11/01/2017

:00:07. > :00:19.Order. Urgent question, Caroline Lucas. To ask the Secretary of State

:00:20. > :00:22.for business energy and industrial strategy if you will make a

:00:23. > :00:31.statement on the sale of the Green Investment Bank. Government has set

:00:32. > :00:34.up its plans for the sale of the green investment back laid before

:00:35. > :00:38.Parliament on the 3rd of March 20 16. Government intends to move the

:00:39. > :00:47.GIB into the private sector that it can increase its access to private

:00:48. > :00:51.capital. Potential bidders are interested in GIB because of its

:00:52. > :00:56.green specialism and we are asking potential investors to confirm their

:00:57. > :01:04.commitment to GIB values and how they propose to protect them as part

:01:05. > :01:08.of the bid for the company. The government has created a special

:01:09. > :01:15.share held by independent trustees to protect GIB's green purposes in

:01:16. > :01:19.future. As I'm sure that the house will appreciate the sale is

:01:20. > :01:23.commercially sensitive so I cannot comment on the identity of any

:01:24. > :01:27.bidders discussions taking place between the government and potential

:01:28. > :01:34.bidders. All parties have been required to sign confidentiality

:01:35. > :01:42.agreements. The restrictions applied to the government and the bidders.

:01:43. > :01:46.Thank you. I thank the Minister for his reply, but it gives little

:01:47. > :01:51.reassurance as everyone knows who the preferred bidder is. McQuarrie

:01:52. > :01:55.has a worrying track record. I'm putting the question would support

:01:56. > :01:58.from across the house. This week we heard that the Green Investment Bank

:01:59. > :02:05.stands on the brink of not only being flopped off but being broken

:02:06. > :02:09.up. Founded in 2012 the GIB has been widely recognised as a true success

:02:10. > :02:14.story, kick-starting innovative low carbon projects across the UK. Yet

:02:15. > :02:19.this preferred bidder, McQuarrie, not only has a dismal and terrible

:02:20. > :02:24.environmental record, it has an appalling track record of asset

:02:25. > :02:28.stripping. So why has the government given preferred bidder status to

:02:29. > :02:33.this company? What assessment has it made of McQuarrie's called given

:02:34. > :02:48.that in 2005 the board of the London stock exchange said McQuarrie were

:02:49. > :02:55.unfit to undertake takeovers. Changes suggest that McQuarrie is

:02:56. > :03:00.planning to hollow out the GIB. Why have ten new companies been set up?

:03:01. > :03:07.Can he confirm that the changes made at the last year were made at the

:03:08. > :03:15.behest of McQuarrie? Why is the government infighting and asset

:03:16. > :03:25.stripper to take over the Green Investment Bank? Isn't this exactly

:03:26. > :03:27.the wrong time to be selling off the Green Investment Bank given that the

:03:28. > :03:33.government has decided to embark upon a new industrial strategy which

:03:34. > :03:37.must to be in accord with our own climate change commitments have low

:03:38. > :03:41.carbon projects at its core. And finally will the Minister admit that

:03:42. > :03:46.this selling of could lead to the bank being fatally undermined as an

:03:47. > :03:50.inn during institution. Will he stop the killing off of the Green

:03:51. > :03:56.Investment Bank? Will you hold the sale process with immediate effect.

:03:57. > :04:02.I think the honourable lady knows that is a string of questions that I

:04:03. > :04:07.am not able to answer. She will also know that I cannot make any public

:04:08. > :04:11.comment on the identity of bidders for the process under way for

:04:12. > :04:18.reasons I elaborated at the top. She is drawing a lot of imprecations

:04:19. > :04:22.from media speculation. It would be irresponsible for me to comment on

:04:23. > :04:27.that. I will try to give her reassurance which flows back to the

:04:28. > :04:31.objectives behind the sale, which I set out in the statement. It is

:04:32. > :04:38.precisely been those we want the Green Investment Bank to be more

:04:39. > :04:43.unfettered from because rates of state that we are putting it into

:04:44. > :04:47.the private sector. The objectives had been discussed in this House, we

:04:48. > :04:52.are looking at very clear objectives around securing value for money for

:04:53. > :04:56.the taxpayer which must be out primary responsibility. We want to

:04:57. > :04:58.ensure that it can be reclassified to the private sector. We have also

:04:59. > :05:11.been clear that the reason we want to move it into the private sector

:05:12. > :05:16.is two enable it to grow and become a going concern. Investors will be

:05:17. > :05:21.buying into the green business plan. These are the criteria we have set.

:05:22. > :05:30.These are the criteria against which we are evaluating the proposals

:05:31. > :05:36.before us. The Green Investment Bank is a horrendous Conservative success

:05:37. > :05:39.story, devised by the Conservatives before 2010 and introduced by a

:05:40. > :05:45.Conservative led government. It has been a great catalyst for investment

:05:46. > :05:49.in the green economy, in particular the wind farm of the East Anglia

:05:50. > :05:52.Coast. There is a concern that if the press stories are to be believed

:05:53. > :05:56.regarding asset stripping and loss of jobs, it won't be able to perform

:05:57. > :06:01.that role in future. Will my honourable friend consider in that

:06:02. > :06:09.light a pause to the process so that we can ensured the Green Investment

:06:10. > :06:14.Bank will continue to perform its great role that it has done since

:06:15. > :06:20.2012? I will join my honourable friend in saluting what was a great

:06:21. > :06:25.success story of the coalition government, let's maintain the

:06:26. > :06:30.season of goodwill, but under a Conservative led coalition. It was

:06:31. > :06:33.the right thing to set up. It was asked that did it it was a great

:06:34. > :06:39.success. Mobilising on the last figures about ?8 billion of private

:06:40. > :06:45.investment into the critical area of infrastructure. So a great success

:06:46. > :06:50.story. Can I assure him, and I know he is to experienced to be

:06:51. > :06:56.influenced by such speculation in the media, that we are not being

:06:57. > :07:03.naive in this process. We have set some clear criteria, we have one a

:07:04. > :07:06.genuinely competitive process, and we are now evaluating the proposals

:07:07. > :07:12.before us. But through the lens of the criteria that we have set, which

:07:13. > :07:19.include value for money, deep is a vocation -- reclassification and the

:07:20. > :07:22.Ford plans for a dynamic, ongoing concern seeking to mobilise for

:07:23. > :07:28.private capital into the green industries. We need to mobilise a

:07:29. > :07:37.lot of private sector capital to get the mean energy we need. I will

:07:38. > :07:43.admit it has been a great success story. It is also a Labour success

:07:44. > :07:48.story. It first appeared in our 2010 manifesto and I'm glad that the

:07:49. > :07:59.coalition government took it up. If it is a success story, why are you

:08:00. > :08:08.selling it off? Is it to be the case of public, good, private bad? I'm

:08:09. > :08:12.telling you quite simply that given the assessment of Macquarie and what

:08:13. > :08:15.we have seen of them, it has a history of asset stripping. How

:08:16. > :08:20.exactly will the Minister protect his valuable public institution from

:08:21. > :08:30.having its assets sold off? That is a fair question. We know the garment

:08:31. > :08:38.plan to hold a share of the company which will maintain the green

:08:39. > :08:43.approach. What oversight for the Government have of those companies

:08:44. > :08:46.once the sale goes through? The Prime Minister told us that

:08:47. > :08:49.industrial strategy would be at the heart of her government. Yet now the

:08:50. > :08:53.Government is selling off an institution that has exceeded from

:08:54. > :08:58.scratch and against the odds in attracting investment to our Green

:08:59. > :09:03.info structure. The ministers have been outmanoeuvred by Macquarie and

:09:04. > :09:06.we have no confidence that it will not happen again. Will the

:09:07. > :09:12.Government agreed to stop the sale of the green investment bank today

:09:13. > :09:17.until such time as its green purpose and core assets can be genuinely

:09:18. > :09:20.protected? If the Minister will not, does he accept that the Green

:09:21. > :09:27.Investment Bank's fate rests on his shoulders?

:09:28. > :09:32.I will pass over the bizarre claim that the green investment bank is a

:09:33. > :09:38.Labour success story by virtue of it being mentioned in a 2010 manifesto

:09:39. > :09:50.with nothing done for 13 years of government before that. We started

:09:51. > :10:01.with low levels of green investment, which we have done. I will warn them

:10:02. > :10:07.against speculation. He reflects on the head of its and values of the

:10:08. > :10:14.private sector. He should be aware, holding the position he does, that

:10:15. > :10:17.we need to mobilise a huge amount of private capital. It is private

:10:18. > :10:21.capital, not public capital that will make the difference in terms of

:10:22. > :10:27.the big shift in infrastructure. What he misses is the critical role

:10:28. > :10:31.that the state has played in correcting a market failure. The

:10:32. > :10:35.fact we have 18 competitive process and private investors want to buy

:10:36. > :10:40.this as a going concern because of its green specialism actually

:10:41. > :10:47.indicates that the market failure has been corrected. The fact these

:10:48. > :10:53.institutions have mobilised capital into this infrastructure is a key

:10:54. > :11:01.sign. It will do more and be an even more successful institution as a

:11:02. > :11:09.going concern. The Government has a whiz been clear that the green

:11:10. > :11:13.investment bank was always created as possibly going to the private

:11:14. > :11:19.sector. Will it remain as green investment. I know he is dedicated

:11:20. > :11:23.to environmental issues, so will he give us assurances that we will

:11:24. > :11:28.stick to our laudable manifesto pledge of leaving the are met in a

:11:29. > :11:38.better situation than we found it? -- leading the environment? I will

:11:39. > :11:42.pay to be to do her record and authenticity in regard to the

:11:43. > :11:49.protection of environment and climate change? I will give her this

:11:50. > :11:53.assurance. We have taken before Parliament the whole procedure for

:11:54. > :11:57.protecting the green purpose of the Green Investment Bank through the

:11:58. > :12:01.special share arrangement, that will be held by an independent company

:12:02. > :12:05.and will have the power to approve or reject any proposed changes to

:12:06. > :12:17.the two Lord Pannick's green purposes. -- to the Green Investment

:12:18. > :12:19.Bank's green purposes. It was selected through a genuinely

:12:20. > :12:25.independent process. She will see that the names are independent and

:12:26. > :12:29.extremely credible. That is a mechanism we have set up. I will

:12:30. > :12:32.return to this point around the objectives of the sale. We want this

:12:33. > :12:37.to go into the private sector to do more of what it is doing, unfettered

:12:38. > :12:44.by the inevitable restrictions that the state has to put on it at this

:12:45. > :12:47.stage. Thank you for granting this urgent question and I thank the

:12:48. > :12:54.honourable men before putting it forward, and we support it. The

:12:55. > :12:58.Prime -- the Minister said that he wants to see this continued and it

:12:59. > :13:03.will not be happening if it is asset stripped. The wrong reports will see

:13:04. > :13:09.a 90% fall in renewable investment. That must be addressed and the Green

:13:10. > :13:16.Investment Bank should be the vehicle for that. What assurances

:13:17. > :13:24.other that assets will be re-invested in green infrastructure?

:13:25. > :13:29.What reassurances can he give us that the HQ in Edinburgh will

:13:30. > :13:33.continue? How will the Government ensure that the shortfall in

:13:34. > :13:39.investment in renewables will be met? Finally, in light of the

:13:40. > :13:43.forthcoming industrial strategy and emissions reduction plan, will he

:13:44. > :13:47.pours the sale so Parliament can properly look at these and see what

:13:48. > :13:56.role the won can play in that process? -- the Green Investment

:13:57. > :14:00.Bank can play in that process? It would be nice if you paid more

:14:01. > :14:06.recognition of the extraordinary progress this country has made

:14:07. > :14:08.towards clean energy and we now generate more electors are deep from

:14:09. > :14:14.renewables than from coal, which is a pivotal moment in this country.

:14:15. > :14:20.Green Investment Bank will pay an abortive role in being a catalyst

:14:21. > :14:23.for that investment. In terms of the assurances he seeks, which I

:14:24. > :14:27.understand and share, it is part of our process of evaluating proposals

:14:28. > :14:32.before us against the criteria that we have set out, being very

:14:33. > :14:36.transparent about, agreed through the House, it is true that lends

:14:37. > :14:39.that we are now evaluating the proposals before us. That obviously

:14:40. > :14:48.includes attitudes to the workforce and sensitivities around jobs in

:14:49. > :14:54.Scotland. These are part of the criteria that we're looking at the

:14:55. > :14:59.proposals with regard to. I cannot say much because of the concert and

:15:00. > :15:10.jealousy -- confidentiality situation we are in.

:15:11. > :15:18.For the member and the opposite bench to make a sweeping statement

:15:19. > :15:22.that private investment is bad... When he looks at the golden share,

:15:23. > :15:25.will he consider if it could be possible for the golden share not to

:15:26. > :15:30.just provide guarantees for future implement but on the existing

:15:31. > :15:38.portfolio? Perhaps for the first couple of years, during the transfer

:15:39. > :15:42.to any bidder. I thank my honourable friend for that observation. The is

:15:43. > :15:47.right about his first point. It couldn't have been clear from the

:15:48. > :15:51.opposition front bench, R Blick good, try that bad. That will have

:15:52. > :15:58.been noted in the business community, reinforcing the question

:15:59. > :16:05.asked about the attitude of the party opposite about it. With regard

:16:06. > :16:08.to the maintenance of assets, I have set out the mechanisms for it. They

:16:09. > :16:12.are bust. Parliament agreed they were robust. What I would say about

:16:13. > :16:18.so-called asset stripping and freedom to sell assets, let's not

:16:19. > :16:23.get ourselves into a position where we are just hoping assets for ever,

:16:24. > :16:32.and that is a good thing. We would not want that for Green Investment

:16:33. > :16:38.Bank under its current situation. We have to be practical in terms of the

:16:39. > :16:41.limitations that we would place on a private sector bid. I come back to

:16:42. > :16:47.the point, we are clear about the criteria we are setting for the sale

:16:48. > :16:50.and we are looking at proposals to a holistically view of the criteria we

:16:51. > :16:56.have set, which include the need for reassurance about the forward plans

:16:57. > :16:58.for the organisation, the level and ambition in terms of mobilising

:16:59. > :17:05.private sector capital into this critical area of clean

:17:06. > :17:09.infrastructure. I think if the interest of consensus, there was

:17:10. > :17:14.spotty support for the Green Investment Bank from the get go,

:17:15. > :17:17.there is cross-party concern, I say to the Minister, about this. Lord

:17:18. > :17:22.Barker, a minister in the last Parliament, Vince cable and people

:17:23. > :17:27.on this side of the House. Is the key question this, they promised a

:17:28. > :17:33.new approach to industrial strategy with a new Department in contrast to

:17:34. > :17:40.their predecessor, who did not use the term industrial strategy. What

:17:41. > :17:44.has changed? If there is a moment to prove their commitment to this new

:17:45. > :17:50.strategy, it is this, their plans around the tent won. -- it is their

:17:51. > :17:58.plans around the Green Investment Bank. There was a need to do it, we

:17:59. > :18:05.did it, they didn't. His party had plenty of opportunity to do it. He

:18:06. > :18:09.talks about the need for continued commitment in investment in

:18:10. > :18:12.renewables. I think we have shown that. One of the most decisive steps

:18:13. > :18:17.this Department has taken in the short time we have been in power is

:18:18. > :18:22.the announcement of the new contract for difference auction which will be

:18:23. > :18:37.the next age of support for the more mature renewable sources. The whole

:18:38. > :18:39.point, where think there is a diversion to view about this, is

:18:40. > :18:44.that the party opposite things that state ownership is a good in itself

:18:45. > :18:49.whereas, in this situation, we have moved on. This important

:18:50. > :18:55.organisation has done a great job, not to liberate it. So that it can

:18:56. > :18:57.do more. -- we want to liberate it. It is true that led we're looking at

:18:58. > :19:08.the proposals before us. Thank you Mr Speaker. Would my

:19:09. > :19:16.honourable friend agreed that it's not about the assets that are owned

:19:17. > :19:21.that already exist that bother in the future is there a greater or

:19:22. > :19:28.lesser amount in renewable green projects. This will be a success if

:19:29. > :19:33.the level of investment in new projects increases as a result of

:19:34. > :19:37.privatisation. I'm delighted to detect that question from my right

:19:38. > :19:41.honourable friend who was in many ways the Guardian angel of the

:19:42. > :19:45.coalition government in terms of the deliberations that led to the

:19:46. > :19:49.establishment of this. He is right and makes a fundamental point. We

:19:50. > :19:53.should not be judging this organisation for what it is at the

:19:54. > :19:56.moment, it's about what it can be about the levels of future

:19:57. > :19:59.investment and the commitment to the Green purpose of this organisation.

:20:00. > :20:05.I don't think this government could have clearer about that. It's about

:20:06. > :20:09.the future. Can I give the Minister the opportunity to answer the

:20:10. > :20:13.question I posed to him at select committee yesterday. How can he

:20:14. > :20:19.reconcile insisting on preserving the green purposes of the bank and

:20:20. > :20:22.preventing asset stripping from a new buyer with satisfying the ONS

:20:23. > :20:32.classification is about public sector control and on balance Street

:20:33. > :20:38.requirements post disposal? He is making a game presumptions about

:20:39. > :20:43.asset stripping. He knows the structure we set up because he was

:20:44. > :20:48.involved in the Parliamentary debate around it. There is a lot of concern

:20:49. > :20:51.in this house about protecting the integrity of the green purpose of

:20:52. > :20:56.the GIB which is why we have gone through this process which is

:20:57. > :21:02.robust. It's about setting up the green chair and the government's

:21:03. > :21:05.mechanism around it. That has had the agreement of Parliament and is

:21:06. > :21:09.the system we have put in place. Also I come back to the human

:21:10. > :21:16.motives of people wanting to buy this organisation to grow it and to

:21:17. > :21:21.do more with it. The authenticity and integrity of those proposals are

:21:22. > :21:24.what we are evaluating. I'm sure the Minister will share my slight

:21:25. > :21:34.amusement that the opposition this afternoon are arguing about

:21:35. > :21:36.everything you read about the Green Investment Bank you should believe,

:21:37. > :21:41.but yesterday they said the opposite. Private investors are keen

:21:42. > :21:44.to come in and it shows the purpose it served and without the

:21:45. > :21:56.restriction it could deliver more investment, not less. My honourable

:21:57. > :22:00.friend has made the from the parental -- the fundamental point I

:22:01. > :22:08.was trying to make. As a market failure been corrected? There is

:22:09. > :22:14.evidence of the large amount of Private investment flowing into the

:22:15. > :22:19.green infrastructure. We want to make sure the GIB is free and

:22:20. > :22:25.unfettered from the state to do more. The environmental audit

:22:26. > :22:30.committee's report into the cell found ministers had rushed to

:22:31. > :22:35.privatise it without consultation and stated that the bank should

:22:36. > :22:41.continue to exist as a low investor, or its sale should not proceed. We

:22:42. > :22:44.don't want a repeat of the Royal Mail debacle where the public as it

:22:45. > :22:52.was sold off at ?1.4 billion before it's true -- below its true value.

:22:53. > :23:00.Is it not extraordinary that the bank's assets were restructured last

:23:01. > :23:07.November or it done at the request of the shareholder Executive to

:23:08. > :23:13.present itself to the preferred bidder? I do believe that is the

:23:14. > :23:20.case at all. We have a responsibility to deliver value for

:23:21. > :23:24.money to taxpayers. We are conscious of the deal if it materialises to

:23:25. > :23:28.present it well to the public we serve and represent. That's why

:23:29. > :23:32.value for money is the top of our list in terms of the criteria. We

:23:33. > :23:39.are setting high standards in terms of the presentation of this deal and

:23:40. > :23:43.the delivery of materials. Can I remind the Minister that during the

:23:44. > :23:46.cause of the enterprise built the government rejected our amendment

:23:47. > :23:51.which would have guaranteed the green purpose of the bank. Can he

:23:52. > :23:54.give this assurance to the bank today that after privatisation would

:23:55. > :24:00.the Green Investment Bank be free to invest in fracking projects? To the

:24:01. > :24:06.substantive point about the protection of the green procedure

:24:07. > :24:13.and if the honourable gentleman disagrees that fine, but Parliament

:24:14. > :24:17.recognise that we have set up a robust mechanism whereby the green

:24:18. > :24:24.purpose of the organisation is set in the articles of association and

:24:25. > :24:28.any change to that needs to be done through a resolution to the

:24:29. > :24:42.trustees. It's worth recognising the integrity of these people. James

:24:43. > :24:46.Curran, Lord take this on, Peter Young, a good group of people set up

:24:47. > :24:55.by rigorously independent processes to safeguard the integrity of the

:24:56. > :25:01.green purpose of the bag. We were told that we will be the greenest

:25:02. > :25:05.government ever and yet the failed Greendale Project collapse.

:25:06. > :25:09.Investment in renewable resources have slashed and we have slipped in

:25:10. > :25:17.the world ranking for low carbon economies. Will he look urgently at

:25:18. > :25:22.the financial and economic reasons why it it is crucial that we invest

:25:23. > :25:27.in these areas and reverse the decision he is making today on the

:25:28. > :25:36.Green Investment Bank. You're struggling a bit of an old horse. --

:25:37. > :25:40.flogging. They've is real investment going into clean energy in this

:25:41. > :25:45.country. The Hinckley deal made one of the biggest commitments in the

:25:46. > :25:48.world to low carbon energy. There is no question about this government's

:25:49. > :25:56.commitment to the transition to a low carbon economy. We inherited a

:25:57. > :26:00.situation where we were operating on a far to lower base and it was a

:26:01. > :26:08.coalition government led by conservatives that change that. The

:26:09. > :26:11.minister refused to name the bidders for the Green Investment Bank but

:26:12. > :26:15.then he went on to say that private companies were saying they wanted to

:26:16. > :26:18.buy the Green Investment Bank because of its success. Which

:26:19. > :26:29.private companies were saying that what did the Minister make the

:26:30. > :26:36.quotation up? I'm not sure what part of the confidante Richard -- part of

:26:37. > :26:44.the confidentiality he does not understand. We are selling a going

:26:45. > :26:50.concern and we are not entering proposals that don't respect that.

:26:51. > :26:57.When is this government going to learn the lessons of the past on

:26:58. > :27:02.selling off public assets? I was here when Mrs Thatcher decided to

:27:03. > :27:11.sell off not only electricity, but gas and then finally water. She said

:27:12. > :27:16.we were going to be a British share owning democracy. That was the

:27:17. > :27:22.phrase. Now if you look at the list, you'll find that some of them are

:27:23. > :27:27.owned in Germany, some are owned in France, some like McQuarrie is in

:27:28. > :27:32.Australia, who brought up the Birmingham toll road in a flash

:27:33. > :27:37.under the Tory government. -- Macquarie. And now we are having

:27:38. > :27:42.another lecture on how he is going to preserve the identity of the

:27:43. > :27:47.Green Investment Bank. History tells us it is not possible. It will go to

:27:48. > :27:54.those who are reading for it and it will not be just Britain. We are

:27:55. > :27:59.just being the process of leaving the EU and now the chances are it

:28:00. > :28:06.will be somebody in the EU that will be buying up British assets. Maybe

:28:07. > :28:13.not this. Why don't you learn the lessons? One of the lessons of

:28:14. > :28:16.privatisation is record levels of investment that have flowed into

:28:17. > :28:23.organisation since they have been privatise. I respect the experience

:28:24. > :28:28.and sincerity and integrity, but I think he is totally wrong and I have

:28:29. > :28:34.a strong instinct that the honourable gentleman would still

:28:35. > :28:42.like British Telecom to be a government owned company. In the

:28:43. > :28:47.Financial Times Vince Cable raise concerns about asset stripping and

:28:48. > :28:51.he thought that was Macquarie's objective. Ed Davey said he thinks

:28:52. > :28:57.it is unlikely that the golden share would give ministers enough clout to

:28:58. > :29:01.influence the bank's investment strategy. Those two people who were

:29:02. > :29:06.very much involved in setting up the bank should be taken seriously and

:29:07. > :29:10.we should act upon those concerns? I'd take seriously all the concerns

:29:11. > :29:16.expressed by politicians, past and present, because it is important

:29:17. > :29:20.through this urgent question that the message comes out of the house

:29:21. > :29:25.to potential bidders about the concerns that people have. I

:29:26. > :29:29.absolutely respect that and the individuals that she mentioned, but

:29:30. > :29:33.she says I'm dismissing media speculation. I'm not, I'm just not

:29:34. > :29:45.commenting on it because Minister shouldn't. Thank you for the

:29:46. > :29:49.reminder of the involvement of the Liberal Democrats in the initiation

:29:50. > :29:53.of the Green Investment Bank breg. Vince Cable said that he is

:29:54. > :29:56.unconvinced that the golden share will prevent the asset stripping of

:29:57. > :30:00.the company and therefore will threaten the original intentions of

:30:01. > :30:10.the Green Investment Bank at its inception. They are hol arrangements

:30:11. > :30:14.under which the special share solution was reached and discussed.

