11/01/2017 House of Commons


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


for business energy and industrial strategy if you will make a


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


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


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


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


capital. Potential bidders are interested in GIB because of its


green specialism and we are asking potential investors to confirm their


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


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


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


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


commercially sensitive so I cannot comment on the identity of any


bidders discussions taking place between the government and potential


bidders. All parties have been required to sign confidentiality


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


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


reassurance as everyone knows who the preferred bidder is. McQuarrie


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


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


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


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


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


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


environmental record, it has an appalling track record of asset


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


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


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


unfit to undertake takeovers. Changes suggest that McQuarrie is


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


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


behest of McQuarrie? Why is the government infighting and asset


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


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


government has decided to embark upon a new industrial strategy which


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


These are the criteria against which we are evaluating the proposals


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


genuinely competitive process, and we are now evaluating the proposals


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


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


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


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


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


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


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


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


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


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


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


exactly will the Minister protect his valuable public institution from


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


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


approach. What oversight for the Government have of those companies


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


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


Government is selling off an institution that has exceeded from


scratch and against the odds in attracting investment to our Green


info structure. The ministers have been outmanoeuvred by Macquarie and


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


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


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


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


Investment Bank's fate rests on his shoulders?


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


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


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


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


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


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


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


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


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


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


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


this as a going concern because of its green specialism actually


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


institutions have mobilised capital into this infrastructure is a key


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


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


investment bank was always created as possibly going to the private


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


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


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


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


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


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


assurance. We have taken before Parliament the whole procedure for


protecting the green purpose of the Green Investment Bank through the


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Investment Bank should be the vehicle for that. What assurances


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


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


continue? How will the Government ensure that the shortfall in


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


forthcoming industrial strategy and emissions reduction plan, will he


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


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


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


recognition of the extraordinary progress this country has made


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


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


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


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


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


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


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


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


includes attitudes to the workforce and sensitivities around jobs in


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


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


jealousy -- confidentiality situation we are in.


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


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


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


just provide guarantees for future implement but on the existing


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


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


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


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


been noted in the business community, reinforcing the question


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


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


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


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


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


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


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


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


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


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


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


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


private sector capital into this critical area of clean


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


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


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


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


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


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


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


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


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


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


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


talks about the need for continued commitment in investment in


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


coalition government in terms of the deliberations that led to the


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


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


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


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


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


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


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


reconcile insisting on preserving the green purposes of the bank and


preventing asset stripping from a new buyer with satisfying the ONS


classification is about public sector control and on balance Street


requirements post disposal? He is making a game presumptions about


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


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


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


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


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


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


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


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


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


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


amusement that the opposition this afternoon are arguing about


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


but yesterday they said the opposite. Private investors are keen


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


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


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


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


evidence of the large amount of Private investment flowing into the


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


unfettered from the state to do more. The environmental audit


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


privatise it without consultation and stated that the bank should


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


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


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


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


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


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


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


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


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


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


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


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


cause of the enterprise built the government rejected our amendment


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


give this assurance to the bank today that after privatisation would


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


substantive point about the protection of the green procedure


and if the honourable gentleman disagrees that fine, but Parliament


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


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


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


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


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


by rigorously independent processes to safeguard the integrity of the


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


government ever and yet the failed Greendale Project collapse.


Investment in renewable resources have slashed and we have slipped in


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


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


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


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


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


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


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


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


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


coalition government led by conservatives that change that. The


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


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


buy the Green Investment Bank because of its success. Which


private companies were saying that what did the Minister make the


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


privatisation is record levels of investment that have flowed into


organisation since they have been privatise. I respect the experience


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


a strong instinct that the honourable gentleman would still


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


Financial Times Vince Cable raise concerns about asset stripping and


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


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


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


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


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


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


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


to potential bidders about the concerns that people have. I


absolutely respect that and the individuals that she mentioned, but


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


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


reminder of the involvement of the Liberal Democrats in the initiation


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


unconvinced that the golden share will prevent the asset stripping of


the company and therefore will threaten the original intentions of


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


under which the special share solution was reached and discussed.


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


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


underpinning, given the integrity and independence of the people that


have been selected to be the trustees and guardians of this


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


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


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


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


colleagues fought for the headquarters of the Green Investment


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


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


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


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


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


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


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


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


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


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


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


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


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


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


admiration and respect the government has for the senior


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


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


but the professionalism with which they have conducted themselves. The


Green Investment Bank has made substantial investment in Wales in


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


out in the articles of the Association and therefore the degree


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


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


guardians of this process. When Vince Cable was legislating for


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


operating in Northern Ireland and not protruding cross-border


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


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


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


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


something that people associate readily with the preferred bidder.


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


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


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


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


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


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


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


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


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


guarantees without breaking any confidential at the around the


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


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


will continue and that the green investment moving forward will


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


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


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


a mechanism for protecting the green purposes of the organisation going


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


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


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


point where we are evaluating proposals from bidders against that


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


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


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


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


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


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


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


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


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


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


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


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


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


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


Can the Minister tell me how he envisages government ensuring there


will be money available for those new, innovative technologies that


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


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


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


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


Department has a ?500 million spending review portfolio dedicated


to a wider system of budgetary support for energy-efficient


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


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


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


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


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


finance sectors and also its proximity to green energy activity.


We also said that choosing Edinburgh supported the wider narrative of


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


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


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


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


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


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


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


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


of millions of dividend payments shipped off to investors, minimal


tax paid, and disappointing investment in the network. The


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


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


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


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


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


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


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


attractiveness investment in renewable energy and low carbon


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


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


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


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


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


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


the market. The gold escape group has supported


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


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


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


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


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


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


criteria we set. The Minister has been clear that the


creation of the special share and the Government arrangements around


that will protect the integrity of the green purpose in future


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


share will protect successful bidders from off-loading current


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


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


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


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


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


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


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


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


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


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


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


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


carbon capture or indeed wind energy. Given how disastrous his


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


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


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


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


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


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


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


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


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


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


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


cuts to renewable energy and the abolition of the Department of


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


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


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


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


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


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


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


shirking its responsibilities in elation to Britain's role in


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


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


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


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


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


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


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


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


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


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


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


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


Attorney General of civilian casualties associated with their


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


with the instruments available for backbench scrutiny of the executive


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


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


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


affairs of missing persons and for connected purposes.


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


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


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


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


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


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


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


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


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


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


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


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


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


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


realised something was wrong. Increasingly frantic calls and


players going unanswered. Voicemails never retrieved. Those turned into


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


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


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


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


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


With all those unanswered questions and difficult emotions. These


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


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


Data protection of financial services law prevents even the


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


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


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


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


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


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


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


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


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


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


Wales won a person disappears the property is effectively left


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


can lead to assets depreciating and property falling into despair and


leaving those behind without the access to finances that the missing


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


missing person will fill this void and will provide a practical


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


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


sufficient interest in the property and affairs of someone who is


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


missing people occurrences every year and I would like to thank


everyone connected to support and campaign organisation missing


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


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


Laurence who have a deep connection with my constituency. They


championed the cause of guardianship, even though it can no


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


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


motion, particularly to my honourable friend from York and


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


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


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


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


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


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


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


group for runaway and missing children and crucially government


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


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


all honourable members to guarantee its passage through the house and


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


I have received messages from doctors and clinicians from across


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


week all elected in patient appointments were cancelled and the


ambulance turnarounds have reached up to five others. The Prime


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


but the honest heartfelt considered testimonies of doctors and


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


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


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


these remarks have been made anonymously because according to


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


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


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


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


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


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


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


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


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


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


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


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


our responsibility as members of Parliament because we must never


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


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


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


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


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


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


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


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


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


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


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


of State will respond to my honourable friend when he responds


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


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


getting stories from constituents, telling of their recent experiences


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


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


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


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


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


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


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


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


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


An appointment for early December was cancelled owing to the hospital


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


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


are not agents trying to score political points or politicise


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


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


another parliament, I not on individual stories and challenges


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


the NHS providers organisation representing NHS providers who are


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


also need to be careful in extrapolating from individual


incidents in hospitals under particular pressure. Yes, times are


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


inappropriate use of individual stories. The lady ought to be


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


impression that she is dismissing these examples that I am reading


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


chronic underfunding of the NHS under this government. NHS providers


have continually warned that head forehead spending in this country


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


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


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


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


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


treatment fund announced to allow better access to treatment. My


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


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


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


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


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


winter, the demands on the service become unpredictable. Infections


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


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


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


unfortunate incident in various places, does he have any policy


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


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


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


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


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


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


financial settlements that he was delivering as the Chancellor of the


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


occupancy levels now routinely exceed the recommended maximum


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


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


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


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


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


is there a problem? Because there is a


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


apply to at least 95% of all patients attending emergency


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


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


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


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


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


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


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


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


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


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


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


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


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


us how he would define the difference between urgent at minor


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


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


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


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


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


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


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


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


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


away at all throughout the Parliament from the standard and it


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


heat: local authorities whose budgets have been cut question Mike


would he give the new resources for this education campaign?


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


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


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


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


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


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


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


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


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


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


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


MPs have raised these matters for weeks, including urgent questions


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


honourable lady meant was there were two backbench Labour members who


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


honourable lady refers to the history. Under this government the


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


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


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


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


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


general election manifesto that would have spent billions less on


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


vulnerable services such as maternity and paediatrics. In


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


deliver better health outcomes for its growing 10 million residents


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


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


when we have a growing elderly population and STPs are pursuing


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


an excellent and respected GP and clinical psychiatrist who had been


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


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


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


right honourable member mentioned spending, but does he share my


concern infection spreading of arrogance, complacency, from being


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


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


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


ludicrously the suggestion that Labour did not perform on spending


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


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


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


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


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


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


were in government opposing every penny piece of money Labour was


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


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


indecent. It is no wonder we are sceptical about government


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


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


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


one hospital but accident and emergency in 2005, as well? I do not


have the details of the Sussex STP to hand but presumably if it is


suggesting closures, the honourable gentleman will campaign against


closures and knock on the door of the Secretary of State if those


remarks are an indication of his view on these matters. He is saying


everything was rosy under Labour but it was ten years ago the Mid


Staffordshire scandal broke in which hundreds of elderly patients more


had died and expected to, it was a terrible scandal and he should


remember that because our shadow spokesman were holding a Labour


government to account at the time. I take all deaths in hospitals


seriously. My commitment to patient safety is unswerving and I will


raise matters, whether it is Royal Worcestershire or elsewhere, not in


a partisan way with the Secretary of State. I was not being partisan when


I ask questions about while Worcestershire. I will raise matters


because that is the responsible thing to do. It is not becoming of


the honourable gentleman to play politics in that way. Madam Deputy


Speaker, the culpability for the state the NHS is in today lies at


the door of Downing Street. A government that promise to protect


the NHS and cut the deficit and it didn't. The government gives away ?1


billion tax cuts to corporations. The government wastes billions


pushing the NHS in the direction of fragmentation and greater


outsourcing while ignoring lengthening queues of the sick and


elderly in our constituencies. Yesterday we saw the Secretary of


State on Sky losing his ministerial car and being chased down the


street, his approach laid bare, not a clue where he is going. Nothing to


say, not facing up to the problems. Last year he blamed junior doctors.


On Monday he blamed the patients and today he blames Simon Stephens.


Tomorrow he will blame the weather. It is time he started pointing the


finger at himself and not everybody else, the NHS is in crisis,


ministers are in denial. I say to the government on behalf of


patients, their families, our behalf of NHS staff, please get a grip. I


commend our motion to the house. The question is as on the order paper. I


call Jeremy Hunt to move the amendment. I beg to move the


amendment standing in the name of my right honourable friend the Prime


Minister. I want to thank the Shadow Health Secretary for bringing the


debate, he is right to draw attention to pressures in the neck


chess but I am regrettably going to have to spend much time correcting


totally inaccurate assertions -- in the NHS. That is a shame because it


is an important debate for constituents and the NHS and the


country deserves a proper debate but that is difficult when we have


misinformation at a time when the NHS faces sustained pressure. I am


pleased to see the Leader of the Opposition in his place. I think he


is rather a fan of my Parliamentary appearances recently. It is a Jeremy


think, he says. If only. I wish to address one part of my speech to him


because it is an area of policy for which he is perhaps more personally


responsible. Winter is a challenging period and I want to repeat thanks


the Shadow Health Secretary said and the banks I gave on Monday to NHS


staff. -- my thanks. On Tuesday, the NHS had its bid -- busiest day,


treating a record number of patients in four hours. And 2500 more


patients within the four-hour standard everyday compare to 2010.


As we discussed on Monday, the NHS made record numbers of preparations


for the winter because it is difficult, including 3000 more


nurses and 1600 more doctors on full-time employment. I will address


so that it does get dealt with early what the Shadow Health Secretary


talked about with respect to Worcestershire. I met colleagues


there on Monday. A huge amount of action is being taken but we should


say it is totally not acceptable for anyone to wait 35 hours on a trolley


and we expect the hospital to ensure it does not happen again. There are


plans to open additional capacity. We have had capacity made available


by Worcester community trust. It supplied its chief operating officer


to be based at the trust to facilitate discharges, and we have a


new chief executive, the trust is in special measures and the new chief


executive will start later this spring. What is wrong about what the


Shadow Health Secretary has said is the suggestion that winter problems


are unusual. The NHS had difficult winters in 99, 2008 and 2009, as The


Right Honourable member said. I will give way in a moment. He remembers


difficult winters from his time as Health Secretary. There are things


that are different today and one of them is compared to six years ago,


we have 340,000 more over 80s, many honourable, many with dementia, and


we know when people of that age go to A at this time of year there is


an 80% chance they will be admitted. I will give way. I thank him. He


talks about correcting points and it is important the house has


information. Can I repeat the question, the latest figures, can he


tell us the number of people remaining in hospital, that could be


discharged, because there is no community support they have stayed


in hospital. Could he give us that figure?


It was around 7000 beds last year, which is far too many. Which is why


it was announced that a new package of support worth around ?400


million, I will just answer his question, I said I would write to


him and I will. He may have noticed there are other issues we are


dealing with which is why I may not have had time to sign the letter.


What the Communities Secretary announced, ?400 million extra over


the next two years will make a significant difference and he should


recognise that. I am grateful for him giving way, there will be


constituents who are concerned about the headlines they have read. I am


pleased the secretary of state will correct some of the points that were


made. They also want to know what is being done and what should be done.


I listened for 33 minutes to the Shadow Secretary of State, the


Labour spokesman of the NHS, not a single new idea other than spending


money. Could my right honourable friend provide practical answers to


allay concerns in the papers. That is why I will be talking later about


what our solutions are to these problems. I will give way but I also


want to make some progress, which I will do now. I want to talk about


something else that is different today in our AMD departments


compared to six years ago. Which -- a and E departments. We also insist


on much higher standards of safety and quality. On Monday, I


congratulated labour for the introduction of the four our target.


I support it. We should all member that four years after that standard


was introduced, we started to see some horrific problems among staff


in the a and E departments, many thought they would be fired if they


missed the target. What Robert Francis said about this that the


failure of its staffs were "Imparts the consequence of allowing a focus


on reaching national access targets." While we retain targets,


we will not allow them to be followed slavishly in a way that


damages patient care. My point is that that is why we have a new


inspection regime which makes it harder to cut corners in a way that


frankly used to happen which meant beds were not being washed. There


was poor infection control and ambulances were being used as


waiting rooms and so on. I will give way. I am grateful for him outlining


the steps he is taking in this emergency but does he also recognise


that the major cause of the problems in A are the lack of staff we


have? As a result of that, does he regret the huge cuts there were two


training projects in 2010, 2011, 2012, which is having an impact now


on the number of doctors and nurses in our NHS? I agree Stockman was


critical in this but we have more doctors in A departments, more


consultants, more than 11,000 additional doctors. We are


recognising the pressures being faced in the NHS. 1600 more doctors


since this time last year, this is something we are doing a lot about.


I will give way once more on this side. Does my right honourable


friend agree that learning Best practice within the NHS, the


hospitals that manage to integrate and help with social care, such as


Wigan and Salford hospitals who reduced and created those beds, that


is an example of best practice is that the whole NHS can learn from?


My honourable friend is absolutely right, it is a mistake in this


debate, which I understand that opposition parties want to do, to


put it down to government funding but in the country, we see a lot of


variability. This period of the year is always difficult but some


hospitals are doing superbly well in challenging circumstances. We have


just heard some of the hospital is doing well and there are a number. I


will give way to as many people as I can but I also want to address the


substantive point is that the Shadow Health Secretary said. He talked


about the four our target and in his motion and hit in his speech, he


made the totally spurious suggestion that we are not committed to that


target. I remind him of what might right honourable friend said, quoted


me as saying on Monday, what I said was not just committing the


government to the target but that it was one of the best things the NHS


does. I also said that we need to find different ways to offer


treatment to people who do not need to be in A This is hardly rocket


science. When you have pressure in A, it is sensible and indeed, I


would argue the duty of the Health Secretary to suggest that people who


can relieve pressure on A do so. I am grateful to the Health Secretary


for giving way, yesterday at Crawley Hospital, and acute care unit was


opened which precisely to ensure that those people who don't need to


attend A are properly directed to the most appropriate care. Which is


good for them as individual patients and good for the whole system as


well. He is absolutely right. To back up his point, we had a report


from the OECD yesterday that said that in Australia, Belgium, Canada,


France, Portugal, at least 20% of A visits are inappropriate. NHS


England's figure is that this is up to 30%. That is why we need the


public's help to relieve pressure. That is what I meant when I talked


about an honest discussion. I give way. The Secretary of State told us


a moment ago that there are 300,000 more people over the age of 80,


surely he would know this information when his government took


over seven years ago from the sensors data. Why is it that we are


now seeing on the front pages of newspapers that one in four of A


awards are unsafe and that we have similar challenges across the


country West Chamakh we did know that information and that is why we


thought it was totally responsible to cut the NHS budget in 2010. As a


result of that, we have 11,000 more doctors and in her own local


hospital, every single day, we are treating within four hours, 243 more


people. What I said, I will make some progress and then give way. I


could have put what I said on Monday a different way. I could have said


that we have to persuade those people not in medical emergencies to


use other parts of the system to get the help they need. I didn't


actually say that but I will tell you who did say that, the Labour


health minister in Wales, Mark Drake that, in January last year. And


frankly, when the NHS is under the pressure it is under, it is


responsible for the party of the city criticised the Health Secretary


in England for Sanogo same thing that the Health Secretary in Wales


is also saying. -- for saying the same thing. I am grateful, I think


the Secretary of State is so in confusion in the House and the


country on this question and again today. If what he is saying is the


same as my honourable friend the Health Secretary of Wales that we


want to divert people who don't need to go to A from doing so, then I'm


sure everybody in this House would support that. But what we suspect he


is saying is that the four our waiting target is going to be


disappointed to some people turning up to ten par and that is the


downgrading he is talking on if that is the case, he should come clear


and he should be clear whose job it is going to be to do supply the


target to some people with minor ailments. I did not say that and I


didn't say it because we are not going to do it. Let me tell him, we


did have an intervention from a Welshman, rather inconvenient truth


about what is happening in Wales. Last you, and par performance with


10% lower than in England and in Wales, they have not hit the A


target for eight years. We are not going to let that happen in England.


