitably it would look at the circumstances that

:06:51. > :06:53.pertained that the time. We need a process of discussing the NHS and

:06:54. > :06:57.its funding, where the monex comes from, how it is spent. It is the

:06:58. > :07:02.process that needs to work rather than just feel one particul`r push

:07:03. > :07:08.into the grass will do the job. And again, I am not sure that the weight

:07:09. > :07:12.is borne. The honourable... Of course: I am grateful to my right

:07:13. > :07:15.honourable. He has talked about having a discussion within the