:30:15. > :30:19.It was debated through Parliament and settled through that process. My

:30:20. > :30:26.personal view is that it's a robust mechanism in itself, given its legal

:30:27. > :30:29.underpinning, given the integrity and independence of the people that

:30:30. > :30:33.have been selected to be the trustees and guardians of this

:30:34. > :30:38.process, but I also come back to the fundamental point about the

:30:39. > :30:46.motivation behind people who might want to make, by this organisation

:30:47. > :30:50.and the criteria and the discipline we will have been evaluating those

:30:51. > :30:55.proposals and deciding whether we go ahead or not. I along with many

:30:56. > :30:59.colleagues fought for the headquarters of the Green Investment

:31:00. > :31:04.Bank to come to Edinburgh which it now has over 50 staff. How many of

:31:05. > :31:08.those 50 staff will remain in Edinburgh after privatisation? Can I

:31:09. > :31:14.just say, many people have mentioned Vince Cable but the legacy of Vince

:31:15. > :31:21.Cable is the botched privatisation of Royal Mail and that's why people

:31:22. > :31:24.have concerns. By its nature, it invests in projects the markets

:31:25. > :31:28.won't touch when the projects come on stream they are much more

:31:29. > :31:31.profitable than normal projects. If a preferred bidder sells it off,

:31:32. > :31:44.they will sell it at great profit the taxpayers expense. I've agreed

:31:45. > :31:48.to meet with a member of Parliament in that area because I recognise the

:31:49. > :31:55.importance of the process and jobs. It was the right decision to locate

:31:56. > :32:00.part of the organisation then and jobs are part of what we want to

:32:01. > :32:06.hear a commitment to staff are ongoing organisation is part of what

:32:07. > :32:09.we to hear from bidders. But because he has mentioned stuff, let me place

:32:10. > :32:12.on record and I hope this is shared by members across the house the

:32:13. > :32:16.admiration and respect the government has for the senior

:32:17. > :32:22.management team and all start at GIB, led by Sean Smith and -- Lord

:32:23. > :32:29.Smith and Sean 's Kingsbury, not just for what they have achieved,

:32:30. > :32:32.but the professionalism with which they have conducted themselves. The

:32:33. > :32:40.Green Investment Bank has made substantial investment in Wales in

:32:41. > :32:44.partnership with five local authorities. It's a model that works

:32:45. > :32:48.well. What guarantees can diminish the give that the new owners will

:32:49. > :32:52.invest in this sort of way and in the regions and nations of the

:32:53. > :32:57.United Kingdom rather than abroad or possibly in the golden Southeast?

:32:58. > :33:01.Again, I'll come back to the main points regarding the questions we

:33:02. > :33:07.ask of bidders in the criteria we set. We want to achieve value for

:33:08. > :33:12.money and we are selling an ongoing concern. We are determined to

:33:13. > :33:15.protect the green purpose of the organisation and we want to hear

:33:16. > :33:25.plans for the mobilisation of future investment. If models are working

:33:26. > :33:29.and professional organisations for whom will be bidders, they will pay

:33:30. > :33:33.regard to it. That's what we want to hear from bidders and we are at the

:33:34. > :33:39.point in the process where we are evaluating it. I can't say any more.

:33:40. > :33:41.For the sake of transparency can you let the house know whether or not

:33:42. > :33:47.the Green Investment Bank will be able to invest in fracking in the

:33:48. > :33:55.future? The Green Investment Bank will be required under this process

:33:56. > :33:58.to continue to respect the green purpose of the organisation as set

:33:59. > :34:03.out in the articles of the Association and therefore the degree

:34:04. > :34:07.to which the proposals fit the criteria are a judgment to be made

:34:08. > :34:09.by management and the trustees we have set up to be independent

:34:10. > :34:20.guardians of this process. When Vince Cable was legislating for

:34:21. > :34:27.the bank, we were guaranteed it would operate throughout the UK and

:34:28. > :34:31.operating in Northern Ireland and not protruding cross-border

:34:32. > :34:34.projects. One of the first investments was in Northern Ireland,

:34:35. > :34:37.in my own constituency. Many of us are concerned that the quality of

:34:38. > :34:44.that investment and that reach will be lost in this sell-off. When the

:34:45. > :34:48.Minister talks about integrity in relation to this, it is not

:34:49. > :34:55.something that people associate readily with the preferred bidder.

:34:56. > :35:00.I'm not going to comment on the identity or character or values of

:35:01. > :35:07.any bidder at this stage but I will join him in recognising the good

:35:08. > :35:09.work done and the approach taken by the Green Investment Bank in

:35:10. > :35:15.ensuring that the investors they make are spread across the country.

:35:16. > :35:19.I come back to the point I was saying, our motivation for this

:35:20. > :35:31.being in the private sector is for this to grow in the private sector

:35:32. > :35:38.across the UK. Having listened to the Minister rewrite history from

:35:39. > :35:46.2010 on the Government's appalling approach in this area. The Green

:35:47. > :35:50.Investment Bank was an success story that had cross-party support. What

:35:51. > :35:58.guarantees without breaking any confidential at the around the

:35:59. > :36:04.negotiations that are going on, can he give to this House that moving

:36:05. > :36:08.forward that those risky investments that bank is so good at supporting

:36:09. > :36:12.will continue and that the green investment moving forward will

:36:13. > :36:22.continue in as good a state as it is now in five years' time or even

:36:23. > :36:26.better? I'm forced to repeat a large amount of what I have said before.

:36:27. > :36:32.We have set up through a process agreed to the Parliamentary process

:36:33. > :36:36.a mechanism for protecting the green purposes of the organisation going

:36:37. > :36:39.forward. Beyond that, as I have said, we are very serious about

:36:40. > :36:44.selling this as a going concern, serious about wanting to see

:36:45. > :36:47.positive proposals for growth and future investment, we're at that

:36:48. > :36:53.point where we are evaluating proposals from bidders against that

:36:54. > :36:59.lens. I will say that we are and will be in the process by the

:37:00. > :37:07.attitudes of the senior management team. Last year, Macquarie, to quote

:37:08. > :37:13.a company at random, made its largest ever profit, and it did so,

:37:14. > :37:24.as the markets will tell the Minister, by selling off Moto,

:37:25. > :37:31.Britain's largest motorway service company and selling the profits to

:37:32. > :37:35.shareholders. What is there in the current safeguards that. The future

:37:36. > :37:39.buyer, whoever they may be, from doing the same kind of thing as Tim

:37:40. > :37:47.two has always done, selling assets, taking the money out of the company

:37:48. > :37:53.and using it to pay shareholders? -- the same kind of thing as Macquarie.

:37:54. > :38:03.He has chosen a company at random, I will not talk about any companies at

:38:04. > :38:12.all. The safeguards we have set up a protected by law. An important part

:38:13. > :38:22.of that is the forward intention and the intention to mobilise private

:38:23. > :38:28.capital in the future. With Brexit and the uncertainty around that, is

:38:29. > :38:34.this not a risky idea, to sell the Green Investment Bank at this time?

:38:35. > :38:37.Can the Minister tell me how he envisages government ensuring there

:38:38. > :38:41.will be money available for those new, innovative technologies that

:38:42. > :38:46.will be important to areas like mine in Hull and the Humber? With respect

:38:47. > :38:51.to the honourable lady, I'm not sure why exit is related to this process

:38:52. > :38:56.and the decisions underpinning it. Her fundamental point about the need

:38:57. > :39:04.to invest in energy innovation, I agree with her 110%. That is why our

:39:05. > :39:13.Department has a ?500 million spending review portfolio dedicated

:39:14. > :39:21.to a wider system of budgetary support for energy-efficient

:39:22. > :39:30.systems. If we are to give the carbon reduction, we have to

:39:31. > :39:37.continue to innovate. We have to support that. The Green Investment

:39:38. > :39:43.Bank employs 55 employees out of the head office in my constituency. When

:39:44. > :39:48.it was setup in 2012, the Business Secretary Vince Cable, said that

:39:49. > :39:53.Edinburgh has a lot going for it in terms of asset management and

:39:54. > :39:56.finance sectors and also its proximity to green energy activity.

:39:57. > :40:02.We also said that choosing Edinburgh supported the wider narrative of

:40:03. > :40:04.binding Scotland into the UK in the run-up to the independence

:40:05. > :40:12.referendum. Will the Minister meet with me to discuss how such promises

:40:13. > :40:21.can be delivered to those 55 employees in my constituency? I

:40:22. > :40:27.extend the same invitation, I will meet any colleagues who are affected

:40:28. > :40:30.by this proposal. My question is in regard to the bidding process. I

:40:31. > :40:38.wonder what the minister's view is on the potential bidder, Macquarie,

:40:39. > :40:43.the cuff link buccaneers, and whether he believes in the most

:40:44. > :40:46.recent experience as Thames Water owners, where they saw off hundreds

:40:47. > :40:52.of millions of dividend payments shipped off to investors, minimal

:40:53. > :40:57.tax paid, and disappointing investment in the network. The

:40:58. > :41:02.honourable lady has made her point and she will know what point I can

:41:03. > :41:12.make. I cannot comment on the identity of any bidder at this

:41:13. > :41:17.point. If green investments are profitable, attractive and sound as

:41:18. > :41:20.has been claimed, there should be no concern about the introduction of

:41:21. > :41:24.private finance for such projects. Is not surprised that given the

:41:25. > :41:31.pressure on the public purse at the moment, this House is not welcoming

:41:32. > :41:34.another source of funds? He makes an aborted point about the increased

:41:35. > :41:43.attractiveness investment in renewable energy and low carbon

:41:44. > :41:45.infrastructure. What I say in terms of not just what has happened in the

:41:46. > :41:55.UK but around the world, governments has -- governments have seen

:41:56. > :42:00.dramatic falls and the cost of capital attached to them makes them

:42:01. > :42:04.a more investor bowl proposition. It helps reinforce our argument that,

:42:05. > :42:08.in many ways, this makes it the right time to liberate the Green

:42:09. > :42:18.Investment Bank from state control, to be able to play a bigger part in

:42:19. > :42:24.the market. The gold escape group has supported

:42:25. > :42:35.innovative projects throughout the UK that not only help us drive down

:42:36. > :42:39.costs, can he keep them warning that the bank is heading for break-up and

:42:40. > :42:45.halt the sale so it remains a single public institution that is one step

:42:46. > :42:53.ahead of the market? Lord Barker is a good friend of mine, I hold him in

:42:54. > :42:56.great respect, I reassure him and the House that the Government is not

:42:57. > :43:06.being naive in this process. We are clear about the pride teary --

:43:07. > :43:09.criteria we set. The Minister has been clear that the

:43:10. > :43:12.creation of the special share and the Government arrangements around

:43:13. > :43:16.that will protect the integrity of the green purpose in future

:43:17. > :43:21.investments. Can I press on more detail at about how the special

:43:22. > :43:29.share will protect successful bidders from off-loading current

:43:30. > :43:33.projects? I make two points on that. Firstly, the special share is set up

:43:34. > :43:36.to protect the integrity of the green purpose, which is set out in

:43:37. > :43:41.the articles of association, they are there to read now. Any proposed

:43:42. > :43:44.changes to that need to be improved by the trustees that had been

:43:45. > :43:52.selected independently. That is the mechanism. To the point, I will go

:43:53. > :43:58.back to what we were talking about before, it is not a sensible view

:43:59. > :44:04.that investment company should hold onto assets for ever. If they get

:44:05. > :44:15.attractive offers to buy the rest -- to divest assets, they would look

:44:16. > :44:21.seriously at that. We will look at future investment, what this could

:44:22. > :44:26.become under private ownership. He is right when he says that there was

:44:27. > :44:29.cross-party support for the green investment bank. There was not

:44:30. > :44:34.cross-party support for support in Scotland for removing support for

:44:35. > :44:38.carbon capture or indeed wind energy. Given how disastrous his

:44:39. > :44:41.party's policies have been in Scotland, it might explain why they

:44:42. > :44:46.don't do so well with the electorate in Scotland. Will he commit to all

:44:47. > :44:51.of the projects that have been invested in that total hundreds of

:44:52. > :44:56.millions of pounds in Scotland, regardless of whether the buyer is,

:44:57. > :45:04.they will continue and see them in? I dispute her analysis. This country

:45:05. > :45:06.has made enormous progress in the shift to green energy and Scotland

:45:07. > :45:15.has been a big part of that. Again, I point her to the recent admit to

:45:16. > :45:19.the next round of contract auctions. Last year, we generated 25% of our

:45:20. > :45:23.electricity from renewable sources. Issue looks at the starting point in

:45:24. > :45:29.2010, how argument falls away. To her point about continued

:45:30. > :45:36.investment, I point to my earlier comments. When taken alongside the

:45:37. > :45:39.cuts to renewable energy and the abolition of the Department of

:45:40. > :45:44.energy and climate change last year, does the sell-off of the green

:45:45. > :45:49.investment bank now show that the Government is no longer committed to

:45:50. > :45:54.being a world leader on climate change and sustainability? I'm

:45:55. > :45:59.afraid that is total nonsense. If she wants proof points about, one of

:46:00. > :46:04.the first actions of this Department within days of the new government

:46:05. > :46:09.warming it was to lower the fifth carbon Budget. She knows how

:46:10. > :46:13.ambitious that is. That was not the actions of a government that is

:46:14. > :46:22.shirking its responsibilities in elation to Britain's role in

:46:23. > :46:28.mitigating climate change. Is the managed to -- is are seeking any

:46:29. > :46:32.assurances that the sales of assets must be 100% free invested in green

:46:33. > :46:37.energy and the UK? I have laboured the point to exhaustion that one

:46:38. > :46:41.about priorities is to protect the integrity of the green purpose of

:46:42. > :46:46.the organisation. What we want to hear from bidders is their plans for

:46:47. > :46:55.future investment. Order. Point of order. The Attorney General is

:46:56. > :46:59.making a speech today, indeed may have already made the speech which

:47:00. > :47:05.is paving the way for more military drone strikes against jihadi 's.

:47:06. > :47:09.This looks like, smells like, walks like a policy announcement, Mr

:47:10. > :47:14.Speaker. Mr Speaker, you will be aware of concerns in this House

:47:15. > :47:17.about the use of drones, the lack of parliamentary scrutiny of their use,

:47:18. > :47:22.and their terms of engagement, and the risk acknowledged by the

:47:23. > :47:24.Attorney General of civilian casualties associated with their

:47:25. > :47:28.deployment. Given the controversial nature of drones, do you, Mr

:47:29. > :47:33.Speaker, I agree that any step change in the use, a policy shift,

:47:34. > :47:40.is a matter that should be raised and debated in this House, not

:47:41. > :47:43.trailed in a speech? I am grateful to the Right Honourable Jedward for

:47:44. > :47:48.his point of order and for his courtesy in giving the advance

:47:49. > :47:57.notice of his intention to raise it. I share his concerns that policy

:47:58. > :48:01.announcements should be made in this House, rather than outside of it. I

:48:02. > :48:05.am not familiar with the contents of the speech and I am not in a

:48:06. > :48:14.position to pronounce as to whether the Attorney General's speech and

:48:15. > :48:18.outs to an absence of policy change. That said, he has made his concern

:48:19. > :48:22.clear and no doubt it will have been heard on the Treasury bench. He can

:48:23. > :48:28.be sure it will be conveyed to the relevant ministers. I think the

:48:29. > :48:33.fairest thing I can say is, let us await events and perhaps I might add

:48:34. > :48:38.that, as the right honourable gentleman, is a former deputy Leader

:48:39. > :48:44.of the House, he will be well aware of and personally closely familiar

:48:45. > :48:51.with the instruments available for backbench scrutiny of the executive

:48:52. > :48:52.in this place. If there are no further points of order, we come now

:48:53. > :49:04.to the ten minute rule motion. I beg to move that lead be given to

:49:05. > :49:09.bring in a Bill to make provision for the affairs, property and

:49:10. > :49:16.affairs of missing persons and for connected purposes.

:49:17. > :49:24.Sooner or later all parents come to the realisation that our children

:49:25. > :49:28.are slipping away. Those calling, then toggling them running. The

:49:29. > :49:33.gentle guiding hand no longer needed as with great delight as they

:49:34. > :49:37.discover the trick of balancing on two wheels and there they go,

:49:38. > :49:43.pedalling off down the lane. That first day at school, then a few days

:49:44. > :49:48.later, a few years later, the hand starts to slip from yours when you

:49:49. > :49:52.get anywhere near the school gates. Those teenage bedroom years spent in

:49:53. > :49:57.self-imposed solitary confinement. The date when they cram all the

:49:58. > :50:02.stuff into the boot of the car and it is off to university. First job

:50:03. > :50:07.are moving into their first home. All bittersweet moments for most

:50:08. > :50:15.parents because for most of us, we know they will return. Not so for Mr

:50:16. > :50:19.and Mrs Laurence, parents of Claudia, a missing person since the

:50:20. > :50:27.18th of March 2009, nearly eight years ago. We could never imagine

:50:28. > :50:31.the rising panic of those first few minutes, hours and days when they

:50:32. > :50:35.realised something was wrong. Increasingly frantic calls and

:50:36. > :50:46.players going unanswered. Voicemails never retrieved. Those turned into

:50:47. > :50:52.weeks, weeks to months, months two years. The fate of Claudia is still

:50:53. > :50:57.unknown, still be subject of a police investigation. Many faults

:50:58. > :51:02.hopes raised over the years, a lead, a prosecution, nothing. Hopes

:51:03. > :51:06.raised, hopes dashed. When a person disappears with no explanation the

:51:07. > :51:10.friends and family are left with an unbelievable amount to cope with.

:51:11. > :51:16.With all those unanswered questions and difficult emotions. These

:51:17. > :51:21.desperate situations are worsened by the need to pick up the pieces of

:51:22. > :51:26.their lives, pay the mortgage, the rent, the car loan, the insurances.

:51:27. > :51:29.Data protection of financial services law prevents even the

:51:30. > :51:36.closest relative from dealing with the finances. As Mr Laurence told

:51:37. > :51:40.me, banks, insurance companies, mortgage lenders all say we can't

:51:41. > :51:45.accept your instructions, you are not our customer. He went on to say,

:51:46. > :51:51.you are at your lowest ebb and you have to fight all these problems.

:51:52. > :51:56.It's terribly distressing. I firmly believe that the vast majority of

:51:57. > :52:00.members join this house because they want a better world for all our

:52:01. > :52:05.children but there are some problems we will never be able to solve. The

:52:06. > :52:09.floors of mankind will always be there. Our police forces cannot

:52:10. > :52:16.prevent and solve all crimes, but we can help. We can ease the burden in

:52:17. > :52:22.a small but very important way. Under the current law of England and

:52:23. > :52:25.Wales won a person disappears the property is effectively left

:52:26. > :52:29.homeless. No one has legal authority to protect it on their behalf. This

:52:30. > :52:36.can lead to assets depreciating and property falling into despair and

:52:37. > :52:44.leaving those behind without the access to finances that the missing

:52:45. > :52:47.person would have provided. A guardian of the affairs of the

:52:48. > :52:55.missing person will fill this void and will provide a practical

:52:56. > :53:00.financial solution to those left behind. The court will have the

:53:01. > :53:03.power were to appoint a guardian of the application of a person with a

:53:04. > :53:07.sufficient interest in the property and affairs of someone who is

:53:08. > :53:12.missing. In essence the provisions of the bill will mean that generally

:53:13. > :53:17.the person will have to be missing for at least 90 days. The Guardian

:53:18. > :53:20.will take control of the property and financial affairs of the missing

:53:21. > :53:23.person and will have authority to act on behalf of the missing person.

:53:24. > :53:30.They will be able to use the property of the missing person to

:53:31. > :53:35.help those left the hound -- left behind they will be accountable and

:53:36. > :53:39.will be supervise. The terms of the appointment will be for a period of

:53:40. > :53:43.up to four years but will be renewable by application to the

:53:44. > :53:47.court. The small fee involved will be payable by the missing person's

:53:48. > :53:53.estate so there will be little or no cost to the taxpayer. Crucially the

:53:54. > :54:07.Guardian will act in the best interest of the missing person. The

:54:08. > :54:12.proposals draw and a Presidents used in Australia and under the mental

:54:13. > :54:25.capacity act 2005. Many of us have benefited from similar powers in

:54:26. > :54:31.different situations. Quite simply, this legislation fills a gap in the

:54:32. > :54:35.Lord that few people even realise exists. There are around 4000

:54:36. > :54:41.missing people occurrences every year and I would like to thank

:54:42. > :54:44.everyone connected to support and campaign organisation missing

:54:45. > :54:50.people, many of whom are involved because they have also lost a loved

:54:51. > :54:53.one. I would like to offer particular axe to Mr and Mrs

:54:54. > :54:57.Laurence who have a deep connection with my constituency. They

:54:58. > :55:02.championed the cause of guardianship, even though it can no

:55:03. > :55:06.longer help the situation. I am also grateful to members from across the

:55:07. > :55:09.house and from the other players who have pledged their support for this

:55:10. > :55:15.motion, particularly to my honourable friend from York and

:55:16. > :55:19.Selby and the honourable member for York Central who have done so much

:55:20. > :55:27.work on this already. Missing people have many tragic stories of loved

:55:28. > :55:34.ones lost and hearts broken of those left behind. Husbands, wives,

:55:35. > :55:39.fathers, mothers, brothers, sisters and children. This is possibly one

:55:40. > :55:45.of those all too rare occasions where members can certainly make a

:55:46. > :55:50.difference, simply by supporting this straightforward bill. I'm

:55:51. > :55:54.grateful to the Justice select committee, the work of the all-party

:55:55. > :55:56.group for runaway and missing children and crucially government

:55:57. > :56:02.ministers who have pledged their full support for this bill. All I

:56:03. > :56:06.ask, Madam Deputy Speaker, respectfully, is for the support of

:56:07. > :56:13.all honourable members to guarantee its passage through the house and

:56:14. > :56:16.into legislation. Here, here. The question is that the honourable

:56:17. > :56:33.member have leave to bring in the bill. I think the ayes habit. Who

:56:34. > :56:40.will bring in the bill. Christina Rhys, Nigel Adams, David Warburton,

:56:41. > :57:00.lin supple Roberts, Rebecca Powell, Doctor Philippa Whitford and myself.

:57:01. > :57:24.Guardianship missing Persons Bill. Second reading what day? 3rd of

:57:25. > :57:29.February. We now come to the opposition Day motion on NHS and

:57:30. > :57:32.social care funding in the name of the Leader of the Opposition. I

:57:33. > :57:36.informed the house that the speaker has selected amendment eight in the

:57:37. > :57:40.name of the Prime Minister. I called John Ashworth to move the motion.