I noticed the Shadow Health Secretary quoted a number of people


but one organisation he didn't quote was the Royal College of emergency


medicine, I wonder if the reason is because of what they said about


Wales this week. They said emergency care in Wales is in a state of


crisis. "Performance Is as bad, if not worse than England in some


areas. " In areas Labour is in contrast -- labour is in control,


these issues are worse. I say that, not to make the political point but


to say that it is blatantly ridiculous to start trying to play


politics when you have winter pressures in the NHS because this


happens in the whole NHS, in Wales as well as in England. I'm going to


make progress but I will give way to my honourable friend. I thank him,


can I reiterate the point he made about the four our target. During


the Labour government I was working in the NHS and significant pressure


was put on us by managers to meet the four our target and negate


clinical need and often patients were prioritised according to


meeting the target rather than the clinical need and that was a


disgrace. That is exactly the problem we had with mid staffs. What


we had was a culture in the NHS where people were hitting targets


but missing the point. While targets are important, management tools, it


is important they followed in a sensible way that puts the welfare


of patients first. I would like to make another point about Wales why


we have the privilege of someone who aspired to lead the Labour Party


here, as the current leader of the Labour Party is no longer in this


place. I want to make this point, something England and Wales have in


common is the need to make sure that if we want all senators to A that


people are able to get to see their GP. I have said many times that


people wait too long to see their GPs. I have to say in all honesty,


the GP contract changes in 2004 were a disaster. Because the result of


those changes were that 90% of GPs opted out of out-of-hours care. But


we have been putting that right. Now, 17 million people in England,


30% of the publishing, have access to weekend and evening GP


appointments. More than that, in this Parliament, we have committed


to a 14% real terms increase in the GP budget, that is an extra ?2.4


billion. And we sped that to see an extra 5000 doctors working in


general practice. I give way to the honourable lady. I received a very


distressed e-mail this morning from a senior NHS manager who has written


to me saying" I truly despair there will not be an NHS this time next


year. " You need to listen on the opposition benches, you need to


listen and understand what your secretary of state is doing to the


health service. I will give you a pr cis of what they are talking


about it. The honourable lady will return to has it, there are 33


members wishing to speak in this debate, it is an important debate,


if she can keep intervention in brief, I will let her but very


brief. Thank you madam touch to Speaker, I shouldn't have used the


word "You." The government knows the NHS is in crisis, foundation trust


are failing, GPs are on their knees, so they are, the government are


handling it back to local areas and saying you fix it and by the way,


there is no money. All I would say is that I hope that people in the


NHS don't listen to much to what the Labour Party says about the state of


the NHS and listen to what the government is saying which is giving


a more accurate picture. As I will go on to explain. I will make some


progress and I will then give way further. The second part of the


motion talks about funding. And there is never questioned at all


that we will be needing to look after 1 million more people over 65


in five years' time, we will need to continue increasing investment in


the NHS and the social care system. That is happening this year with an


extra ?3.8 billion going into the NHS, going in this year. They are


remind honourable members, it is ?1.3 billion more than they


themselves promised when they stood for election last year. I will just


say this, it is not enough to talk about extra funding, you act -- you


have to actually deliver it. They have to answer to their own


constituents why Fort two elections in a row they have missed less money


to the NHS than the Conservatives and the one area they are


responsible for the NHS, they have cut funding.


I think he is taking the right measured tone that was absent


earlier. We recognise the NHS is under financial pressure but some of


these are historic, reflecting in my area poor PFI contracts forced upon


them in the Gordon Brown sleight of hand. He is right. What we did not


hear from the party opposite was in 2010 we inherited a ?70 billion PFI


overhang that is making it difficult for hospitals to recruit staff


because they are having to pay so much money to pay for it. An example


of how we are spending money practically on the ground to make


sure patientss get a better deal is in Lincolnshire where, with a


shortage of GPs, the local health authority is offering ?20,000 as a


golden hello to do GPs. Isn't that the way of managing resources and


attracting the best talent to our areas and helping ensure patients


get the best care? She is right. I have talked about these issues when


I've visited her. The trick is to solve the problem we will have to


have a dramatic increase in people working in general practice, which


is why we are funding the second biggest increase in NHS history for


GPs. It is a shame the Leader of the Opposition is not here because this


is the bit I wanted to address to him, his proposal to put extra


funding into the NHS by scrapping corporation tax cuts. This reveals a


fundamental misunderstanding about how you fund the NHS. Corporation


taxes or cut so we can boost jobs and strengthen the economy, so we


can fund the NHS. The reason we have been able to protect and increase


funding in the NHS in the last six years when the party opposite was


not willing, is because we have created 2 million jobs and given


this country the fastest-growing economy in the G7. That is more


important posts Brexit. To risk that growth, which is what their proposal


would do, would not just risk funding for the NHS, it would be


dangerous for the economy and mortally dangerous for the NHS. I


want to understand what he will say about the four-hour target. Is it


conceivable that some of the people who are currently within the A


target will at some stage fall outside the target in the future? I


am committed to people using A falling within the four-hour target.


I also think we need to be more effective out diverted people who do


not need to go to A to other places as happens in Wales and


Scotland and is the only sensible thing. Going back to funding, for


all the heat in this chamber on debates on the NHS, probably the


biggest difference between the two sides is not on policy, but on the


ability to deliver the strong economy the NHS needs to give it the


funding required. I am afraid the proposal today in the motion


revealed that divide more starkly. I am grateful. We have this debate at


the election about the need for the stronger economy to pay for the NHS


and the public decided we won that argument. Can I give another example


from his friend Jeremy, from yesterday, he made a proposal to cap


high pay. The top 1% of taxpayers pay 27% of income tax revenues and


that proposal would cut funding available to the NHS and damaged the


services staff have produced. It is the worst kind of gesture politics


because it may get him more votes or Momentum supporters, but it would


damage the NHS. Would he agree with me that rather than making


meaningless and totally underfunded promises on more money for the NHS


contrary to their manifesto back in 2015, members opposite would do


better to recognise the demographic changes, ageing population need for


the NHS to change, and to support the locally developed plans for


change in the NHS, the STPs? She is absolutely right. People in the


country will find it hugely ironic that the party that spent so much


energy in the last Parliament campaigning against top-down


reorganisation is now campaigning against locally driven changes. I


will give way and then I will conclude. As the government points


out often, they want to hand decisions to local groups, but could


he give an explanation too worried patients in the south and west of


Cumbria as to why the local health services are suggesting the changes


to A in the west and potentially in the South? I know he spent time


looking at this area. I would like to use this moment to congratulate


his local trust for coming out of special measures and the progress


they are making. In a way, that is the answer, because his local trust


was in special measures and north Cumbria is still in special measures


and we have profound worries about patient care in both trusts but we


still do in North Cumbria. That is why the status quo is not an option


that we understand the concerns of constituents about proposals being


made. What does he make of this talk among professionals in relation to


the potential for a flu outbreak and what does he make of the doctor who


wrote to me on Sunday saying she is wrote to me on Sunday saying she is


concerned they are too busy to isolate patients coming in who need


oxygen and they are too busy to cover that, to isolate patients so


others do not capture potential flu epidemic? There is a concern about a


growth in respiratory infections and that is causing capacity


constraints. We are watching what is happening on this carefully but we


have 13 million people vaccinated this year against flu which is a


record. Money is important, but can I support the Health Secretary in


not viewing these issues so the three that lends? My local trust,


Sherwood forest cover has some of the worst finances of any trust,


almost all due to a PFI deal signed by Gordon Brown. My trust is


improving. It is under pressure this winter but management says it is not


in crisis, and that is a trust improving because of quality


management, reform and good quality processes. That is absolutely the


point. We miss a trick and I think the Shadow Health Secretary is in


some ways more reasonable than his leader on these issues, if we say it


is simply an issue... That is probably terminal for his career! If


we say it is just about money, we forget the debate we went through on


schools 20 years ago when there was a debate about money and we realised


it is about standards and quality or so and that has happened in Sherwood


forest and I congratulate the hospital. It is important we don't


let debates about funding eclipse the progress we need to make


standards. I am going to conclude, because lots of people want to come


in. He made as his central claim, his words, the culpability for what


is happening in the NHS lies at the door of Downing Street. I think I


owe it to the country and this House to set the record straight on this


government's record on the NHS, not just 11,000 more nurses and 11,000


more doctors and on cancer we are starting treatment for 130 more


people every day and have record survival rates, not just the fact we


have 1400 more people getting mental health treatment every day and some


of the highest dementia diagnosis rates in the world, not just the


fact we are doing 5000 more operations every day and despite


that, MRSA rates have hard. We have the NHS with more doctors, nurses,


and despite difficult winters, patients saying they have never been


treated more safely and with more dignity and respect. Next year, the


NHS will be 70 years old and this government's vision is simple, we


want it to offer the safest, highest quality care anywhere in the world,


and when you have difficult winters and an ageing population, that makes


things more challenging, but it makes us more determined and means


we are backing the NHS plan, more GPs, it means better mental health


provision and a NHS turning heads in the 21st century just as it did when


it was founded in the 20th. Here we are again debating the NHS. We had


the statement... All on my own because this is predominantly a


crisis, this is NHS England, not a crisis that is NHS Scotland, as I


will talk about. The problem is we are talking about patients who are


suffering, patients who may suffer from more infections. We are talking


about staffing tears, who are desperate, who feel they cannot


deliver the care they would expect to deliver. This is not just a


matter of isolated stories. We hear from NHS improvement that only one


trust met the target in December. Only nine out of 152 made it over


90%. This is not something that is just a matter of Joe from Wiltshire


and Mike from Leeds, this is something happening on a major


scale. 50 out of 152 trusts have declared a black or red situation


over December, and 158 diverts of ambulances. It is not just normal


winter pressures, it is not what the honourable lady opposite who is an


A nurse and people like myself and other medics in the chamber have


seen in our careers. This is a really bad winter, and yet we have


not had a really bad winter, we have not had bitter weather, we have not


had a flu epidemic. What we have seen when we look at the four-hour


data is the last one published was October, when the NHS in England


managed to achieve the four-hour target 83.7% of the time, 5% down


from the same time the previous year and compares with 93.9% in Scotland.


Scotland managed 93.5% in Christmas week. I'm sorry, the crisis in


Scotland, we have our challenges, but it is not the same as discussed


here. I will happily give way. I am grateful. Will she confirmed,


though, that throughout the whole of 2016, which includes winter, summer,


autumn and spring, the Scottish Government's A target was only met


in seven out of the 52 weeks? I'd be delighted to agree but I would like


to point out that NHS England did not make it over 90% anywhere in


2016, so I think perhaps the honourable gentleman might want to


check the NHS England figures before having a punt at me. NHS England is


performing 8-10% lower than NHS Scotland, which has been the top


performing of the nation 's for the last 19 months. We have not done


that from magic, we face the same ageing population, exactly the same


increased demand and complexity and exactly the same indeed often worse,


shortage of doctors than NHS England, because of our rural areas.


It is not something that is a different measure, we use the same


measure, but if you look at the data, there is a difference and it


has been maintained. The Secretary of State is right, winter is


challenging. Summer is when A is often busier for attendances because


the children are on companies and people go out and do silly things.


-- are wrong trampolines. But the people who come to A are sicker,


older, more complicated, and that is the problem that we have at the


moment. What we have not seen is any summer respite in NHS England. The


worst performance in the summer was 80.8%. The best performance was


86.4%. NHS England is under pressure in the summer and when you add the


winter on top, it is no wonder we are talking about the situation is


doctors, nurses, patients and relatives are describing. I remember


my first health debate after my maiden speech was an Opposition Day


debate on the four-hour target. I commented at the time and still


maintain that this target is not a stick for each party to hit each


other over the head with. But it is a thermometer to take the


temperature of the acute service. It does that really well. Because what


it measures is not just people coming in through the front door,


but how they are moving through the hospital, and how they are moving


out. We are seeing a system that is


completely overheated. The comments about it not being anything unusual


and just a normal winter and everyone is whingeing means the


government isn't recognising the problem. And the first step to


dealing with any problem is to recognise it. Then you can look at


how you want to tackle it. I thank her for giving way. I would remind


her the point that Prime Minister made in prime ministers questions on


the Tuesday after Christmas that the NHS received the highest number of


visitors it has ever received, A receiving the highest number of


visitors it has ever received in its history. Doesn't that show the


challenges facing the NHS nationally and locally? Those are extraordinary


figures and the Secretary of State is very much doing his best to help


the professionals deal with those numbers. I would totally accept that


the NHS has been under inordinate pressure am absolutely is busiest


day in its history. But with an ageing population that has been


discussed for years, we should have been able to see this coming. If in


the next few months we get a massive flu epidemic, we are really going to


see things keel over. What we can't have is the debates we have already


had in this chamber about STPs, taking more beds away. I totally


agree with the Secretary of State that some of it is that patients


could be seen somewhere else. But it is not a matter of changing the four


our target and saying someone won't count is that we provide better


automotives. If we provide better alternatives, people will go to


them. We have discussed community pharmacies in this chamber and it


has been recognised that the minor ailments service we have in Scotland


can deal with five or 10% of those patients. We have located out of


hours GP 's units beside our A, someone sent along the corridor into


the next building if it is a GP and not A that they need to see. We do


need to educate the public but the public will use an alternative


service if it is there. If it isn't, then if they turn up at A and they


keep sitting there, someone will see them. We shouldn't blame them for


that. I thank her for giving way. She is right to say we have an


ageing population but it is predictable. The significant thing


is that in 2008, the UK was spending around the same as all the major EU


nations, we are now spending considerably less than major


nations, isn't that what is causing the problem? I don't think money is


the only problem, I do accept part of it is how things are done. The


Secretary of State talks about the variation and hospitals performing


well but only one of them is meeting the target. Only nine of them are


over 90%. It is not that the majority are doing well and few are


failing, we will come onto STPs in a minute, in how we deliver the NHS is


crucial but change costs money. Therefore you have two invest in


alternatives in your community services, primary care, step up and


step down to take that pressure. At the moment, one of the concerns


about the STPs is because they don't have the money. What we see are a


lot of them are starting that way and thinking they will shut A and


a couple of wards and community beds which we need more of. To fund


change in primary and social care. And in actual fact, the system will


fall over, you need to have double running and develop alternatives and


then you are able to gradually send patients into that. I was enjoyed


listening to her well-informed remarks, I agree also that most


people don't want to go to A if they can avoid it. Would she agree


that part of the problem is when people phone general practices, they


tend to either not be offered an appointment in a reasonable time


frame or they can't get to see the doctor that they closely associate


with and that particular applies to people with chronic and long-term


conditions. A report makes there today that we need to address that


as a matter of urgency and possibly seven days a week general practice


may paradoxically be mitigating against the possibility of providing


people with that continuity of care during core hours. I think having


access to a GP and I think many doctors in general practice would


accept the argument for something like a Saturday morning, that people


who are work, but someone who can't see their favourite doctor is


actually very unlikely to go to A and wait eight hours to see a doctor


they have never seen in their life. I don't think it is that, I think


people feel they can't find an alternative. If it is taking three


or four weeks to get any appointment with their GP if they don't yet have


a community pharmacy that will offer a service, and eventually they end


up at A Therefore it is the service of last resort for people.


They go there and just stay there. We have do develop those other


alternatives first and as the honourable gentleman says, no point


in their right mind will choose to go and wait four hours in A if


they could be seen in half an hour at a community pharmacy. I have do


disagree with her because winter pressures that we are seeing at the


moment, tend not to be people with short-term conditions, they tend to


be the chronically sick. And those people want to have a relationship


with a particular practitioner who understands their needs and


understands the family contest, surely that is the essence of


general practice. I totally agree with that. But the chances of them


having their doctor on a Saturday morning or Sunday afternoon is


reduced. One of the things they have done in Scotland is to identify that


40% of admissions from 5% of patients. Because those patients are


automatically flagged. No matter what they ring up with, they will


get a double appointment because it is not just the chest infection or


the year in infection, you have to look at how it interferes with


everything else. It is not a catastrophe of people living longer,


those of us who are medical in-house do remember that was definitely the


point of why we went into medicine and that is the point of the NHS.


But we are not ageing very well. From about 40 or 50 onwards, people


are starting to accumulate conditions that maybe they wouldn't


have survived in the past. By the time they are 70, they have four or


five things that make treating them a challenge. I have friends still


working on the front line and they say it is not even just numbers but


complex T. Someone comes with what sounds like an easy issue but in


actual fact, with their diabetes and their renal failure and their


previous heart attack, it is a complex issue. And this is part of


the problem we face. We need to be looking forward to preparing for


that. STPs need to be thinking about being designed around old people.


Not being designed around young people who can come in and have an


operation as a day case and go away. That is not what we are facing.


Older people need longer in hospital. Even medically before they


reach the point of being able to go home, it will take them a couple of


days longer to be strong enough, they probably live alone. They


probably do not have family near them. They will need a degree of


convalescent support, they will need social care. This is really where


the nub of the problem lies, that social care funding has gone down.


And therefore more people are stuck in hospital or more people end up in


hospital who actually wouldn't have needed to be there in the first


place. I'm grateful to her for giving way. In terms of the


frailties of older people, just as Scotland led the way with a primary


school introducing the daily mile, is there something we can learn from


countries like Andorra that have a focus on exercise for older people.


So they are not as frail in their 70s and 80s? I think the prevention


and public health message is crucial. I think that is one of the


other challenges we have. I am grateful the Secretary of State no


longer talks about 10 billion because actually, the increase in


the Department of Health budget is 4.5 billion, part of that has been a


reduction in public health funding. Just at a time where we need to move


it to a totally different scale, whether it is children doing the


daily mile, adults doing the daily mile, maybe we should run up to


Trafalgar Square there and back every lunchtime. I am sure that


would do all of us the power of good. We need to invest in these


things that prevent. One of the points I would make is that when we


end up desperate, and whether it is patching up how the NHS runs or


dealing with illnesses we didn't bother to prevent, we always end up


spending more money. I am grateful to her for giving way. She knows how


much I respect what she is saying and she is the chairman of the


all-party running group and I endorse the daily mile and encourage


all adults, Park runs are a good example of that. They happen across


the nation. My question to her, her huge expertise in Scotland,


including NHS England learned from Scotland, what is best practice?


Could she give us some example is a best practice in Scotland, hospitals


and trusts that we can take away and learn from? I think the whole issue


is down to sustainability. That is the idea of the sustainability and


transformation plans, those who have heard me speak know that I support


the idea in principle. The idea is to go back to place -based planning


on an integrated basis for a community. That is what the


difference is with Scotland, what we have focused on is integration. We


got rid of hospital trusts in 2004, PCTs in the late 2000s, and since


April 2014, we set up integrated joint boards. That is a bag of money


from the NHS, a bag of money from the local authorities goes on the


table and a group sit around and work out what is the best way to


deal with that interface and to support social care. Because anyone


in this chamber or anyone with family members who have been stuck


in hospital, they know that you get into a bickering situation. Mrs


Bloggs is in a bed so the local authority are not interested because


she is sick, they are busy with Mrs Smith who has just fallen off a


ladder trying to put her curtains up and is not considered safe because


she is leaving the gas on. You have all this perverse obstruction and


that is what gets rid of that. I thank her for giving way, I welcome


the tone she brings to this debate, unlike what we saw earlier. One of


the points she makes is the importance of integrated care,


social and health. Does she believe that with further evolution in


England in the major cities, there is a huge opportunity to move that


agenda forward south of the border? You I think the whole idea of STPs


going to areas, we simply have geographical health wards, that is


the only layer we have. We are not wasting huge amounts of money on


layers and layers. You can integrate. For an STP to work, it


has to make sense geographically and that might be a county, maybe


something bigger or smaller. Personally I think they should have


a statutory position. We have 211 CCGs, an average of six CCGs for


every STP. That is a waste of layers, that is going to be very


difficult to integrate. One of the biggest difference is, is we got rid


of in 2004, the purchaser provider split. There is no evidence in


25-year is of any clinical benefit from the purchaser provider split.