:57:41. > :57:45.I'm grateful Madam Deputy Speaker and I want to move the motion that

:57:46. > :57:48.stands in my name and the name of my right honourable friend. Can I begin

:57:49. > :57:57.by paying tribute to the staff working in the NHS. To the nurses,

:57:58. > :58:01.doctors, paramedics, all the staff. We say thank you for all the hard

:58:02. > :58:08.work, commitment goodwill and commitment to this winter crisis. I

:58:09. > :58:12.have a pleasure of meeting some of those staff at St George 's Hospital

:58:13. > :58:18.in tooting it on the the pressures they have been facing last night I

:58:19. > :58:26.convened a summit of various royal colleges and trade unions working in

:58:27. > :58:30.the health service. Many will colleges have spoken out today,

:58:31. > :58:34.warning of the underfunding and understaffing. In the last few days

:58:35. > :58:37.I have received messages from doctors and clinicians from across

:58:38. > :58:43.the country who all tale of the immense pressure, strain and crisis

:58:44. > :58:49.we are basing this winter. Let me share with the house some of the

:58:50. > :58:54.stories I have been told and I have excluded the names of hospitals and

:58:55. > :58:58.trusts so as not to cause undue stress and alarm, but let me offer a

:58:59. > :59:03.flavour of what I have heard. One doctor told me there was a point

:59:04. > :59:07.when A was full and we had no space for a major trauma call that

:59:08. > :59:11.was coming in. The trauma case was going to have to be put into a

:59:12. > :59:17.corridor because the resuscitation area was full. Another story. In my

:59:18. > :59:29.A corridor care is not unusual, it is now the norm. We are trying to

:59:30. > :59:33.keep patients save, but there are not enough of us and we are on our

:59:34. > :59:40.knees. Doctors and nurses are in tears. Let me just finish and I will

:59:41. > :59:43.gladly give way. Another story. Over the weekend my bosses repeatedly

:59:44. > :59:48.asked for ambulances to be diverted away from our hospital because we

:59:49. > :59:55.have no beds, but we have multiple requests denied. The A is

:59:56. > :59:58.perpetually round with trolleys. I have many more examples, but I'm

:59:59. > :00:07.sure the house understands the broader point I'm trying to make. I

:00:08. > :00:10.will give way. I thank my honourable friend for giving way. There is

:00:11. > :00:19.unprecedented pressure in Wirral as well. As recently as last week there

:00:20. > :00:26.has been A attendances and GP referral was massively up in and

:00:27. > :00:31.unprecedented way. Extra beds have been laid on and they are full. Last

:00:32. > :00:35.week all elected in patient appointments were cancelled and the

:00:36. > :00:38.ambulance turnarounds have reached up to five others. The Prime

:00:39. > :00:43.Minister did not seem to think there was a crisis in the NHS at Prime

:00:44. > :00:49.Minister's Questions. If this isn't a crisis, but my honourable friend

:00:50. > :00:52.tell us what is? She makes a point eloquently and powerfully represents

:00:53. > :00:57.her constituents as she always does in this place. I hope the secretary

:00:58. > :01:00.of state can respond to some of the points that have been made. I did

:01:01. > :01:09.promise my honourable friend from Stoke, I will give way later. I'm

:01:10. > :01:14.grateful for my honourable friend giving way. The Royal Stoke in my

:01:15. > :01:17.city is under intense pressure. No doubt we will hear from the

:01:18. > :01:21.Secretary of State that this is part of the winter pressure. Winter

:01:22. > :01:24.hasn't really started, we haven't really had a winter and yet this is

:01:25. > :01:33.the pressure we have been under not for a few weeks, but for months. The

:01:34. > :01:37.whole NHS system is broken. An eloquent point about the situation

:01:38. > :01:41.facing Stoke and many of us are aware of the situation facing state

:01:42. > :01:45.for some time. I hope the Secretary of State can touch on the situation

:01:46. > :01:50.in Stoke because it is sadly something we have had to refer to

:01:51. > :01:55.over again. I promise I will try to give way to as many honourable

:01:56. > :02:00.members as possible. Let me assure the Secretary of State I will pass

:02:01. > :02:05.on the names of these trusts and hospitals so he could look into the

:02:06. > :02:08.matters that have been raised. Let's be clear. These desperate stories

:02:09. > :02:13.are not the words of politicians trying to score political points,

:02:14. > :02:18.but the honest heartfelt considered testimonies of doctors and

:02:19. > :02:22.clinicians on the front line in our hospitals. They just simply want to

:02:23. > :02:26.do the very best for their patients and many clinicians want to speak

:02:27. > :02:30.out but of course they feel they can't speak out and this is why

:02:31. > :02:41.these remarks have been made anonymously because according to

:02:42. > :02:48.reports on the BBC, hospital trusts have received instructions from the

:02:49. > :02:50.Prime Minister not to speak out. But the Secretary of State verified

:02:51. > :02:57.those reports in his remarks in a few moments. I give way. What he is

:02:58. > :03:02.describing, and I've worked in the NHS over this Christmas period, it

:03:03. > :03:07.has been a very tough winter so fair, but this is nothing new. I've

:03:08. > :03:11.worked in the NHS over 20 years and under previous governments we had

:03:12. > :03:15.ambulances queueing around the block to get into A and major incidents

:03:16. > :03:23.declared because there were four. This is not a new problem. We accept

:03:24. > :03:29.that? Said to the honourable lady and I entirely respect her work as I

:03:30. > :03:36.believe a nurse before she came into this place... I begged the

:03:37. > :03:41.honourable lady Pozner pardon. She is still a nurse. If we are not

:03:42. > :03:45.raising these matters on behalf of our constituents we are failing in

:03:46. > :03:49.our responsibility as members of Parliament because we must never

:03:50. > :03:53.forget that this is just not about the staff in our NHS, it is about

:03:54. > :03:59.patients and their safety which has always got to be our absolute

:04:00. > :04:04.priority. I will give way. Thank you for giving way. I echo the point he

:04:05. > :04:09.made about this being about patients across the country. My constituent

:04:10. > :04:13.was my mother Angela has been waiting for an acute mental health

:04:14. > :04:17.but for over a week. She was taken to A where they couldn't treat

:04:18. > :04:21.locally in Liverpool because it was full. She was treated for the

:04:22. > :04:24.physical help the facts in an ambulance and sent home and her

:04:25. > :04:27.family are devastated and are very concerned about her condition. These

:04:28. > :04:41.stories we need to focus on today. More broadly on the issues of mental

:04:42. > :04:44.health provision... On the specifics of that case, I have the Secretary

:04:45. > :04:50.of State will respond to my honourable friend when he responds

:04:51. > :04:56.to the debate. My honourable friend talked about patient care. She is

:04:57. > :04:59.right. All of us across this out, all many of us, will have been

:05:00. > :05:05.getting stories from constituents, telling of their recent experiences

:05:06. > :05:11.in hospital. I have been given some examples. I will share them with the

:05:12. > :05:15.House. Again, I will not reveal the names of trusts and hospitals, I

:05:16. > :05:20.will pass them on after the debate. A mother of four children, under ten

:05:21. > :05:23.years old, as a secondary tumour in her leather. She was due to go into

:05:24. > :05:28.hospital this Thursday to have it removed. Her surgery has been

:05:29. > :05:32.delayed for at least two macro weeks due to the hospital coping with a

:05:33. > :05:36.winter crisis and there being no beds available. She has not yet been

:05:37. > :05:41.given a new date. Someone else got in touch this morning whose wife has

:05:42. > :05:44.been on the waiting list for a knee replacement since April last year.

:05:45. > :05:50.An appointment for early December was cancelled owing to the hospital

:05:51. > :05:54.being and black colour. Weeks later, the hospital phoned with another

:05:55. > :06:01.appointment for today, which was cancelled yesterday. Again, these

:06:02. > :06:11.are not agents trying to score political points or politicise

:06:12. > :06:19.matters, they are wanting possibly to be done. I will give way. I thank

:06:20. > :06:24.him. We on this side care deeply about patients. Personally, as

:06:25. > :06:26.another parliament, I not on individual stories and challenges

:06:27. > :06:31.experienced by my constituents. He has surely seen the guidance from

:06:32. > :06:34.the NHS providers organisation representing NHS providers who are

:06:35. > :06:39.not always friends of the Government am about who said this week that we

:06:40. > :06:45.also need to be careful in extrapolating from individual

:06:46. > :06:51.incidents in hospitals under particular pressure. Yes, times are

:06:52. > :06:53.tough in the NHS, there are winter pressures, but he should not make

:06:54. > :06:59.inappropriate use of individual stories. The lady ought to be

:07:00. > :07:04.careful. I will be charitable but you would not one to give the

:07:05. > :07:10.impression that she is dismissing these examples that I am reading

:07:11. > :07:16.out. With respect to NHS providers, they have continually warned of the

:07:17. > :07:19.chronic underfunding of the NHS under this government. NHS providers

:07:20. > :07:27.have continually warned that head forehead spending in this country

:07:28. > :07:33.will be falling. She should quit all of the facts from the NHS providers.

:07:34. > :07:40.I thank you for giving way he is telling some shocking stories. Was

:07:41. > :07:45.he shocked to hear people heckling in Prime Minister's Questions, what

:07:46. > :07:50.about Wales? There is more funding in Wales than in England. We have

:07:51. > :07:54.brand-new hospitals including my own constituency and we have had a new

:07:55. > :07:58.treatment fund announced to allow better access to treatment. My

:07:59. > :08:03.honourable friend makes a powerful point about Wales. As a member for

:08:04. > :08:11.Cardiff, he will understand what is happening in the Welsh NHS. I will

:08:12. > :08:17.give way. Then I will make some progress if I may. Would he accept

:08:18. > :08:22.that every winter for as long as I can remember, we have had a winter

:08:23. > :08:29.crisis in the NHS? It usually happens after Christmas because, in

:08:30. > :08:32.winter, the demands on the service become unpredictable. Infections

:08:33. > :08:35.spread and you lose staff and there are bound to be parts of the system

:08:36. > :08:40.that come under real strain and no one is trying to minimise the fact

:08:41. > :08:44.that they do. Apart from producing this year's crop of stories of very

:08:45. > :08:51.unfortunate incident in various places, does he have any policy

:08:52. > :08:56.proposal to make at all apart from simply spending more money wherever

:08:57. > :09:03.the reports are coming from? He is very experienced, but he will know

:09:04. > :09:08.that this is one of the worst winters for probably 20 years.

:09:09. > :09:12.Actually, he casually suggests that this happens every year. I remove

:09:13. > :09:19.the years of a Labour government when it didn't happen. Ireland and

:09:20. > :09:23.the years of a Labour government when it went further than the

:09:24. > :09:25.financial settlements that he was delivering as the Chancellor of the

:09:26. > :09:30.Exchequer and more than doubling the money going into the NHS. If I may,

:09:31. > :09:36.I really would like to make a little bit of progress. I promised my or

:09:37. > :09:40.for friends and mothers of the other side that I will give way as much as

:09:41. > :09:42.possible but I am aware there are many members waiting to speak. I

:09:43. > :09:47.will make some progress and then give an opportunity for people to

:09:48. > :09:53.make an intervention. We are all becoming far too familiar with the

:09:54. > :09:58.grim statistics. In September, 50 of the 152 trusts call for urgent

:09:59. > :10:06.action to cope with demand. The number of patients being turned away

:10:07. > :10:11.from A at a record high. 15 hospitals ran out of beds in one day

:10:12. > :10:16.in December. Last night, the BBC revealed leaked documents from NHS

:10:17. > :10:22.improvements that showed that there were more than 18,000 trolley waits

:10:23. > :10:28.of four hours or more. Almost a quarter of patients waited longer

:10:29. > :10:33.than four hours in A last week. Just one hospital met its target.

:10:34. > :10:42.Since the start of December, hospitals of only seen 82 percent of

:10:43. > :10:46.patients within the target. Ministers can try and deny what is

:10:47. > :10:53.going on and I cannot deny these facts about what is happening this

:10:54. > :10:57.winter in the NHS and their watch. We know that what happens in the NHS

:10:58. > :11:03.in winter is a signifier of a wider crisis. Across the piece, bed

:11:04. > :11:11.occupancy levels now routinely exceed the recommended maximum

:11:12. > :11:14.levels, often to levels higher than 95%. We have an NHS going through

:11:15. > :11:21.the largest financial squeeze in its history. Indeed, the former

:11:22. > :11:25.Secretary of State said they plan for five years of NHS austerity,

:11:26. > :11:33.they were never expecting ten years of NHS austerity. We have seen 4.6

:11:34. > :11:36.billion cut from the social care Budget and as the Kings fund said,

:11:37. > :11:47.is there a problem? Because there is a

:11:48. > :11:55.simply a series of cuts affecting our hospitals. It has been a

:11:56. > :11:59.position of utter complacency. Things had only been falling over in

:12:00. > :12:03.a couple of places, he said. When he came to the House on Monday to make

:12:04. > :12:08.his statement, he did not commit to extra emergency funding for social

:12:09. > :12:12.care, he didn't promise that the financial settlements would be

:12:13. > :12:15.reassessed in the March Budget. In fact, it is worse than that. When he

:12:16. > :12:21.was making his statement, his own spin doctors were telling the Health

:12:22. > :12:24.Service Journal, this is on the day when the winter crisis is leading

:12:25. > :12:32.the news and he's making a statement in his house, come his spin doctors

:12:33. > :12:34.were saying that, there is no prospect of additional funding to

:12:35. > :12:39.support emergency care any time before the next election. So nothing

:12:40. > :12:42.for social care, nothing for emergency care, nothing to tackle

:12:43. > :12:49.understaffing, nothing to tackle underfunding. Thank you very much(!)

:12:50. > :12:55.What did we get in response? A downgrade of the four our A

:12:56. > :13:02.target. He shakes his head, he says nonsense. I will remind him of what

:13:03. > :13:07.he said. We need to have an honest discussion with the public about the

:13:08. > :13:12.purpose of A departments. He said he wanted to provoke a discussion,

:13:13. > :13:16.he wanted to provoke a discussion. He has certainly provoked a

:13:17. > :13:22.backlash, not these by blaming the public for turning up at A

:13:23. > :13:27.departments. He said, the four our target is a promise to sort out all

:13:28. > :13:38.urgent health problems within four hours. He was his clarification, but

:13:39. > :13:43.not all health problems, however minor. We have now seen a letter to

:13:44. > :13:50.trust a few weeks ago which talks of the need to broaden Harrah oversight

:13:51. > :14:00.of A They said, we believe there is merit in broadening out oversight

:14:01. > :14:06.response further than a single metric. Can he answer our questions.

:14:07. > :14:11.I know he avoided the questions yesterday and Sky News. Does he

:14:12. > :14:16.recall that in 2015, he Arthur Abraham you on these matters are

:14:17. > :14:24.waiting times. Bruce Keogh said that A standards have been important in

:14:25. > :14:28.making sure that people get access to emergency care. I do not consider

:14:29. > :14:33.there is a chase for changing the standard this time. The Secretary of

:14:34. > :14:38.State still agree with Bruce Keogh? If he does agree, can he tell us,

:14:39. > :14:41.why did he make his remarks on Monday when he said we need have a

:14:42. > :14:47.discussion about future of the A standard. If he wants to lead a

:14:48. > :14:53.discussion about the future of the standard, what discussions has he

:14:54. > :14:58.had with the Royal College of Nursing medicines? They argue that

:14:59. > :15:01.the standard is a vital measure of performance and safety. It should

:15:02. > :15:05.apply to at least 95% of all patients attending emergency

:15:06. > :15:09.departments. If he is still committed to that standard, is he

:15:10. > :15:22.still committed to maintaining it at 95%? My honourable friend has had

:15:23. > :15:27.one bite at the cherry. If he doesn't mind, I will make some

:15:28. > :15:34.progress for now. I will do my best to get as many people in if I may.

:15:35. > :15:39.Does the Secretary of State agree that the four hour standard is a

:15:40. > :15:43.reasonable proxy for patient safety? Does he agree that every reach of

:15:44. > :15:52.the standard can be regarded as a potentially elevated...? I will give

:15:53. > :15:56.way, she has been persistent. If the honourable gentleman were to read

:15:57. > :16:08.the Government amendment, he said he endorses and supports the 95% target

:16:09. > :16:15.for A waiting times. I will pay tribute to the bunch is doing and

:16:16. > :16:22.loneliness -- is doing and loneliness. The Secretary of State

:16:23. > :16:32.did the English between urgent and minor... He heckles so much, the

:16:33. > :16:37.web, it is sometimes difficult to hear what he is saying. Can he tell

:16:38. > :16:43.us how he would define the difference between urgent at minor

:16:44. > :16:47.care for this for our standard? Can he tell is the minimum severity of

:16:48. > :16:50.physical injury or other medical problem switch will be needed for a

:16:51. > :16:55.patient to qualify for access to A? How will we determine these new

:16:56. > :17:04.standards? How quickly will they be available? Which injuries will

:17:05. > :17:07.qualify? If the Secretary of State is not moving away from this

:17:08. > :17:10.standard, I'm afraid he needs to clarify matters urgently because the

:17:11. > :17:16.oppression has been given that he is moving away from that standard. Not

:17:17. > :17:22.by me, but by his own remarks on Monday. If he is not moving away

:17:23. > :17:25.from the standard, can he give a guarantee that he will not shift

:17:26. > :17:29.away at all throughout the Parliament from the standard and it

:17:30. > :17:38.will remain at the current rate it is now? I will give way. I was in

:17:39. > :17:41.the chamber on Monday and listened carefully. He was challenged on the

:17:42. > :17:46.target and asked if he was watering it down, he said explicitly that far

:17:47. > :17:50.from watering it down, he was recommitting the Government to it

:17:51. > :17:53.and he actually said, and he was generous to the Labour Party, it is

:17:54. > :18:01.one of the best things the NHS did. I think that was clear.

:18:02. > :18:06.I will say to the right honourable gentleman, the former chief Whip,

:18:07. > :18:09.the Secretary of State said we need to be clear it is a promise to sort

:18:10. > :18:15.out all urgent health problems within four hours, not all health

:18:16. > :18:19.problems. The Secretary of State enemy to cover the House and make

:18:20. > :18:25.these remarks and said these hares running. You should make his

:18:26. > :18:31.objections not to meet but to the Secretary of State. I will move on a

:18:32. > :18:40.little bit. If the Secretary of State is not abandoning the

:18:41. > :18:43.standard, we look forward to him making that clear. He has also said

:18:44. > :18:49.and implied that we need to educate the public that so they do not turn

:18:50. > :18:52.up at A departments. That was the implication of his remarks on

:18:53. > :18:57.Monday. Can he tell us how he's going to do that? What will be the

:18:58. > :19:02.cost of locations of expanding to the public not turning up at Axa

:19:03. > :19:09.macro departments? Will we see a large advertising campaign? The

:19:10. > :19:13.heat: local authorities whose budgets have been cut question Mike

:19:14. > :19:19.would he give the new resources for this education campaign?

:19:20. > :19:27.He makes an important point. The key thing is in the 90s when Labour took

:19:28. > :19:32.over in 97, the health service was in crisis and is today, but the

:19:33. > :19:37.point I want to make is isn't part of the problem people go to A

:19:38. > :19:42.because they cannot see their GP? It is difficult to get to the GP which

:19:43. > :19:49.is why we have the pressures on A and it will get worse with community

:19:50. > :19:56.pharmacy cuts this year, losing them from our towns and streets because

:19:57. > :20:00.of the cuts pursued. The figure of 3000 community pharmacy is being

:20:01. > :20:04.lost, was what the previous minister said to MPs. I will give way one

:20:05. > :20:10.last time and then I must make progress. I had a debate in

:20:11. > :20:15.Westminster Hall on pharmacies and integration in the NHS and not one

:20:16. > :20:26.single Labour MP from the backbench bother to take part. Not one. Labour

:20:27. > :20:30.MPs have raised these matters for weeks, including urgent questions

:20:31. > :20:37.and an Opposition Day debate. On that point, I presume what the

:20:38. > :20:44.honourable lady meant was there were two backbench Labour members who

:20:45. > :20:49.took part in the debate. Would he agreed the point about community

:20:50. > :20:52.pharmacies and GPs and investment in social care is it says the

:20:53. > :20:55.government money if it does it, that is why they should make the

:20:56. > :21:02.investment now to take pressure off A I'm grateful for him correcting

:21:03. > :21:10.the record on the debate in Westminster Hall. The Secretary of

:21:11. > :21:14.State denies he will water down the A target, we welcome that but will

:21:15. > :21:19.watch carefully to ensure he does not sneakily water it down for the

:21:20. > :21:23.remaining years of Parliament. Can he tell us what he expects to happen

:21:24. > :21:28.as we go through winter, because we know whether warnings have been

:21:29. > :21:33.issued and we could be heading for a cold snap. Could he update us on

:21:34. > :21:40.urgent preparations put in place to ensure the NHS can cope? Is the NHS

:21:41. > :21:45.prepared for a flu outbreak. What is his assessment if overstretched

:21:46. > :21:48.hospitals could cope if there is a flu outbreak? So far it appears

:21:49. > :21:58.ministers have buried their heads in the sand and that will not do. I

:21:59. > :22:03.will give way. I'm grateful. Honourable members both made the

:22:04. > :22:11.point of the issues in the NHS are historic. On Radio 4 today, the

:22:12. > :22:18.right honourable member for 's Leigh accepted he had not spent the right

:22:19. > :22:25.money on social care. Will he accept these are historic and not new? The

:22:26. > :22:30.honourable lady refers to the history. Under this government the

:22:31. > :22:33.NHS is going through its largest financial squeeze in its history and

:22:34. > :22:37.when we had a Labour government we more than doubled the investment

:22:38. > :22:40.going into the NHS. Because he is a member from the East Midlands I will

:22:41. > :22:46.give way to the honourable member from Corby. I am grateful. I agree

:22:47. > :22:50.we need to have an honest debate. Would he accept he stood on a

:22:51. > :23:00.general election manifesto that would have spent billions less on

:23:01. > :23:03.the NHS? Willy set out exactly what services he would spend less on in

:23:04. > :23:07.the NHS now. We stood on a manifesto that would have delivered more

:23:08. > :23:12.doctors and nurses and he stood on a manifesto that said they would cut

:23:13. > :23:21.the deficit and not the NHS. They are cutting the NHS and failing on

:23:22. > :23:25.the deficit. Can I ask the Secretary of State direct questions about

:23:26. > :23:30.Worcestershire. I was grateful for his remarks on Monday. Can I press

:23:31. > :23:35.him further, because it has been reported NHS England was warned of

:23:36. > :23:39.the bed crisis on 22nd of December and I would be grateful if he could

:23:40. > :23:43.update the house on urgent meetings he is having on Royal Worcestershire

:23:44. > :23:49.and where we will be closer to knowing the outcome of an enquiry

:23:50. > :23:53.and in the context of that, we know the STB for the Worcestershire area

:23:54. > :24:02.is proposing a number of acute beds productions. I wonder in the context

:24:03. > :24:06.of the issues that appear to be fair, witty remark upon that whether

:24:07. > :24:14.he thinks that is the right to follow. The NHS is going through

:24:15. > :24:21.this winter crisis and then it is about to go on another top-down

:24:22. > :24:26.reorganisation, if you like, aimed at... He says bottom-up, they are

:24:27. > :24:43.not. They are being told they have to fill a financial gap. Of 21.76 4

:24:44. > :24:48.billion. That is the reality that STPs have to face. We have seen

:24:49. > :24:52.community hospitals closed. It will mean a number of a deeply Mac

:24:53. > :24:58.downgraded and it will mean acute beds lost in places like Devon for

:24:59. > :25:11.example, where the STP talks of an overreliance on bed. They talk about

:25:12. > :25:15.vulnerable services such as maternity and paediatrics. In

:25:16. > :25:21.London, a city with the worst health inequalities they are expected to

:25:22. > :25:27.deliver better health outcomes for its growing 10 million residents

:25:28. > :25:33.with 4.3 billion less to spend. I ask the Secretary of State, can he

:25:34. > :25:39.explain to the house how he expects the NHS to perform in future winters

:25:40. > :25:44.when we have a growing elderly population and STPs are pursuing

:25:45. > :25:52.cuts to beds and A and wider services? I was recently briefed by

:25:53. > :25:57.an excellent and respected GP and clinical psychiatrist who had been

:25:58. > :26:01.authors of our county's STP. Can he explain how on earth they are

:26:02. > :26:08.responsible for a top-down reorganisation? I have been told by

:26:09. > :26:20.NHS England who would told by the Secretary of State, that is how. The

:26:21. > :26:31.right honourable member mentioned spending, but does he share my

:26:32. > :26:36.concern infection spreading of arrogance, complacency, from being

:26:37. > :26:43.out of touch from family suffering and witnessing in action on an epic

:26:44. > :26:50.scale? I think he makes his point extremely well. I would not want to

:26:51. > :27:00.be so mean about the Secretary of State. I'm grateful. We have heard

:27:01. > :27:05.ludicrously the suggestion that Labour did not perform on spending

:27:06. > :27:08.or performance at our track record was excellent and it is not just my

:27:09. > :27:13.words but the words of the former Prime Minister who said in 2011, I

:27:14. > :27:19.refuse to go back to the days when people had to wait hours to be seen

:27:20. > :27:23.in A or months to have surgery. Let me be clear we went. He knew

:27:24. > :27:30.that Labour had a good record and the NHS used to be good, why do the

:27:31. > :27:33.Tories not admit it? I remember Shadow Health Secretary is when we

:27:34. > :27:41.were in government opposing every penny piece of money Labour was

:27:42. > :27:46.putting into the NHS and I remember Shadow Health Secretary who now sits

:27:47. > :27:52.in the cabinet, talking about the A target as being, quote,

:27:53. > :27:55.indecent. It is no wonder we are sceptical about government

:27:56. > :28:04.intentions on this A target when we look at their history. I will

:28:05. > :28:08.give way. I'm grateful. He is talking about the Labour years and

:28:09. > :28:15.record of the NHS, does he recall Labour closing not only maternity at

:28:16. > :28:22.one hospital but accident and emergency in 2005, as well? I do not

:28:23. > :28:29.have the details of the Sussex STP to hand but presumably if it is

:28:30. > :28:33.suggesting closures, the honourable gentleman will campaign against

:28:34. > :28:35.closures and knock on the door of the Secretary of State if those

:28:36. > :28:42.remarks are an indication of his view on these matters. He is saying

:28:43. > :28:45.everything was rosy under Labour but it was ten years ago the Mid

:28:46. > :28:52.Staffordshire scandal broke in which hundreds of elderly patients more

:28:53. > :28:55.had died and expected to, it was a terrible scandal and he should

:28:56. > :29:04.remember that because our shadow spokesman were holding a Labour

:29:05. > :29:09.government to account at the time. I take all deaths in hospitals

:29:10. > :29:13.seriously. My commitment to patient safety is unswerving and I will

:29:14. > :29:17.raise matters, whether it is Royal Worcestershire or elsewhere, not in

:29:18. > :29:22.a partisan way with the Secretary of State. I was not being partisan when

:29:23. > :29:26.I ask questions about while Worcestershire. I will raise matters

:29:27. > :29:30.because that is the responsible thing to do. It is not becoming of

:29:31. > :29:37.the honourable gentleman to play politics in that way. Madam Deputy

:29:38. > :29:42.Speaker, the culpability for the state the NHS is in today lies at

:29:43. > :29:48.the door of Downing Street. A government that promise to protect

:29:49. > :29:56.the NHS and cut the deficit and it didn't. The government gives away ?1

:29:57. > :30:01.billion tax cuts to corporations. The government wastes billions

:30:02. > :30:03.pushing the NHS in the direction of fragmentation and greater

:30:04. > :30:09.outsourcing while ignoring lengthening queues of the sick and

:30:10. > :30:13.elderly in our constituencies. Yesterday we saw the Secretary of

:30:14. > :30:17.State on Sky losing his ministerial car and being chased down the

:30:18. > :30:25.street, his approach laid bare, not a clue where he is going. Nothing to

:30:26. > :30:31.say, not facing up to the problems. Last year he blamed junior doctors.

:30:32. > :30:35.On Monday he blamed the patients and today he blames Simon Stephens.

:30:36. > :30:40.Tomorrow he will blame the weather. It is time he started pointing the

:30:41. > :30:45.finger at himself and not everybody else, the NHS is in crisis,

:30:46. > :30:50.ministers are in denial. I say to the government on behalf of

:30:51. > :30:57.patients, their families, our behalf of NHS staff, please get a grip. I

:30:58. > :31:01.commend our motion to the house. The question is as on the order paper. I

:31:02. > :31:08.call Jeremy Hunt to move the amendment. I beg to move the

:31:09. > :31:12.amendment standing in the name of my right honourable friend the Prime

:31:13. > :31:15.Minister. I want to thank the Shadow Health Secretary for bringing the

:31:16. > :31:20.debate, he is right to draw attention to pressures in the neck

:31:21. > :31:24.chess but I am regrettably going to have to spend much time correcting

:31:25. > :31:31.totally inaccurate assertions -- in the NHS. That is a shame because it

:31:32. > :31:34.is an important debate for constituents and the NHS and the

:31:35. > :31:39.country deserves a proper debate but that is difficult when we have

:31:40. > :31:43.misinformation at a time when the NHS faces sustained pressure. I am

:31:44. > :31:47.pleased to see the Leader of the Opposition in his place. I think he

:31:48. > :31:55.is rather a fan of my Parliamentary appearances recently. It is a Jeremy

:31:56. > :32:02.think, he says. If only. I wish to address one part of my speech to him

:32:03. > :32:06.because it is an area of policy for which he is perhaps more personally

:32:07. > :32:11.responsible. Winter is a challenging period and I want to repeat thanks

:32:12. > :32:18.the Shadow Health Secretary said and the banks I gave on Monday to NHS

:32:19. > :32:27.staff. -- my thanks. On Tuesday, the NHS had its bid -- busiest day,

:32:28. > :32:33.treating a record number of patients in four hours. And 2500 more

:32:34. > :32:38.patients within the four-hour standard everyday compare to 2010.