The internal market now the external market. It is estimated the cost of


running that market are between five and ?10 billion a year. That is


money that is not actually going to health care but either going to


bidding, tendering, administration or profit. I think, we can't do an


overnight change but if we made a principled decision to work our way


back to the NHS as the main provider of public health treatment and


integration of care through the STP or a macro, I think we could reach a


point of sustainability. As I said earlier, you have two actually both


protect things like into hospitals and community services. Invest in


them. We have rebuilt three cottage hospitals as modern hospitals in our


health wards. That is where you want to put an older person on their own


with a chest infection who actually needs a few days of antibiotics and


TLC and decent feeding. You don't want them in the big hospital, you


want them close to home. What we are seeing with the ST people macro is


that people seek community hospitals as easy to get rid of. It is only an


efficiency saving if what you are getting rid of is inefficiency. If


you are slashing and burning, what you are ending up doing is spending


more money in the end. Much of what she says is music to my


ears, as someone who is campaigning to save the local General Hospital,


but I wonder if we could have the benefit of her views on the role of


patients and consultation in all of this when considering and


transformation plans. Not just consultation in the way it has often


been done in the past - here we are, we have made a decision, we are


telling you about it. Unfortunately, that is very much what we have heard


around the STP process, partly because it has been so short, and


partly, another, because it is budget- centred and not patient-


centred care. They have all been given a number, and if you are not


meeting it, do not bother submitting your plan. That will not give an


integrated service. The public also have to be involved, but I think the


front line clinicians, they are the people who work in the service. They


know where the bottlenecks are, they know where -- they know what is the


horseshoe nail that the service is missing that is holding it back, and


if you have clinician- led redesign, as I was involved in in my health


board 17 years ago the breast cancer, you can end up where you


track the part of the patient. You very quickly imagine yourself that a


patient, UCD bottlenecks, and that is where you focus investment. I


read an article yesterday, -- you see the bottlenecks. I read an


article about management consultants coming in advising to shut a board,


increase parking spaces, and that was not good value for money for ?2


million. I thank her for eloquently pushing issues that face all of us,


no matter where we are from. Would she agree with me that the use of


good health care data for those clinicians, enabling patients to be


seamlessly put through the system are important. Many people don't


realise that their information from the GP does not go into the acute


service and at the social care. I believe that would help patients. I


would not say we are super IT wizards in Scotland, but we did not


get involved in the care. Data issue, which is now a shadow over


the NHS in England. Nothing goes in the post. All of our letters back


are electronic. I block my dictation machine during a clinic and when I


finish, they all go away. They are on their way by 2pm. We have already


done that. AGP can e-mail my colleagues and say, I do not know


whether you need to see this person or not. And what I have heard from


clinicians is, we cannot e-mail about a patient. Because of the


wrong move around the data service, that is holding things back. Our GPs


use a care summary, so if they have a palliative patient, that will be


put on the out of our system so that if there is a call about that person


who has been accepted as being in terminal care, the doctor already


knows. We not throwing them in an ambulance. We're keeping them


comfortable. We have had a discussion on the aim is for them to


be at home. It is about sharing information, which is the first


step, and that is something that England has to get. In finishing


off, I think, really, integration... I'm sorry if I was taking too long


for the lady at the back. I think, really, integration is the key, and


it is possible, through the STPs, but only if they are designed around


patients, safety and services, and not just starting with a bottom line


and working backwards. Order. Before I call the next speaker, it will be


obvious to colleagues that there are a great many people who wish to


speak this afternoon, and that the debate although it has advanced a


long way in time, has not advanced very far as far as the number of


people called is concerned, so we now have to have a time limit of ten


minutes. Surely less. I can see there was some surprise at that. Ten


minutes for the moment. Anyone who can do arithmetic will be aware that


it will need to be reduced later, so I suggest starting working on your


speeches now. Doctor Sarah Wollaston. Thank you, Madam Deputy


Speaker, and I will be mindful of those comments. Thank you for the


member's thoughtful and thought-provoking comments. I would


like to endorse what she said and expand on some of those points. We


have heard that NHS staff are facing unprecedented demand over the


winter, but the point is, it is not just winter pressures, they are


extending into the summer. As we heard, it is not just about numbers


but about the complexity and the frailty of those who are presenting


in our A departments. The 4-mac- our target -- the four-hour target,


the trusts that were most successful in getting close to that target are


those that see this as a systemic issue where both health and care


staff are all contributing to this, not just some box ticking exercise,


but because they recognise that fundamentally this is an issue about


patient safety and about the quality of patient experience. That is why


the target matters and the Secretary of State is right to endorse that. I


think he is also right to raise the fact that sometimes we need to be


more nuanced about our targets and to be able to be open to listening


to what clinicians are telling him about how we can improve the way


targets are applied. I think it would be a great shame if in this


House, because of political for raw Ballance political upheaval, we fail


to have those discussions. I would urge the Secretary of State to


listen to clinicians in terms of where we can improve targets. He has


made it clear that we are right to keep the four-hour target. I would


also like to say, in talking about this as a whole system issue, of


course, with accident and emergency, it is a barometer, as my honourable


friend has pointed out, for wider system pressures. I would like to


focus my remarks on integration of health and social care, and also,


with those colleagues across this House who have called for a


convention in how we review the funding of this as a whole system


issue, we have heard it is the 70th birthday of the NHS next year, and


what could be a better president than politicians changing the debate


and the way we talk about funding of health and social care, and to do so


in a collaborative manner that works out the right solution for our


patients? The consequences of us not doing that are really profound for


our constituents, and they won't thank us for not being prepared to


put aside party differences and work towards the right solution, because


ultimately, this is about a demographic change that we are


simply not prepared for. We did this for pension age, recognising that


had to be a different debate, given the change in longevity. Over the


decade to 2015, we have seen a 31% increase in the number of those


living to 85 and older, and of course, that is a cause for


celebration, but what we are not seeing is a commensurate increase, a


matching increase, in the disease- free life expectancy. Unfortunately,


we are also not making sufficient progress on tackling inequality. And


I welcome the Prime Minister's focus on that. In her very first speech,


she talked about the burning injustice of health inequality and


tackling that, but I believe we have a role in this House in doing that


together in a consensual manner. I give weight to my right honourable


friend. I thank the honourable lady for allowing me to intervene. Does


she share my welcomer the Prime Minister's response today that she


is prepared to meet with us and other members of Parliament from


across this house with the hope that this might start a more constructive


approach? I thank the right honourable gentleman. Absolutely, I


thought it was extraordinarily encouraging to hear the Prime


Minister prepared to consider the centimetre with us across the House.


I would urge colleagues who feel this is a better way forward to sign


up to this and two, themselves, speak to their party whips and make


it clear that there is widespread support for considering this. I give


way. I wonder if on this vital issue the honourable lady wants to say


something about what her own party did admit to my previous times when


we have tried to get important cross-party working on health and


social care, in that once they made it an election issue and produced


posters on a death tax, and the second time just walked away from


talks. This is exactly not the kind of debate we want to be having.


Let's look to the future and say that where we are now, if the


honourable lady would let me finish, what I would say now is that we are


in a different part of the electoral cycle, and whilst I accept her


comments, I was still a clinician in the NHS at the time that that


happened, and I, like many of those who work in health and social care,


look at this place and think... I watch the debate we have here and


think, surely there has to be a better way. I would ask the


honourable lady perhaps to put that aside and look to the future rather


than be looking backwards, because I don't think we're going to get


anywhere, so I think what our constituents want us to do as


politicians is to recognise the scale of the challenge and get to


grips with it. I am going to take one more intervention, then I am


conscious of time. I thank the honourable lady for giving way.


Looking to the future, would you not agree with me that there should be a


new funding settlement, certainly in terms of the budget for the NHS and


social care, and bring both together? At the moment, we have had


cuts of 4.6 billion. That is exactly what I hope. We must end the silos


of health and social care, thinking of this money being a health pound


or a social care pound, and think of it as a patient pound and a taxpayer


pound, and how we get the best from that, which brings me onto a point I


would like to raise directly with the Secretary of State. There is an


example that has happened in my constituency. There is the Torbay


and South Devon NHS Foundation Trust, which has formed an


integrated care organisation. Across health and social care, there are


people, passionate people, about this, who sweated blood to get this


organisation off the ground. They recognise the benefits. It is talk


about not just nationally but internationally, a recognised way of


doing this better bust I regret to say that because of the scale of the


financial pressure on the ICO, what we are now hearing is that the NHS


is pulling out of the risk sharing agreement next year. I'm afraid this


is totally unacceptable. I hope the Secretary of State meet with me to


discuss the pressures facing the ICO, because it has achieved the


kind of things we're talking about in this debate. They can have their


pooled risk sharing and working together to genuinely get people out


of hospital more rapidly who do not need to be there ban is happening in


other various, to put people from social care into hospitals to see


how we can speed that process up, and unfortunately, if that risk


share falls apart, we will see one of the key pillars of how we want to


improve the flow through hospitals and at the other end breaking down.


Part of the reason, as I understand it, is, unless the control totals


are met, what is put at risk if the funding that they are hoping to use


to improve the facilities in the accident and emergency department,


because the challenge for Torbay isn't the way they work together to


get people out of hospital, it's the facilities at the front door, and


they could do so much there. We have this odd paradox that we could end


up improving the facilities at the front door but worsening the ability


of the facility to respond at the point where we are trying to get


people cared for in the community. I would say a certain degree of


financial challenge would have the effect of bringing health and social


care organisations to work more closely together because they know


it makes sense, but when there are unrealistic targets being set, and


what we can find is that we can go the other way and it starts to mean


that people have to retreat to protect their budget silos. I have


the Secretary of State will look closely at what is happening there


and meet with me to discuss whether or not we can't just get this back


on track again for next year. Although I am confident that the


local authority and the NHS staff -- the NHS staff and those in the trust


will continue to work together. They have an extraordinary tradition of


doing so. I think there are threats, and as I say, I hope they can be


addressed, because this is about the entire flow from the front door


right the way through to getting people cared for back at home, but


more widely, there is an issue here that we now have more than 1 million


people who are not able to receive the care that they need in


communities. In my area, we have a prime provider in special measures,


and these are financial issues. Yes, there is much the NHS can do that


isn't about money. We know there is a lot of variation that can't be


explained just by financial challenge and demographics alone,


but finance is inevitably part of this. Finance and workforce - these


are the key challenges we face, and we have to work together across all


parties, in my opinion, to achieve that.


In closing, on a slightly separate point, let me raise the front page


of the Times newspaper today which I think his extraordinary


disappointing. This is the second time we've seen a major national


newspaper reporting events the Chief Executive of the NHS, Simon


Stephens. I would like to invite the Secretary of State or the minister


closing the debate to unequivocally support the Chief Executive of the


NHS. What he is doing, when it comes to a select committee, as chair I


ask him to respond to a question, I expect him to be truthful and


transparent in his answers and I think that he should be commended


for doing so, and not find himself the subject of briefings. I would


invite someone to unequivocally support him and ask for best to


stop. Dame Rosie Winterton. Thank you. Thank you Madam Deputy Speaker.


I think that the debate so far has shown the huge level of concern from


the public and from NHS staff, about the crisis in the NHS and social


care. And, I would say that I think the honourable member reflected some


of the views of the select committee, but I would ask all


members opposite to really take seriously these concerns, and not


dismiss them. All honourable member 's must surely be getting


representations from staff, and from patients. About what is happening


locally. I would like to pay tribute to all health and social care staff


in Doncaster, particularly at Doncaster Royal Infirmary whose work


I've seen first-hand and I know how dedicated and committed they are to


caring for patients in the most difficult of circumstances. At the


end of December, they've managed to achieve 90% against the 95% I get


and had good ambulance hand the times, as well are as good support


from the council and partners. But they are facing real pressures and


are fearful about pressure is still to come, especially if there is a


cold spell, as predicted. That is why the mixed messages from the


secretary of state have been extremely damaging. Madam Deputy


Speaker, I was the health minister for four years and had


responsibility for emergency care. I know how important it is to work


with NHS staff to help to implement targets, and not give the impression


that the NHS is somehow giving up on those targets. The lead from the top


is incredibly important. There has was been controversy about targets.


But, as health minister, I have visited many A departments. There


is absolutely no doubt in my mind that the A target has led to


improved care for patients and dramatically reduced the waiting


times, which the evidence has shown and has been clear. That is what


happened. One of the striking things about those visits was seeing how


consultants, nurses, ambulance teams, all members of the health


care team while working together. They would work out protocol so


that, for example, nurses could take over some of the work that had


previously been done by consultants. Nurse practitioners and emergency


care consultants. So, they could ease the burden and share between


the team the work that was needed. Triage became the norm. Seeing who


needed treatment urgently from a consultant, and who could be seen by


a nurse practitioner. I would always ask staff, is the target getting in


the way? Or, is it helping? Invariably, the answer would come


back that it is helpful in making us work together more effectively. I


vividly remember a nurse practitioner saying, please do not


abandon the target because it is making the consultants sit down with


us and look at the whole team. And for patients, the difference is


crucial. For their working life as well, they were not seeing patients


who had been sitting around for hours and hours and were feeling


very depressed and tomorrow lowest. That made the difference to the


health care team as well. -- and demoralised. As well as improving


care for the patients. I will give way... With the right honourable


lady agree that it is not so much meeting the target which is


important but getting patients seen quickly, expeditiously and well.


And, there is not an A Department in this country who does not want to


improve its position in a league table of response times. They all


want to do that and the difference which now applies did not apply


quite so much when she was Minister, but that level of comparison is much


better. I ever so gently suggest that whilst a four-hour target was


important when she was Minister, that importance has degraded over


time because everyone is trying to see patients more quickly? I do not


agree with the honourable gentleman on that. I think that the experience


of implementing the four our target led to much better diagnosis of the


type of treatment that people needed -- four hour. Also better


interaction with the community. Let me come onto that, I also think the


secretary of state and maybe the honourable gentleman is guilty of


that as well, was trying to separate the target within the accident and


emergency department from what went on outside that. I see the


importance and putting the two together and I would like to say


something about that because providing the alternative treatment,


which is maybe what he is getting out, means proper support from the


community and it is bringing those two together which makes it possible


to achieve the target but it was a driver. I give way to the honourable


lady who I know has some experience. In my experience in working to try


to meet the four-hour target, there's often an emphasis... In the


past there was one, and emphasis which took priority over everything


else including patient care and clinical need, sometimes it was


abused. Huge pressure was put onto staff to meet that four-hour target


and patient care suffered, I have seen it myself, it has suffered as a


result of to meet targets. What I would say is that I think it is a


way... It is always important, I did this as the health Minister, to look


out for the feedback from clinicians was. I can see, because it was


starting during my time as health minister, that we constantly had to


look at whether what was the 95% target, whether there was clinical


reason as to why there should be a reduction on that. It became clear


that there were some patients who needed longer to be assessed,


because of their particular condition. I can see that is why it


would be reduced to 95% but the point that I am making is that it


was based on the clinical need and I think what happened last week was


the impression was given that it was, my goodness, we had to cope


with winter pressures, let's reduce the target in order to meet it,


rather than make an assessment about clinical need, I think it is


completely the wrong message for the NHS and I think that was the wrong


thing to do. I want to briefly set out some areas where I think we can


bring the community input together with what is happening in emergency


departments themselves, in order to produce some of the pressures. I


think the first point was made by my honourable friend from the front


bench, social care is absolutely vital in ensuring that people do not


end up in A, good social care. I have previously raised problems that


I think the current proposition by the government to, in a sense, move


responsibility to local councils to raise the money, is particularly


unfair in areas like mine because they simply cannot raise through a


council preset the same amount of money as can be made in other less


deprived... Better off areas. It simply does not work. We needed


probably more than any other area but our ability to raise money will


be less. I've been speaking to NHS staff in Doncaster, senior staff,


and there are some real problems in terms of the emergency care


staffing. What they are telling me is that it will take years, and


there are more doctors being trained, I accept that, but it will


take years for those to come through and the single most effective thing,


the most effective step, to ease the pressure at the moment and A


departments would be to immediately increase funding into social care.


Because, that would keep people away from accident and emergency


departments, and that could be done straightaway. There are the personal


out there but it just needs the government to make the decision, as


my honourable friend from the front bench said, to increase funding.


Secondly, we had to look seriously at the problem with GP shortages,


because again, as others have said, if a patient is waiting three weeks


for an appointment with a GP, they are bound to end up in A This is


something which needs to be addressed quickly with proper,


forward looks at exactly where the gaps are occurring in GP services. I


have said before that I think PCTs, or the care commissioning groups


now, or NHS England, should take over practices and employ salaried


GPs which would make a huge difference. Community pharmacists,


again, if people had confidence that going to the pharmacy would save


them a visit to A, that would relieve pressure on the system. I


hope that the minister can assure us that he is looking seriously at the


community pharmacy forward view which sets out how pharmacists can


be integrated into the NHS and social care. Whilst I have him here,


I do want to touch briefly on mental health, because the Prime Minister


answered a question today about mental health and the crisis people


can get into where they end up in A She particularly talked about


young people and I would urge the Minister to look at the role and


educational psychologists can play in mental health for children and


not then ending up in A Finally, I do also want to say that one of


the things in my experience of a health minister was that you needed


people on the ground locally, to help the organisations across the


whole spectrum. Local government through social care, pharmacists,


GPs, ambulances, working with A departments. That reorganisation,


the ?2 billion reorganisation which took away PCTs and SHAs, that has


made it much more difficult, the changes that are needed. I hope that


the Minister will look seriously at how it is happening because local


knowledge can be vital in these circumstances. So, I believe that


from the contribution to the secretary of state, it seems as


though he was trying to use every excuse not to face up to the reality


of what is happening, and I think it sends a terrible message to NHS


staff, and I hope that as a result of the debate today, the concerns


which have been raised will be taken on board by ministers and the


Secretary of State, and they will come back to the house with a proper


plan which recognises the problems and offers real solutions.


The house was right to assume that ten minutes per person is


unsustainable, after the next speaker I will reduce the time limit


to seven minutes. But the time limit remains, the house will be very glad


to know, at ten minutes first Sir Simon Burns. Thank you, Madam Deputy


Speaker. I welcome the debate today, to have the opportunity to discuss


an issue which is extremely important to all honourable members


on all sides of the house, because there is a significant problem


during the recent weeks because of the extra increasing number of


people needing services at A and from the health services locally. I


would like to pay tribute to the magnificent work often in very


difficult circumstances that doctors, nurses, consultants and


other staff, and people in general practice, carry out on a day-to-day


basis, not simply during a winter crisis period, but throughout the


year, looking after people to the best of their abilities. I think


that my own hospital, Broomfield Hospital in Chelmsford, is in


difficult circumstances and doing a fantastic job to provide the best


possible care in good times and more difficult times, and I am certainly


aware as a constituency MP that there are been some problems for


some of my constituents in the last week or so because of the demands


and pressures but we have to look at what we can do to move forward in a


positive, not partisan, politicised way. To make sure that our


constituents get the best treatment is possible.