:32:39. > :32:44.As we discussed on Monday, the NHS made record numbers of preparations

:32:45. > :32:47.for the winter because it is difficult, including 3000 more

:32:48. > :32:54.nurses and 1600 more doctors on full-time employment. I will address

:32:55. > :32:57.so that it does get dealt with early what the Shadow Health Secretary

:32:58. > :33:03.talked about with respect to Worcestershire. I met colleagues

:33:04. > :33:07.there on Monday. A huge amount of action is being taken but we should

:33:08. > :33:12.say it is totally not acceptable for anyone to wait 35 hours on a trolley

:33:13. > :33:19.and we expect the hospital to ensure it does not happen again. There are

:33:20. > :33:23.plans to open additional capacity. We have had capacity made available

:33:24. > :33:29.by Worcester community trust. It supplied its chief operating officer

:33:30. > :33:35.to be based at the trust to facilitate discharges, and we have a

:33:36. > :33:38.new chief executive, the trust is in special measures and the new chief

:33:39. > :33:45.executive will start later this spring. What is wrong about what the

:33:46. > :33:53.Shadow Health Secretary has said is the suggestion that winter problems

:33:54. > :33:59.are unusual. The NHS had difficult winters in 99, 2008 and 2009, as The

:34:00. > :34:04.Right Honourable member said. I will give way in a moment. He remembers

:34:05. > :34:08.difficult winters from his time as Health Secretary. There are things

:34:09. > :34:16.that are different today and one of them is compared to six years ago,

:34:17. > :34:21.we have 340,000 more over 80s, many honourable, many with dementia, and

:34:22. > :34:27.we know when people of that age go to A at this time of year there is

:34:28. > :34:34.an 80% chance they will be admitted. I will give way. I thank him. He

:34:35. > :34:40.talks about correcting points and it is important the house has

:34:41. > :34:44.information. Can I repeat the question, the latest figures, can he

:34:45. > :34:49.tell us the number of people remaining in hospital, that could be

:34:50. > :34:52.discharged, because there is no community support they have stayed

:34:53. > :35:01.in hospital. Could he give us that figure?

:35:02. > :35:07.It was around 7000 beds last year, which is far too many. Which is why

:35:08. > :35:11.it was announced that a new package of support worth around ?400

:35:12. > :35:14.million, I will just answer his question, I said I would write to

:35:15. > :35:18.him and I will. He may have noticed there are other issues we are

:35:19. > :35:22.dealing with which is why I may not have had time to sign the letter.

:35:23. > :35:27.What the Communities Secretary announced, ?400 million extra over

:35:28. > :35:33.the next two years will make a significant difference and he should

:35:34. > :35:35.recognise that. I am grateful for him giving way, there will be

:35:36. > :35:40.constituents who are concerned about the headlines they have read. I am

:35:41. > :35:44.pleased the secretary of state will correct some of the points that were

:35:45. > :35:49.made. They also want to know what is being done and what should be done.

:35:50. > :35:52.I listened for 33 minutes to the Shadow Secretary of State, the

:35:53. > :35:58.Labour spokesman of the NHS, not a single new idea other than spending

:35:59. > :36:03.money. Could my right honourable friend provide practical answers to

:36:04. > :36:07.allay concerns in the papers. That is why I will be talking later about

:36:08. > :36:11.what our solutions are to these problems. I will give way but I also

:36:12. > :36:17.want to make some progress, which I will do now. I want to talk about

:36:18. > :36:21.something else that is different today in our AMD departments

:36:22. > :36:28.compared to six years ago. Which -- a and E departments. We also insist

:36:29. > :36:32.on much higher standards of safety and quality. On Monday, I

:36:33. > :36:38.congratulated labour for the introduction of the four our target.

:36:39. > :36:42.I support it. We should all member that four years after that standard

:36:43. > :36:48.was introduced, we started to see some horrific problems among staff

:36:49. > :36:52.in the a and E departments, many thought they would be fired if they

:36:53. > :36:57.missed the target. What Robert Francis said about this that the

:36:58. > :37:01.failure of its staffs were "Imparts the consequence of allowing a focus

:37:02. > :37:06.on reaching national access targets." While we retain targets,

:37:07. > :37:17.we will not allow them to be followed slavishly in a way that

:37:18. > :37:21.damages patient care. My point is that that is why we have a new

:37:22. > :37:25.inspection regime which makes it harder to cut corners in a way that

:37:26. > :37:29.frankly used to happen which meant beds were not being washed. There

:37:30. > :37:34.was poor infection control and ambulances were being used as

:37:35. > :37:40.waiting rooms and so on. I will give way. I am grateful for him outlining

:37:41. > :37:44.the steps he is taking in this emergency but does he also recognise

:37:45. > :37:48.that the major cause of the problems in A are the lack of staff we

:37:49. > :37:55.have? As a result of that, does he regret the huge cuts there were two

:37:56. > :37:59.training projects in 2010, 2011, 2012, which is having an impact now

:38:00. > :38:07.on the number of doctors and nurses in our NHS? I agree Stockman was

:38:08. > :38:12.critical in this but we have more doctors in A departments, more

:38:13. > :38:17.consultants, more than 11,000 additional doctors. We are

:38:18. > :38:21.recognising the pressures being faced in the NHS. 1600 more doctors

:38:22. > :38:25.since this time last year, this is something we are doing a lot about.

:38:26. > :38:30.I will give way once more on this side. Does my right honourable

:38:31. > :38:36.friend agree that learning Best practice within the NHS, the

:38:37. > :38:40.hospitals that manage to integrate and help with social care, such as

:38:41. > :38:44.Wigan and Salford hospitals who reduced and created those beds, that

:38:45. > :38:51.is an example of best practice is that the whole NHS can learn from?

:38:52. > :38:55.My honourable friend is absolutely right, it is a mistake in this

:38:56. > :38:59.debate, which I understand that opposition parties want to do, to

:39:00. > :39:04.put it down to government funding but in the country, we see a lot of

:39:05. > :39:07.variability. This period of the year is always difficult but some

:39:08. > :39:12.hospitals are doing superbly well in challenging circumstances. We have

:39:13. > :39:19.just heard some of the hospital is doing well and there are a number. I

:39:20. > :39:23.will give way to as many people as I can but I also want to address the

:39:24. > :39:28.substantive point is that the Shadow Health Secretary said. He talked

:39:29. > :39:32.about the four our target and in his motion and hit in his speech, he

:39:33. > :39:36.made the totally spurious suggestion that we are not committed to that

:39:37. > :39:43.target. I remind him of what might right honourable friend said, quoted

:39:44. > :39:46.me as saying on Monday, what I said was not just committing the

:39:47. > :39:53.government to the target but that it was one of the best things the NHS

:39:54. > :39:57.does. I also said that we need to find different ways to offer

:39:58. > :40:04.treatment to people who do not need to be in A This is hardly rocket

:40:05. > :40:08.science. When you have pressure in A, it is sensible and indeed, I

:40:09. > :40:16.would argue the duty of the Health Secretary to suggest that people who

:40:17. > :40:21.can relieve pressure on A do so. I am grateful to the Health Secretary

:40:22. > :40:26.for giving way, yesterday at Crawley Hospital, and acute care unit was

:40:27. > :40:31.opened which precisely to ensure that those people who don't need to

:40:32. > :40:35.attend A are properly directed to the most appropriate care. Which is

:40:36. > :40:42.good for them as individual patients and good for the whole system as

:40:43. > :40:47.well. He is absolutely right. To back up his point, we had a report

:40:48. > :40:53.from the OECD yesterday that said that in Australia, Belgium, Canada,

:40:54. > :40:58.France, Portugal, at least 20% of A visits are inappropriate. NHS

:40:59. > :41:02.England's figure is that this is up to 30%. That is why we need the

:41:03. > :41:07.public's help to relieve pressure. That is what I meant when I talked

:41:08. > :41:15.about an honest discussion. I give way. The Secretary of State told us

:41:16. > :41:18.a moment ago that there are 300,000 more people over the age of 80,

:41:19. > :41:20.surely he would know this information when his government took

:41:21. > :41:27.over seven years ago from the sensors data. Why is it that we are

:41:28. > :41:33.now seeing on the front pages of newspapers that one in four of A

:41:34. > :41:38.awards are unsafe and that we have similar challenges across the

:41:39. > :41:42.country West Chamakh we did know that information and that is why we

:41:43. > :41:49.thought it was totally responsible to cut the NHS budget in 2010. As a

:41:50. > :41:54.result of that, we have 11,000 more doctors and in her own local

:41:55. > :42:02.hospital, every single day, we are treating within four hours, 243 more

:42:03. > :42:07.people. What I said, I will make some progress and then give way. I

:42:08. > :42:10.could have put what I said on Monday a different way. I could have said

:42:11. > :42:14.that we have to persuade those people not in medical emergencies to

:42:15. > :42:17.use other parts of the system to get the help they need. I didn't

:42:18. > :42:22.actually say that but I will tell you who did say that, the Labour

:42:23. > :42:27.health minister in Wales, Mark Drake that, in January last year. And

:42:28. > :42:30.frankly, when the NHS is under the pressure it is under, it is

:42:31. > :42:35.responsible for the party of the city criticised the Health Secretary

:42:36. > :42:43.in England for Sanogo same thing that the Health Secretary in Wales

:42:44. > :42:50.is also saying. -- for saying the same thing. I am grateful, I think

:42:51. > :42:54.the Secretary of State is so in confusion in the House and the

:42:55. > :42:58.country on this question and again today. If what he is saying is the

:42:59. > :43:01.same as my honourable friend the Health Secretary of Wales that we

:43:02. > :43:07.want to divert people who don't need to go to A from doing so, then I'm

:43:08. > :43:12.sure everybody in this House would support that. But what we suspect he

:43:13. > :43:18.is saying is that the four our waiting target is going to be

:43:19. > :43:21.disappointed to some people turning up to ten par and that is the

:43:22. > :43:26.downgrading he is talking on if that is the case, he should come clear

:43:27. > :43:30.and he should be clear whose job it is going to be to do supply the

:43:31. > :43:37.target to some people with minor ailments. I did not say that and I

:43:38. > :43:43.didn't say it because we are not going to do it. Let me tell him, we

:43:44. > :43:45.did have an intervention from a Welshman, rather inconvenient truth

:43:46. > :43:50.about what is happening in Wales. Last you, and par performance with

:43:51. > :43:55.10% lower than in England and in Wales, they have not hit the A

:43:56. > :44:00.target for eight years. We are not going to let that happen in England.

:44:01. > :44:03.I noticed the Shadow Health Secretary quoted a number of people

:44:04. > :44:08.but one organisation he didn't quote was the Royal College of emergency

:44:09. > :44:12.medicine, I wonder if the reason is because of what they said about

:44:13. > :44:17.Wales this week. They said emergency care in Wales is in a state of

:44:18. > :44:24.crisis. "Performance Is as bad, if not worse than England in some

:44:25. > :44:33.areas. " In areas Labour is in contrast -- labour is in control,

:44:34. > :44:38.these issues are worse. I say that, not to make the political point but

:44:39. > :44:41.to say that it is blatantly ridiculous to start trying to play

:44:42. > :44:45.politics when you have winter pressures in the NHS because this

:44:46. > :44:49.happens in the whole NHS, in Wales as well as in England. I'm going to

:44:50. > :44:57.make progress but I will give way to my honourable friend. I thank him,

:44:58. > :45:00.can I reiterate the point he made about the four our target. During

:45:01. > :45:05.the Labour government I was working in the NHS and significant pressure

:45:06. > :45:08.was put on us by managers to meet the four our target and negate

:45:09. > :45:12.clinical need and often patients were prioritised according to

:45:13. > :45:16.meeting the target rather than the clinical need and that was a

:45:17. > :45:21.disgrace. That is exactly the problem we had with mid staffs. What

:45:22. > :45:26.we had was a culture in the NHS where people were hitting targets

:45:27. > :45:32.but missing the point. While targets are important, management tools, it

:45:33. > :45:37.is important they followed in a sensible way that puts the welfare

:45:38. > :45:42.of patients first. I would like to make another point about Wales why

:45:43. > :45:47.we have the privilege of someone who aspired to lead the Labour Party

:45:48. > :45:51.here, as the current leader of the Labour Party is no longer in this

:45:52. > :45:55.place. I want to make this point, something England and Wales have in

:45:56. > :45:59.common is the need to make sure that if we want all senators to A that

:46:00. > :46:04.people are able to get to see their GP. I have said many times that

:46:05. > :46:09.people wait too long to see their GPs. I have to say in all honesty,

:46:10. > :46:16.the GP contract changes in 2004 were a disaster. Because the result of

:46:17. > :46:21.those changes were that 90% of GPs opted out of out-of-hours care. But

:46:22. > :46:27.we have been putting that right. Now, 17 million people in England,

:46:28. > :46:31.30% of the publishing, have access to weekend and evening GP

:46:32. > :46:36.appointments. More than that, in this Parliament, we have committed

:46:37. > :46:42.to a 14% real terms increase in the GP budget, that is an extra ?2.4

:46:43. > :46:46.billion. And we sped that to see an extra 5000 doctors working in

:46:47. > :46:54.general practice. I give way to the honourable lady. I received a very

:46:55. > :47:00.distressed e-mail this morning from a senior NHS manager who has written

:47:01. > :47:04.to me saying" I truly despair there will not be an NHS this time next

:47:05. > :47:10.year. " You need to listen on the opposition benches, you need to

:47:11. > :47:14.listen and understand what your secretary of state is doing to the

:47:15. > :47:22.health service. I will give you a pr cis of what they are talking

:47:23. > :47:25.about it. The honourable lady will return to has it, there are 33

:47:26. > :47:29.members wishing to speak in this debate, it is an important debate,

:47:30. > :47:40.if she can keep intervention in brief, I will let her but very

:47:41. > :47:47.brief. Thank you madam touch to Speaker, I shouldn't have used the

:47:48. > :47:50.word "You." The government knows the NHS is in crisis, foundation trust

:47:51. > :47:56.are failing, GPs are on their knees, so they are, the government are

:47:57. > :48:04.handling it back to local areas and saying you fix it and by the way,

:48:05. > :48:09.there is no money. All I would say is that I hope that people in the

:48:10. > :48:13.NHS don't listen to much to what the Labour Party says about the state of

:48:14. > :48:17.the NHS and listen to what the government is saying which is giving

:48:18. > :48:21.a more accurate picture. As I will go on to explain. I will make some

:48:22. > :48:25.progress and I will then give way further. The second part of the

:48:26. > :48:29.motion talks about funding. And there is never questioned at all

:48:30. > :48:35.that we will be needing to look after 1 million more people over 65

:48:36. > :48:38.in five years' time, we will need to continue increasing investment in

:48:39. > :48:44.the NHS and the social care system. That is happening this year with an

:48:45. > :48:48.extra ?3.8 billion going into the NHS, going in this year. They are

:48:49. > :48:51.remind honourable members, it is ?1.3 billion more than they

:48:52. > :48:56.themselves promised when they stood for election last year. I will just

:48:57. > :49:01.say this, it is not enough to talk about extra funding, you act -- you

:49:02. > :49:05.have to actually deliver it. They have to answer to their own

:49:06. > :49:09.constituents why Fort two elections in a row they have missed less money

:49:10. > :49:12.to the NHS than the Conservatives and the one area they are

:49:13. > :49:16.responsible for the NHS, they have cut funding.

:49:17. > :49:25.I think he is taking the right measured tone that was absent

:49:26. > :49:30.earlier. We recognise the NHS is under financial pressure but some of

:49:31. > :49:34.these are historic, reflecting in my area poor PFI contracts forced upon

:49:35. > :49:43.them in the Gordon Brown sleight of hand. He is right. What we did not

:49:44. > :49:48.hear from the party opposite was in 2010 we inherited a ?70 billion PFI

:49:49. > :49:52.overhang that is making it difficult for hospitals to recruit staff

:49:53. > :50:00.because they are having to pay so much money to pay for it. An example

:50:01. > :50:06.of how we are spending money practically on the ground to make

:50:07. > :50:10.sure patientss get a better deal is in Lincolnshire where, with a

:50:11. > :50:15.shortage of GPs, the local health authority is offering ?20,000 as a

:50:16. > :50:20.golden hello to do GPs. Isn't that the way of managing resources and

:50:21. > :50:24.attracting the best talent to our areas and helping ensure patients

:50:25. > :50:29.get the best care? She is right. I have talked about these issues when

:50:30. > :50:33.I've visited her. The trick is to solve the problem we will have to

:50:34. > :50:37.have a dramatic increase in people working in general practice, which

:50:38. > :50:44.is why we are funding the second biggest increase in NHS history for

:50:45. > :50:48.GPs. It is a shame the Leader of the Opposition is not here because this

:50:49. > :50:55.is the bit I wanted to address to him, his proposal to put extra

:50:56. > :50:58.funding into the NHS by scrapping corporation tax cuts. This reveals a

:50:59. > :51:06.fundamental misunderstanding about how you fund the NHS. Corporation

:51:07. > :51:12.taxes or cut so we can boost jobs and strengthen the economy, so we

:51:13. > :51:16.can fund the NHS. The reason we have been able to protect and increase

:51:17. > :51:21.funding in the NHS in the last six years when the party opposite was

:51:22. > :51:25.not willing, is because we have created 2 million jobs and given

:51:26. > :51:30.this country the fastest-growing economy in the G7. That is more

:51:31. > :51:35.important posts Brexit. To risk that growth, which is what their proposal

:51:36. > :51:39.would do, would not just risk funding for the NHS, it would be

:51:40. > :51:45.dangerous for the economy and mortally dangerous for the NHS. I

:51:46. > :51:58.want to understand what he will say about the four-hour target. Is it

:51:59. > :52:02.conceivable that some of the people who are currently within the A

:52:03. > :52:09.target will at some stage fall outside the target in the future? I

:52:10. > :52:15.am committed to people using A falling within the four-hour target.

:52:16. > :52:19.I also think we need to be more effective out diverted people who do

:52:20. > :52:25.not need to go to A to other places as happens in Wales and

:52:26. > :52:30.Scotland and is the only sensible thing. Going back to funding, for

:52:31. > :52:34.all the heat in this chamber on debates on the NHS, probably the

:52:35. > :52:39.biggest difference between the two sides is not on policy, but on the

:52:40. > :52:45.ability to deliver the strong economy the NHS needs to give it the

:52:46. > :52:49.funding required. I am afraid the proposal today in the motion

:52:50. > :52:55.revealed that divide more starkly. I am grateful. We have this debate at

:52:56. > :52:59.the election about the need for the stronger economy to pay for the NHS

:53:00. > :53:05.and the public decided we won that argument. Can I give another example

:53:06. > :53:12.from his friend Jeremy, from yesterday, he made a proposal to cap

:53:13. > :53:17.high pay. The top 1% of taxpayers pay 27% of income tax revenues and

:53:18. > :53:22.that proposal would cut funding available to the NHS and damaged the

:53:23. > :53:28.services staff have produced. It is the worst kind of gesture politics

:53:29. > :53:35.because it may get him more votes or Momentum supporters, but it would

:53:36. > :53:40.damage the NHS. Would he agree with me that rather than making

:53:41. > :53:47.meaningless and totally underfunded promises on more money for the NHS

:53:48. > :53:52.contrary to their manifesto back in 2015, members opposite would do

:53:53. > :53:57.better to recognise the demographic changes, ageing population need for

:53:58. > :54:04.the NHS to change, and to support the locally developed plans for

:54:05. > :54:10.change in the NHS, the STPs? She is absolutely right. People in the

:54:11. > :54:16.country will find it hugely ironic that the party that spent so much

:54:17. > :54:18.energy in the last Parliament campaigning against top-down

:54:19. > :54:25.reorganisation is now campaigning against locally driven changes. I

:54:26. > :54:35.will give way and then I will conclude. As the government points

:54:36. > :54:41.out often, they want to hand decisions to local groups, but could

:54:42. > :54:47.he give an explanation too worried patients in the south and west of

:54:48. > :54:51.Cumbria as to why the local health services are suggesting the changes

:54:52. > :54:59.to A in the west and potentially in the South? I know he spent time

:55:00. > :55:03.looking at this area. I would like to use this moment to congratulate

:55:04. > :55:09.his local trust for coming out of special measures and the progress

:55:10. > :55:13.they are making. In a way, that is the answer, because his local trust

:55:14. > :55:17.was in special measures and north Cumbria is still in special measures

:55:18. > :55:22.and we have profound worries about patient care in both trusts but we

:55:23. > :55:27.still do in North Cumbria. That is why the status quo is not an option

:55:28. > :55:35.that we understand the concerns of constituents about proposals being

:55:36. > :55:39.made. What does he make of this talk among professionals in relation to

:55:40. > :55:41.the potential for a flu outbreak and what does he make of the doctor who

:55:42. > :55:49.wrote to me on Sunday saying she is wrote to me on Sunday saying she is

:55:50. > :55:53.concerned they are too busy to isolate patients coming in who need

:55:54. > :55:57.oxygen and they are too busy to cover that, to isolate patients so

:55:58. > :56:07.others do not capture potential flu epidemic? There is a concern about a

:56:08. > :56:10.growth in respiratory infections and that is causing capacity

:56:11. > :56:17.constraints. We are watching what is happening on this carefully but we

:56:18. > :56:25.have 13 million people vaccinated this year against flu which is a

:56:26. > :56:28.record. Money is important, but can I support the Health Secretary in

:56:29. > :56:32.not viewing these issues so the three that lends? My local trust,

:56:33. > :56:38.Sherwood forest cover has some of the worst finances of any trust,

:56:39. > :56:43.almost all due to a PFI deal signed by Gordon Brown. My trust is

:56:44. > :56:47.improving. It is under pressure this winter but management says it is not

:56:48. > :56:53.in crisis, and that is a trust improving because of quality

:56:54. > :57:00.management, reform and good quality processes. That is absolutely the

:57:01. > :57:04.point. We miss a trick and I think the Shadow Health Secretary is in

:57:05. > :57:09.some ways more reasonable than his leader on these issues, if we say it

:57:10. > :57:17.is simply an issue... That is probably terminal for his career! If

:57:18. > :57:21.we say it is just about money, we forget the debate we went through on

:57:22. > :57:26.schools 20 years ago when there was a debate about money and we realised

:57:27. > :57:30.it is about standards and quality or so and that has happened in Sherwood

:57:31. > :57:34.forest and I congratulate the hospital. It is important we don't

:57:35. > :57:44.let debates about funding eclipse the progress we need to make

:57:45. > :57:52.standards. I am going to conclude, because lots of people want to come

:57:53. > :57:57.in. He made as his central claim, his words, the culpability for what

:57:58. > :58:01.is happening in the NHS lies at the door of Downing Street. I think I

:58:02. > :58:07.owe it to the country and this House to set the record straight on this

:58:08. > :58:11.government's record on the NHS, not just 11,000 more nurses and 11,000

:58:12. > :58:16.more doctors and on cancer we are starting treatment for 130 more

:58:17. > :58:21.people every day and have record survival rates, not just the fact we

:58:22. > :58:25.have 1400 more people getting mental health treatment every day and some

:58:26. > :58:30.of the highest dementia diagnosis rates in the world, not just the

:58:31. > :58:35.fact we are doing 5000 more operations every day and despite

:58:36. > :58:41.that, MRSA rates have hard. We have the NHS with more doctors, nurses,

:58:42. > :58:45.and despite difficult winters, patients saying they have never been

:58:46. > :58:52.treated more safely and with more dignity and respect. Next year, the

:58:53. > :58:57.NHS will be 70 years old and this government's vision is simple, we

:58:58. > :59:02.want it to offer the safest, highest quality care anywhere in the world,

:59:03. > :59:06.and when you have difficult winters and an ageing population, that makes

:59:07. > :59:11.things more challenging, but it makes us more determined and means

:59:12. > :59:16.we are backing the NHS plan, more GPs, it means better mental health

:59:17. > :59:25.provision and a NHS turning heads in the 21st century just as it did when

:59:26. > :59:33.it was founded in the 20th. Here we are again debating the NHS. We had

:59:34. > :59:39.the statement... All on my own because this is predominantly a

:59:40. > :59:47.crisis, this is NHS England, not a crisis that is NHS Scotland, as I

:59:48. > :59:52.will talk about. The problem is we are talking about patients who are

:59:53. > :59:58.suffering, patients who may suffer from more infections. We are talking

:59:59. > :00:01.about staffing tears, who are desperate, who feel they cannot

:00:02. > :00:10.deliver the care they would expect to deliver. This is not just a

:00:11. > :00:15.matter of isolated stories. We hear from NHS improvement that only one

:00:16. > :00:23.trust met the target in December. Only nine out of 152 made it over

:00:24. > :00:29.90%. This is not something that is just a matter of Joe from Wiltshire

:00:30. > :00:34.and Mike from Leeds, this is something happening on a major

:00:35. > :00:41.scale. 50 out of 152 trusts have declared a black or red situation

:00:42. > :00:48.over December, and 158 diverts of ambulances. It is not just normal

:00:49. > :00:52.winter pressures, it is not what the honourable lady opposite who is an

:00:53. > :00:57.A nurse and people like myself and other medics in the chamber have

:00:58. > :01:02.seen in our careers. This is a really bad winter, and yet we have

:01:03. > :01:08.not had a really bad winter, we have not had bitter weather, we have not

:01:09. > :01:13.had a flu epidemic. What we have seen when we look at the four-hour

:01:14. > :01:19.data is the last one published was October, when the NHS in England

:01:20. > :01:25.managed to achieve the four-hour target 83.7% of the time, 5% down

:01:26. > :01:31.from the same time the previous year and compares with 93.9% in Scotland.

:01:32. > :01:38.Scotland managed 93.5% in Christmas week. I'm sorry, the crisis in

:01:39. > :01:45.Scotland, we have our challenges, but it is not the same as discussed

:01:46. > :01:51.here. I will happily give way. I am grateful. Will she confirmed,

:01:52. > :01:58.though, that throughout the whole of 2016, which includes winter, summer,

:01:59. > :02:05.autumn and spring, the Scottish Government's A target was only met

:02:06. > :02:10.in seven out of the 52 weeks? I'd be delighted to agree but I would like

:02:11. > :02:16.to point out that NHS England did not make it over 90% anywhere in

:02:17. > :02:20.2016, so I think perhaps the honourable gentleman might want to

:02:21. > :02:27.check the NHS England figures before having a punt at me. NHS England is

:02:28. > :02:32.performing 8-10% lower than NHS Scotland, which has been the top

:02:33. > :02:38.performing of the nation 's for the last 19 months. We have not done

:02:39. > :02:43.that from magic, we face the same ageing population, exactly the same

:02:44. > :02:48.increased demand and complexity and exactly the same indeed often worse,

:02:49. > :02:54.shortage of doctors than NHS England, because of our rural areas.

:02:55. > :02:58.It is not something that is a different measure, we use the same

:02:59. > :03:03.measure, but if you look at the data, there is a difference and it

:03:04. > :03:08.has been maintained. The Secretary of State is right, winter is

:03:09. > :03:11.challenging. Summer is when A is often busier for attendances because

:03:12. > :03:20.the children are on companies and people go out and do silly things.

:03:21. > :03:25.-- are wrong trampolines. But the people who come to A are sicker,

:03:26. > :03:32.older, more complicated, and that is the problem that we have at the

:03:33. > :03:39.moment. What we have not seen is any summer respite in NHS England. The

:03:40. > :03:46.worst performance in the summer was 80.8%. The best performance was

:03:47. > :03:51.86.4%. NHS England is under pressure in the summer and when you add the

:03:52. > :03:56.winter on top, it is no wonder we are talking about the situation is

:03:57. > :04:01.doctors, nurses, patients and relatives are describing. I remember

:04:02. > :04:07.my first health debate after my maiden speech was an Opposition Day

:04:08. > :04:13.debate on the four-hour target. I commented at the time and still

:04:14. > :04:17.maintain that this target is not a stick for each party to hit each

:04:18. > :04:22.other over the head with. But it is a thermometer to take the

:04:23. > :04:27.temperature of the acute service. It does that really well. Because what

:04:28. > :04:31.it measures is not just people coming in through the front door,

:04:32. > :04:33.but how they are moving through the hospital, and how they are moving

:04:34. > :04:44.out. We are seeing a system that is

:04:45. > :04:49.completely overheated. The comments about it not being anything unusual

:04:50. > :04:53.and just a normal winter and everyone is whingeing means the

:04:54. > :04:57.government isn't recognising the problem. And the first step to

:04:58. > :05:02.dealing with any problem is to recognise it. Then you can look at

:05:03. > :05:05.how you want to tackle it. I thank her for giving way. I would remind

:05:06. > :05:10.her the point that Prime Minister made in prime ministers questions on

:05:11. > :05:16.the Tuesday after Christmas that the NHS received the highest number of

:05:17. > :05:19.visitors it has ever received, A receiving the highest number of

:05:20. > :05:24.visitors it has ever received in its history. Doesn't that show the

:05:25. > :05:29.challenges facing the NHS nationally and locally? Those are extraordinary

:05:30. > :05:34.figures and the Secretary of State is very much doing his best to help

:05:35. > :05:39.the professionals deal with those numbers. I would totally accept that

:05:40. > :05:44.the NHS has been under inordinate pressure am absolutely is busiest

:05:45. > :05:48.day in its history. But with an ageing population that has been

:05:49. > :05:53.discussed for years, we should have been able to see this coming. If in

:05:54. > :05:57.the next few months we get a massive flu epidemic, we are really going to

:05:58. > :06:03.see things keel over. What we can't have is the debates we have already

:06:04. > :06:07.had in this chamber about STPs, taking more beds away. I totally

:06:08. > :06:12.agree with the Secretary of State that some of it is that patients

:06:13. > :06:18.could be seen somewhere else. But it is not a matter of changing the four

:06:19. > :06:23.our target and saying someone won't count is that we provide better

:06:24. > :06:27.automotives. If we provide better alternatives, people will go to

:06:28. > :06:31.them. We have discussed community pharmacies in this chamber and it

:06:32. > :06:35.has been recognised that the minor ailments service we have in Scotland

:06:36. > :06:43.can deal with five or 10% of those patients. We have located out of

:06:44. > :06:50.hours GP 's units beside our A, someone sent along the corridor into

:06:51. > :06:56.the next building if it is a GP and not A that they need to see. We do

:06:57. > :07:00.need to educate the public but the public will use an alternative

:07:01. > :07:05.service if it is there. If it isn't, then if they turn up at A and they

:07:06. > :07:12.keep sitting there, someone will see them. We shouldn't blame them for

:07:13. > :07:15.that. I thank her for giving way. She is right to say we have an

:07:16. > :07:20.ageing population but it is predictable. The significant thing

:07:21. > :07:27.is that in 2008, the UK was spending around the same as all the major EU

:07:28. > :07:32.nations, we are now spending considerably less than major

:07:33. > :07:36.nations, isn't that what is causing the problem? I don't think money is

:07:37. > :07:41.the only problem, I do accept part of it is how things are done. The

:07:42. > :07:44.Secretary of State talks about the variation and hospitals performing

:07:45. > :07:49.well but only one of them is meeting the target. Only nine of them are

:07:50. > :07:55.over 90%. It is not that the majority are doing well and few are

:07:56. > :08:00.failing, we will come onto STPs in a minute, in how we deliver the NHS is

:08:01. > :08:07.crucial but change costs money. Therefore you have two invest in

:08:08. > :08:11.alternatives in your community services, primary care, step up and

:08:12. > :08:16.step down to take that pressure. At the moment, one of the concerns

:08:17. > :08:19.about the STPs is because they don't have the money. What we see are a

:08:20. > :08:25.lot of them are starting that way and thinking they will shut A and

:08:26. > :08:30.a couple of wards and community beds which we need more of. To fund

:08:31. > :08:36.change in primary and social care. And in actual fact, the system will

:08:37. > :08:39.fall over, you need to have double running and develop alternatives and

:08:40. > :08:48.then you are able to gradually send patients into that. I was enjoyed

:08:49. > :08:52.listening to her well-informed remarks, I agree also that most

:08:53. > :08:56.people don't want to go to A if they can avoid it. Would she agree

:08:57. > :09:00.that part of the problem is when people phone general practices, they

:09:01. > :09:05.tend to either not be offered an appointment in a reasonable time

:09:06. > :09:09.frame or they can't get to see the doctor that they closely associate

:09:10. > :09:14.with and that particular applies to people with chronic and long-term

:09:15. > :09:18.conditions. A report makes there today that we need to address that

:09:19. > :09:24.as a matter of urgency and possibly seven days a week general practice

:09:25. > :09:28.may paradoxically be mitigating against the possibility of providing

:09:29. > :09:34.people with that continuity of care during core hours. I think having

:09:35. > :09:38.access to a GP and I think many doctors in general practice would

:09:39. > :09:44.accept the argument for something like a Saturday morning, that people

:09:45. > :09:49.who are work, but someone who can't see their favourite doctor is

:09:50. > :09:53.actually very unlikely to go to A and wait eight hours to see a doctor

:09:54. > :09:57.they have never seen in their life. I don't think it is that, I think

:09:58. > :10:02.people feel they can't find an alternative. If it is taking three

:10:03. > :10:06.or four weeks to get any appointment with their GP if they don't yet have

:10:07. > :10:11.a community pharmacy that will offer a service, and eventually they end

:10:12. > :10:15.up at A Therefore it is the service of last resort for people.

:10:16. > :10:20.They go there and just stay there. We have do develop those other

:10:21. > :10:23.alternatives first and as the honourable gentleman says, no point

:10:24. > :10:28.in their right mind will choose to go and wait four hours in A if

:10:29. > :10:32.they could be seen in half an hour at a community pharmacy. I have do

:10:33. > :10:38.disagree with her because winter pressures that we are seeing at the

:10:39. > :10:41.moment, tend not to be people with short-term conditions, they tend to

:10:42. > :10:45.be the chronically sick. And those people want to have a relationship

:10:46. > :10:50.with a particular practitioner who understands their needs and

:10:51. > :10:54.understands the family contest, surely that is the essence of

:10:55. > :11:00.general practice. I totally agree with that. But the chances of them

:11:01. > :11:03.having their doctor on a Saturday morning or Sunday afternoon is

:11:04. > :11:10.reduced. One of the things they have done in Scotland is to identify that

:11:11. > :11:14.40% of admissions from 5% of patients. Because those patients are

:11:15. > :11:18.automatically flagged. No matter what they ring up with, they will

:11:19. > :11:23.get a double appointment because it is not just the chest infection or

:11:24. > :11:28.the year in infection, you have to look at how it interferes with

:11:29. > :11:33.everything else. It is not a catastrophe of people living longer,

:11:34. > :11:36.those of us who are medical in-house do remember that was definitely the

:11:37. > :11:41.point of why we went into medicine and that is the point of the NHS.

:11:42. > :11:46.But we are not ageing very well. From about 40 or 50 onwards, people

:11:47. > :11:49.are starting to accumulate conditions that maybe they wouldn't

:11:50. > :11:57.have survived in the past. By the time they are 70, they have four or

:11:58. > :12:01.five things that make treating them a challenge. I have friends still

:12:02. > :12:06.working on the front line and they say it is not even just numbers but

:12:07. > :12:11.complex T. Someone comes with what sounds like an easy issue but in

:12:12. > :12:15.actual fact, with their diabetes and their renal failure and their

:12:16. > :12:18.previous heart attack, it is a complex issue. And this is part of

:12:19. > :12:26.the problem we face. We need to be looking forward to preparing for

:12:27. > :12:30.that. STPs need to be thinking about being designed around old people.

:12:31. > :12:34.Not being designed around young people who can come in and have an

:12:35. > :12:39.operation as a day case and go away. That is not what we are facing.

:12:40. > :12:44.Older people need longer in hospital. Even medically before they

:12:45. > :12:54.reach the point of being able to go home, it will take them a couple of

:12:55. > :12:57.days longer to be strong enough, they probably live alone. They

:12:58. > :13:03.probably do not have family near them. They will need a degree of

:13:04. > :13:08.convalescent support, they will need social care. This is really where

:13:09. > :13:12.the nub of the problem lies, that social care funding has gone down.

:13:13. > :13:17.And therefore more people are stuck in hospital or more people end up in

:13:18. > :13:21.hospital who actually wouldn't have needed to be there in the first

:13:22. > :13:25.place. I'm grateful to her for giving way. In terms of the

:13:26. > :13:31.frailties of older people, just as Scotland led the way with a primary

:13:32. > :13:35.school introducing the daily mile, is there something we can learn from

:13:36. > :13:40.countries like Andorra that have a focus on exercise for older people.

:13:41. > :13:46.So they are not as frail in their 70s and 80s? I think the prevention

:13:47. > :13:51.and public health message is crucial. I think that is one of the

:13:52. > :13:56.other challenges we have. I am grateful the Secretary of State no

:13:57. > :14:00.longer talks about 10 billion because actually, the increase in

:14:01. > :14:04.the Department of Health budget is 4.5 billion, part of that has been a

:14:05. > :14:08.reduction in public health funding. Just at a time where we need to move

:14:09. > :14:12.it to a totally different scale, whether it is children doing the

:14:13. > :14:16.daily mile, adults doing the daily mile, maybe we should run up to

:14:17. > :14:20.Trafalgar Square there and back every lunchtime. I am sure that

:14:21. > :14:25.would do all of us the power of good. We need to invest in these

:14:26. > :14:30.things that prevent. One of the points I would make is that when we

:14:31. > :14:34.end up desperate, and whether it is patching up how the NHS runs or

:14:35. > :14:39.dealing with illnesses we didn't bother to prevent, we always end up

:14:40. > :14:45.spending more money. I am grateful to her for giving way. She knows how

:14:46. > :14:49.much I respect what she is saying and she is the chairman of the

:14:50. > :14:53.all-party running group and I endorse the daily mile and encourage

:14:54. > :14:59.all adults, Park runs are a good example of that. They happen across

:15:00. > :15:04.the nation. My question to her, her huge expertise in Scotland,

:15:05. > :15:08.including NHS England learned from Scotland, what is best practice?

:15:09. > :15:13.Could she give us some example is a best practice in Scotland, hospitals

:15:14. > :15:17.and trusts that we can take away and learn from? I think the whole issue

:15:18. > :15:22.is down to sustainability. That is the idea of the sustainability and

:15:23. > :15:26.transformation plans, those who have heard me speak know that I support

:15:27. > :15:32.the idea in principle. The idea is to go back to place -based planning

:15:33. > :15:37.on an integrated basis for a community. That is what the

:15:38. > :15:42.difference is with Scotland, what we have focused on is integration. We

:15:43. > :15:52.got rid of hospital trusts in 2004, PCTs in the late 2000s, and since

:15:53. > :15:57.April 2014, we set up integrated joint boards. That is a bag of money

:15:58. > :16:01.from the NHS, a bag of money from the local authorities goes on the

:16:02. > :16:05.table and a group sit around and work out what is the best way to

:16:06. > :16:09.deal with that interface and to support social care. Because anyone

:16:10. > :16:14.in this chamber or anyone with family members who have been stuck

:16:15. > :16:17.in hospital, they know that you get into a bickering situation. Mrs

:16:18. > :16:22.Bloggs is in a bed so the local authority are not interested because

:16:23. > :16:26.she is sick, they are busy with Mrs Smith who has just fallen off a

:16:27. > :16:30.ladder trying to put her curtains up and is not considered safe because

:16:31. > :16:39.she is leaving the gas on. You have all this perverse obstruction and

:16:40. > :16:43.that is what gets rid of that. I thank her for giving way, I welcome

:16:44. > :16:48.the tone she brings to this debate, unlike what we saw earlier. One of

:16:49. > :16:50.the points she makes is the importance of integrated care,

:16:51. > :16:55.social and health. Does she believe that with further evolution in

:16:56. > :17:01.England in the major cities, there is a huge opportunity to move that

:17:02. > :17:07.agenda forward south of the border? You I think the whole idea of STPs

:17:08. > :17:11.going to areas, we simply have geographical health wards, that is

:17:12. > :17:16.the only layer we have. We are not wasting huge amounts of money on

:17:17. > :17:20.layers and layers. You can integrate. For an STP to work, it

:17:21. > :17:23.has to make sense geographically and that might be a county, maybe

:17:24. > :17:31.something bigger or smaller. Personally I think they should have

:17:32. > :17:37.a statutory position. We have 211 CCGs, an average of six CCGs for

:17:38. > :17:42.every STP. That is a waste of layers, that is going to be very

:17:43. > :17:48.difficult to integrate. One of the biggest difference is, is we got rid

:17:49. > :17:55.of in 2004, the purchaser provider split. There is no evidence in

:17:56. > :17:59.25-year is of any clinical benefit from the purchaser provider split.

:18:00. > :18:05.The internal market now the external market. It is estimated the cost of

:18:06. > :18:08.running that market are between five and ?10 billion a year. That is

:18:09. > :18:12.money that is not actually going to health care but either going to

:18:13. > :18:19.bidding, tendering, administration or profit. I think, we can't do an

:18:20. > :18:24.overnight change but if we made a principled decision to work our way

:18:25. > :18:30.back to the NHS as the main provider of public health treatment and

:18:31. > :18:36.integration of care through the STP or a macro, I think we could reach a

:18:37. > :18:41.point of sustainability. As I said earlier, you have two actually both

:18:42. > :18:46.protect things like into hospitals and community services. Invest in

:18:47. > :18:50.them. We have rebuilt three cottage hospitals as modern hospitals in our

:18:51. > :18:54.health wards. That is where you want to put an older person on their own

:18:55. > :18:59.with a chest infection who actually needs a few days of antibiotics and

:19:00. > :19:05.TLC and decent feeding. You don't want them in the big hospital, you

:19:06. > :19:08.want them close to home. What we are seeing with the ST people macro is

:19:09. > :19:14.that people seek community hospitals as easy to get rid of. It is only an

:19:15. > :19:18.efficiency saving if what you are getting rid of is inefficiency. If

:19:19. > :19:19.you are slashing and burning, what you are ending up doing is spending

:19:20. > :19:32.more money in the end. Much of what she says is music to my

:19:33. > :19:36.ears, as someone who is campaigning to save the local General Hospital,

:19:37. > :19:43.but I wonder if we could have the benefit of her views on the role of

:19:44. > :19:48.patients and consultation in all of this when considering and

:19:49. > :19:52.transformation plans. Not just consultation in the way it has often

:19:53. > :19:57.been done in the past - here we are, we have made a decision, we are

:19:58. > :20:02.telling you about it. Unfortunately, that is very much what we have heard

:20:03. > :20:06.around the STP process, partly because it has been so short, and

:20:07. > :20:10.partly, another, because it is budget- centred and not patient-

:20:11. > :20:14.centred care. They have all been given a number, and if you are not

:20:15. > :20:20.meeting it, do not bother submitting your plan. That will not give an

:20:21. > :20:23.integrated service. The public also have to be involved, but I think the

:20:24. > :20:28.front line clinicians, they are the people who work in the service. They

:20:29. > :20:36.know where the bottlenecks are, they know where -- they know what is the

:20:37. > :20:42.horseshoe nail that the service is missing that is holding it back, and

:20:43. > :20:46.if you have clinician- led redesign, as I was involved in in my health

:20:47. > :20:50.board 17 years ago the breast cancer, you can end up where you

:20:51. > :20:55.track the part of the patient. You very quickly imagine yourself that a

:20:56. > :21:02.patient, UCD bottlenecks, and that is where you focus investment. I

:21:03. > :21:09.read an article yesterday, -- you see the bottlenecks. I read an

:21:10. > :21:17.article about management consultants coming in advising to shut a board,

:21:18. > :21:24.increase parking spaces, and that was not good value for money for ?2

:21:25. > :21:27.million. I thank her for eloquently pushing issues that face all of us,

:21:28. > :21:30.no matter where we are from. Would she agree with me that the use of

:21:31. > :21:34.good health care data for those clinicians, enabling patients to be

:21:35. > :21:40.seamlessly put through the system are important. Many people don't

:21:41. > :21:49.realise that their information from the GP does not go into the acute

:21:50. > :21:55.service and at the social care. I believe that would help patients. I

:21:56. > :22:02.would not say we are super IT wizards in Scotland, but we did not

:22:03. > :22:09.get involved in the care. Data issue, which is now a shadow over

:22:10. > :22:18.the NHS in England. Nothing goes in the post. All of our letters back

:22:19. > :22:23.are electronic. I block my dictation machine during a clinic and when I

:22:24. > :22:28.finish, they all go away. They are on their way by 2pm. We have already

:22:29. > :22:32.done that. AGP can e-mail my colleagues and say, I do not know

:22:33. > :22:36.whether you need to see this person or not. And what I have heard from

:22:37. > :22:44.clinicians is, we cannot e-mail about a patient. Because of the

:22:45. > :22:49.wrong move around the data service, that is holding things back. Our GPs

:22:50. > :22:53.use a care summary, so if they have a palliative patient, that will be

:22:54. > :22:58.put on the out of our system so that if there is a call about that person

:22:59. > :23:04.who has been accepted as being in terminal care, the doctor already

:23:05. > :23:06.knows. We not throwing them in an ambulance. We're keeping them

:23:07. > :23:14.comfortable. We have had a discussion on the aim is for them to

:23:15. > :23:18.be at home. It is about sharing information, which is the first

:23:19. > :23:24.step, and that is something that England has to get. In finishing

:23:25. > :23:32.off, I think, really, integration... I'm sorry if I was taking too long

:23:33. > :23:38.for the lady at the back. I think, really, integration is the key, and

:23:39. > :23:43.it is possible, through the STPs, but only if they are designed around

:23:44. > :23:51.patients, safety and services, and not just starting with a bottom line

:23:52. > :23:55.and working backwards. Order. Before I call the next speaker, it will be

:23:56. > :23:59.obvious to colleagues that there are a great many people who wish to

:24:00. > :24:03.speak this afternoon, and that the debate although it has advanced a

:24:04. > :24:08.long way in time, has not advanced very far as far as the number of

:24:09. > :24:18.people called is concerned, so we now have to have a time limit of ten

:24:19. > :24:27.minutes. Surely less. I can see there was some surprise at that. Ten

:24:28. > :24:31.minutes for the moment. Anyone who can do arithmetic will be aware that

:24:32. > :24:35.it will need to be reduced later, so I suggest starting working on your

:24:36. > :24:41.speeches now. Doctor Sarah Wollaston. Thank you, Madam Deputy

:24:42. > :24:47.Speaker, and I will be mindful of those comments. Thank you for the

:24:48. > :24:53.member's thoughtful and thought-provoking comments. I would

:24:54. > :25:00.like to endorse what she said and expand on some of those points. We

:25:01. > :25:03.have heard that NHS staff are facing unprecedented demand over the

:25:04. > :25:06.winter, but the point is, it is not just winter pressures, they are

:25:07. > :25:10.extending into the summer. As we heard, it is not just about numbers

:25:11. > :25:18.but about the complexity and the frailty of those who are presenting

:25:19. > :25:26.in our A departments. The 4-mac- our target -- the four-hour target,

:25:27. > :25:33.the trusts that were most successful in getting close to that target are

:25:34. > :25:37.those that see this as a systemic issue where both health and care

:25:38. > :25:40.staff are all contributing to this, not just some box ticking exercise,

:25:41. > :25:46.but because they recognise that fundamentally this is an issue about

:25:47. > :25:50.patient safety and about the quality of patient experience. That is why

:25:51. > :25:54.the target matters and the Secretary of State is right to endorse that. I

:25:55. > :25:59.think he is also right to raise the fact that sometimes we need to be

:26:00. > :26:03.more nuanced about our targets and to be able to be open to listening

:26:04. > :26:07.to what clinicians are telling him about how we can improve the way

:26:08. > :26:16.targets are applied. I think it would be a great shame if in this

:26:17. > :26:23.House, because of political for raw Ballance political upheaval, we fail

:26:24. > :26:26.to have those discussions. I would urge the Secretary of State to

:26:27. > :26:31.listen to clinicians in terms of where we can improve targets. He has

:26:32. > :26:35.made it clear that we are right to keep the four-hour target. I would

:26:36. > :26:40.also like to say, in talking about this as a whole system issue, of

:26:41. > :26:44.course, with accident and emergency, it is a barometer, as my honourable

:26:45. > :26:49.friend has pointed out, for wider system pressures. I would like to

:26:50. > :26:53.focus my remarks on integration of health and social care, and also,

:26:54. > :26:57.with those colleagues across this House who have called for a

:26:58. > :27:01.convention in how we review the funding of this as a whole system

:27:02. > :27:05.issue, we have heard it is the 70th birthday of the NHS next year, and

:27:06. > :27:09.what could be a better president than politicians changing the debate

:27:10. > :27:16.and the way we talk about funding of health and social care, and to do so

:27:17. > :27:20.in a collaborative manner that works out the right solution for our

:27:21. > :27:25.patients? The consequences of us not doing that are really profound for

:27:26. > :27:30.our constituents, and they won't thank us for not being prepared to

:27:31. > :27:34.put aside party differences and work towards the right solution, because

:27:35. > :27:38.ultimately, this is about a demographic change that we are

:27:39. > :27:44.simply not prepared for. We did this for pension age, recognising that

:27:45. > :27:52.had to be a different debate, given the change in longevity. Over the

:27:53. > :27:56.decade to 2015, we have seen a 31% increase in the number of those

:27:57. > :28:00.living to 85 and older, and of course, that is a cause for

:28:01. > :28:08.celebration, but what we are not seeing is a commensurate increase, a

:28:09. > :28:12.matching increase, in the disease- free life expectancy. Unfortunately,

:28:13. > :28:17.we are also not making sufficient progress on tackling inequality. And

:28:18. > :28:21.I welcome the Prime Minister's focus on that. In her very first speech,

:28:22. > :28:25.she talked about the burning injustice of health inequality and

:28:26. > :28:30.tackling that, but I believe we have a role in this House in doing that

:28:31. > :28:38.together in a consensual manner. I give weight to my right honourable

:28:39. > :28:44.friend. I thank the honourable lady for allowing me to intervene. Does

:28:45. > :28:48.she share my welcomer the Prime Minister's response today that she

:28:49. > :28:52.is prepared to meet with us and other members of Parliament from

:28:53. > :28:57.across this house with the hope that this might start a more constructive

:28:58. > :29:00.approach? I thank the right honourable gentleman. Absolutely, I

:29:01. > :29:04.thought it was extraordinarily encouraging to hear the Prime

:29:05. > :29:09.Minister prepared to consider the centimetre with us across the House.