There is no point in just shouting, as my honourable friend, the cherub


a health select committee said, and engaging in -- the chair of the


health select committee said, in engaging in yah boo politics. I have


to say, I am extremely proud of the record of this Government in the way


it has been committed to funding the NHS over the last seven years, and


its commitments for the next three or four years. We made sure when we


came into office at a time of austerity, where Government


department budgets were cut, that the health Department budget was one


of the few departments whose budgets were protected so that they got a


real terms increase in funding every year since we came into power,


albeit, I will accept, it was a modest real terms increase, but it


showed our commitment and our intent to invest in improving the National


Health Service. I am also proud of the fact that I and all my


honourable and right Honourable friends on this side of the House


fought the last general election on a commitment that we were going to


substantially, over the five-year period of this Parliament, increase


funding on the NHS to what has turned out to be bit chewed up ?10


billion, which is more, I say in a very gentle way, than was on offer


to the country from certain other parties. I am also pleased that my


right honourable friend, the Secretary of State, and the Minister


of State for health, have been planning for any potential strains


on demand during this winter period with the provision of ?400 million


to local health economies, and other measures like the vaccination


programme, a preventative measure to get a record number, 30 million


people, vaccinated to try to offset some of the potential health


problems that can flow during a winter period. That is using


foresight, that is using planning to try and minimise problems, and at


the same time, providing funding to back up their actions, and that is


what a responsible Department of Health should do and has done. Now,


you can demand as much money as you like for the health service, but my


argument is that, yes, the health service does have to have extra


money, year in, year out but it shouldn't just be thrown at an


issue. There is a far bigger part of the equation, and that is building


upon the performance and the standards and the quality of care


that that health service is going to provide to our constituents. Very


briefly... I thank the honourable member, and I absolutely agree with


what he is saying about increased resources, but would he agree that


we need more resources now for integrated health and social care,


and this is the time to remove the NHS as a political football and have


a cross-party review? I certainly agree that under the leadership of


the Department of Health, we should work with anyone and everyone to


come up with a solution. I was the Minister for social care in the late


1990s, before we left office, where integrating health and social care


was in its very early, formative stage. And the ambitions were


immense and tremendous. I'm afraid, the reality has not matched the


ambitions of what was being said in the 1990s, and that is why I was


particularly interested in hearing the comments of my honourable


friend, the chair of the select committee. Because yes, we have to


look at that, but we also have to look, pushing the funding side to


one side for the moment, is building on the work that my right honourable


friend, the current Secretary of State for Health, has particularly


invested in, which is patient safety and raising standards and dignity


for patients in our hospitals and throughout the health system. And


also making sure that we cut out waste and inefficiency is. Now,


there was the Nicholson challenge when I was at the Department of help


the second time round, in 2010. The challenge was, over three or four


years, to save ?20 billion by cutting out waste, by sharing best


practice to improve the quality of care, and I know from the bait just


before Christmas that the NHS achieved ?19.4 billion worth of


those savings. The beauty of that was, not only was it creating


greater effectiveness and efficiency in the delivery of health care and


sharing best practice, but it also didn't mean that the Treasury got


?19.4 billion that they could spend or do with as they wished. It was


?19.4 billion that was reinvested in patient care. Yes. Was it not the


case that a significant proportion of that was due to wage freezes for


NHS medical and nursing staff, and therefore that is not something that


can easily be repeated? The honourable lady is absolutely right


that if you are earning under ?20,000... Sorry, if you are earning


over ?20,000 a year, there was a wage freeze, but that was in keeping


with the policy throughout the public sector, including members of


Parliament and ministers. The important thing was that they were


able, by a variety of means, one of them was a pay freeze, but others


were by improving the delivery of service, cutting out inefficiencies,


in effective ways of operating and getting rid of almost 20,000 surplus


managers so that you can then concentrate on having clinicians,


nurses, ancillary workers and everyone else to work towards


patient care, that achieved that. And that is the right way forward.


We cannot give up on that in also continuing to see if we can... I am


about to finish, I'm afraid. Finally, a lot has been said about


the STP programme. We had one in mid and South Essex. I have to say that


I strongly support it, because it is completely focused on improving and


enhancing the quality of accident and emergency care. What annoys me


is those who wish to politicise it for grubby political reasons. It


involves, and funnily enough, I am not talking about honourable members


opposite. It involves three hospitals, with three A


departments. The proposals, not one of those A departments will be


close, yet, as soon as the proposals were put out, and on the assumption,


correctly I suspect, that most people have not read the proposals,


the word went out that my local A department was going to be closed


down by the Department of Health because of this nasty Government's


proposals to save money. The exact opposite was the case. If one read


the documents, all three A are remaining open. What is happening,


and it is building on what happens now, is that if you have a heart


attack, you are taken immediately to Basildon Hospital, because that is


the specialist for cardiothoracic treatment. If you need treatment for


burns up plastic surgery, you come to Broomfield Hospital in


Chelmsford, because that has one of the finest units in the of Europe.


If you have head injuries, you will go down to the east of London, to


Romford, because that is a specialist area for people with head


injuries. Now, if I had any of those conditions, I would want, for me or


my constituents, the best possible treatment from the best experts


available, and that is what is happening. And that will be built


upon, enhanced and improved. That is an improvement, that is not a cut.


That is not taking away services from local communities. But for


those people who have an agenda where they want to play politics,


they will tell people anything, in the hope it will frighten them, to


try to discredit the work of the NHS. So, I am pleased we've had the


opportunity to discuss this matter also it is very tricky, there was no


simple answer. It is not unique. We frequently have winter crises,


particularly because of the ageing population and the increasing demand


that the health service has had to deal with in recent years. But we


must not lose sight of the fact that we have an NHS and a Government that


is determined to further improve and enhance the quality of care, the


safety and the standards of care, for all our constituents, aided and


abetted by a first-class service that is working under very difficult


circumstances often. Thank you, Madam Deputy Speaker. It is very


important to talk more widely about the NHS, about its importance, its


funding, and perhaps about its organisation too, but today's debate


is to bring focus to the current crisis in many parts of our National


Health Service, and to ask the Government to do something about it.


Undoubtedly, our National Health Service is highly valued. It has a


dedicated staff, and it provides excellent services, but in many


parts of the country, it is under pressure, and today's debate does


call for specific actions to address the crisis. It calls for more


funding for social care now, and it calls for an improved settlement for


both the National Health Service and social care in the next budget. So,


in our general discussion about how things might be reorganised and


changed in the future, it's very important not to lose focus on the


current problems, and those are the reasons for today's debate. That has


been -- there has been a lot of discussion about what is happening


in hospitals, and inevitably that will be so, because that is where


there is, in many areas, a crisis in A, and great pressure on hospital


services. But there has also been reference to services provided by


our health service outside of hospitals - community services - and


it is important to focus on them as well, not just because they are


important in their own right, that because if they are working


effectively, they can prevent hospital admissions and indeed


improve people's health. Those services include community health


services. That involves the GP services, the absolute bedrock of


our national health service, nurses, physios and pharmacies. The National


Health Service does have some responsibility, but local


authorities, currently under ever increasing pressure, Opera narrowly


responsible for social care. I am concerned about the cats that the


Government has imposed on community pharmacists. Pharmacists are


absolutely essential to our National Health Service. They are part of the


NHS, they are privately run, in the name. They offer advice as well as


specific services, and they can often prevent people having to go,


not just a hospital, but to their local GP, where the pharmacist is


able to give proper advice and services. It is of great concern


that the Government's plan for cuts to community pharmacists will put


pharmacies in areas like mine, in Liverpool, at risk. I also deplore


the reduction in independent pharmacists who provide such an


excellent service. So, I do ask the Government to think again about its


cuts to community pharmacies, a vitally important part of our health


service. When they are closed, it will be far too late. The Government


should act now and should not go ahead with those cuts, which will


have a dramatic effect on places such as Liverpool and other places


in the country. I also asked honourable members to think more


about social care and what is happening. In Liverpool, we're


facing a major crisis in social care. As local authority funding has


been cut severely, and is to be cut again. 58% of Liverpool City


Council's budget has already been cut, and ?90 million more of savings


is demanded of the next three years, half of that to be achieved in the


next year. There has been a reduction in social


care provision. Social care packages reduced from 40,000 to 9000, many


more cuts in the pipeline. Providing social care is essential, not just


to enable people to leave hospital when they are healthy and ready to


leave, that is a very important issue. But also, to enable people to


live a constructive life. There are many people who are currently


fearful of impending and possible cuts to their social care packages.


Who believe that they will not be able to live reasonable lives within


their own home if essential services are cut. I asked the government to


again think about what they are doing and telling us that the better


care fund is an answer is not the case, in Liverpool, ?35 million is


promised for the fund in the coming years but that will only scratch the


surface of the problem. In areas like Liverpool and areas where it is


difficult to raise money, a 1% increase in the council tax fund


will raise ?1.4 million. Neither of these things address looming and


very real crisis in social care, and I urge the government to look again


at this and not talk about platitudes. It is not fair, not plan


to be there, there needs to be an urgent approach for something to be


done. Mental health has been raised by a number of honourable members


and in my constituency, I mentioned two instances. Assistance has been


withdrawn, like opening letters for normal queries, that has gone.


Another example is from a man who faces very serious until health


conditions and he has a condition which means he cannot work. He was


promised specialist help in York but the offer was withdrawn as it was


made in error. That is unforgivable. I have followed this through, and he


was promised local treatment, although it was very unclear as to


whether it would be appropriate. That has not been offered in the way


it was suggested. I have followed it up but I know that 14 months on from


the time that he was offered help for a very incapacitating and


extremely Sirius mental health condition, nothing has happened.


That is simply not good enough and I will pursue it further -- serious.


That is one illustration of cruel cuts on mental health services and


how they are affecting individuals. I agree that we should look more


generally at funding for our national health service but the


crisis to date, the government has to act now. I am very pleased to


follow the honourable lady, and before I start off on my remarks, I


am sorry the honourable member for Central Ayrshire is no longer in her


place, I particularly enjoyed her remarks because in her contribution,


she actually set out a number of constructive policy amendments


trawling on the Scottish example where we could reflect on them --


drawing. And improve the situation. In his 33 minute contribution, I did


not hear a single contribution from the shadow secretary of state which


is disappointing and something he may reflect on otherwise the debate


will not move far forward. I may also say that I suspect it was


because she was under the Central for Ayrshire in clinical experience,


I enjoyed the contribution from the right honourable member for


Doncaster Central who, after a period of unforced violence as


opposition Chief Whip, was clawing on her ministerial experience


demonstrating I think it is valuable when they draw on their own


experience and bring it to the debate -- drawing on her experience.


With the motions before us today, the Labour motion we are debating


talked about the four-hour target, and the funding issues. I want to


touch on those in my inevitably brief speech. I raised this in the


intervention I made earlier, I was in the house on Monday and the


secretary of state was very clear. I do not understand why Labour members


fail to see this. He did not, in any way, water down the target and as I


said, the right honourable member for Exeter challenged him on it. The


secretary of state specifically said he recommitted the government to


that target and was generous in paying tribute to the Labour


government for having introduced it, saying it was one of the best things


about the NHS. I think the shadow secretary of state said in his


remarks that somehow the secretary of state had talked about making


sure that target applied to those with urgent health problems, and had


somehow set is secretly outside of the House of Commons. I looked


carefully at the secretary of state 's oral statement which she gave in


the House of Commons two days ago and they were explicit in making


sure that the four-hour standard related to urgent health problems


and specifically talked about the NHS England's medical director for


acute care said, that no country in what has it four-hour standard for


all health problems, it is for urgent health problems and if we are


too protected for vulnerable patients, that is what we need to


do. -- protected. That is incredibly valuable. I would like to say,


because it is related to the motion, about social care funding and the


charge that keeps being thrown by the opposition about local authority


decisions. It is entirely true that in the last parliament the coalition


government had to make savings to local government budgets, because of


the impact of the financial crisis, and how unprepared the country had


been left due to the previous Labour government. In the dramatic


financial crisis that we inherited with a budget deficit of 11%, we had


to make savings. But local councils had choices about the decisions that


they made and where the cuts fell. In Gloucestershire, the county


council prioritised spending on adult social care, and said it was


the single most important service it delivered, not just for older people


but a said the budget goes on provisions for with disabilities,


including learning disabilities, and it protected the budget in cash


terms which is one of the reasons why we are the best performers in


the region for no delayed patient discharge timings in the acute


sector. Of course, there problems and challenges but the hard-working


health and social care staff do an excellent job... His comments about


the local governor and are just ludicrous. The level of cuts that


were placed were far greater than any other government department. You


cannot introduce that kind of level of cuts and say to local Gottman,


you had to decide. Of course it would lead to social care problems


-- government. The point was made that Mike authority had cuts as well


and had to make choices. It had to make difficult cuts. But it chose to


prioritise the single most important service it delivered, adult social


care, which meant it had to make difficult cuts in other areas which


were not easy but difficult. That choice to put adult social care at


the top of the list of priorities was the right choice six years ago


and remains the right choice today. Or I simply say is if councils


choose to put adult social care at the bottom of their list of


priorities, I do not think it was the right decision to have made. I


would also like to say that I have been to visit the A department, I


do not have an acute A department in my constituency but my


constituency is served by an A department in Gloucester and


Cheltenham. I went to visit the new Chief Executive at Gloucestershire


hospitals NHS Foundation Trust to visit with some of the staff in the


A department. That hospital has had its challenges, she is a new


Chief Executive and is working hard with her management team on turning


around a performance in A which has not been up to scratch. I spoke


to her about the processes that are being put in place and I'm confident


with the hard-working staff they have at that hospital, with that


improve leadership, that they will be able to hit the targets the


government has asked them to do. I've joined the police on a night


shift, and I saw compassionate staff offering care in pressured


circumstances. Would you agree that the STB process is to enhance


capacity elsewhere in the county, including bolstering and enhancing


provisions at Cheltenham General Hospital? The whole point about this


process is making sure that we have capacity across the health sector.


One of the things I thought was important from what the secretary of


state said, and is in the Prime Minister's amendment to the debate


today, which is why will be supporting that amendment, it talks


about other changes to the health and social care system. I agree


completely with what the chair of the select committee has said, in


Gloucester we are fortunate, unlike the member for Central Ayrshire. We


are lucky that for our county we have a single CCG and county


council. They work very well together with a lot of joint working


and increasingly over time they want to bring health and social care


together which is exactly what the chair of the select committee said,


it is the right thing to do and what the member for Central Ayrshire said


they have done in Scotland which helps deliver a better service. The


more we can improve capacity in the system, we can make sure people


access primary care where they need to and access social care where they


need to, and take pressure off the accident and emergency system. When


I visited the A department, they have a very good triage department


in place, if you gone there for conditions which can be treated in


general practice, we have general practitioners based in the A


department, ready to ensure that you are signposted and treated in an


appropriate setting, and not damaging the ability of the service


to properly deliver that acute care to those who really needed, and I


think those kinds of steps are the things we had to look at going


forward. Of course, give way. With those people fall within the


four-hour target? That's the heart of the debate we're having at the


moment as whether four hours should cover more urgent and more elective


problems in A departments? I don't know the detail of the statistics


and how they measured but you want to Mitchell that those -- you want


to make sure that those people who walk through and do not need urgent


care, they still need appropriate care. Whether it is to a community


pharmacy or general practice, or using information services which the


NHS provides online or on the telephone, it is making sure people


go to the right settings which is not right at the moment. That is why


it is being acknowledged and worked on in future. Finally, I would also


like to say that I think the government's moods in terms of


devolving spending power and decision-making to local areas --


moves. In what will take place in greater Manchester, enabling the


ability of bringing social care together, I have encouraged my


authority as it leads the devolution proposals as it is an ambitious ask


and I hope the government will look seriously at it in the months ahead.


Catherine West... Thank you. I do not know what the coral is of Chief


Whip... I believe it is a crop of whips! I wonder if I can begin on a


slightly less happy note -- the plural is. Quoting from an education


psychologist who has written to me this week saying that "I and my


colleagues are often in disbelief about the amount of work we need to


manage, the difficulties in working across services because of cuts and


changes to policy. Everyone is perpetually exhausted and burnt out.


When we are not ill at work because of training, illness or leave, we


feel guilty and relieved simultaneously". Her e-mail


describes how she is the only clinical psychologist on duty in the


whole of a very busy in London constituency. Mr Speaker, I wanted


to comment briefly on the juncture between primary and secondary care.


And, indeed, acute care as well. I think many of us have experience in


the last 18 months of fighting for a generally pack -- general


practitioners service. And the Westbury clinic which is just


between the constituency of Hornsey and Wood Green and Tottenham, it has


been quite a battle ground in the last 12 months and we've really had


to fight for the services of basic general practitioners for our


constituents, both myself and the honourable member for Tottenham.


I think this is replicated across the country and is what is leading


to the build-up in individuals, as the Secretary of State said


previously, we have so many people coming who probably could be seen by


a GP but cannot get an appointment so they turn up to accident and


emergency. I am grateful. Thank you, Mr Speaker. In Stoke-on-Trent,


certainly, one of the problems we face is that we are something like


six GPs away from the whole system collapsing, because as they retire


or leave for other reasons, those patients are going onto the ever


smaller number of GPs that there are. And that means that if another


couple of GPs retire, and two our Brit -- are due to retire, the whole


system is likely to collapse in Stoke-on-Trent. What will that do to


A? I think it is that sort of situation which does lead to an


individual patient waiting 35 hours on a trolley to be seen, as we saw


this weekend. I know a number of members have made this point, but it


bears repetition, that it seems quite disgraceful that one blames


one's staff when this is going wrong, when clearly the


responsibility lies with politicians and the Government. I was quite


upset to see that the front page of today's Times blames the senior


civil servant at the heart of the NHS, when really it is about poor


planning from the Government. On the subject of poor planning, I am sure


the honourable lady, like the rest of the House, heard James O'Brien


speaking on LBC yesterday, describing his experience of having


conjunctivitis over the holidays and having to go to a community pharmacy


because he could not get a GP appointment. Is this the time when


we should be supporting, not closing, community pharmacies?