:29:10. > :29:14.I would urge colleagues who feel this is a better way forward to sign

:29:15. > :29:18.up to this and two, themselves, speak to their party whips and make

:29:19. > :29:25.it clear that there is widespread support for considering this. I give

:29:26. > :29:28.way. I wonder if on this vital issue the honourable lady wants to say

:29:29. > :29:33.something about what her own party did admit to my previous times when

:29:34. > :29:36.we have tried to get important cross-party working on health and

:29:37. > :29:43.social care, in that once they made it an election issue and produced

:29:44. > :29:47.posters on a death tax, and the second time just walked away from

:29:48. > :29:54.talks. This is exactly not the kind of debate we want to be having.

:29:55. > :29:59.Let's look to the future and say that where we are now, if the

:30:00. > :30:04.honourable lady would let me finish, what I would say now is that we are

:30:05. > :30:08.in a different part of the electoral cycle, and whilst I accept her

:30:09. > :30:13.comments, I was still a clinician in the NHS at the time that that

:30:14. > :30:20.happened, and I, like many of those who work in health and social care,

:30:21. > :30:23.look at this place and think... I watch the debate we have here and

:30:24. > :30:26.think, surely there has to be a better way. I would ask the

:30:27. > :30:30.honourable lady perhaps to put that aside and look to the future rather

:30:31. > :30:34.than be looking backwards, because I don't think we're going to get

:30:35. > :30:38.anywhere, so I think what our constituents want us to do as

:30:39. > :30:42.politicians is to recognise the scale of the challenge and get to

:30:43. > :30:46.grips with it. I am going to take one more intervention, then I am

:30:47. > :30:50.conscious of time. I thank the honourable lady for giving way.

:30:51. > :30:55.Looking to the future, would you not agree with me that there should be a

:30:56. > :30:58.new funding settlement, certainly in terms of the budget for the NHS and

:30:59. > :31:04.social care, and bring both together? At the moment, we have had

:31:05. > :31:10.cuts of 4.6 billion. That is exactly what I hope. We must end the silos

:31:11. > :31:14.of health and social care, thinking of this money being a health pound

:31:15. > :31:19.or a social care pound, and think of it as a patient pound and a taxpayer

:31:20. > :31:22.pound, and how we get the best from that, which brings me onto a point I

:31:23. > :31:27.would like to raise directly with the Secretary of State. There is an

:31:28. > :31:31.example that has happened in my constituency. There is the Torbay

:31:32. > :31:36.and South Devon NHS Foundation Trust, which has formed an

:31:37. > :31:41.integrated care organisation. Across health and social care, there are

:31:42. > :31:45.people, passionate people, about this, who sweated blood to get this

:31:46. > :31:52.organisation off the ground. They recognise the benefits. It is talk

:31:53. > :31:54.about not just nationally but internationally, a recognised way of

:31:55. > :31:59.doing this better bust I regret to say that because of the scale of the

:32:00. > :32:03.financial pressure on the ICO, what we are now hearing is that the NHS

:32:04. > :32:07.is pulling out of the risk sharing agreement next year. I'm afraid this

:32:08. > :32:13.is totally unacceptable. I hope the Secretary of State meet with me to

:32:14. > :32:16.discuss the pressures facing the ICO, because it has achieved the

:32:17. > :32:25.kind of things we're talking about in this debate. They can have their

:32:26. > :32:28.pooled risk sharing and working together to genuinely get people out

:32:29. > :32:32.of hospital more rapidly who do not need to be there ban is happening in

:32:33. > :32:38.other various, to put people from social care into hospitals to see

:32:39. > :32:41.how we can speed that process up, and unfortunately, if that risk

:32:42. > :32:45.share falls apart, we will see one of the key pillars of how we want to

:32:46. > :32:50.improve the flow through hospitals and at the other end breaking down.

:32:51. > :32:55.Part of the reason, as I understand it, is, unless the control totals

:32:56. > :33:00.are met, what is put at risk if the funding that they are hoping to use

:33:01. > :33:03.to improve the facilities in the accident and emergency department,

:33:04. > :33:07.because the challenge for Torbay isn't the way they work together to

:33:08. > :33:11.get people out of hospital, it's the facilities at the front door, and

:33:12. > :33:15.they could do so much there. We have this odd paradox that we could end

:33:16. > :33:20.up improving the facilities at the front door but worsening the ability

:33:21. > :33:24.of the facility to respond at the point where we are trying to get

:33:25. > :33:26.people cared for in the community. I would say a certain degree of

:33:27. > :33:30.financial challenge would have the effect of bringing health and social

:33:31. > :33:34.care organisations to work more closely together because they know

:33:35. > :33:39.it makes sense, but when there are unrealistic targets being set, and

:33:40. > :33:42.what we can find is that we can go the other way and it starts to mean

:33:43. > :33:46.that people have to retreat to protect their budget silos. I have

:33:47. > :33:49.the Secretary of State will look closely at what is happening there

:33:50. > :33:53.and meet with me to discuss whether or not we can't just get this back

:33:54. > :33:57.on track again for next year. Although I am confident that the

:33:58. > :34:03.local authority and the NHS staff -- the NHS staff and those in the trust

:34:04. > :34:06.will continue to work together. They have an extraordinary tradition of

:34:07. > :34:10.doing so. I think there are threats, and as I say, I hope they can be

:34:11. > :34:13.addressed, because this is about the entire flow from the front door

:34:14. > :34:17.right the way through to getting people cared for back at home, but

:34:18. > :34:22.more widely, there is an issue here that we now have more than 1 million

:34:23. > :34:27.people who are not able to receive the care that they need in

:34:28. > :34:32.communities. In my area, we have a prime provider in special measures,

:34:33. > :34:36.and these are financial issues. Yes, there is much the NHS can do that

:34:37. > :34:40.isn't about money. We know there is a lot of variation that can't be

:34:41. > :34:43.explained just by financial challenge and demographics alone,

:34:44. > :34:48.but finance is inevitably part of this. Finance and workforce - these

:34:49. > :34:51.are the key challenges we face, and we have to work together across all

:34:52. > :34:55.parties, in my opinion, to achieve that.

:34:56. > :35:04.In closing, on a slightly separate point, let me raise the front page

:35:05. > :35:07.of the Times newspaper today which I think his extraordinary

:35:08. > :35:13.disappointing. This is the second time we've seen a major national

:35:14. > :35:17.newspaper reporting events the Chief Executive of the NHS, Simon

:35:18. > :35:21.Stephens. I would like to invite the Secretary of State or the minister

:35:22. > :35:25.closing the debate to unequivocally support the Chief Executive of the

:35:26. > :35:30.NHS. What he is doing, when it comes to a select committee, as chair I

:35:31. > :35:34.ask him to respond to a question, I expect him to be truthful and

:35:35. > :35:39.transparent in his answers and I think that he should be commended

:35:40. > :35:43.for doing so, and not find himself the subject of briefings. I would

:35:44. > :35:51.invite someone to unequivocally support him and ask for best to

:35:52. > :35:57.stop. Dame Rosie Winterton. Thank you. Thank you Madam Deputy Speaker.

:35:58. > :36:04.I think that the debate so far has shown the huge level of concern from

:36:05. > :36:09.the public and from NHS staff, about the crisis in the NHS and social

:36:10. > :36:15.care. And, I would say that I think the honourable member reflected some

:36:16. > :36:19.of the views of the select committee, but I would ask all

:36:20. > :36:26.members opposite to really take seriously these concerns, and not

:36:27. > :36:31.dismiss them. All honourable member 's must surely be getting

:36:32. > :36:37.representations from staff, and from patients. About what is happening

:36:38. > :36:41.locally. I would like to pay tribute to all health and social care staff

:36:42. > :36:47.in Doncaster, particularly at Doncaster Royal Infirmary whose work

:36:48. > :36:54.I've seen first-hand and I know how dedicated and committed they are to

:36:55. > :36:59.caring for patients in the most difficult of circumstances. At the

:37:00. > :37:04.end of December, they've managed to achieve 90% against the 95% I get

:37:05. > :37:10.and had good ambulance hand the times, as well are as good support

:37:11. > :37:15.from the council and partners. But they are facing real pressures and

:37:16. > :37:20.are fearful about pressure is still to come, especially if there is a

:37:21. > :37:23.cold spell, as predicted. That is why the mixed messages from the

:37:24. > :37:30.secretary of state have been extremely damaging. Madam Deputy

:37:31. > :37:34.Speaker, I was the health minister for four years and had

:37:35. > :37:40.responsibility for emergency care. I know how important it is to work

:37:41. > :37:47.with NHS staff to help to implement targets, and not give the impression

:37:48. > :37:54.that the NHS is somehow giving up on those targets. The lead from the top

:37:55. > :37:59.is incredibly important. There has was been controversy about targets.

:38:00. > :38:04.But, as health minister, I have visited many A departments. There

:38:05. > :38:12.is absolutely no doubt in my mind that the A target has led to

:38:13. > :38:16.improved care for patients and dramatically reduced the waiting

:38:17. > :38:22.times, which the evidence has shown and has been clear. That is what

:38:23. > :38:28.happened. One of the striking things about those visits was seeing how

:38:29. > :38:32.consultants, nurses, ambulance teams, all members of the health

:38:33. > :38:37.care team while working together. They would work out protocol so

:38:38. > :38:42.that, for example, nurses could take over some of the work that had

:38:43. > :38:49.previously been done by consultants. Nurse practitioners and emergency

:38:50. > :38:56.care consultants. So, they could ease the burden and share between

:38:57. > :39:01.the team the work that was needed. Triage became the norm. Seeing who

:39:02. > :39:07.needed treatment urgently from a consultant, and who could be seen by

:39:08. > :39:12.a nurse practitioner. I would always ask staff, is the target getting in

:39:13. > :39:16.the way? Or, is it helping? Invariably, the answer would come

:39:17. > :39:20.back that it is helpful in making us work together more effectively. I

:39:21. > :39:24.vividly remember a nurse practitioner saying, please do not

:39:25. > :39:28.abandon the target because it is making the consultants sit down with

:39:29. > :39:32.us and look at the whole team. And for patients, the difference is

:39:33. > :39:39.crucial. For their working life as well, they were not seeing patients

:39:40. > :39:41.who had been sitting around for hours and hours and were feeling

:39:42. > :39:48.very depressed and tomorrow lowest. That made the difference to the

:39:49. > :39:52.health care team as well. -- and demoralised. As well as improving

:39:53. > :39:57.care for the patients. I will give way... With the right honourable

:39:58. > :40:02.lady agree that it is not so much meeting the target which is

:40:03. > :40:06.important but getting patients seen quickly, expeditiously and well.

:40:07. > :40:13.And, there is not an A Department in this country who does not want to

:40:14. > :40:16.improve its position in a league table of response times. They all

:40:17. > :40:24.want to do that and the difference which now applies did not apply

:40:25. > :40:29.quite so much when she was Minister, but that level of comparison is much

:40:30. > :40:33.better. I ever so gently suggest that whilst a four-hour target was

:40:34. > :40:36.important when she was Minister, that importance has degraded over

:40:37. > :40:41.time because everyone is trying to see patients more quickly? I do not

:40:42. > :40:50.agree with the honourable gentleman on that. I think that the experience

:40:51. > :40:55.of implementing the four our target led to much better diagnosis of the

:40:56. > :41:01.type of treatment that people needed -- four hour. Also better

:41:02. > :41:05.interaction with the community. Let me come onto that, I also think the

:41:06. > :41:08.secretary of state and maybe the honourable gentleman is guilty of

:41:09. > :41:16.that as well, was trying to separate the target within the accident and

:41:17. > :41:20.emergency department from what went on outside that. I see the

:41:21. > :41:23.importance and putting the two together and I would like to say

:41:24. > :41:27.something about that because providing the alternative treatment,

:41:28. > :41:31.which is maybe what he is getting out, means proper support from the

:41:32. > :41:36.community and it is bringing those two together which makes it possible

:41:37. > :41:41.to achieve the target but it was a driver. I give way to the honourable

:41:42. > :41:45.lady who I know has some experience. In my experience in working to try

:41:46. > :41:49.to meet the four-hour target, there's often an emphasis... In the

:41:50. > :41:53.past there was one, and emphasis which took priority over everything

:41:54. > :41:58.else including patient care and clinical need, sometimes it was

:41:59. > :42:02.abused. Huge pressure was put onto staff to meet that four-hour target

:42:03. > :42:07.and patient care suffered, I have seen it myself, it has suffered as a

:42:08. > :42:12.result of to meet targets. What I would say is that I think it is a

:42:13. > :42:16.way... It is always important, I did this as the health Minister, to look

:42:17. > :42:22.out for the feedback from clinicians was. I can see, because it was

:42:23. > :42:27.starting during my time as health minister, that we constantly had to

:42:28. > :42:30.look at whether what was the 95% target, whether there was clinical

:42:31. > :42:33.reason as to why there should be a reduction on that. It became clear

:42:34. > :42:37.that there were some patients who needed longer to be assessed,

:42:38. > :42:43.because of their particular condition. I can see that is why it

:42:44. > :42:47.would be reduced to 95% but the point that I am making is that it

:42:48. > :42:51.was based on the clinical need and I think what happened last week was

:42:52. > :42:56.the impression was given that it was, my goodness, we had to cope

:42:57. > :43:03.with winter pressures, let's reduce the target in order to meet it,

:43:04. > :43:08.rather than make an assessment about clinical need, I think it is

:43:09. > :43:14.completely the wrong message for the NHS and I think that was the wrong

:43:15. > :43:22.thing to do. I want to briefly set out some areas where I think we can

:43:23. > :43:30.bring the community input together with what is happening in emergency

:43:31. > :43:39.departments themselves, in order to produce some of the pressures. I

:43:40. > :43:42.think the first point was made by my honourable friend from the front

:43:43. > :43:51.bench, social care is absolutely vital in ensuring that people do not

:43:52. > :43:55.end up in A, good social care. I have previously raised problems that

:43:56. > :44:01.I think the current proposition by the government to, in a sense, move

:44:02. > :44:03.responsibility to local councils to raise the money, is particularly

:44:04. > :44:08.unfair in areas like mine because they simply cannot raise through a

:44:09. > :44:15.council preset the same amount of money as can be made in other less

:44:16. > :44:19.deprived... Better off areas. It simply does not work. We needed

:44:20. > :44:28.probably more than any other area but our ability to raise money will

:44:29. > :44:32.be less. I've been speaking to NHS staff in Doncaster, senior staff,

:44:33. > :44:38.and there are some real problems in terms of the emergency care

:44:39. > :44:42.staffing. What they are telling me is that it will take years, and

:44:43. > :44:46.there are more doctors being trained, I accept that, but it will

:44:47. > :44:54.take years for those to come through and the single most effective thing,

:44:55. > :45:00.the most effective step, to ease the pressure at the moment and A

:45:01. > :45:06.departments would be to immediately increase funding into social care.

:45:07. > :45:09.Because, that would keep people away from accident and emergency

:45:10. > :45:15.departments, and that could be done straightaway. There are the personal

:45:16. > :45:20.out there but it just needs the government to make the decision, as

:45:21. > :45:25.my honourable friend from the front bench said, to increase funding.

:45:26. > :45:29.Secondly, we had to look seriously at the problem with GP shortages,

:45:30. > :45:33.because again, as others have said, if a patient is waiting three weeks

:45:34. > :45:37.for an appointment with a GP, they are bound to end up in A This is

:45:38. > :45:41.something which needs to be addressed quickly with proper,

:45:42. > :45:51.forward looks at exactly where the gaps are occurring in GP services. I

:45:52. > :45:56.have said before that I think PCTs, or the care commissioning groups

:45:57. > :46:00.now, or NHS England, should take over practices and employ salaried

:46:01. > :46:06.GPs which would make a huge difference. Community pharmacists,

:46:07. > :46:10.again, if people had confidence that going to the pharmacy would save

:46:11. > :46:14.them a visit to A, that would relieve pressure on the system. I

:46:15. > :46:18.hope that the minister can assure us that he is looking seriously at the

:46:19. > :46:22.community pharmacy forward view which sets out how pharmacists can

:46:23. > :46:29.be integrated into the NHS and social care. Whilst I have him here,

:46:30. > :46:32.I do want to touch briefly on mental health, because the Prime Minister

:46:33. > :46:37.answered a question today about mental health and the crisis people

:46:38. > :46:40.can get into where they end up in A She particularly talked about

:46:41. > :46:45.young people and I would urge the Minister to look at the role and

:46:46. > :46:52.educational psychologists can play in mental health for children and

:46:53. > :46:59.not then ending up in A Finally, I do also want to say that one of

:47:00. > :47:05.the things in my experience of a health minister was that you needed

:47:06. > :47:10.people on the ground locally, to help the organisations across the

:47:11. > :47:15.whole spectrum. Local government through social care, pharmacists,

:47:16. > :47:23.GPs, ambulances, working with A departments. That reorganisation,

:47:24. > :47:29.the ?2 billion reorganisation which took away PCTs and SHAs, that has

:47:30. > :47:34.made it much more difficult, the changes that are needed. I hope that

:47:35. > :47:38.the Minister will look seriously at how it is happening because local

:47:39. > :47:43.knowledge can be vital in these circumstances. So, I believe that

:47:44. > :47:47.from the contribution to the secretary of state, it seems as

:47:48. > :47:52.though he was trying to use every excuse not to face up to the reality

:47:53. > :47:58.of what is happening, and I think it sends a terrible message to NHS

:47:59. > :48:02.staff, and I hope that as a result of the debate today, the concerns

:48:03. > :48:06.which have been raised will be taken on board by ministers and the

:48:07. > :48:09.Secretary of State, and they will come back to the house with a proper

:48:10. > :48:16.plan which recognises the problems and offers real solutions.

:48:17. > :48:25.The house was right to assume that ten minutes per person is

:48:26. > :48:30.unsustainable, after the next speaker I will reduce the time limit

:48:31. > :48:34.to seven minutes. But the time limit remains, the house will be very glad

:48:35. > :48:44.to know, at ten minutes first Sir Simon Burns. Thank you, Madam Deputy

:48:45. > :48:48.Speaker. I welcome the debate today, to have the opportunity to discuss

:48:49. > :48:52.an issue which is extremely important to all honourable members

:48:53. > :49:00.on all sides of the house, because there is a significant problem

:49:01. > :49:05.during the recent weeks because of the extra increasing number of

:49:06. > :49:11.people needing services at A and from the health services locally. I

:49:12. > :49:15.would like to pay tribute to the magnificent work often in very

:49:16. > :49:21.difficult circumstances that doctors, nurses, consultants and

:49:22. > :49:26.other staff, and people in general practice, carry out on a day-to-day

:49:27. > :49:30.basis, not simply during a winter crisis period, but throughout the

:49:31. > :49:36.year, looking after people to the best of their abilities. I think

:49:37. > :49:40.that my own hospital, Broomfield Hospital in Chelmsford, is in

:49:41. > :49:47.difficult circumstances and doing a fantastic job to provide the best

:49:48. > :49:51.possible care in good times and more difficult times, and I am certainly

:49:52. > :49:56.aware as a constituency MP that there are been some problems for

:49:57. > :50:02.some of my constituents in the last week or so because of the demands

:50:03. > :50:07.and pressures but we have to look at what we can do to move forward in a

:50:08. > :50:14.positive, not partisan, politicised way. To make sure that our

:50:15. > :50:18.constituents get the best treatment is possible.

:50:19. > :50:26.There is no point in just shouting, as my honourable friend, the cherub

:50:27. > :50:33.a health select committee said, and engaging in -- the chair of the

:50:34. > :50:38.health select committee said, in engaging in yah boo politics. I have

:50:39. > :50:43.to say, I am extremely proud of the record of this Government in the way

:50:44. > :50:49.it has been committed to funding the NHS over the last seven years, and

:50:50. > :50:55.its commitments for the next three or four years. We made sure when we

:50:56. > :50:57.came into office at a time of austerity, where Government

:50:58. > :51:03.department budgets were cut, that the health Department budget was one

:51:04. > :51:09.of the few departments whose budgets were protected so that they got a

:51:10. > :51:17.real terms increase in funding every year since we came into power,

:51:18. > :51:22.albeit, I will accept, it was a modest real terms increase, but it

:51:23. > :51:27.showed our commitment and our intent to invest in improving the National

:51:28. > :51:30.Health Service. I am also proud of the fact that I and all my

:51:31. > :51:35.honourable and right Honourable friends on this side of the House

:51:36. > :51:39.fought the last general election on a commitment that we were going to

:51:40. > :51:43.substantially, over the five-year period of this Parliament, increase

:51:44. > :51:50.funding on the NHS to what has turned out to be bit chewed up ?10

:51:51. > :51:56.billion, which is more, I say in a very gentle way, than was on offer

:51:57. > :52:02.to the country from certain other parties. I am also pleased that my

:52:03. > :52:05.right honourable friend, the Secretary of State, and the Minister

:52:06. > :52:13.of State for health, have been planning for any potential strains

:52:14. > :52:20.on demand during this winter period with the provision of ?400 million

:52:21. > :52:28.to local health economies, and other measures like the vaccination

:52:29. > :52:32.programme, a preventative measure to get a record number, 30 million

:52:33. > :52:38.people, vaccinated to try to offset some of the potential health

:52:39. > :52:42.problems that can flow during a winter period. That is using

:52:43. > :52:50.foresight, that is using planning to try and minimise problems, and at

:52:51. > :52:53.the same time, providing funding to back up their actions, and that is

:52:54. > :53:04.what a responsible Department of Health should do and has done. Now,

:53:05. > :53:10.you can demand as much money as you like for the health service, but my

:53:11. > :53:16.argument is that, yes, the health service does have to have extra

:53:17. > :53:22.money, year in, year out but it shouldn't just be thrown at an

:53:23. > :53:28.issue. There is a far bigger part of the equation, and that is building

:53:29. > :53:32.upon the performance and the standards and the quality of care

:53:33. > :53:40.that that health service is going to provide to our constituents. Very

:53:41. > :53:44.briefly... I thank the honourable member, and I absolutely agree with

:53:45. > :53:49.what he is saying about increased resources, but would he agree that

:53:50. > :53:53.we need more resources now for integrated health and social care,

:53:54. > :53:57.and this is the time to remove the NHS as a political football and have

:53:58. > :54:02.a cross-party review? I certainly agree that under the leadership of

:54:03. > :54:06.the Department of Health, we should work with anyone and everyone to

:54:07. > :54:16.come up with a solution. I was the Minister for social care in the late

:54:17. > :54:19.1990s, before we left office, where integrating health and social care

:54:20. > :54:25.was in its very early, formative stage. And the ambitions were

:54:26. > :54:33.immense and tremendous. I'm afraid, the reality has not matched the

:54:34. > :54:40.ambitions of what was being said in the 1990s, and that is why I was

:54:41. > :54:43.particularly interested in hearing the comments of my honourable

:54:44. > :54:49.friend, the chair of the select committee. Because yes, we have to

:54:50. > :54:53.look at that, but we also have to look, pushing the funding side to

:54:54. > :54:58.one side for the moment, is building on the work that my right honourable

:54:59. > :55:02.friend, the current Secretary of State for Health, has particularly

:55:03. > :55:07.invested in, which is patient safety and raising standards and dignity

:55:08. > :55:14.for patients in our hospitals and throughout the health system. And

:55:15. > :55:17.also making sure that we cut out waste and inefficiency is. Now,

:55:18. > :55:23.there was the Nicholson challenge when I was at the Department of help

:55:24. > :55:29.the second time round, in 2010. The challenge was, over three or four

:55:30. > :55:35.years, to save ?20 billion by cutting out waste, by sharing best

:55:36. > :55:47.practice to improve the quality of care, and I know from the bait just

:55:48. > :55:52.before Christmas that the NHS achieved ?19.4 billion worth of

:55:53. > :55:58.those savings. The beauty of that was, not only was it creating

:55:59. > :56:03.greater effectiveness and efficiency in the delivery of health care and

:56:04. > :56:10.sharing best practice, but it also didn't mean that the Treasury got

:56:11. > :56:16.?19.4 billion that they could spend or do with as they wished. It was

:56:17. > :56:23.?19.4 billion that was reinvested in patient care. Yes. Was it not the

:56:24. > :56:29.case that a significant proportion of that was due to wage freezes for

:56:30. > :56:33.NHS medical and nursing staff, and therefore that is not something that

:56:34. > :56:39.can easily be repeated? The honourable lady is absolutely right

:56:40. > :56:44.that if you are earning under ?20,000... Sorry, if you are earning

:56:45. > :56:49.over ?20,000 a year, there was a wage freeze, but that was in keeping

:56:50. > :56:53.with the policy throughout the public sector, including members of

:56:54. > :56:58.Parliament and ministers. The important thing was that they were

:56:59. > :57:03.able, by a variety of means, one of them was a pay freeze, but others

:57:04. > :57:12.were by improving the delivery of service, cutting out inefficiencies,

:57:13. > :57:18.in effective ways of operating and getting rid of almost 20,000 surplus

:57:19. > :57:23.managers so that you can then concentrate on having clinicians,

:57:24. > :57:29.nurses, ancillary workers and everyone else to work towards

:57:30. > :57:39.patient care, that achieved that. And that is the right way forward.