Whether it was a Brexit fever madness that took over or not, I


don't know, but there was a moment when cutting community pharmacists


seemed the right thing to do, especially when it was the wrong


thing, particularly with the impact of the illnesses we all fall prey to


over the winter months. In my earlier intervention, I ask the


Secretary of State for Health about the influenza epidemic, and he


assured me on the number of vaccinations, and that more people


had been vaccinated against seasonal flu. But the point I was making was


that went tragically people do get the flu, and I understand there is


quite an increase in the number of young people getting it, not


necessarily in the group where they would be advised to be inoculated,


they are suffering, and the doctors don't have time to isolate those


individual cases, which means there is a real risk, given how busy the


staff are, that that flu could become an epidemic, and I hope that


the Secretary of State, having given us assurances today, will take the


point up farther with chief executives of acute trusts. Briefly,


on the question of social care, just to give colleagues an indication, in


2010, when I was a council leader, we had a social care budget for


children. It is nothing to do with schools, just children will stop


?102 million. The same local authority now, in a busy London


area, now has 420 17-18, a budget of 26 million. If you're telling me


that the needs are half as much as they were, or that families need


half as much support, I would be very surprised. That cut is deeply


worrying for the children who are in desperate need of social care. On


the adult social care side, of course, that is equally worrying,


where on Monday, the Secretary of State told us that we shouldn't


worry because ?600 million is going into social care. Well, I wouldn't


worry, except that I happen to know that between 2010 and 2015, four 8p


was taken out. Anyone who has even Key stage two maths will know that


that does not add up. If you take... Not only that, but I feel very sorry


for cancelled because they in -- if they increase council tax it is not


popular. And if they don't do it, they are blamed for not sorting out


the social care crisis. We know that the amounts raised even in an area


where the preset does bring back a lot of money as a local authority,


that doesn't help in the longer term, because it is a short-term fix


and it is not fixing the problem we need to be looking at, which is


basically having more homes where older people can live comfortably,


have fewer faults and accidents, be warmer so they are not suffering


from fuel poverty, and therefore stay out of accident and emergency,


which is about long-term planning. As we know, we have hardly build any


new homes, even new homes for older folk where we could be using that as


a change to help families come into those homes, thereby sobbing another


problem, and we end up with this crisis of older people being in


accident and emergency, and on occasion, even being on a trolley


for 35 hours, which I still feel I can't quite believe. I am sure the


newspapers are telling the truth, but it does seem that 35 hours is an


awfully long time not to be seen on a trolley. In relation to melt


ill-health, the member for Tottenham and I had a debate earlier in the


year, followed by a meeting with the local sub region of members of


Parliament. We were very worried about people suffering mental health


problems. We have a perfect storm at the moment for people suffering from


mental health. Number one, the cuts in benefits. We are in the seventh


year of austerity, and there was no doubt that people with mental health


problems are right at the bottom of the pile where those cuts are


concerned. Two, housing and those programmes that help people with


mental health problems stay in their tenancies. That has been cut back,


there is no one to support them, and it is part of the reason why they


fall ill. Number three, the cutbacks to the number of nurses. We have


fewer mental health nurses than two years ago in the system. And of


course, begs. A constituent came to see me at my surgery in November,


saying he had fallen ill with a mental health problem. He was amazed


at the poor level of care he received, including because there


was no one really to diagnosing properly. He was given no indication


about what sort of service. He was sent about 20 miles away to another


hospital to be cared for, causing great stress and worry for his


family. Mr Speaker, in conclusion, the whole of the health system is in


crisis and needs our urgent attention, and I do hope that


despite all the demands, the political demands, that the Brexit


process will create, that we will not forget not just the most


vulnerable but our basic, universal NHS for all. Andrea Jenkins. Thank


you, Mr Speaker. I would like to begin by objecting to the


exaggerated language used by Mike Adamson, the chief executive of the


British Red Cross, over the weekend. What was said by him does a huge


disservice to our hard-working health care professionals in the


NHS. It was sloppy and irresponsible language. The Red Cross does some


fantastic work, which I'm sure we agree on both sides of the Hours,


but as a registered charity, the organisation is legally obliged not


to be political, and if Mike Adamson cannot remain neutral, I suggest he


examine his position carefully. As a member of the health committee and


chair and co-founder of the patient safety all party Parliamentary


group, health care is extremely important to me, and I am proud to


be a Conservative member of Parliament under this Government. It


is thanks to this Government and this Health Secretary that the NHS


funding is at record levels. Mr Speaker, the Government's commitment


to delivering a seven-day NHS, expanding access to GP surgeries and


hospital-based consultants at evenings and weekends, and the NHS


has made more extensive winter preparations than ever before. In


the run-up to the winter period, as the Secretary of State stated


earlier, there were over 1600 more doctors and 3000 more nurses than


just a year ago. This is a record to be proud of and something that would


not have been achieved if we had had the opposition party running our


National Health Service. Mr Speaker, as chair of the patient safety APG


Gee, I am pleased to say that the Government has introduced a new


OFSTED- style safety regime to improve patient safety. Hospital


infections have been virtually halved since 2010. The level of MRSA


is virtually half, and CDP sealed cases are down by 20%. It is this


Health Secretary that has taken the lead on this issue and putting


patients at the heart of the NHS. Record numbers of people are being


treated in our health service, and there are pressures on the service,


but it is not this Conservative Government that is a threat to the


NHS. If we look at the appalling situation of the NHS in


Labour-controlled Wales, where they are cutting funding, and as our


latest statistic shows, they are failing to meet the four-hour A


tigers by a wide margin, it is easy to see who is the defender of the


NHS and who would cut investment. To conclude, Mr Speaker, it is this


Government that is increasing spending on our NHS, focusing on


improving patient safety, and is dedicated to providing the best


possible service. I am grateful for the opportunity to raise some


serious concerns about this Government's refusal to fully fund


our NHS. We are seeing this Government running out of places to


cut corners to save money. We see a lack of respect and compassion given


to people who need health care. We see those needing care at home


having to make do with 15 minute flying visits. We have seen the


pressure in A department building over the last six years, and yet,


every year, we have reached a winter crisis. Somehow, this is a surprise


that the Government. We have seen A waiting times increasing to the


point where now over 1.8 million people are more than four hours, an


increase of 400% since 2010. Bed blocking is increasing as our


underfunded social care services struggle to deal with the demand. We


have seen an increase in the number of patients waiting on trolleys to


be treated or admitted and the number of hospitals running out of


beds increasing. We are also about to see a 12% cut to community


pharmacies, which will lead to the closure or reduction in services on


our local pharmacies, and the time it takes to get a GP and appointment


-- a GP appointment in policing -- increasing. If we want a care system


that works with compassion and treats those in the professionally


and efficiently, this Government has to fund it. In 2015, the head of the


NHS, Sir Simon Stephens, said that the NHS needed ?8 billion. It was


this party which committed to fund it the Labour Party didn't. If she


is so keen on funding the NHS, why didn't the Labour Party pledged to


do so back in 2015? Pharmacies, this Government failed to grasp that cuts


to one service directly impact upon another. Let me be clear, only two


months ago I stood in this chamber to condemn the Government proposing


to cut community pharmacies by 12%. That would potentially see 25% of my


42 pharmacies facing closure in Bradford West. This highlights the


short-sighted approach taken by this Government. They are attacking all


forms of primary health care and front line services that people rely


upon. If the figures are correct, nearly 30% of people that attended


A services in Bradford Royal Infirmary, within my constituency,


over the last month, they could have been treated elsewhere for minor


ailments. Many would go to the local pharmacy board to see their GP, but


what is this Government's long-term approach to the systematic issues if


they continue to water down primary care services? All we will see is


the number of visitors unnecessarily attending A increase and the


problems faced by those needing access to services increase. Let's


talk about GP services. We are seeing the same impact from a


reduction in GP services. Only a few months ago, I campaign with the


local community to save manning health practice. That was


temporarily put on hold. However, we have managed to stop this centre in


the short-term, but I know that others are right risk in my


constituency, and many GPs face uncertain future is due to funding


restraints. It paints not only a picture of under picked --


underfunding of primary care services, but also a picture of a


strategy that simply does not work together. Even a simple


understanding of health care provision would allow us to see that


if we decrease NHS services in one sector, it impacts upon the rest of


it. This will increase pressures on


service providers but this government continues to underfund,


and cut funding to all aspects of front line services, and expect the


quality of care to remain the same. Where is the long-term planning that


would ensure people are getting access to the care that they deserve


and are entitled to? Local government social care funding,


again, we see the same strategy from this government with social care


funding. With cuts to care funding has been dramatic, as members have


highlighted. Nearly ?4.6 billion has been taken out of the sector since


2010. Mainly from local governor and funding cuts. My district of


Bradford has had to announce that they will need to find another ?8


million in savings in their budgets going forward. They are trying to be


innovative and find ways to make sure that this does not affect from


front line care by putting resources into prevention. As far as I am


concerned, this government still fails to recognise the impact of


deprivation on our care needs. One of the most deprived constitutions,


mental health issues go hand-in-hand with deprivation. The cuts to local


government funding make this even more evident. It is not the work of


our exceptional health care staff which causes this crisis. It is the


reduction in funding, and the short-term strategy of this


government to which is responsible, and it is time that they wake up and


provide the health care provision that people deserve. Thank your very


much Mr Speaker, many of my constituents are extremely fortunate


to be served by the Luton and Dunstable Hospital, which was named


checked twice by the secretary of state in his statement on Monday.


One of the things they do extremely well is that they have an excellent


streaming process in A with good alternatives where


A services are not suitable. It gives them high standards. Social


care is provided by Central Bedfordshire Council which has been


extremely innovative in building extra care provisions for older


people. I visited these provisions which are hugely popular and are in


central locations. They are much cheaper than residential care. And,


they provide a much better living environment for older people. This


is exactly the sort of thing that we need to see a lot more of across the


country. I think these are two examples of really good individual


practice, within the NHS and social care. And, what we need to be much


better at is spreading good practice across the country as a whole. It is


just worth putting on the record in this debate that since this time


last year, we do have over 1600 more doctors, 3100 more hospital nurses


since 2010, over 11,000 more doctors and nurses. The proportion of


patients harmed by the NHS fell by over one third between 2012 and


2015. Infraction is 50% lower than a year ago. A tremendous achievement.


Health spending in England is actually 1% higher than the OECD


average. And, the UK is spending more on long-term care as a


percentage of GDP than Germany, Canada and USA. The King 's fund has


also that STBs are the best hope for the future of the NHS in England --


S T P. The head of NHS providers has said that the system as a whole is


doing slightly better than this time last year. This is dependent on


having a strong economy and I would argue that this party has


demonstrated confidence in running the economy. I'm not complacent, I


recognise there is an arms race between the extra provisions the


government has put in and increasing demands on the NHS. One issue which


disappoints me is that we do not have enough focus on holiday in


these debates, it is always about funding. I draw attention again to


the initiative brought in by the government just before Christmas,


which is projected to save ?1.5 billion, and could be redirected to


patient care across 18 specialties. Low infections, less provision


operations, and we are using data to shine the spotlight on variability.


That is absolutely key for our constituents and, in relation to


mental health and the welcome statement by the Prime Minister on


Monday, I was delighted to hear emphasis on first aid for mental


health, something that will take place within our schools. Equally as


important, if not more so, I would say, is the issue of keep fit for


mental health, what do we need to do, all of us, to maintain good


mental health? The mental health foundation says we have to talk


about our feelings, eat well, keep in touch with family and friends,


take a break, accept who we are, keep active, drink sensibly, ask for


help and look after others. Those ten pointers are not as well-known


as they should be, I am pleased to put them on the record just now but


it is crucial that we all look after our mental health which will help to


reduce the stigma within this area. Another area that I am passionate


about is doing something about obesity, we have a National Health


Service and we do not do enough to keep our fellow citizens healthy. I


would like to see more emphasis done following an academic of the


University of Oxford, she published an article in the Lancet just before


Christmas showing that where GPs offer a referral to 12 one-hour


weekly sessions to obese patients, there was a significant reduction in


their obesity. In 2015, a quarter of adults were obese... Honourable


member like me is a regular reader of the Daily Mail, their proposal


that are obese or heavy smokers or both, they are denied medical


treatment until they lose weight or stop smoking. Would he recommend to


the front bench that policy? I'm fixing on how we can keep ourselves


healthy to reduce demands on the NHS by behaving responsibly. 40% of


children aged 2-15, 80% in lower households. Those figures showed


shame as all. That is why I mentioned the Daily Mail, and the


scheme brought in by that school in Stirling, we need to see more of


that and the strength and obesity policy. My daily newspaper at the


moment is the China daily which is delivered free to my office at the


moment. I was intrigued to see, Mr Speaker, that universities in China,


students had to take a physical fitness test lasting 50 minutes. I'm


not suggesting that we introduce it here, but we should look around the


world to see what other countries are doing to promote keeping


populations fit and healthy and reduce pressure on health services.


At the other end of the age spectrum, we need to do a lot more


to keep older people fit and healthy, as many issues of social


care would be greatly lessened if older people were to stay healthy in


later life. I am very proud to be associated with the Buzzard's 50


plus organisation in my constituency, which helps older


people take regular exercise at local leisure centres. In Andorra,


where I mentioned earlier, this is normal for the whole population.


Older people in the 70s and 80s regularly take place in water


aerobics classes and go to the gym. When a BBC correspondence went there


a few years ago, some of the women he spoke to were in their 70s and


taking part -- correspondent. They said what is more important than


keeping yourself it? If you don't keep your body moving, you won't


keep your mind in shape. We need more of that kind of activity within


our own country -- keeping yourself fit. We have heard from the opposite


benches today about the so-called annual winter crisis, as if the


situation at the moment that we are in has always been there. There have


been crises but nothing like on the scale that we have recently seen. We


are hearing about corridors being used as wards, and I have seen it in


my own local hospital when I took my young son to hospital. When we went


through into the water and salt use of trolleys with patients on there,


before my little son was seen to -- and saw the use of trolleys. In


December of last year, the minister in his place at the moment, the


honourable member for nut low, answered that question. -- Ludlow.


Could the government give figures for patients left queueing in


corridors? I was told there were no such figures. The government and


minister is well aware this is going on in hospitals up and down the


country and if the government does not collect these figures centrally,


if hospitals collect those figures, the government should ask for them.


If the hospitals do not, they aren't really carrying out the duty of care


to our constituents because I think that it is important that we know


how many are being held in corridors. We hear stories of


ambulances being redirected and bed occupancy is over 85%


recommendations and in some cases over 95% that we are seeing. We have


heard about the ?4.6 billion in cuts in the social care funding. And


already, whilst it has not been explicit, we are seeing talk about a


discussion on the downgrade in the four-hour A weight. I know myself,


in Preston, there is difficulty in getting GP appointments -- wait. If


I bring to see the doctor, I'm often told that we had to wait 2-3 weeks


to see that Doctor. It's probably 2-3 hours at the very least if I go


to the hospital and it is a serious case that we are looking at. No


wonder A is in crisis. There is a whole cohort of doctors in their mid


to late 50s looking forward to retirement. I know the number of


doctors has increased, we heard that today from the Health Secretary, but


I do not think it is anywhere near meeting the number leaving the


service or going to work elsewhere as well. On the social care sector,


we are seeing in Lancashire tens of millions of pounds of cuts in


Lancashire County Council which is leaving the elderly vulnerable and


more likely to have accidents at home which is putting her Sian A


as well. The Cinderella service has always been there, -- putting


pressure on A as well. They do not get the support that they deserve


and I've seen in my own constituency since the closure of the acute


mental health ward hospitals, the agent Dale unit, how mental health


patients have been decanted across Lancashire because they do not have


the support they need in Preston itself. Over a five-month period


last year, we saw a 16% increase in attendance at A in Preston


Hospital and over the same period, average attendances increased from


217 to 225 per day. A small percentage of the increase was due


to the version of Chorley hospitals A and I'm sure if the member for


Chorley was here today, he would echo what I have just said. But that


is not all down to the closure of Chorley's A Many of the patients


who would have gone there are now going to weaken and going elsewhere.


The problem in Preston, as well as Chorley and elsewhere, the


government should not be allowing wards to close when they demand --


when the demand is so high. Ambulance arrivals have increased


from 68 to 91, according to the north-west Ambulance Services. In


the meantime, a return to a 24-hour A service that Chorley Hospital


has been ruled out. At best, there would be a 12 hour A service


sometime later this month. At Preston, we have 134, Alta 138, of


the A departments up and down the country when 95% of patients are not


seen within the four ours. Which means that only four hospitals, A


in the country, our meeting the four-hour standard. Mr Speaker, I


believe this is a disgrace. And, it is testimony to the cuts and


austerity being forced on the NHS and local government social services


departments up and down the country. I call upon the government to


increase spending on social care, and further fund the NHS at this


years budget as a of urgency. It's a pleasure to follow the member


for Preston in today's debate. I am also conscious that I am following


many more learning members -- learned members, from both sides of


the chamber, who bring very valuable experience from the front line


within the NHS. Like probably all members across the chamber, I


receive letters, visits from constituents, with concerns and


issues about the NHS, about their own health issues, and some of them,


as we all know, Mr Speaker, can be very sad and the motive, and we all


do our utmost to help them and what can be very difficult situations.


But let's not forget the many positive stories and experiences we


hear also. Many of us in the chamber, again, will have had our


own very positive experiences about the NHS as well, and away it has


helped us and our families and continues to do so, and I think it


would be wrong and unfair of us not to recognise those today. So, I


would like to start by thanking those NHS staff and those who work


in the health and social care services, not just for the work they


do at this time of year but for the work that they do throughout the


year, day in, day out. My mother was a home-care rather many years, and


my sister is a practice nurse, so I often hear from them what it is like


to work on the front line. I also include the Manor Hospital, our


local hospital in Walsall, and they, like many hospitals, have their own


precious to face. We heard today, on the Tuesday after Christmas, A saw


the highest number of patients, and I believe all those involved in


health care are working extremely hard to this. I include the


Secretary of State and his ministers in this, in the work that they do to


tackle this immediate problem, and what are doing in moving us towards,


I'm sure, a better and more sustainable future. Hospitals across


the country are facing huge pressures, and as I said, as we


enter the winter period. We have an increasingly ageing population but


also one that is increasing in terms of numbers as well. There are many


more treatment options available than ever before. Some of them come,


we all know, at a high cost, but a cost we would like to be able to


meet to help those patients. All of these factors place challenges and


pressures on the NHS, its staff and its resources. The impact of an


ageing population is something that has been raised with me by some of


my local GPs, and the need to recognise and tackle this. I know


that local GPs in my surgery would be very welcoming the Minister if he


would like to drop by Oldridge on his way back to Shropshire one


Friday for a very useful and positive roundtable discussion, so


there is an invitation for you there, Minister. Also, the


importance of having an integrated and effective social care system is


part of this too. I don't believe that whilst money is an important


factor, it is not just about that. The Secretary of State said earlier


that we miss a trick if we say that it is. We forget it is also about


safety, standards and quality, and making progress on these areas too.


I can recall, a number of years ago, the headlines were always about MRSA


and some of those really nasty hospital bugs and infections, and we


have gone a long way in terms of the work we are doing to combat those. I


am proud this Government is committed to the NHS, and that as we


enter the inter--- the winter period, we have nearly 1800 more


doctors, nearly 3000 more hospital nurses than we had a year ago. We


launched the largest ever flu vaccine programme. We allocated ?400


million to local health Systems for winter preparing this. There are


12,000 additional GP sessions over the festive period. Of course, there


is more to do, and there always will be, but I believe that we are


writing to the challenge and that we will continue to do so and I am sure


the Secretary of State and his team will continue to rise to that


challenge as well. I don't intend to take too long, because I am mindful


of the fact that the motion before us largely talks about NHS England,


but I am goaded to speak by the repeated references by the current


Secretary of State, and indeed the previous Prime Minister, and the


current Prime Minister, to the NHS in Wales, and the relative


performance of eight. I want to use a few minutes to try and set the


record straight and give a clearer illustration of the relative


performance of the two NHSs. Before I do, I wanted to reflect on the


speech the Prime Minister gave, and interesting, thoughtful speech


earlier this week about her desire to create a shared society, as she


put it, in Britain. As many members did, I read it and thought it was


precisely what all governments ought to be doing in this country at all


times. I thought I would briefly read one passage. She said: That is


why I believe that the central challenge of our times is to


overcome division and to bring our country together to create a society


that respects the bonds we share as a union of people and of nations.


And I completely agree with the current Prime Minister about that,


but I find it impossible to reconcile that stated objective and


the rhetoric that we hear from a current Prime Minister with the


reality of the way in which she, and in particular her predecessor, have


sought to divide this country, in particular, on the issue of the NHS,


illegitimately, in my view, demeaning the performance of the NHS


in Wales, demoralising staff and destroying confidence and faith in


the NHS in Wales in Welsh citizens. All of those things I think, have


been completely illegitimate, and I hope with a few short statistics to


illustrate how misleading some of the representation has been in


recent years. I would say that it was in fact 37 times, the first


autistic, that the previous Prime Minister referred in a disparaging


fashion to the NHS in Wales, using it on every occasion as a political


attempt to mitigate against criticism of the NHS in England, and


in my view, breaking the bonds, those important bonds, between


different parts of the UK. I will set out a few facts. The truth is,


the budget for Wales, the entire budget, is about ?15 billion per


annum. Of that, ?7.1 billion is spent on the NHS, that's 48% of all


spending by the Government in Wales. The difference between that and


England is enormous, because in England, of course, the entire


budget of the NHS is ?120 billion and the entire budget of the


country, if you like, is around ?750 billion, so around 16% of the budget


in England is spent on the NHS, Violet is about 40% in Wales. --


while it is about. The Government has manipulated statistics on this


issue. The second thing the Government has done repeatedly in


the last six years, and we heard it three times already today, is


referred to the lesser rate of spending per head in Wales compared


to England. In 2010, the Welsh Government chose to reduce spending


in the NHS by 1%. A 1% reduction in order to increase spending and


prioritise education in Wales. Since then, we have seen successive rounds


of investment by the Welsh Government, ?80 million announced


this week for a new treatment fun, ?40 million last week for capital


spending. It's now broadly comparable in percentage terms. If


you look at per capita spending last year, we spent in wells around ?2026


on the NHS, violin England it is ?228. -- 2000 ?228. It is


negligible. Wales spent 6% more per head than England overall. Those are


the realities of comparative spending. Their rise some things


where the Welsh NHS does worse. You do wait longer for some diagnostic


treatment in Wales, and there is a need to spend more on MRI scanners


and CT scans, but part of the issue there is to do with an older, more


sick, post-industrial population, rural sparsity, lesser ability to


attract people to more far-flung hospitals, all perfectly explicable,


reasonable solutions. In England over the last nine months, we have


seen rising waiting lists, the biggest we have seen in the last


nine years. In other areas, Wales does well. Ambulance response times,


getting therein eight minutes and 77% of those calls are met in Wales


will stop cancer treatment times - most people would agree to is vital


to get people treated. The target is consistently missed in England,


averaging 81%. In Wales, it is 86%. Let's look at A, given that is the


crucial area we're looking at today. The four-hour target, in Wales 83%


of people are seen within that target. In England, it is presently


88%. In England, whether our 150 A departments, versus the six or seven


we have in wells, another completely ludicrous and meaningless


statistical comparison, of those 150 A trust departments in England are


below the Welsh average. In several of the Welsh trusts, out of the sex,


they are up at the 96-98% mark. It is another illustration have how


misleading and abuse of it has been the Tories to use the Welsh NHS as a


stick to political points in this place. In conclusion, I want to say


two things. The truth about the Welsh NHS is that it performs


excellently in some areas and could be improved in others. As the OECD


said in a 10-year of all the help care systems across this country, no


part of Britain performs their miserably better than any other.


That is the truth of the differences between our NHS in this country. The


minister, the Prime Minister and others need to remember that they


are ministers for the whole of the UK, not just for England, and their


duty is to increase the bonds of solidarity, not destroy them. Thank


you very much, Mr Speaker. I think this has been an absolutely


first-rate debate this afternoon, with a number of extremely fine


contributions. I was particularly taken, as ever, by the remarks of my


honourable friend, the chair of the select committee, who pointed out


rightly that we are all living longer, which is great, but


unfortunately our healthy lives are not expanding, which causes problems


for A, who have to deal with that. Although we talk about large numbers


of people passing through A, and they deal with Bobby below the time,


the truth of the matter is that it is those with chronic and long-term


complicated conditions who tend to use the lion's share of resources in


A and the secondary care system. As we get older, there will be more


and more of those cases, and we need to prepare for that. We also need to


mitigate against them, and one thing that has not been discussed terribly


much this afternoon is prevention and public health and our need to


ensure that we deal with things that are avoidable. The Prime Minister


rightly in her excellent speech on Monday on the shared society said


that we live in a country where, if you're poor, you will die on average


nine years earlier than others. That is an absolutely appalling thing. We


should all be ashamed of that in this country. Now, half of that


health inequality is because of tobacco consumption and the fact


that if you are in a manual occupation, you are far more likely


to be a smoker and smoke more than if you are a professional or


managerial person. We have to be serious about controlling the


scourge of tobacco, and I would really encourage ministers to


produce the Tobacco control plan as quickly as possible. It is overdue


now, and we do need to deal with this. I would hope very much that it


will contain some helpful remarks on the tobacco duty escalator. I hope


it might contain some remarks on the licensing of retailers, and serious


conversations with supermarkets, the aim being to reduce availability of


tobacco, re-juice consumption and therefore reduce the burden of


disease affecting our National Health Service and having appalling


consequences for citizens. I very much support the amendment on the


order paper today. I am sorry that I was not present


when the honourable lady who speaks for the SNP was present when she was


making her remarks about community hospitals, I'm sorry about that


because community hospitals are particularly important to me and I


would like to have contributed in response to some of her remarks. I


have community hospitals in my area, and I had one particular that serves


Shaftesbury and is threatened with closure is because of STP plans, we


need to be very careful about short-term funding cuts which may


appear to be expedient, if we have not properly costed out a service


like that because it is certainly the case that Community Hospital


beds, providing the case mix is right and traditionally they've been


pretty appalling, in providing that right, providing a cost-effective


means of treating people, particularly the elderly, in a


setting close to their homes and not in acute hospitals which is the


wrong place for elderly and sick people, and steals quite effectively


with the delayed discharge problems that afflict our system at the


moment. We are often faced with the political choice of whether to pose


for expediency, our own expediency, the closure or reorganisation of


services. I face it in my own constituency and was pleased to hear


from my right honourable friend, the MP for Chelmsford. That we need to


be brave, sometimes, in approaching that. It is certainly the case that


if you want to drive up standards and outcomes in the NHS we had to


increasingly look at specialist centres which inevitably means


service reconfiguration and probably mean some closures, which will be


disagreeable to many colleagues, but it is certainly the case that


standards, and outcomes, I improved in things like cancers, strokes and


heart attacks if we have specialist centres which have regional and


subregional services. I would not be one to oppose closure or


reconfiguration for its own sake and we have two always understand that


resources are finite and we need to get the most and the best outcomes


available. I say gently that we need to look at funding and be aware of


the campaign supported by me and the right honourable member for North


Norfolk in relation to a commission or convention, which seems to me a


nonpartisan way of reaching a problem in how we will


fund the NHS going forward. I commend it to him and I look forward


to hearing that the prime ministers prepare to meet colleagues and see


if this can be a productive way forward. We do not spend as much on


the NHS as we need to spend, that's the bottom line. It is no good that


people say we spend 1% of the OECD average. Most people in this country


would not wish to be compared to it, we need to close that gap and as the


government of the day made clear, several years ago now, we need to


close the gap with the EU 15, particularly countries like France,


Germany and the Netherlands whose outcomes are much better than this


country and it is no coincidence that they spend much, much more on


health care. Today, the chief executive of the NHS is being


examined in a committee, I hope one of the things he will be examined on


is the ?22 billion efficiency measures that he felt might be


achievable in the five-year forward view, clearly two years into that


five-year forward view, those efficiency savings will not be met,


they never were going to be met. They need to determine how they are


going to make up that difference between the efficiency measures that


the NHS can reasonably achieve and those projected two years ago. May I


finish by congratulating the Minister, the government, for


achieving what they have. We've heard how things have improved in


relation to things like activity, hospital infections, there is much


more to do and I hope particularly that he will look at this funding


issue. This is a very important issue and I congratulate my


honourable friend on bringing it to the house. The pressures on our


National Health Service have a multitude of consequences.


Limited financial resources, ageing populations and global competition


for skills, but there are many aspects which do have a political


origin and the covenant cannot continue to avert their eyes from


that. Today, I want to talk about my own


experience of pressures on staff in the NHS and those in A are facing.


And walking a mile in the shoes of those on the front line making


life-and-death decisions daily. My exposure to these pressures are


professional and personal. Professionally, like many other MPs,


I spent time in the A departments of Chester Royal Hospital recently


-- Chesterfield. Shadowing staff on the watch. But exposure to those


issues are also personal. Last year on Friday, July the 15th,


my father died from an aneurysm and four days earlier he had spent -- he


had been sent home with what a vascular surgeon described at the


inquest as classic aneurysm symptoms.


He presented at the A Department with severe pain in his right groin,


and was described as being confused and not communicating. After five


hours in A, he was sent home in a taxi and four days later he died in


my arms. It was particularly haunting, and


what was wanted was his response to the question of why my father was


sent home, there were pressures in the department that day, you said it


was nonstop on the Friday afternoon, particularly busy and from one case


to the next comic he constantly had to decide as he did most days, which


should be in a hospital bed and which to send him this time. Every


day, we had to make these choices, he said. I probably sent home five


people that they who should have been in a bed. Those are the choices


we are left with when there simply are not enough. He asked if my


father minded going home and when he did not object, he put him in a


taxi. Doctor Steven Hitchens, an out of hours Doctor at Chesterfield


Royal, said that the hospital would confirm today that they are


experiencing severe pressures in A, the clinical decision unit,


this all comes from a toxic combination of underinvestment,


staff cuts, poor planning and GP surgery shortages. He says this is a


failure from the Scotland plain and simple. They are to blame and they


have to take responsibility -- failure from this government. To


keep the wheels vaguely on, it's a grim determination of


professionalism. In the government have thought emergency departments


can soak up exploitation and abuse but we cannot. We have exceeded


acceptable tolerances long ago. This is what the experience of people


working in the system is, how can we be surprised when it leads to


personal catastrophes? How can we also be surprised when doctors who


have had tens of thousands of pounds spent on their training move to


other countries where they feel they are more appreciated? Those concerns


were echoed when I shadowed the Department at Chesterfield Royal.


There were those who were not urgent cases and should have been at a GP


surgery. When I asked one man and he had come


to A, you try for three days to get a doctor 's appointment.


-- he had tried. Problems could have been sorted out and identified if


they were seen early enough, but the escalate without access to primary


care. The budgets in 2011 and 2012 were


catastrophic for the provision of the next generation of staff and we


are reaping the full costs of those decisions. Aside from the ethics of


relying on overseas staff to keep our NHS sustainable and the impact


on health services on developing countries, it's crazy that at a time


and there is a global shortage of trained medical staff, the


government cuts off the flow of new recruits.


It is similar in nursing. In 2011, 20 5525 students enrolled in nursing


to recourses but cuts to budgets meant that within two years of the


Tory covenant, we are more than 10% down. Staff shortages -- Tory


government. And it should ?2 billion has been spent on agency staff in


recent years, this money could have been spent on additional staff and


is not being spent as it should be on patient care. What we need to


remind ourselves, if things were different under a Labour government,


they led to record NHS satisfaction levels, achievement of 98% weighting


targets, a sustainable GP system and in the words of the King's Fund, the


most efficient health system in the world. It led to higher patient


expectations yet, under the government, this process has been


eradicated. In 2008, after 11 years of Labour


investment, health spending caught up with leading EU nations. The OECD


has shown that once again, spending is significantly below leading


nations again. I am ashamed to say that I am grateful that my father


had his first life-threatening aneurysm on holiday in Germany, the


quality of emergency care he received their saved his life and


gave his family three more years with him. I regret that last year


the same could not be said of our NHS. We have it within our hands to


make our NHS the service admired around the world. Whilst the


challenges that face it are substantial they are predictable. If


the government listened to those who questioned cuts to training, the


impact of GP shortages in A, the impact of care cuts in the poorest


areas in our health service, we would not be facing the crisis that


we do today. So, the call for further action on A waiting times


and investment in our care system cannot be ignored. The government


seems to provide -- the scale of this crisis will engulf them if they


do not take action now. The elderly struggle to cope and disabled are


stuck in their homes not taking advantage of what we take for


granted. People are sent home from A to die. We must do better. Thank


you very much. There is no NHS A waiting crisis in my constituency


because there is no A unit in my constituency because it was closed a


dozen years ago by the Labour government and people had to access


emergency services by travelling almost ten miles on single


carriageway roads up to East Surrey Hospital, which is the legacy of the


party opposite in my constituency. I am pleased to say, Mr Speaker, that


since 2010, services have been returning to Crawley Hospital, as a


direct consequence of the enhancements of the health budget is


which this government has committed to and still commits to. I know that


it is often dismissed by the Labour opposition, and others. But, it is


quite significant that the NHS asked for an additional ?8 billion in the


coming period. And, the Conservative Party in government are delivering


10 billion of extra investment. It has a very real effect, that is not


tonight -- not to deny that there are huge pressures on the health


service, as many members have said in this debate. We have an ageing


population and a growing population. Fortunately, people are living


longer and we have new drugs available to treat conditions where


previously they were not able to be treated. That puts additional


pressure on our health service and the way -- and they can be nice


problems to have with a population living longer. The way to address it


is not using this as some sort of political tit-for-tat, but the


health service and well-being is something that we all share, both us


as individuals, Mr Speaker, and for our families and loved ones as well.


I would prefer that we focus on constructive arguments as to how we


address increasing health care needs as a nation, rather than political


point scoring which we have had a lot of today. I would have to say


that in the 33 minutes of the shadow health spokesman speaking as other


right honourable member 's have mentioned, we have not seen one


policy suggestion as to how, under Labour administrations, we would see


a different approach to the National health service. Mr Speaker, this


week, I'm delighted to say that Crawley, my constituency, celebrates


the 70th anniversary of being designated a new town. I think one


of the most disastrous decisions in that 70 years has been in 2005, as I


mentioned, the loss of A, but I mentioned previously that some


services are returning and only yesterday, I am pleased to report to


the house that a new clinical assessment unit was opened, which


precisely seeks to do what we have been discussing, which is to take


pressure off A whereby those people who should not be being


treated in an emergency situation are triage and signposted to better


support services. The clinical assessment unit that


opened yesterday seeks to do that and will be successful. Also opened


in recent years in Crawley Hospital a new 24-hour a week urgent care


centre and an out of hours GP surgery as well. All of these things


are ways, as we strive to get to that 24/7 NHS, all of these things


are ways that we can better serve patients and as a whole on the


health system relieve pressure on emergency care, which, of course,


particularly at this time of year and almost every winter comes under


additional strain. So, this evening, Mr Deputy Speaker, I will be


supporting the Government's amendment to the opposition motion


that was initially submitted. Because, I do think we need to


recognise the hard work that our staff in the NHS put in. I think we


do need to recognise the initial investment. I think we need to


recognise that it isn't just about the funding, but it is also, Mr


Deputy Speaker, about the way we deliver health care in an acute


setting when people present. And also, finally, in my closing


remarks, I would like to briefly touch on social care as well. Health


care and social care are, of course, inextricably linked. We have an


ageing population, as many Right Honourable member is have mentioned.


And they have, of course, increasing health needs. -- members one of


those areas is an increased health need in terms of dementia. I'm


pleased to say Crawley was one of the first designated dementia free


towns and that isn't just a label, multi-agency working between health


and local authorities and indeed voluntary and private sectors to


ensure that those with dementia are better supported. Again, I am


delighted to announce that recently a new award, the piper Ward opened


in Crawley Hospital, a dementia ward specifically to better treat the


health and social care needs of our elderly population. Mr Deputy


Speaker, there is much more that I would want to contribute to this


vitally important debate today, and indeed throughout this Parliament,


but with limited time I will let other honourable and Right


Honourable member is have their contribution. Thank you.


Thank you, Mr Deputy Speaker command may I start this afternoon by paying


tribute to my friend for his incredibly moving speech this


afternoon. Mr Deputy Speaker, people are dying, literally. We are no


longer sane people will die unnecessarily, we are in the present


tense and we are hearing horror stories from around the country of


people dying on hospital trolleys and at home waiting for ambulances


to arrive. These are lies that potentially could have been saved


had it not been for this crisis. People are dying in hospitals


undetected, and overworked nurses. A constituent went to visit her rant


that in hospital and found him dead on the ward in his bed because the


nurses were overworked. He died alone while his relatives were at


home completely unaware of quite how seriously ill he was. I am somewhat


bemused to hear member after member stand up and defend the government


when the facts are absolutely clear about what is going on. There seems


to be a sense of severe denial going on. How can this be ignored? How can


the government sit back and save the solution is to discard the waiting


time targets? It is not the people who turn up with sore throats


clogging up the system, it is genuinely sick people, people who


desperately need adequate attention. Another constituent who arrived at


A last week was told she would have to wait at least ten hours to


see a doctor. This is not good enough. We are one of the richest


nations in the world. It transpired she had sepsis, a potentially fatal


illness, and it was only down to an overworked and stressed triage nurse


who recognised her symptoms and immediately instigated treatment


that she is alive today and able to come to me and talk about her


horrendous story. Her treatment was started in the hospital corridor


where she sat on a chair on an intravenous drip because there were


no beds available. Not just in the hospital but in any of the


neighbouring hospitals within the trust. The theme is always the same


from all of my constituents who come to me with their horrendous


experiences. The doctors and nurses and other health care staff are


doing absolutely everything they can. They are literally on their


knees. Nobody wants to blame them, they can see what is being asked of


them is far beyond what anybody would be asked of in any other


profession but they can all see the system is literally at breaking


point. And instead of berating the Red Cross for suggesting that our


NHS is in the midst of a humanitarian crisis, let's stop for


a moment and think about why they have had to use that term and let's


talk about what we can do. A friend of mine recently attended an


outpatient appointment at our local hospital and mentioned to the


overworked junior doctor, to whom we owe so much, how incredible junior


doctors who were treated so appallingly recently. He pleaded


with her, with my friend, to tell me just how bad things were, however


overworked they were, how the NHS was crumbling around us and by his


colleagues couldn't perform to the best of their abilities because of


the horrendous pressure they were under. He talked about working 12,


14 hour shifts with a ten minute break. He told her that he loved his


job, it was a vocation, never a job. He was proud of his country and of


the National Health Service. The only thing that kept him from


working here instead of fleeing abroad like many of his friends had


was the fact that he cared for his NHS so much. When is the Secretary


of State going to stand up and take some responsibility for what is


going on? People waiting hours for ambulances, people waiting hours in


A, people lying on trolleys being treated, in seminar rooms, in


corridors. Where does it end? We are already seen creeping privatisation


of the NHS with companies like virgin care putting profits before


patients. Is the end goal to move to an American-style system where


people are literally dying on the streets? Where you turn up at A


and the first question they have you got insurance and can you prove it?


My constituency is served by two hospitals, Dewsbury district and


Huddersfield Royal Infirmary. Both of which are due to be downgraded,


losing vital services and beds as the respective trusts struggle to


meet the financial pressures placed upon them. One of the hospitals that


are supposed to pick up the resulting demand from these


downgrades is Pinderfields Hospital in Wakefield which last week warned


people against attending A before the downgrades have even taken


place. These downgrades go ahead, I am in absolutely no doubt that lives


will be lost. I plead with the ministers and Secretary of State,


now, to stop these downgrades and bring forward the much-needed funds


that could potentially save the lives of my constituents. It was


very interesting to hear the Prime Minister refer to these hospitals


today during Prime Minister's Questions and she talked about the


fact there were two hospitals in the trust, if somebody can pass on that


there are three hospitals within the trust. I quoted this before but


again I feel today is more relevant than ever. The founder of our great


National Health Service said the NHS will last as long as there are folk


left with the faith to fight for it. Since the benches opposite appeared


to have lost faith and stopped fighting, it is our duty on these


benches now more than ever to step up that fight. I wouldn't like to


speculate where members -- when members of the opposite bench last


visited an NHS hospital outside of an official visit. In between


Christmas and New Year. I thank the honourable member for his


intervention. Perhaps then he should show some more empathy towards the


patients that are waiting on trolleys for ten hours just to be


seen. One thing I have known for sure is many thousands of my


constituents rely on the services every day. The message from them is


unequivocal, the NHS needs the funds and needs them now. I was admonished


today by the Speaker for berating the Prime Minister during Prime


Minister's Questions and I will continue to do that, let's be


absolutely clear, while this mismanagement of our National Health


Service is ongoing and I will never, ever stop fighting for our NHS. I


appreciate the opportunity to speak in this debate, and for the record,


the last time I was in an NHS hospital was when I was working on a


night shift on Saturday night. I declare an interest as a nurse who


has worked during this winter crisis this year. But I have also worked


during winters for the last 20 years as a nurse who has been qualified


for over 20 years. Thank you for giving way. I apologise for doing so


so early in her speech but the previous speaker is too busy


congratulating herself on her own speech that the honourable member


for Lewes was working in an NHS hospital on Saturday. That is not of


interest to the Labour benches but I have been a nurse for over 20 years


and have seen winter crises and this is not an unusual thing to happen.


There is no doubt this year there is more pressure than ever before and


we have heard there are record numbers of people attending A But


there have been winter crises year-on-year under many previous


governments. It wasn't unusual when I worked in A for patients to be


treated in corridors, on chairs, where ever there was a space. It


wasn't unusual for ambulances being queued up around the block waiting


for hours to unload patients. I dispute it, I'm still working in the


NHS and I dispute the Lady's chuntering from the other side. It


was not unusual... I want to make progress and there are others who


want to speak. It was not unusual for major incidences to be declared


because we could not take any more patients. It was not unusual for


neighbouring hospitals to declare major incidences and we would have


to take up the slack. I'm sure the truth hurts but that is actually


what happened over my 20 years experience of working in the NHS and


in this winter crisis over the last few days. It is absolutely


outrageous for members opposite to suggest this is something new. They


are in denial if they believe this hasn't been happening for many years


and I will tell you a story. The party opposite is so fixated on the


four hour rule that managers used to bully us and tell us which patients


would get a bed, not on clinical need but on the need of the target


that was about to expire. For example, one night I was working in


a busy A when an elderly gentleman was admitted and have fallen at home


and broken his hip and had to be nursed on a trolley in the middle of


a busy corridor. Before our target was looming. At three and a half


hours he called out to me and said nurse, nurse, I need to go to the


toilet. I had no cubicle to put that man in. He couldn't get off his


trolley because he had broken his hip. The best I could do under a


Labour government was to wheel a curtain around him and in the middle


of a busy hospital corridor with his war medals on his chest he went to


the toilet. He got to the ward in four hours, his target was met but


that was not good care and its members opposite think that was I


think this is a new problem they have been burying their heads in the


sand. I will not give way. SPEAKER: Border. If the Honourable Lady wants


to give way she will not, you cannot shout two at once. It is recognised


if you are going to give weight you will give way but if not it is the


choice of the Speaker. Thank you, Mr Speaker. These problems are not new.