:57:40. > :57:42.We cannot give up on that in also continuing to see if we can... I am

:57:43. > :57:50.about to finish, I'm afraid. Finally, a lot has been said about

:57:51. > :57:57.the STP programme. We had one in mid and South Essex. I have to say that

:57:58. > :58:00.I strongly support it, because it is completely focused on improving and

:58:01. > :58:08.enhancing the quality of accident and emergency care. What annoys me

:58:09. > :58:13.is those who wish to politicise it for grubby political reasons. It

:58:14. > :58:19.involves, and funnily enough, I am not talking about honourable members

:58:20. > :58:24.opposite. It involves three hospitals, with three A

:58:25. > :58:30.departments. The proposals, not one of those A departments will be

:58:31. > :58:34.close, yet, as soon as the proposals were put out, and on the assumption,

:58:35. > :58:41.correctly I suspect, that most people have not read the proposals,

:58:42. > :58:44.the word went out that my local A department was going to be closed

:58:45. > :58:51.down by the Department of Health because of this nasty Government's

:58:52. > :58:58.proposals to save money. The exact opposite was the case. If one read

:58:59. > :59:02.the documents, all three A are remaining open. What is happening,

:59:03. > :59:07.and it is building on what happens now, is that if you have a heart

:59:08. > :59:12.attack, you are taken immediately to Basildon Hospital, because that is

:59:13. > :59:17.the specialist for cardiothoracic treatment. If you need treatment for

:59:18. > :59:20.burns up plastic surgery, you come to Broomfield Hospital in

:59:21. > :59:25.Chelmsford, because that has one of the finest units in the of Europe.

:59:26. > :59:31.If you have head injuries, you will go down to the east of London, to

:59:32. > :59:35.Romford, because that is a specialist area for people with head

:59:36. > :59:40.injuries. Now, if I had any of those conditions, I would want, for me or

:59:41. > :59:44.my constituents, the best possible treatment from the best experts

:59:45. > :59:48.available, and that is what is happening. And that will be built

:59:49. > :59:55.upon, enhanced and improved. That is an improvement, that is not a cut.

:59:56. > :00:00.That is not taking away services from local communities. But for

:00:01. > :00:08.those people who have an agenda where they want to play politics,

:00:09. > :00:13.they will tell people anything, in the hope it will frighten them, to

:00:14. > :00:18.try to discredit the work of the NHS. So, I am pleased we've had the

:00:19. > :00:27.opportunity to discuss this matter also it is very tricky, there was no

:00:28. > :00:30.simple answer. It is not unique. We frequently have winter crises,

:00:31. > :00:32.particularly because of the ageing population and the increasing demand

:00:33. > :00:38.that the health service has had to deal with in recent years. But we

:00:39. > :00:44.must not lose sight of the fact that we have an NHS and a Government that

:00:45. > :00:51.is determined to further improve and enhance the quality of care, the

:00:52. > :00:56.safety and the standards of care, for all our constituents, aided and

:00:57. > :01:03.abetted by a first-class service that is working under very difficult

:01:04. > :01:08.circumstances often. Thank you, Madam Deputy Speaker. It is very

:01:09. > :01:13.important to talk more widely about the NHS, about its importance, its

:01:14. > :01:19.funding, and perhaps about its organisation too, but today's debate

:01:20. > :01:23.is to bring focus to the current crisis in many parts of our National

:01:24. > :01:27.Health Service, and to ask the Government to do something about it.

:01:28. > :01:32.Undoubtedly, our National Health Service is highly valued. It has a

:01:33. > :01:37.dedicated staff, and it provides excellent services, but in many

:01:38. > :01:41.parts of the country, it is under pressure, and today's debate does

:01:42. > :01:46.call for specific actions to address the crisis. It calls for more

:01:47. > :01:51.funding for social care now, and it calls for an improved settlement for

:01:52. > :01:55.both the National Health Service and social care in the next budget. So,

:01:56. > :01:59.in our general discussion about how things might be reorganised and

:02:00. > :02:03.changed in the future, it's very important not to lose focus on the

:02:04. > :02:09.current problems, and those are the reasons for today's debate. That has

:02:10. > :02:12.been -- there has been a lot of discussion about what is happening

:02:13. > :02:18.in hospitals, and inevitably that will be so, because that is where

:02:19. > :02:23.there is, in many areas, a crisis in A, and great pressure on hospital

:02:24. > :02:29.services. But there has also been reference to services provided by

:02:30. > :02:33.our health service outside of hospitals - community services - and

:02:34. > :02:36.it is important to focus on them as well, not just because they are

:02:37. > :02:40.important in their own right, that because if they are working

:02:41. > :02:44.effectively, they can prevent hospital admissions and indeed

:02:45. > :02:48.improve people's health. Those services include community health

:02:49. > :02:56.services. That involves the GP services, the absolute bedrock of

:02:57. > :03:03.our national health service, nurses, physios and pharmacies. The National

:03:04. > :03:10.Health Service does have some responsibility, but local

:03:11. > :03:14.authorities, currently under ever increasing pressure, Opera narrowly

:03:15. > :03:17.responsible for social care. I am concerned about the cats that the

:03:18. > :03:22.Government has imposed on community pharmacists. Pharmacists are

:03:23. > :03:26.absolutely essential to our National Health Service. They are part of the

:03:27. > :03:32.NHS, they are privately run, in the name. They offer advice as well as

:03:33. > :03:36.specific services, and they can often prevent people having to go,

:03:37. > :03:41.not just a hospital, but to their local GP, where the pharmacist is

:03:42. > :03:46.able to give proper advice and services. It is of great concern

:03:47. > :03:50.that the Government's plan for cuts to community pharmacists will put

:03:51. > :03:56.pharmacies in areas like mine, in Liverpool, at risk. I also deplore

:03:57. > :04:01.the reduction in independent pharmacists who provide such an

:04:02. > :04:05.excellent service. So, I do ask the Government to think again about its

:04:06. > :04:09.cuts to community pharmacies, a vitally important part of our health

:04:10. > :04:13.service. When they are closed, it will be far too late. The Government

:04:14. > :04:19.should act now and should not go ahead with those cuts, which will

:04:20. > :04:22.have a dramatic effect on places such as Liverpool and other places

:04:23. > :04:27.in the country. I also asked honourable members to think more

:04:28. > :04:31.about social care and what is happening. In Liverpool, we're

:04:32. > :04:38.facing a major crisis in social care. As local authority funding has

:04:39. > :04:45.been cut severely, and is to be cut again. 58% of Liverpool City

:04:46. > :04:51.Council's budget has already been cut, and ?90 million more of savings

:04:52. > :04:53.is demanded of the next three years, half of that to be achieved in the

:04:54. > :05:04.next year. There has been a reduction in social

:05:05. > :05:10.care provision. Social care packages reduced from 40,000 to 9000, many

:05:11. > :05:15.more cuts in the pipeline. Providing social care is essential, not just

:05:16. > :05:20.to enable people to leave hospital when they are healthy and ready to

:05:21. > :05:27.leave, that is a very important issue. But also, to enable people to

:05:28. > :05:30.live a constructive life. There are many people who are currently

:05:31. > :05:35.fearful of impending and possible cuts to their social care packages.

:05:36. > :05:39.Who believe that they will not be able to live reasonable lives within

:05:40. > :05:44.their own home if essential services are cut. I asked the government to

:05:45. > :05:51.again think about what they are doing and telling us that the better

:05:52. > :05:57.care fund is an answer is not the case, in Liverpool, ?35 million is

:05:58. > :06:01.promised for the fund in the coming years but that will only scratch the

:06:02. > :06:05.surface of the problem. In areas like Liverpool and areas where it is

:06:06. > :06:10.difficult to raise money, a 1% increase in the council tax fund

:06:11. > :06:17.will raise ?1.4 million. Neither of these things address looming and

:06:18. > :06:24.very real crisis in social care, and I urge the government to look again

:06:25. > :06:28.at this and not talk about platitudes. It is not fair, not plan

:06:29. > :06:33.to be there, there needs to be an urgent approach for something to be

:06:34. > :06:44.done. Mental health has been raised by a number of honourable members

:06:45. > :06:53.and in my constituency, I mentioned two instances. Assistance has been

:06:54. > :06:58.withdrawn, like opening letters for normal queries, that has gone.

:06:59. > :07:03.Another example is from a man who faces very serious until health

:07:04. > :07:11.conditions and he has a condition which means he cannot work. He was

:07:12. > :07:17.promised specialist help in York but the offer was withdrawn as it was

:07:18. > :07:23.made in error. That is unforgivable. I have followed this through, and he

:07:24. > :07:26.was promised local treatment, although it was very unclear as to

:07:27. > :07:32.whether it would be appropriate. That has not been offered in the way

:07:33. > :07:36.it was suggested. I have followed it up but I know that 14 months on from

:07:37. > :07:42.the time that he was offered help for a very incapacitating and

:07:43. > :07:47.extremely Sirius mental health condition, nothing has happened.

:07:48. > :07:52.That is simply not good enough and I will pursue it further -- serious.

:07:53. > :07:57.That is one illustration of cruel cuts on mental health services and

:07:58. > :08:00.how they are affecting individuals. I agree that we should look more

:08:01. > :08:07.generally at funding for our national health service but the

:08:08. > :08:14.crisis to date, the government has to act now. I am very pleased to

:08:15. > :08:19.follow the honourable lady, and before I start off on my remarks, I

:08:20. > :08:24.am sorry the honourable member for Central Ayrshire is no longer in her

:08:25. > :08:31.place, I particularly enjoyed her remarks because in her contribution,

:08:32. > :08:36.she actually set out a number of constructive policy amendments

:08:37. > :08:42.trawling on the Scottish example where we could reflect on them --

:08:43. > :08:47.drawing. And improve the situation. In his 33 minute contribution, I did

:08:48. > :08:50.not hear a single contribution from the shadow secretary of state which

:08:51. > :08:55.is disappointing and something he may reflect on otherwise the debate

:08:56. > :08:59.will not move far forward. I may also say that I suspect it was

:09:00. > :09:03.because she was under the Central for Ayrshire in clinical experience,

:09:04. > :09:06.I enjoyed the contribution from the right honourable member for

:09:07. > :09:10.Doncaster Central who, after a period of unforced violence as

:09:11. > :09:19.opposition Chief Whip, was clawing on her ministerial experience

:09:20. > :09:23.demonstrating I think it is valuable when they draw on their own

:09:24. > :09:29.experience and bring it to the debate -- drawing on her experience.

:09:30. > :09:34.With the motions before us today, the Labour motion we are debating

:09:35. > :09:38.talked about the four-hour target, and the funding issues. I want to

:09:39. > :09:44.touch on those in my inevitably brief speech. I raised this in the

:09:45. > :09:48.intervention I made earlier, I was in the house on Monday and the

:09:49. > :09:53.secretary of state was very clear. I do not understand why Labour members

:09:54. > :09:57.fail to see this. He did not, in any way, water down the target and as I

:09:58. > :10:02.said, the right honourable member for Exeter challenged him on it. The

:10:03. > :10:05.secretary of state specifically said he recommitted the government to

:10:06. > :10:08.that target and was generous in paying tribute to the Labour

:10:09. > :10:15.government for having introduced it, saying it was one of the best things

:10:16. > :10:19.about the NHS. I think the shadow secretary of state said in his

:10:20. > :10:22.remarks that somehow the secretary of state had talked about making

:10:23. > :10:29.sure that target applied to those with urgent health problems, and had

:10:30. > :10:33.somehow set is secretly outside of the House of Commons. I looked

:10:34. > :10:37.carefully at the secretary of state 's oral statement which she gave in

:10:38. > :10:41.the House of Commons two days ago and they were explicit in making

:10:42. > :10:44.sure that the four-hour standard related to urgent health problems

:10:45. > :10:50.and specifically talked about the NHS England's medical director for

:10:51. > :10:55.acute care said, that no country in what has it four-hour standard for

:10:56. > :10:58.all health problems, it is for urgent health problems and if we are

:10:59. > :11:03.too protected for vulnerable patients, that is what we need to

:11:04. > :11:09.do. -- protected. That is incredibly valuable. I would like to say,

:11:10. > :11:14.because it is related to the motion, about social care funding and the

:11:15. > :11:17.charge that keeps being thrown by the opposition about local authority

:11:18. > :11:22.decisions. It is entirely true that in the last parliament the coalition

:11:23. > :11:27.government had to make savings to local government budgets, because of

:11:28. > :11:33.the impact of the financial crisis, and how unprepared the country had

:11:34. > :11:37.been left due to the previous Labour government. In the dramatic

:11:38. > :11:43.financial crisis that we inherited with a budget deficit of 11%, we had

:11:44. > :11:48.to make savings. But local councils had choices about the decisions that

:11:49. > :11:50.they made and where the cuts fell. In Gloucestershire, the county

:11:51. > :11:55.council prioritised spending on adult social care, and said it was

:11:56. > :11:59.the single most important service it delivered, not just for older people

:12:00. > :12:05.but a said the budget goes on provisions for with disabilities,

:12:06. > :12:08.including learning disabilities, and it protected the budget in cash

:12:09. > :12:14.terms which is one of the reasons why we are the best performers in

:12:15. > :12:19.the region for no delayed patient discharge timings in the acute

:12:20. > :12:23.sector. Of course, there problems and challenges but the hard-working

:12:24. > :12:29.health and social care staff do an excellent job... His comments about

:12:30. > :12:34.the local governor and are just ludicrous. The level of cuts that

:12:35. > :12:37.were placed were far greater than any other government department. You

:12:38. > :12:41.cannot introduce that kind of level of cuts and say to local Gottman,

:12:42. > :12:46.you had to decide. Of course it would lead to social care problems

:12:47. > :12:52.-- government. The point was made that Mike authority had cuts as well

:12:53. > :12:59.and had to make choices. It had to make difficult cuts. But it chose to

:13:00. > :13:02.prioritise the single most important service it delivered, adult social

:13:03. > :13:07.care, which meant it had to make difficult cuts in other areas which

:13:08. > :13:11.were not easy but difficult. That choice to put adult social care at

:13:12. > :13:15.the top of the list of priorities was the right choice six years ago

:13:16. > :13:19.and remains the right choice today. Or I simply say is if councils

:13:20. > :13:24.choose to put adult social care at the bottom of their list of

:13:25. > :13:30.priorities, I do not think it was the right decision to have made. I

:13:31. > :13:38.would also like to say that I have been to visit the A department, I

:13:39. > :13:41.do not have an acute A department in my constituency but my

:13:42. > :13:46.constituency is served by an A department in Gloucester and

:13:47. > :13:49.Cheltenham. I went to visit the new Chief Executive at Gloucestershire

:13:50. > :13:55.hospitals NHS Foundation Trust to visit with some of the staff in the

:13:56. > :13:58.A department. That hospital has had its challenges, she is a new

:13:59. > :14:03.Chief Executive and is working hard with her management team on turning

:14:04. > :14:07.around a performance in A which has not been up to scratch. I spoke

:14:08. > :14:12.to her about the processes that are being put in place and I'm confident

:14:13. > :14:15.with the hard-working staff they have at that hospital, with that

:14:16. > :14:20.improve leadership, that they will be able to hit the targets the

:14:21. > :14:28.government has asked them to do. I've joined the police on a night

:14:29. > :14:36.shift, and I saw compassionate staff offering care in pressured

:14:37. > :14:42.circumstances. Would you agree that the STB process is to enhance

:14:43. > :14:45.capacity elsewhere in the county, including bolstering and enhancing

:14:46. > :14:54.provisions at Cheltenham General Hospital? The whole point about this

:14:55. > :14:57.process is making sure that we have capacity across the health sector.

:14:58. > :15:03.One of the things I thought was important from what the secretary of

:15:04. > :15:07.state said, and is in the Prime Minister's amendment to the debate

:15:08. > :15:10.today, which is why will be supporting that amendment, it talks

:15:11. > :15:14.about other changes to the health and social care system. I agree

:15:15. > :15:22.completely with what the chair of the select committee has said, in

:15:23. > :15:27.Gloucester we are fortunate, unlike the member for Central Ayrshire. We

:15:28. > :15:30.are lucky that for our county we have a single CCG and county

:15:31. > :15:34.council. They work very well together with a lot of joint working

:15:35. > :15:38.and increasingly over time they want to bring health and social care

:15:39. > :15:41.together which is exactly what the chair of the select committee said,

:15:42. > :15:44.it is the right thing to do and what the member for Central Ayrshire said

:15:45. > :15:50.they have done in Scotland which helps deliver a better service. The

:15:51. > :15:54.more we can improve capacity in the system, we can make sure people

:15:55. > :15:57.access primary care where they need to and access social care where they

:15:58. > :16:03.need to, and take pressure off the accident and emergency system. When

:16:04. > :16:06.I visited the A department, they have a very good triage department

:16:07. > :16:11.in place, if you gone there for conditions which can be treated in

:16:12. > :16:16.general practice, we have general practitioners based in the A

:16:17. > :16:20.department, ready to ensure that you are signposted and treated in an

:16:21. > :16:23.appropriate setting, and not damaging the ability of the service

:16:24. > :16:27.to properly deliver that acute care to those who really needed, and I

:16:28. > :16:32.think those kinds of steps are the things we had to look at going

:16:33. > :16:36.forward. Of course, give way. With those people fall within the

:16:37. > :16:41.four-hour target? That's the heart of the debate we're having at the

:16:42. > :16:46.moment as whether four hours should cover more urgent and more elective

:16:47. > :16:50.problems in A departments? I don't know the detail of the statistics

:16:51. > :16:55.and how they measured but you want to Mitchell that those -- you want

:16:56. > :17:03.to make sure that those people who walk through and do not need urgent

:17:04. > :17:08.care, they still need appropriate care. Whether it is to a community

:17:09. > :17:13.pharmacy or general practice, or using information services which the

:17:14. > :17:17.NHS provides online or on the telephone, it is making sure people

:17:18. > :17:22.go to the right settings which is not right at the moment. That is why

:17:23. > :17:26.it is being acknowledged and worked on in future. Finally, I would also

:17:27. > :17:33.like to say that I think the government's moods in terms of

:17:34. > :17:37.devolving spending power and decision-making to local areas --

:17:38. > :17:44.moves. In what will take place in greater Manchester, enabling the

:17:45. > :17:49.ability of bringing social care together, I have encouraged my

:17:50. > :17:55.authority as it leads the devolution proposals as it is an ambitious ask

:17:56. > :18:05.and I hope the government will look seriously at it in the months ahead.

:18:06. > :18:12.Catherine West... Thank you. I do not know what the coral is of Chief

:18:13. > :18:24.Whip... I believe it is a crop of whips! I wonder if I can begin on a

:18:25. > :18:28.slightly less happy note -- the plural is. Quoting from an education

:18:29. > :18:33.psychologist who has written to me this week saying that "I and my

:18:34. > :18:37.colleagues are often in disbelief about the amount of work we need to

:18:38. > :18:42.manage, the difficulties in working across services because of cuts and

:18:43. > :18:46.changes to policy. Everyone is perpetually exhausted and burnt out.

:18:47. > :18:52.When we are not ill at work because of training, illness or leave, we

:18:53. > :18:56.feel guilty and relieved simultaneously". Her e-mail

:18:57. > :18:59.describes how she is the only clinical psychologist on duty in the

:19:00. > :19:11.whole of a very busy in London constituency. Mr Speaker, I wanted

:19:12. > :19:18.to comment briefly on the juncture between primary and secondary care.

:19:19. > :19:23.And, indeed, acute care as well. I think many of us have experience in

:19:24. > :19:26.the last 18 months of fighting for a generally pack -- general

:19:27. > :19:30.practitioners service. And the Westbury clinic which is just

:19:31. > :19:35.between the constituency of Hornsey and Wood Green and Tottenham, it has

:19:36. > :19:39.been quite a battle ground in the last 12 months and we've really had

:19:40. > :19:45.to fight for the services of basic general practitioners for our

:19:46. > :19:50.constituents, both myself and the honourable member for Tottenham.

:19:51. > :19:57.I think this is replicated across the country and is what is leading

:19:58. > :20:02.to the build-up in individuals, as the Secretary of State said

:20:03. > :20:05.previously, we have so many people coming who probably could be seen by

:20:06. > :20:11.a GP but cannot get an appointment so they turn up to accident and

:20:12. > :20:14.emergency. I am grateful. Thank you, Mr Speaker. In Stoke-on-Trent,

:20:15. > :20:21.certainly, one of the problems we face is that we are something like

:20:22. > :20:24.six GPs away from the whole system collapsing, because as they retire

:20:25. > :20:29.or leave for other reasons, those patients are going onto the ever

:20:30. > :20:38.smaller number of GPs that there are. And that means that if another

:20:39. > :20:42.couple of GPs retire, and two our Brit -- are due to retire, the whole

:20:43. > :20:47.system is likely to collapse in Stoke-on-Trent. What will that do to

:20:48. > :20:52.A? I think it is that sort of situation which does lead to an

:20:53. > :20:57.individual patient waiting 35 hours on a trolley to be seen, as we saw

:20:58. > :21:03.this weekend. I know a number of members have made this point, but it

:21:04. > :21:07.bears repetition, that it seems quite disgraceful that one blames

:21:08. > :21:10.one's staff when this is going wrong, when clearly the

:21:11. > :21:16.responsibility lies with politicians and the Government. I was quite

:21:17. > :21:22.upset to see that the front page of today's Times blames the senior

:21:23. > :21:27.civil servant at the heart of the NHS, when really it is about poor

:21:28. > :21:34.planning from the Government. On the subject of poor planning, I am sure

:21:35. > :21:41.the honourable lady, like the rest of the House, heard James O'Brien

:21:42. > :21:44.speaking on LBC yesterday, describing his experience of having

:21:45. > :21:47.conjunctivitis over the holidays and having to go to a community pharmacy

:21:48. > :21:55.because he could not get a GP appointment. Is this the time when

:21:56. > :21:59.we should be supporting, not closing, community pharmacies?

:22:00. > :22:06.Whether it was a Brexit fever madness that took over or not, I

:22:07. > :22:10.don't know, but there was a moment when cutting community pharmacists

:22:11. > :22:15.seemed the right thing to do, especially when it was the wrong

:22:16. > :22:21.thing, particularly with the impact of the illnesses we all fall prey to

:22:22. > :22:23.over the winter months. In my earlier intervention, I ask the

:22:24. > :22:28.Secretary of State for Health about the influenza epidemic, and he

:22:29. > :22:31.assured me on the number of vaccinations, and that more people

:22:32. > :22:36.had been vaccinated against seasonal flu. But the point I was making was

:22:37. > :22:39.that went tragically people do get the flu, and I understand there is

:22:40. > :22:45.quite an increase in the number of young people getting it, not

:22:46. > :22:51.necessarily in the group where they would be advised to be inoculated,

:22:52. > :22:54.they are suffering, and the doctors don't have time to isolate those

:22:55. > :23:02.individual cases, which means there is a real risk, given how busy the

:23:03. > :23:06.staff are, that that flu could become an epidemic, and I hope that

:23:07. > :23:08.the Secretary of State, having given us assurances today, will take the

:23:09. > :23:13.point up farther with chief executives of acute trusts. Briefly,

:23:14. > :23:19.on the question of social care, just to give colleagues an indication, in

:23:20. > :23:23.2010, when I was a council leader, we had a social care budget for

:23:24. > :23:29.children. It is nothing to do with schools, just children will stop

:23:30. > :23:36.?102 million. The same local authority now, in a busy London

:23:37. > :23:40.area, now has 420 17-18, a budget of 26 million. If you're telling me

:23:41. > :23:51.that the needs are half as much as they were, or that families need

:23:52. > :23:57.half as much support, I would be very surprised. That cut is deeply

:23:58. > :24:02.worrying for the children who are in desperate need of social care. On

:24:03. > :24:06.the adult social care side, of course, that is equally worrying,

:24:07. > :24:11.where on Monday, the Secretary of State told us that we shouldn't

:24:12. > :24:16.worry because ?600 million is going into social care. Well, I wouldn't

:24:17. > :24:23.worry, except that I happen to know that between 2010 and 2015, four 8p

:24:24. > :24:35.was taken out. Anyone who has even Key stage two maths will know that

:24:36. > :24:43.that does not add up. If you take... Not only that, but I feel very sorry

:24:44. > :24:48.for cancelled because they in -- if they increase council tax it is not

:24:49. > :24:51.popular. And if they don't do it, they are blamed for not sorting out

:24:52. > :24:55.the social care crisis. We know that the amounts raised even in an area

:24:56. > :24:59.where the preset does bring back a lot of money as a local authority,

:25:00. > :25:03.that doesn't help in the longer term, because it is a short-term fix

:25:04. > :25:06.and it is not fixing the problem we need to be looking at, which is

:25:07. > :25:11.basically having more homes where older people can live comfortably,

:25:12. > :25:15.have fewer faults and accidents, be warmer so they are not suffering

:25:16. > :25:18.from fuel poverty, and therefore stay out of accident and emergency,

:25:19. > :25:23.which is about long-term planning. As we know, we have hardly build any

:25:24. > :25:27.new homes, even new homes for older folk where we could be using that as

:25:28. > :25:28.a change to help families come into those homes, thereby sobbing another

:25:29. > :25:46.problem, and we end up with this crisis of older people being in

:25:47. > :25:49.accident and emergency, and on occasion, even being on a trolley

:25:50. > :25:52.for 35 hours, which I still feel I can't quite believe. I am sure the

:25:53. > :25:55.newspapers are telling the truth, but it does seem that 35 hours is an

:25:56. > :25:57.awfully long time not to be seen on a trolley. In relation to melt

:25:58. > :26:02.ill-health, the member for Tottenham and I had a debate earlier in the

:26:03. > :26:07.year, followed by a meeting with the local sub region of members of

:26:08. > :26:13.Parliament. We were very worried about people suffering mental health

:26:14. > :26:17.problems. We have a perfect storm at the moment for people suffering from