I have worked in outpatient settings as well wear A Tigers have had an


impact on patients waiting for elective surgery -- targets. There


were such pressure from a Labour government it saw me seeing elective


patients with breast cancer having their operations cancelled time


after time after time because of emergency admissions. I had to tell


a young man who had had her operation cancelled three times


while she had a young family waiting for Christmas. She was waiting to


have a mastectomy and have her breasts removed from breast cancer


but the only bed we had left was in a postnatal ward where she had


recovered from her operation, waking up next young mums learning to


breast-feed. That was in the attempt to meet for our targets. Don't tell


that services have reduced. -- four our targets. Staff were put under


severe pressure, not with quality of care in mind but targets and I will


make no apologies in making that clear. I am a supporter of four our


targets, I was enthusiastic when they were introduced, a way of


monitoring performance and improving service but they came the absolute


king above everything else. I congratulate the Secretary of State


because one of the things he has introduced is looking at the


outcomes, what happens to a patient when admitted and if they have to


stay there for about half hours to avoid an admission or to get full


care what is the problem with that? If they have to go within two hours


because they have been adequately treated, fantastic. But we should


not be held to account by and are Britt Reid four hour rule which has


no clinical significance -- butchery for our rural. -- arbitrary. I just


want to touch on the issue of money. Money is of importance and as the


publishing grows and as our ageing population grows, as our ability to


treat more patients grows we will need more funding for health care


and social care. It is worth noting that in my area, there are trusts


either side of my constituency with the same funding looking after the


same numbers of population, one is in special measures, unable to deal


with its discharges, and so has queues and unable to meet its for


our targets. Another one along the coast five miles away is rated as


outstanding -- four our targets. It does not have the same pressure of


four our weights. They can discharge patients speedily. There is


something about the money and what it amounts to. Labour put a huge


amount of money into the NHS but much was squandered. ?10 million on


a failed IT project that never saw the light of day, PFI deals still


today costing the NHS ?2 billion a year. How much could be done with


that ?2 billion? One brief intervention.


I commend her for making what is a very balanced speech, making the


point that meeting targets does not equate to delivering good health


care, although they do have their place. Would she agree with me that


one of the biggest challenges in A is a consistent lack of ability to


recruit middle grade doctors in a number of A up and down the


country and that is one of the biggest problem is that has not been


addressed, to date? I absolutely agree. There's a problem recruiting


in the south-east, my constituency, although health care professionals


because it is an expensive place to live. I agree with you on that. If


we are to move forward, we need to work in a more cross-party way, and


to continue to use four our targets as a stick to beat the government


with does nothing for cross-party working, so we need to stop the


political cheap shots that are being used, we need to recognise that


money isn't always the solution, it's about how it is spent and what


difference it can make. It also has to be clinically led and, as


politicians we can work together but we don't work with health care


professionals are both in primary and secondary care, then I fear


that, in future, we'll be sitting here again and talking about another


winter crisis in years to come. Thank you very much, Mr Deputy


Speaker. I would like to join many others in commending those people


who work in the NHS and in the care system including the honourable


member for Lewes. I just commended the honourable member for Lewes as


somebody who works in the NHS as well as the member for central


supper, who also works in the NHS, I think without payment -- central


Suffolk. It is important to acknowledge that there are many


people in the NHS working under incredible strain and we owe them a


debt of gratitude. I want to be very clear that I support the Labour


motion, and I recognise the importance of access standards in


our NHS. I remember when I first arrived here in 2001, my first


debate in Westminster Hall was waiting times standards for people


with orthopaedic cases, and people then were waiting three years the


treatment, sometimes, so the waiting time standards that were introduced


dramatically changed people's experience of health care, and we


should celebrate that, but sometimes it distorts behaviour and those


distortions ought to be addressed as the honourable member for Lewes was


making clear. With the ambulance standards there was a very serious


distortion of behaviour, which often causes enormous frustration for


paramedics who also working on the ludicrous amounts of pressure. The


other points I would make on access standards is that, whilst I totally


applaud the Labour government introducing access standards, they


didn't introduce them for mental health. That is why we now have to


complete the picture. Now, the government has confirmed that it


accepts in full the task force report on mental health, but that


report includes the proposal to work -- to roll out comprehensive maximum


waiting time standards in mental health so that someone with mental


health has exactly the same right as anyone else to get access to good


quality evidence -based treatment on a timely basis, and I would urge the


government, and it was in an amendment to be tabled for this


debate which has not been called, I urge the government, they have


accepted that report, let's now make sure that it is implemented, because


it amounts to discrimination in the health service. How can he possibly


justify the fact that someone with mental ill-health does not have the


right to timely treatment which other people enjoy? We have the end


that discrimination, it seems to me. The final thing I wanted to address


relates to the question I asked the Prime Minister today. Asking her to


meet with a group of cross-party MPs, putting forward the proposal


that the government should establish what we are calling an NHS and care


convention, and it's an opportunity, we feel, to engage with the public


in a mature debate about the scale of the challenge we all face, we can


trade insults across this Chamber, we all know in our heart of hearts


that the system is under unsustainable pressure. That is the


truth, we know that. At some point the member for Lewes conceded the


point, that we will need extra resources in the future. Let's plan


now, and that we get everybody on board, get cross-party support, and


just as under the Labour government in the last decade, sometimes you


need a process to unlock a problem that ordinarily, partisan politics


has not been able to resolve. And I am pleased, I welcome the fact that


the Prime Minister agreed today to meet with a group of us who are


making this call. We have set up a petition on the Parliament website


so that any member of the public can join this call, and I would urge


honourable members across this House, if you support, if the member


support this call, then join in it. I actually think that it is in the


government's political interest to do it, but fundamentally it is in


the interest of the citizens of this country that we, together in this


House, collectively address an enormous existential challenge the


NHS and the care system. We surely cannot tolerate over 1 million older


people not getting access to the care and support that they need. And


I don't want to live in a country where your access to care and


support in old age depends on whether you can pay for it, but we


are in genuine risk of slipping towards that situation, and if we


all believe that that is not tolerable, then we have a duty to


Act, and we must be prepared to Act together, not just trade insults at


each other. I think there is a real opportunity now to do what the


public is desperately pleading for, to bury our differences, to work


together, to achieve a long-term, sustainable settlement for the NHS


and the care system. I thank you. Thank you, Mr Deputy Speaker. Mini


for integration of health and social care is the most important issue


facing the NHS today. The most productive way to address this issue


or bed blocking is to integrate services, pool resources and


dramatically raise the profile and support of community health


professionals in care and support providers. We often hear of the


problems facing the health services. I'm going to concentrate on the


solutions. In November last year I set up a local health inquiry and


identified a number of people across the constituency and we, together,


are investigating what health and social care should and could look


like in West Cornwall. This is all part of the process in kernel and


the hours of silly. We're asking this question of representatives of


health and social care providers, we are talking to NHS providers and


managers, health campaigners, daycare managers, pharmacists,


mental health clinicians, hospitals and matrons, age UK, etc, and I am


including my predecessor in this discussion. All the clinicians we


have met have identified savings that can be made through integration


that they believe would improve patient care. The results of this


inquiry were set up with clear recommendations that have concluded


and art at the considered as part of the sustainability planning process"


and the Isles of Scilly. It is clear from the evidence we have heard that


extra funding will be needed to implement the transformation that


has been planned. Already health services in Cornwall and on the


Isles of Scilly have a deficit that runs into tens of millions of


pounds. Delivering rural health services is an expensive and


underfunded exercise in Cornwall and the hours of Scilly, and in that


part of the country, we need a fair funding arrangement for health and


social care. People in my constituency agree that we must


integrate health and social care. They also agree that extra funds are


urgently needed to fund the integration of these services. Any


Autumn Statement the Chancellor confirmed government plans to


continue to increase the tax allowance threshold for workers. I


completely agree with efforts to lower the tax burden. Constituents


have asked me to look at ways where we can raise taxes in order to help


the integration of health and social care. On that basis, would the


government consider opposing the increase that was announced in the


Autumn Statement and use the revenue generated to fund the transformation


of integrated services? This could provide ?6 billion towards the rest


of this Parliament that would assist health and social care providers to


make the improvements they need, to reduce costs in the long run whilst


improving patient care? One example where extra funding would have


dramatic results is increasing the pay and support of care and support


workers. In West Cornwall, some of those community care workers are


paid as little as ?7 20 per hour, but they do incredibly important


work in keeping people at home and keeping them in safe conditions. As


a result of this low pay and the pressure on them, we struggle to


recruit and retain these valuable employees. If we were to look at


increasing the taxable threshold just for a short time, this money


would help to integrate the services that we all are committed to, and


help to make the savings and improvements in patient care that we


all long to see. Thank you, Mr Deputy Speaker. In Cumbria, the


government says that its regime for the NHS is about transforming health


and social care to create a Centre of Excellence for integrated health


and social care provision in rural, remote and dispersed communities.


This sounds fantastic. It sounds exactly what we need. So, if this is


the case, while local people so concerned with the actual proposals


that there was a petition for a vote of no-confidence in this regime and


why did the Secretary of State himself say in this morning's debate


that he has profound concerns about the quality of care in Cumbria? West


Cumbria has seen rapid population growth due to the proposed nuclear


new-build along with proposed tidal energy projects. There are concerns


that none of this is being taken into account. Today I want to focus


my particular concerns about the proposals for maternity services and


community hospitals. Firstly, maternity. The highly skilled and


experienced midwives in West Cumbria have told me that the success


regime's preferred maternity option is not their preferred option. The


idea behind the Success resume is to bring care closer to home with a


model that would ensure provision of safe, high-quality care providing a


first class experience. But the midwives ask, how can this be


achieved by the proposals looking to change maternity care at West


Cumberland Hospital, where the Success regime's preferred option


sees the choice of birthplace removed from hundreds of women and


would potentially see severe delays in women and babies receiving


life-saving assistance. The clinical outcomes and satisfaction rates


currently at West Cumberland Hospital under the maternity care


system they have now are excellent, and provide safe, high-quality care.


And these proposed changes would bring in inequality, in terms of


fair access to maternity services across the county, and discriminate


against West Cumbrian women having a choice about their maternity care.


This will affect those particularly who are vulnerable to deprivation


and social isolation. The proposals would see around 700


additional women deliver their babies at Carlisle every year. But


where are they going to be cared for? The Cumberland infirmary in


Carlisle already struggles with its current workload. West Cumbria and


mothers need proper answers. And, in addition to this, there is a


proposed new Garden Village is to be built south of Carlisle with up to


12,000 new homes. So how on earth is the West Cumberland infirmary in


expected to cope? And now turning to community hospitals. I am


particularly disappointed in the consultation document that there are


no options for the current situation we have regarding beds at Maryport


and Wigton community hospitals. All of the proposals remove all of the


beds. This will be particularly difficult for families with patients


having end of life care because their relatives are often elderly


and have their own medical conditions and with no transport of


their own travelling to visit family members can be particularly arduous.


And both hospitals serve areas with large amounts of deprivation and


very poor transport links. For patients and their families in


Maryport they may have to travel to community hospitals or acute


hospitals, journey times would be long with poor bus links, which is


obviously difficult for elderly and disabled people. The people of


Maryport feel so strongly about it they have run a passionate campaign


to show the Success Regime just how much Maryport hospital means to


them, how much it is an integral part of the local community, and


they are deeply upset at the removal of the beds. It is imperative that


all services are delivered as close to people's homes as possible. This


must include the retention of beds at all of our community hospitals


and keep consultant level maternity services at West Cumberland


Hospital. I would like to finish about a very personal experience, if


I may, and this is in particular reference to beds in community


hospitals. Not long before Christmas my father was taken seriously ill.


He was transferred. We managed to get him transferred from the Acute


Hospital to his local Community Hospital. This was within walking


distance of his home. It was a hospital where he knew the staff,


the district nurse was able to call in to see him. When it became clear


that he was at the end of his life we tried very hard to get him to


move home. We got to the stage of having a hospital bed in the living


room. Unfortunately this was not possible. However, unlike my


honourable friend, the member for Chesterfield, my father had a good


death in his Community Hospital. I believe that all my constituents


should be able to have the opportunity that me and my family


had when we were able to be with my father at the local Community


Hospital where he knew the staff, where he knew the district nurse who


came to see him. I think if we remove palliative care from our


community hospitals we are making a terrible mistake. Thank you, Mr


Deputy Speaker. There was constituency faces real challenges


in health care, ageing ovulation and demand for local NHS is growing


rapidly. There is no doubt that our primary health care system is under


considerable strain and so is the adult social care system and the


record demands in hospitals. Calling this a crisis is a disservice to


those in the Clinical Commissioning Group and our local hospital trust


who have worked so hard to prepare for the incredible challenges they


are facing this winter. Demanding the four Amys that serve our


constituency was higher in the week between Christmas and new event --


new year than in the previous year. Inter Amys demand has doubled. The


A staff had to work incredibly hard to meet the demand -- in two


A I was contacted to say that some people were not seen in the


time they would expect, however I have heard from others who arrived


at A expecting bedlam only to be seen within well under four hours.


During last season's Christmas recess I spent the early hours of


Christmas Eve in Western Hospital A with my then three-year-old.


Like this year the Labour front inch frame Don McLean crisis and yet I


saw incredible clinicians doing an incredible job within the required


timelines. Moreover, an outpatient appointment is needed in the week


between Christmas and New Year was easily arranged and kept. My


personal experiences just one of millions experiences in the NHS each


year but I highlight it because if we are to have an honest, factual


debate about our health system we should caution against the emotion


of individual experiences, for there will always be a least one that


illustrates whatever point are seeking to make. Further into the


hospital system, three of the four hospitals that serve the Wales


constituency, have more beds available this year in the last week


of 2016 and first week of 2017 than they did in the corresponding period


the previous year. While occupancy last week in Taunton and Yeovil was


81% and 82% respectively, it is true that occupancy in Bath was 93% and


in Weston-Super-Mare last week it was 100%. Make no mistake, occupancy


levels such as those are a cause for real concern. It is also important


to note that whilst things are tight so far the trusts are managing.


However, I know that for all four of those hospitals and particularly


Western there are too many beds blocked by those who would be


discharged if care at home could be arranged. The Government has made


more money available for adult social care and given councils


greater flexibility to increase council tax in the interim. Somerset


County Council and our local NHS organisations are justifiably still


very concerned. So I encourage that the government looks again at the


local government funding settled meant for next year and adjust it


and ensure the funding gap between urban and rural areas does not widen


-- settlement. And secondly, funding for adult social care clearly and


fully reflects the places in the country where the demographic is


most top-heavy and where variety increases the cost of delivering


that support. Finally, Mr Deputy Speaker, the challenge faced in


local primary care. Local practices assured me that anyone requiring an


emergency appointment is seen that day, however it is true that my


constituents are too often expected to wait for a week or more if they


require to see their regular GP. Quite understandably, for those with


long-standing and complex health issues they expect to see the doctor


they know so these weights are unacceptable. But it is wrong to


connect these weights solely with funding. The greater challenge in


Somerset is not the primary health care budget which has risen for each


of the last three years, but our ability to recruit new GPs. The


Secretary of State worked hard to bring more GPs into the system as a


whole but now rural CCG is like Somerset will have to look at what


initiatives could be developed to encourage new GPs to ply their trade


in rural general practice. Furthermore we must listen to and


support those responsible for our STPs. We have called again and again


for politicians to keep our noses out of NHS planning. Now that we


have and clinicians are at the helm the opposition dismiss that because


it is expedient to do so. It has been written by people who know


their craft and when I asked them if they would have written the plan as


it is even if there were no resource constraints, they told me that they


would. They say that the demand has changed. They tell me that the


thinking over public health as changed and they tell me the


clinical view of how and where people should recover after they


have been in hospital has changed too. Things will change further yet


over the years ahead. Some of the things the STP proposes are very


challenging to me, Mr Deputy Speaker. Some will be unpopular with


the community I serve but their analysis is based on an expertise


which far outstrips mine, so unless I'm implored to reassert the


supremacy of politicians in these matters, we have had enough of


experts after all, we owe it to be clinicians empowered to design and


run our local health care systems, to scrutinise of course, but also to


support them. Moreover, they deserve to do that without the partisan


hullabaloo being stirred up by those opposite today. Our inboxes give us


a great feel for how things are, Mr Deputy Speaker. Our conversations


with constituents, clinicians and patient participation groups like


the one in Cheddar I will see tomorrow night shaped that the too.


To claim that all is perfect right now is not true. But to claim a


crisis is not true either. Our population and the practice of


medicine are changing. This debate needs to happen. But not in a


partisan funerary but in an honest, constructive, and supportive way


instead. -- funeral stomach for I was going to talk about the cuts


to health and social care funding to hospitals and health care in the


south-west but all of the things I wanted to say have been made by


owner stomach other honourable member is already. In keeping with


previous speeches I have made recently I have decided not to


repeat what has already been said but to scrub all of that and say


something completely different. It is about the health consequences of


loneliness in older people and the impact of funding cuts in NHS and


social care systems on loneliness, and in turn the impact of old


people's loneliness on the health care system. In the run-up to


Christmas I was regularly blinking back tears on the Underground


whenever I saw the advert is I'm sure many honourable member is will


have seen from Age UK saying no one should have no one at Christmas and


if you do not remember it it looked like this, which is the report I


re-read again yesterday, no one should have no one by Age UK


published in December last year about loneliness in old age. I found


reading that report brought home to me just really how much loneliness


affects people and how funding cuts which may appear small and


insignificant can have a cumulative effect on older people. A


constituent illustrated this to me recently when she came to talk to me


about her worries for the older people she cares for. As a lowly


paid care assistant she was not complaining about her pay, I am just


observing that. She told me she regularly stays well beyond her low


hours because she feels that the people she's working for need her.


Partly because they have greater care needs than the time allows, but


also because they are lonely. As I said, she wasn't complaining, but in


my opinion starving social care of adequate funding means that people


like my constituents are subsidising the health and social care system


voluntarily, which she is willing to do, but it should not be left to


chance like this. The Age UK report mentioned a survey they carried out


of 1000 GP practices by their Campaign to End Loneliness in 2013,


which found nearly 90% of GP practices than patients were coming


in because they will only. The report also points out that funding


has been cut and funding cuts mean that deals on -- meals on wheels,


daycare centres, public toilets and community centres have been cut,


closed or reduced in recent years. They point out that all of this


decreases opportunities for older people to get out, to socialise, to


take care of their health, to eat well, to exercise. One of which


increases loneliness and isolation and damages their health. And what


does that have to do with chronic serious illnesses? Age UK carried


out an evidence -based review for their loneliness report and found


out that chronic loneliness increases the risk of serious


illnesses such as diabetes, stroke, depression and dementia, as well as


I have already said, making it much harder for them to get out there to


receive help, or do things that might prevent those conditions


getting worse such as exercise and good diet. I pay tribute today to


all the people across the country who give their time as volunteers,


as staff, and as those who raise money for charities such as Age UK,


nationally and locally, and in Bristol, Bristol ageing better, to


do so much to combat loneliness in older people. If I may read one


example from the Age UK report, I will read an example if I have time,


Arthur's son was worried his health was deteriorating because of the


many hours he spent alone in his flat in sheltered accommodation. He


was unwilling to participate in group activities because of


difficulties he had hearing. He had had a busy social life but most of


the friends he had had died. Age UK introduced him to Paul who also had


to retire early after an accident and was also feeling increasingly


isolated and together they played dominoes, cribbage command would


dissect the latest football match and reminisce about their time in


the building trade, swapping funny stories of mishaps and adventures.


Paul provided after with good company and a link back to the job


he loved. Arthur has helped to restore Paul's sense of purpose and


self worth. This example and many others in the report showed just how


much work on loneliness can help to increase older people's health and


reduce the costs on our health and social care system. So, what the


CEOs, staff in my area have told me about cuts have on health care and I


also want the Minister to tell me how he and the Secretary of State


will lead the way to provide us with a fully integrated and fully funded


health, social care and mental health care service. But I want all


of us to read Age UK's report and follow the recommendations they make


at the end for MPs amongst others. I will end on one. As a member of


Parliament they have asked us, as well as to find out about loneliness


among old people in our constituency, raise awareness,


become an aged champion, encourage political parties to do more and


take steps to put loneliness in later life on the government's


agenda, so I hereby do this, and hold them to account for progress


which I will continue to do, they have asked us to make the case for


investment in local community resources to support sustainable


long-term action to help lonely old people whatever they may be, I urge


the government to take notice of that. I want to finish by saying


they have asked as to support the work of the Jo Cox commission on


loneliness. It is launching shortly. I would like one of us to take those


words to heart. Thank you, Mr Deputy Speaker.