:26:18. > :26:21.mental health. Number one, the cuts in benefits. We are in the seventh

:26:22. > :26:25.year of austerity, and there was no doubt that people with mental health

:26:26. > :26:30.problems are right at the bottom of the pile where those cuts are

:26:31. > :26:36.concerned. Two, housing and those programmes that help people with

:26:37. > :26:39.mental health problems stay in their tenancies. That has been cut back,

:26:40. > :26:43.there is no one to support them, and it is part of the reason why they

:26:44. > :26:47.fall ill. Number three, the cutbacks to the number of nurses. We have

:26:48. > :26:53.fewer mental health nurses than two years ago in the system. And of

:26:54. > :27:01.course, begs. A constituent came to see me at my surgery in November,

:27:02. > :27:07.saying he had fallen ill with a mental health problem. He was amazed

:27:08. > :27:11.at the poor level of care he received, including because there

:27:12. > :27:22.was no one really to diagnosing properly. He was given no indication

:27:23. > :27:26.about what sort of service. He was sent about 20 miles away to another

:27:27. > :27:30.hospital to be cared for, causing great stress and worry for his

:27:31. > :27:36.family. Mr Speaker, in conclusion, the whole of the health system is in

:27:37. > :27:40.crisis and needs our urgent attention, and I do hope that

:27:41. > :27:43.despite all the demands, the political demands, that the Brexit

:27:44. > :27:48.process will create, that we will not forget not just the most

:27:49. > :27:57.vulnerable but our basic, universal NHS for all. Andrea Jenkins. Thank

:27:58. > :28:00.you, Mr Speaker. I would like to begin by objecting to the

:28:01. > :28:04.exaggerated language used by Mike Adamson, the chief executive of the

:28:05. > :28:09.British Red Cross, over the weekend. What was said by him does a huge

:28:10. > :28:15.disservice to our hard-working health care professionals in the

:28:16. > :28:19.NHS. It was sloppy and irresponsible language. The Red Cross does some

:28:20. > :28:25.fantastic work, which I'm sure we agree on both sides of the Hours,

:28:26. > :28:29.but as a registered charity, the organisation is legally obliged not

:28:30. > :28:33.to be political, and if Mike Adamson cannot remain neutral, I suggest he

:28:34. > :28:38.examine his position carefully. As a member of the health committee and

:28:39. > :28:41.chair and co-founder of the patient safety all party Parliamentary

:28:42. > :28:45.group, health care is extremely important to me, and I am proud to

:28:46. > :28:49.be a Conservative member of Parliament under this Government. It

:28:50. > :28:55.is thanks to this Government and this Health Secretary that the NHS

:28:56. > :29:01.funding is at record levels. Mr Speaker, the Government's commitment

:29:02. > :29:06.to delivering a seven-day NHS, expanding access to GP surgeries and

:29:07. > :29:12.hospital-based consultants at evenings and weekends, and the NHS

:29:13. > :29:16.has made more extensive winter preparations than ever before. In

:29:17. > :29:20.the run-up to the winter period, as the Secretary of State stated

:29:21. > :29:24.earlier, there were over 1600 more doctors and 3000 more nurses than

:29:25. > :29:30.just a year ago. This is a record to be proud of and something that would

:29:31. > :29:34.not have been achieved if we had had the opposition party running our

:29:35. > :29:41.National Health Service. Mr Speaker, as chair of the patient safety APG

:29:42. > :29:48.Gee, I am pleased to say that the Government has introduced a new

:29:49. > :29:51.OFSTED- style safety regime to improve patient safety. Hospital

:29:52. > :29:57.infections have been virtually halved since 2010. The level of MRSA

:29:58. > :30:02.is virtually half, and CDP sealed cases are down by 20%. It is this

:30:03. > :30:06.Health Secretary that has taken the lead on this issue and putting

:30:07. > :30:09.patients at the heart of the NHS. Record numbers of people are being

:30:10. > :30:13.treated in our health service, and there are pressures on the service,

:30:14. > :30:18.but it is not this Conservative Government that is a threat to the

:30:19. > :30:20.NHS. If we look at the appalling situation of the NHS in

:30:21. > :30:26.Labour-controlled Wales, where they are cutting funding, and as our

:30:27. > :30:32.latest statistic shows, they are failing to meet the four-hour A

:30:33. > :30:37.tigers by a wide margin, it is easy to see who is the defender of the

:30:38. > :30:42.NHS and who would cut investment. To conclude, Mr Speaker, it is this

:30:43. > :30:46.Government that is increasing spending on our NHS, focusing on

:30:47. > :30:53.improving patient safety, and is dedicated to providing the best

:30:54. > :30:58.possible service. I am grateful for the opportunity to raise some

:30:59. > :31:02.serious concerns about this Government's refusal to fully fund

:31:03. > :31:07.our NHS. We are seeing this Government running out of places to

:31:08. > :31:14.cut corners to save money. We see a lack of respect and compassion given

:31:15. > :31:18.to people who need health care. We see those needing care at home

:31:19. > :31:23.having to make do with 15 minute flying visits. We have seen the

:31:24. > :31:28.pressure in A department building over the last six years, and yet,

:31:29. > :31:32.every year, we have reached a winter crisis. Somehow, this is a surprise

:31:33. > :31:37.that the Government. We have seen A waiting times increasing to the

:31:38. > :31:46.point where now over 1.8 million people are more than four hours, an

:31:47. > :31:49.increase of 400% since 2010. Bed blocking is increasing as our

:31:50. > :31:53.underfunded social care services struggle to deal with the demand. We

:31:54. > :31:57.have seen an increase in the number of patients waiting on trolleys to

:31:58. > :32:02.be treated or admitted and the number of hospitals running out of

:32:03. > :32:06.beds increasing. We are also about to see a 12% cut to community

:32:07. > :32:13.pharmacies, which will lead to the closure or reduction in services on

:32:14. > :32:22.our local pharmacies, and the time it takes to get a GP and appointment

:32:23. > :32:26.-- a GP appointment in policing -- increasing. If we want a care system

:32:27. > :32:30.that works with compassion and treats those in the professionally

:32:31. > :32:41.and efficiently, this Government has to fund it. In 2015, the head of the

:32:42. > :32:46.NHS, Sir Simon Stephens, said that the NHS needed ?8 billion. It was

:32:47. > :32:50.this party which committed to fund it the Labour Party didn't. If she

:32:51. > :32:56.is so keen on funding the NHS, why didn't the Labour Party pledged to

:32:57. > :33:01.do so back in 2015? Pharmacies, this Government failed to grasp that cuts

:33:02. > :33:05.to one service directly impact upon another. Let me be clear, only two

:33:06. > :33:12.months ago I stood in this chamber to condemn the Government proposing

:33:13. > :33:18.to cut community pharmacies by 12%. That would potentially see 25% of my

:33:19. > :33:22.42 pharmacies facing closure in Bradford West. This highlights the

:33:23. > :33:27.short-sighted approach taken by this Government. They are attacking all

:33:28. > :33:31.forms of primary health care and front line services that people rely

:33:32. > :33:37.upon. If the figures are correct, nearly 30% of people that attended

:33:38. > :33:40.A services in Bradford Royal Infirmary, within my constituency,

:33:41. > :33:47.over the last month, they could have been treated elsewhere for minor

:33:48. > :33:53.ailments. Many would go to the local pharmacy board to see their GP, but

:33:54. > :33:57.what is this Government's long-term approach to the systematic issues if

:33:58. > :34:02.they continue to water down primary care services? All we will see is

:34:03. > :34:06.the number of visitors unnecessarily attending A increase and the

:34:07. > :34:11.problems faced by those needing access to services increase. Let's

:34:12. > :34:15.talk about GP services. We are seeing the same impact from a

:34:16. > :34:19.reduction in GP services. Only a few months ago, I campaign with the

:34:20. > :34:26.local community to save manning health practice. That was

:34:27. > :34:30.temporarily put on hold. However, we have managed to stop this centre in

:34:31. > :34:36.the short-term, but I know that others are right risk in my

:34:37. > :34:40.constituency, and many GPs face uncertain future is due to funding

:34:41. > :34:43.restraints. It paints not only a picture of under picked --

:34:44. > :34:47.underfunding of primary care services, but also a picture of a

:34:48. > :34:50.strategy that simply does not work together. Even a simple

:34:51. > :34:55.understanding of health care provision would allow us to see that

:34:56. > :34:56.if we decrease NHS services in one sector, it impacts upon the rest of

:34:57. > :35:04.it. This will increase pressures on

:35:05. > :35:08.service providers but this government continues to underfund,

:35:09. > :35:13.and cut funding to all aspects of front line services, and expect the

:35:14. > :35:17.quality of care to remain the same. Where is the long-term planning that

:35:18. > :35:22.would ensure people are getting access to the care that they deserve

:35:23. > :35:26.and are entitled to? Local government social care funding,

:35:27. > :35:32.again, we see the same strategy from this government with social care

:35:33. > :35:36.funding. With cuts to care funding has been dramatic, as members have

:35:37. > :35:41.highlighted. Nearly ?4.6 billion has been taken out of the sector since

:35:42. > :35:44.2010. Mainly from local governor and funding cuts. My district of

:35:45. > :35:50.Bradford has had to announce that they will need to find another ?8

:35:51. > :35:54.million in savings in their budgets going forward. They are trying to be

:35:55. > :35:59.innovative and find ways to make sure that this does not affect from

:36:00. > :36:03.front line care by putting resources into prevention. As far as I am

:36:04. > :36:11.concerned, this government still fails to recognise the impact of

:36:12. > :36:15.deprivation on our care needs. One of the most deprived constitutions,

:36:16. > :36:18.mental health issues go hand-in-hand with deprivation. The cuts to local

:36:19. > :36:22.government funding make this even more evident. It is not the work of

:36:23. > :36:28.our exceptional health care staff which causes this crisis. It is the

:36:29. > :36:31.reduction in funding, and the short-term strategy of this

:36:32. > :36:35.government to which is responsible, and it is time that they wake up and

:36:36. > :36:41.provide the health care provision that people deserve. Thank your very

:36:42. > :36:46.much Mr Speaker, many of my constituents are extremely fortunate

:36:47. > :36:49.to be served by the Luton and Dunstable Hospital, which was named

:36:50. > :36:55.checked twice by the secretary of state in his statement on Monday.

:36:56. > :36:59.One of the things they do extremely well is that they have an excellent

:37:00. > :37:07.streaming process in A with good alternatives where

:37:08. > :37:15.A services are not suitable. It gives them high standards. Social

:37:16. > :37:19.care is provided by Central Bedfordshire Council which has been

:37:20. > :37:25.extremely innovative in building extra care provisions for older

:37:26. > :37:29.people. I visited these provisions which are hugely popular and are in

:37:30. > :37:33.central locations. They are much cheaper than residential care. And,

:37:34. > :37:38.they provide a much better living environment for older people. This

:37:39. > :37:44.is exactly the sort of thing that we need to see a lot more of across the

:37:45. > :37:48.country. I think these are two examples of really good individual

:37:49. > :37:52.practice, within the NHS and social care. And, what we need to be much

:37:53. > :37:58.better at is spreading good practice across the country as a whole. It is

:37:59. > :38:05.just worth putting on the record in this debate that since this time

:38:06. > :38:11.last year, we do have over 1600 more doctors, 3100 more hospital nurses

:38:12. > :38:16.since 2010, over 11,000 more doctors and nurses. The proportion of

:38:17. > :38:27.patients harmed by the NHS fell by over one third between 2012 and

:38:28. > :38:32.2015. Infraction is 50% lower than a year ago. A tremendous achievement.

:38:33. > :38:37.Health spending in England is actually 1% higher than the OECD

:38:38. > :38:42.average. And, the UK is spending more on long-term care as a

:38:43. > :38:48.percentage of GDP than Germany, Canada and USA. The King 's fund has

:38:49. > :38:56.also that STBs are the best hope for the future of the NHS in England --

:38:57. > :38:59.S T P. The head of NHS providers has said that the system as a whole is

:39:00. > :39:03.doing slightly better than this time last year. This is dependent on

:39:04. > :39:08.having a strong economy and I would argue that this party has

:39:09. > :39:14.demonstrated confidence in running the economy. I'm not complacent, I

:39:15. > :39:16.recognise there is an arms race between the extra provisions the

:39:17. > :39:22.government has put in and increasing demands on the NHS. One issue which

:39:23. > :39:26.disappoints me is that we do not have enough focus on holiday in

:39:27. > :39:31.these debates, it is always about funding. I draw attention again to

:39:32. > :39:39.the initiative brought in by the government just before Christmas,

:39:40. > :39:46.which is projected to save ?1.5 billion, and could be redirected to

:39:47. > :39:51.patient care across 18 specialties. Low infections, less provision

:39:52. > :39:57.operations, and we are using data to shine the spotlight on variability.

:39:58. > :40:01.That is absolutely key for our constituents and, in relation to

:40:02. > :40:05.mental health and the welcome statement by the Prime Minister on

:40:06. > :40:09.Monday, I was delighted to hear emphasis on first aid for mental

:40:10. > :40:14.health, something that will take place within our schools. Equally as

:40:15. > :40:18.important, if not more so, I would say, is the issue of keep fit for

:40:19. > :40:23.mental health, what do we need to do, all of us, to maintain good

:40:24. > :40:26.mental health? The mental health foundation says we have to talk

:40:27. > :40:31.about our feelings, eat well, keep in touch with family and friends,

:40:32. > :40:38.take a break, accept who we are, keep active, drink sensibly, ask for

:40:39. > :40:41.help and look after others. Those ten pointers are not as well-known

:40:42. > :40:46.as they should be, I am pleased to put them on the record just now but

:40:47. > :40:51.it is crucial that we all look after our mental health which will help to

:40:52. > :40:55.reduce the stigma within this area. Another area that I am passionate

:40:56. > :41:02.about is doing something about obesity, we have a National Health

:41:03. > :41:10.Service and we do not do enough to keep our fellow citizens healthy. I

:41:11. > :41:13.would like to see more emphasis done following an academic of the

:41:14. > :41:19.University of Oxford, she published an article in the Lancet just before

:41:20. > :41:24.Christmas showing that where GPs offer a referral to 12 one-hour

:41:25. > :41:29.weekly sessions to obese patients, there was a significant reduction in

:41:30. > :41:38.their obesity. In 2015, a quarter of adults were obese... Honourable

:41:39. > :41:43.member like me is a regular reader of the Daily Mail, their proposal

:41:44. > :41:49.that are obese or heavy smokers or both, they are denied medical

:41:50. > :41:56.treatment until they lose weight or stop smoking. Would he recommend to

:41:57. > :42:00.the front bench that policy? I'm fixing on how we can keep ourselves

:42:01. > :42:14.healthy to reduce demands on the NHS by behaving responsibly. 40% of

:42:15. > :42:19.children aged 2-15, 80% in lower households. Those figures showed

:42:20. > :42:26.shame as all. That is why I mentioned the Daily Mail, and the

:42:27. > :42:30.scheme brought in by that school in Stirling, we need to see more of

:42:31. > :42:35.that and the strength and obesity policy. My daily newspaper at the

:42:36. > :42:40.moment is the China daily which is delivered free to my office at the

:42:41. > :42:44.moment. I was intrigued to see, Mr Speaker, that universities in China,

:42:45. > :42:56.students had to take a physical fitness test lasting 50 minutes. I'm

:42:57. > :42:59.not suggesting that we introduce it here, but we should look around the

:43:00. > :43:05.world to see what other countries are doing to promote keeping

:43:06. > :43:09.populations fit and healthy and reduce pressure on health services.

:43:10. > :43:12.At the other end of the age spectrum, we need to do a lot more

:43:13. > :43:19.to keep older people fit and healthy, as many issues of social

:43:20. > :43:24.care would be greatly lessened if older people were to stay healthy in

:43:25. > :43:30.later life. I am very proud to be associated with the Buzzard's 50

:43:31. > :43:36.plus organisation in my constituency, which helps older

:43:37. > :43:41.people take regular exercise at local leisure centres. In Andorra,

:43:42. > :43:46.where I mentioned earlier, this is normal for the whole population.

:43:47. > :43:50.Older people in the 70s and 80s regularly take place in water

:43:51. > :43:53.aerobics classes and go to the gym. When a BBC correspondence went there

:43:54. > :43:59.a few years ago, some of the women he spoke to were in their 70s and

:44:00. > :44:04.taking part -- correspondent. They said what is more important than

:44:05. > :44:08.keeping yourself it? If you don't keep your body moving, you won't

:44:09. > :44:16.keep your mind in shape. We need more of that kind of activity within

:44:17. > :44:24.our own country -- keeping yourself fit. We have heard from the opposite

:44:25. > :44:27.benches today about the so-called annual winter crisis, as if the

:44:28. > :44:32.situation at the moment that we are in has always been there. There have

:44:33. > :44:38.been crises but nothing like on the scale that we have recently seen. We

:44:39. > :44:42.are hearing about corridors being used as wards, and I have seen it in

:44:43. > :44:48.my own local hospital when I took my young son to hospital. When we went

:44:49. > :44:55.through into the water and salt use of trolleys with patients on there,

:44:56. > :45:01.before my little son was seen to -- and saw the use of trolleys. In

:45:02. > :45:06.December of last year, the minister in his place at the moment, the

:45:07. > :45:14.honourable member for nut low, answered that question. -- Ludlow.

:45:15. > :45:18.Could the government give figures for patients left queueing in

:45:19. > :45:21.corridors? I was told there were no such figures. The government and

:45:22. > :45:24.minister is well aware this is going on in hospitals up and down the

:45:25. > :45:32.country and if the government does not collect these figures centrally,

:45:33. > :45:37.if hospitals collect those figures, the government should ask for them.

:45:38. > :45:41.If the hospitals do not, they aren't really carrying out the duty of care

:45:42. > :45:48.to our constituents because I think that it is important that we know

:45:49. > :45:52.how many are being held in corridors. We hear stories of

:45:53. > :45:58.ambulances being redirected and bed occupancy is over 85%

:45:59. > :46:04.recommendations and in some cases over 95% that we are seeing. We have

:46:05. > :46:09.heard about the ?4.6 billion in cuts in the social care funding. And

:46:10. > :46:17.already, whilst it has not been explicit, we are seeing talk about a

:46:18. > :46:25.discussion on the downgrade in the four-hour A weight. I know myself,

:46:26. > :46:28.in Preston, there is difficulty in getting GP appointments -- wait. If

:46:29. > :46:34.I bring to see the doctor, I'm often told that we had to wait 2-3 weeks

:46:35. > :46:39.to see that Doctor. It's probably 2-3 hours at the very least if I go

:46:40. > :46:46.to the hospital and it is a serious case that we are looking at. No

:46:47. > :46:50.wonder A is in crisis. There is a whole cohort of doctors in their mid

:46:51. > :46:54.to late 50s looking forward to retirement. I know the number of

:46:55. > :46:58.doctors has increased, we heard that today from the Health Secretary, but

:46:59. > :47:01.I do not think it is anywhere near meeting the number leaving the

:47:02. > :47:08.service or going to work elsewhere as well. On the social care sector,

:47:09. > :47:15.we are seeing in Lancashire tens of millions of pounds of cuts in

:47:16. > :47:19.Lancashire County Council which is leaving the elderly vulnerable and

:47:20. > :47:25.more likely to have accidents at home which is putting her Sian A

:47:26. > :47:33.as well. The Cinderella service has always been there, -- putting

:47:34. > :47:36.pressure on A as well. They do not get the support that they deserve

:47:37. > :47:45.and I've seen in my own constituency since the closure of the acute

:47:46. > :47:50.mental health ward hospitals, the agent Dale unit, how mental health

:47:51. > :47:55.patients have been decanted across Lancashire because they do not have

:47:56. > :48:04.the support they need in Preston itself. Over a five-month period

:48:05. > :48:09.last year, we saw a 16% increase in attendance at A in Preston

:48:10. > :48:16.Hospital and over the same period, average attendances increased from

:48:17. > :48:20.217 to 225 per day. A small percentage of the increase was due

:48:21. > :48:25.to the version of Chorley hospitals A and I'm sure if the member for

:48:26. > :48:31.Chorley was here today, he would echo what I have just said. But that

:48:32. > :48:35.is not all down to the closure of Chorley's A Many of the patients

:48:36. > :48:42.who would have gone there are now going to weaken and going elsewhere.

:48:43. > :48:44.The problem in Preston, as well as Chorley and elsewhere, the

:48:45. > :48:49.government should not be allowing wards to close when they demand --

:48:50. > :48:55.when the demand is so high. Ambulance arrivals have increased

:48:56. > :49:01.from 68 to 91, according to the north-west Ambulance Services. In

:49:02. > :49:05.the meantime, a return to a 24-hour A service that Chorley Hospital

:49:06. > :49:10.has been ruled out. At best, there would be a 12 hour A service

:49:11. > :49:20.sometime later this month. At Preston, we have 134, Alta 138, of

:49:21. > :49:24.the A departments up and down the country when 95% of patients are not

:49:25. > :49:33.seen within the four ours. Which means that only four hospitals, A

:49:34. > :49:37.in the country, our meeting the four-hour standard. Mr Speaker, I

:49:38. > :49:43.believe this is a disgrace. And, it is testimony to the cuts and

:49:44. > :49:45.austerity being forced on the NHS and local government social services

:49:46. > :49:50.departments up and down the country. I call upon the government to

:49:51. > :49:52.increase spending on social care, and further fund the NHS at this

:49:53. > :50:06.years budget as a of urgency. It's a pleasure to follow the member

:50:07. > :50:13.for Preston in today's debate. I am also conscious that I am following

:50:14. > :50:19.many more learning members -- learned members, from both sides of

:50:20. > :50:25.the chamber, who bring very valuable experience from the front line

:50:26. > :50:31.within the NHS. Like probably all members across the chamber, I

:50:32. > :50:35.receive letters, visits from constituents, with concerns and

:50:36. > :50:39.issues about the NHS, about their own health issues, and some of them,

:50:40. > :50:45.as we all know, Mr Speaker, can be very sad and the motive, and we all

:50:46. > :50:50.do our utmost to help them and what can be very difficult situations.

:50:51. > :50:56.But let's not forget the many positive stories and experiences we

:50:57. > :51:00.hear also. Many of us in the chamber, again, will have had our

:51:01. > :51:04.own very positive experiences about the NHS as well, and away it has

:51:05. > :51:08.helped us and our families and continues to do so, and I think it

:51:09. > :51:12.would be wrong and unfair of us not to recognise those today. So, I

:51:13. > :51:22.would like to start by thanking those NHS staff and those who work

:51:23. > :51:27.in the health and social care services, not just for the work they

:51:28. > :51:31.do at this time of year but for the work that they do throughout the

:51:32. > :51:36.year, day in, day out. My mother was a home-care rather many years, and

:51:37. > :51:42.my sister is a practice nurse, so I often hear from them what it is like

:51:43. > :51:51.to work on the front line. I also include the Manor Hospital, our

:51:52. > :51:55.local hospital in Walsall, and they, like many hospitals, have their own

:51:56. > :52:00.precious to face. We heard today, on the Tuesday after Christmas, A saw

:52:01. > :52:03.the highest number of patients, and I believe all those involved in

:52:04. > :52:09.health care are working extremely hard to this. I include the

:52:10. > :52:13.Secretary of State and his ministers in this, in the work that they do to

:52:14. > :52:21.tackle this immediate problem, and what are doing in moving us towards,

:52:22. > :52:24.I'm sure, a better and more sustainable future. Hospitals across

:52:25. > :52:31.the country are facing huge pressures, and as I said, as we

:52:32. > :52:34.enter the winter period. We have an increasingly ageing population but

:52:35. > :52:38.also one that is increasing in terms of numbers as well. There are many

:52:39. > :52:45.more treatment options available than ever before. Some of them come,

:52:46. > :52:50.we all know, at a high cost, but a cost we would like to be able to

:52:51. > :52:55.meet to help those patients. All of these factors place challenges and

:52:56. > :52:58.pressures on the NHS, its staff and its resources. The impact of an

:52:59. > :53:05.ageing population is something that has been raised with me by some of

:53:06. > :53:08.my local GPs, and the need to recognise and tackle this. I know

:53:09. > :53:14.that local GPs in my surgery would be very welcoming the Minister if he

:53:15. > :53:21.would like to drop by Oldridge on his way back to Shropshire one

:53:22. > :53:24.Friday for a very useful and positive roundtable discussion, so

:53:25. > :53:32.there is an invitation for you there, Minister. Also, the

:53:33. > :53:35.importance of having an integrated and effective social care system is

:53:36. > :53:42.part of this too. I don't believe that whilst money is an important

:53:43. > :53:45.factor, it is not just about that. The Secretary of State said earlier

:53:46. > :53:50.that we miss a trick if we say that it is. We forget it is also about

:53:51. > :53:55.safety, standards and quality, and making progress on these areas too.

:53:56. > :54:03.I can recall, a number of years ago, the headlines were always about MRSA

:54:04. > :54:07.and some of those really nasty hospital bugs and infections, and we

:54:08. > :54:10.have gone a long way in terms of the work we are doing to combat those. I

:54:11. > :54:17.am proud this Government is committed to the NHS, and that as we

:54:18. > :54:21.enter the inter--- the winter period, we have nearly 1800 more

:54:22. > :54:27.doctors, nearly 3000 more hospital nurses than we had a year ago. We

:54:28. > :54:33.launched the largest ever flu vaccine programme. We allocated ?400

:54:34. > :54:40.million to local health Systems for winter preparing this. There are

:54:41. > :54:47.12,000 additional GP sessions over the festive period. Of course, there

:54:48. > :54:50.is more to do, and there always will be, but I believe that we are