The honourable member for Bristol West has spoken about loneliness


which is a problem across the country and some great work is being


done on that. Some colleagues have spoken about their personal and


family experiences, like the member for Wells and the member for


Chesterfield who have spoken about experiences both good and bad of the


National Health Service. I have personal experiences both good and


bad. Three years ago I spent Christmas Day night in A with my


son he was five years old at the time and he had his appendix taken


out first thing in the morning on Boxing Day, and had absolutely


exemplary care and was home within two days, easily making up the


quantity of sausages that he omitted to eat on Christmas Day with his


tummy a closer last Christmas my grandmother, aged 100, was in


hospital for several months and she had a much, much worse experience,


and it was not the NHS at its best. We all, I think, have good and bad


experiences to drawn and we hear from constituents as well about


those good and bad experiences. It's important to recognise what the NHS


does well and is doing well, and also where the system is failing, to


focus on supporting the good and checking the bad. I can very much


understand why this debate has been called the day, because there was no


question that the NHS is under extraordinary pressure this winter.


We've heard that it had the busiest week ever, last week. I will say I'm


quite disappointed by both the tone of some of the contributions today


and also, because it happens in the Chamber, the lack of proposals,


rather than suggesting more money, but with no proposals for where that


money comes from, which is fundamentally unhelpful, to suggest


there should be more money but with simply no proposals about where it


will come from. I am happy to give way. It's clear where the money


comes from, we are asking for ?700 million to be brought forward from


the better care for from 2019. It is already allocated. It is still quite


a lot of money to be down. This is against the backdrop of less than


two years ago, when the Labour Party was not committed to funding the NHS


with money that it was asking for, which this Conservative Party chose


to, so that is a rather shocking position that they are lying. I


would like to seize this opportunity to say a very heartfelt thank you to


all members of the NHS staff, nurses, doctors, allied health


professionals, porters, Gera Systems and social services and particularly


in Kent, -- care assistants, who are working extremely hard and dealing


with this pressure at the front line. And also to the patients and


their families who I know are being thoughtful and are making sure that


they make best use of the NHS, so I thank them as well. We know that


there is great variation in how the NHS is coping. As I speak I was told


that the waiting time in Maidstone A is just 37 minutes, so Maidstone


is coping well, but nearby, there is a weight of over four hours, so


there is a variation and maybe people listening will divert where


they are going. There may be a case for that and for greater


transparency but that is for another day. The point we were talking about


earlier, about money, there is no question that part of this is a need


for more funding and for more staff, but the government is doing exactly


that, giving the NHS more money, and also investing in significant


increases in the workforce. Quite apart from that, money is not the


whole answer. In part because, if the NHS continues doing all that it


does in the way that it is, and without they level of change, we


will find ourselves with a system that is unaffordable and which will


be look -- using a level of GDP that would not have public support.


Because we know that we have the situation of an ageing population,


people living longer with complex, multiple conditions and costly


treatment, high-cost treatments becoming available that people want,


so the NHS itself recognises that it's not just about more money but


about changing the way services are delivered, and that is actually


happening and are being worked on at the moment. Earlier today I spoke to


the chief executive of the hospital trust who is also the lead for Kent


and Medway sustainability and transformation fund, the STP, which


has come up several times today. What I saw from him and those around


him is the coming together of NHS organisations intended to work


closely together across central Medway, and the coming together with


social services in a way that is so important, necessary and right, to


work out how we can provide a better health service in a more sustainable


way. Breaking down the barriers between organisations were it


doesn't make sense that there's a shift between the NHS and social


care in who is providing what, and looking at how we can moved care out


of acute hospitals and closer to home, which we know is good for


patients, it is exactly what the honourable member was hoping for for


her father and what I hope of my grandmother as she knew the end of a


light enable people to be looked after closer to home, increasing


prevention and one that I feel strongly about, improving mental


health care, which the Prime Minister has personally shown the


lead she has taken on that since Monday, and I particularly value, in


the light of the pressure on A, the commitment to psychiatric


liaison in A which we know has helped people who go to A with


mental health problems and looks after the people who need to be seen


for physical health problems, and I welcome that in my area of Kent they


are looking at having psychiatric liaison in rural A departments by


2018, so bringing that world. There was important work going on at a


local level. -- bringing that forward. I would encourage members


opposite to, rather than perhaps knee jerk or even tear-jerker


contributions that we have had from some members today, to take a longer


view at the situation, to help have a more mature conversation about


what the NHS needs, to talk about policies and concrete proposals


rather than just more money for solving the problems, and, actually,


to define what the NHS is doing at the local level, NHS and local


authorities coming together for plans across their areas to have


better care for patients in an affordable, sustainable way. Thank


you, Mr Deputy Speaker. After four years of having responsibility for


the National Health Service, the Secretary of State for Health has


declared that we need to have an honest discussion of the public


about the purpose of A departments, and we, who have seen


his work from this House and have dealt his work on the front line


know exactly what he means. He means, let me tell you why everyone


else is to blame except for me. Earlier this week the Secretary of


State told the UK that nearly one in three visits to A do not need to


be made. This was his reasoning for weakening the target that every


patient should be seen within four hours. That target only applies to


you if your condition of your condition is serious and urgent


enough. I find it staggering, the sheer hubris of those statements. He


avoids accountability in this position. The danger that is


inherent in both, first as an A specialist Doctor I have treated


patients who have arrived in A with what seemed like minor


complaints that develop into more serious and life-threatening issues.


The Secretary of State, both in his words and his decision are saying


that the people of the UK should self diagnose before heading to A,


and that could have disastrous consequences, of which he would be


responsible. What if, because of it, patients decide just to stay at home


after that serious bang on the head that turns out to be a


life-threatening bleak to the brain? What about that potentially


deteriorating case of pneumonia that is not serious enough to warrant


going to A, that results in somebody being severely septic and


dying? As a citizen of this country and a patient of the NHS I find the


Secretary of State's refusal to accept responsibility for the state


of the A departments in this country deplorable. Instead, he


blames patients for visits that do not need to be made. They do not go


for fun. Patients go to A because they are ill and cannot get a


doctors appointment is for two beach. We've heard from members on


both sides of the House who have taken around young children to A,


did they do so for fun because they felt there was a need for their


child to treated? They go to the A because their GP does not have


resources at their practice for something as simple as handing out


crutches, in some cases. They go because there is something wrong and


they are worried sick and simply desperate to speak to somebody about


their health. No, I won't. Many now that they shouldn't be in A, but


what other option is this government leaving them? Just calm it down.


Let's not get into the habit of shouting at each other. Let's have a


nice, sensible debate. They go to the A because their GP does not


have resources. They go to A because there is something wrong and


they are worried sick and simply desperate to speak to somebody who


is a professional about their health. Many know they should not be


in A I've had patients Sane, the elderly, saying, I am so sorry,


Doctor, for wasting your time. But what other option is this government


leaving them? This is what we are debating today. The Secretary of


State wants an honest conversation. Well, let's have it. Let's talk


about the impact of the current state of the NHS that he has been in


charge of 44 years, and its impact on A departments and hospitals in


this country. Let's talk about rock bottom staff morale. Let's talk


about breakdown of staff managers. Let's talk about a rise in


depression amongst staff, let's talk about the fact that waiting times


are not the responsibility of patients. They are not to blame.


They are those responsibility of the right honourable member, the


Secretary of State for Health, and yet he blames the rise in waiting


times on the number of people going to A since the target was set. I


would say that it is the right and remember's responsibility to lead an


NHS that can meet the needs of its people, and again, the Secretary of


State pleads innocence. He says no other countries have such stringent


targets, suggesting it is unfair that we have. I would say that the


meeting of this target in particular, not water down but then


fall, is what establishes the NHS as their best health service in the


world, one that we can, should and would be proud of, under a Labour


government. After all, the ability of emergency departments to meet the


four our target is directly related to the health of the NHS itself.


It's simple, more people go to A when they have no other options are


available. I thank My Honourable Friend Paul giving way. The issue of


those options in A in my area of Cumbria is entirely down to the lack


of GPs, and it was only going to become more acute with so many GPs


reaching retirement age. But My Honourable Friend agree that this is


something the government needs to tackle urgently? Without a doubt,


yes. I wholeheartedly agree with my Right Honourable Friend and the


point she has made about the lack of GPs and the problems that we shall


see when three more retire. Three contacted me and my tooting


constituency saying that they have been offered jobs that were


subsequently retracted due to, and the reasons cited, financial


pressures. The Secretary of State pleads innocence. He says that no


other countries have such stringent targets. We should not be comparing


ourselves to the worst, we should be leading as the best. The explosion


of waiting times in this country are his failure and a sign of the


dangerous erosion of one of the country's greatest institutions. As


we saw last week when the British Red Cross at the be drafted into


hospitals, our NHS is in crisis, yet instead of listening to doctors and


fixing the systemic problems they have created, the government is


repackaging the A four our target to take attention away from real


challenges. The challenge of social care provision not being in place,


prohibiting floats through A departments. Editing access to GPs


across the country meaning that A is the only resort, and the chronic


cuts in funding at local authority level. Doctors and nurses forced to


miss breaks, as we have heard, working 14 hours, some of them


without a break. Sleep deprived, unsafe to practice clinical work.


And NHS staff do not feel supported, encouraged or motivated by this


government. None of these things would be addressed by a watered-down


four our target. Having spoken to the College of


Emergency Medicine those working on the front line at all levels and


those training junior doctors I would like to put forward questions


for the Secretary of State. Why has the four-hour target been


downgraded, who was consulted? Which body said it would be beneficial to


patients, A staff across the trusts, how he defined the major and


minor health problems? How will doctors and nurses magically know


whether it is major or a minor health problem at first sight


without proper assessment? Who is responsible if a seemingly minor


condition is actually life-threatening? Shall it be he was


Mac who will be responsible? How will this government explain that we


will be going back to the days where patients could wait over 12 hours if


they were not considered ill enough. The Secretary of State must


recognise the impact of this systemic crisis on accident and


emergency rooms across the country. In his words and decision to


downgrade the target the Secretary of State does neither, instead


placing blame on patients and putting patients at risk. Let me be


straight, I've been an A specialist Doctor under a Labour


government and Conservative government and there has been a


change under this government and for sure it's not been for the better.


Lucy Allan. Madam Deputy Speaker. There have been very many excellent


and constructive contributions to this debate and I particularly


welcome the valuable input from those who have real life experience


in the NHS. I would particularly like to congratulate my honourable


friend the member for Lewes and her excellent speech, and it was


disappointing to see a member opposite behaving with such


disrespect for a fellow member during that speech. Will owe a debt


of gratitude to those on the front line and none of them would thank us


for reducing this debate to an ill tempered party political act of


posturing. I know there are many sensible members opposite who fully


understand that no complex problem is ever solved just by increasing


funding in response to ever-increasing demand. There are


very strong members opposite who want to work in a constructive


fashion with all members across the House to tackle the challenges that


our NHS faces and I welcome that. The Right Honourable member for Don


Valley is one such sensible member and she made a point earlier this


week on BBC's radio for Westminster hour saying it is not even


electrically advantageous to the Labour Party to treat the NHS in the


way that the Labour Party so often does. We have just seen an example


of that. I believe it is for the benefit of all our constituents that


we all encourage a more constructive approach. I want to speak very


briefly about the four-hour target. Four-hour targets were introduced


for those with urgent health problems and I am sure that all


members of this House agreed that it is those indeed who should get


access to care as soon as possible, and not find that their needs are


eclipsed by someone with a minor ailment just because targets must be


met. The Secretary of State has spoken this week about his


commitment to protect the four-hour promise for those who actually need


it and he's absolutely right to say this. Because, today if we talk to


those who work in our local Amys and I know lots of members do this


regularly, they often say there are people going to A when they do not


need to do so. -- A Clinicians expressed the desire to prioritise


need rather than simply meet targets. As a constituency MP I


fully understand that it can being friendly difficult to see a GP when


you want to and it can be equally difficult to navigate a system of


ringing at the right moment to get an appointment on the right day.


However, it is not the answer to simply circumnavigate the system and


turn up at A to get fast tracked irrespective of need. We should not


be encouraging the expectation that whatever your element, no matter


what the demands on A staff, if you go to A you will get seen


within four hours. If people are going to A who do not need to be


there why are we offering them a four-hour service when they do get


there? When the minister sums up I should be grateful to hear more


about what can be done to tackle this particular issue. Maybe he


could mention what proposals there are four GPs in A, or what


proposals there are around different mechanisms of triaging or managing


expectations of our constituents. What matters most is that those in


need get access to the appropriate treatment as soon as possible and


that's what a target is for. It must be about safety and safety for those


with critical and urgent health conditions. I would just like to add


that we must never lose sight that our health and well-being is so


often dependent on our lifestyle and with the right help and support we


can all make the right choices to help us live healthy and help us


live happy. Diet, stress management, sleep hygiene, exercise, alcohol use


and smoking are key determinants in our physical and mental health and


well-being. I would like to see much more emphasis on self-care and


self-help, because we can all play our part. There is no amount of


funding that will ever compensate for a lack of self-care. Yes, we do


need a grown-up and honest approach to this incredibly important issue


that matters to all of us here and to all of us who have spoken so


passionately. I respect the passions of all members on both sides. What


we have to avoid is falling into the trap that we have seen today where


we let ourselves down, we let the House down and we actually do not


benefit those we most wish to assist in the way we approach this debate.


So, yes, let's keep on exploring a sensible and collaborative approach,


as articulated so eloquently by the member for North Norfolk and


particularly from our honourable friend from Totnes who echoed the


sentiments of others, and she is also doing excellent work in this


area of working together across the House. None of us, none of us should


ever play politics with the NHS because the NHS matters far too much


for simple games. Julia Chapman. Madam Deputy Speaker, it is a


pleasure to follow the Honourable Lady for Telford, I have not heard


has been before and I look forward to hearing many of her speeches in


the future. I have to say that to imply somehow we are letting each


other down, or the House, or our constituents by standing up and


championing health services in our constituencies, I completely


disagree with that. That is an essential part of our work. That is


why many of us wanted to be elected to this place in the first place,


particularly those of us like my honourable friend from Tooting who


has such relevant experience in today's debate and I thought made a


tremendous speech, and I listened with great interest to what she had


to say. I think the front bench opposite ought to be doing the same.


We have had a lot of debate about whether or not the NHS is in a


crisis, or whether it is a humanitarian crisis, an ordinary


crisis, the winter crisis. I looked up crisis and a crisis is a period


of intense difficulty or danger. I would say that is a good description


of where the NHS is today, a period of intense difficulty. That's what


I'm seeing in my local hospital and that is what my constituents are


coming telling me about. I've been an MP for nearly seven years and I


track the things people come and talk to me about in my surgeries, I


am sure many of us do and it is not hard to do. I have now every week


somebody coming to see me, I'd about an experience at the hospital, or


more and more often because of an experience in adult social care. --


either an experience. That's not something that has occurred in the


last few weeks, it has been growing over time. I would say the crisis we


witness today is something that has been long predicted and that we have


all felt happening over time. And that the Government has chosen, they


made a decision, not to act to prevent the worsening of. That is


why there is such anger on this side of the House. When a quarter of


patients wait longer than four hours in A that is a crisis. I don't


really care whether they are there with a minor ailment or a more


serious problem, because four hours is too long. It's too long to wait.


The fact people are there with minor ailments just tells you, it is a


very clear demonstration of the problems that exist elsewhere in the


system. When you can't get a G8 Dummett GP appointment or phone 101,


you are more often than not directed to A when you phone 101. We need a


selection of services available at a central point where if you need a GP


you can see a GP, if you need to see a practice nurse you can do that. If


you do need to be admitted you can be admitted. I will give way. In an


effort to reassure her colleagues, it is a genuine question. What


impact does she believe, this is the question I would have asked the


honourable member for Tooting, what impact does she believe the 2004 GP


contract has had on out-of-hours care, which seems to be the nub of


many of the issues that have been discussed this afternoon. Well, do


you know what I think about that? The GP contract was changed in 2004


and I did not notice the kind of issues that we face today until far


more recently. I'm not a scientist or a doctor, but I do understand


cause and effect. I think it doesn't ring true to me to say that


something that happened six years prior to the change in government


can be blamed for something that's happening six years after the change


in government. I'm not saying it has no consequence whatsoever, but I do


think there has been ample opportunity to put measures in place


that would have prevented us being where we are now. Her intervention


leads quite nicely into the point I want to make about the Secretary of


State. I hadn't intended to speak today but I was so frustrated


listening to him on the Today Programme trying to blame anybody


but himself. He has a pattern. The first thing he does is he will blame


the Labour government, in government until 2010, and then his party since


then. He blames Labour, he will blame Labour for anything he


possibly can. He will find something that happened at some trust and say


that's why this has gone wrong today. But if that doesn't work, if


he can't evidence that, he will say that particular trust is a basket


case, it is the trust's fault, it's the local managers, local commission


not organising themselves right, it is their fault. If that doesn't work


he blames the public and he says you're going to the wrong place, you


are accessing your care in a way I don't think you ought to, or call


them frequent flyers, or there will be a problem that is the public's


fault. They don't look after themselves properly, but clearly


their fault. If that doesn't work he blames the local council. That, I


think, is probably the worse thing that I've heard him do, blamed the


local authority. My local authority,... In a minute... They


have prioritise local Amaq social care but the pressures are not going


away. -- prioritised social care. They are running out of things to


cut. We are just closing our Central library in Darlington. We are making


hideous cuts and I don't know where the next round is going to come


from. I give way to the honourable gentleman if he still wishes to


intervene. I thank the Honourable Lady for giving way. It is incumbent


upon us all, I am sure she would agree, to discuss the future of our


NHS and health services responsibly. Can she not surely accept that when


the Secretary of State is talking about where people go for their


services, it is not a matter of blaming people's we ought to move


away from this blame culture. There is a benefit in trying to educate


people that if perhaps their illness is not best served at A and is


best served elsewhere that they ought to realise they should go


elsewhere and that helps all of us, both the people who are seeking the


services and the people who are giving them.


Why doesn't he tell his honourable friend, the Secretary of State,


this? He is the one blaming people, not me. I would welcome a programme


of explaining to people and making it easier for the public, including


myself, in helping us decide where it is we ought to go when we need


assistance. The solution, though, that the


government seems to have come up with around watering down the


target, even members on the government side don't seem to be


able to agree or explain exactly what change, or even if there is a


change, to the four hour target, they don't seem to be able to


explain exactly what that is. The other solution they have come up


with is to close a A It is something the local


community will not accept. Part of the reason we do our jobs is to give


a voice to that local community. So far, in that STP process, they have


been completely shut out. We would not have even known what was


contained in that plan, had it not been leaked by Hartlepool Borough


Council on their website. That is quite a shocking way to conduct a


local dialogue. Having started about three years ago, we had the better


health programme across the region where my constituency is. I was


shocked to find out in response to Parliamentary questions that local


health managers have spent ?4.6 million on this process. ?4.6


million that could have been spent, and should have been spent, on


providing front-line health services to my constituents, and has been


spent on a consultation on whether or not to downgrade A I could


have spent that money a lot, lot better. I could have given the


answer to what the local population thinks about this proposal, because


they are very, very angry and upset about it. It is right that we


express that anger and disappointment, outrage and fears


for safety, in this House. Many people today have spoken about their


families and their relatives. The Member for Chesterfield, the Member


for Workington, spoke about their fathers. My dad I'd in 1994, and he


had a heart condition -- died. He was 48 and I was 20. One of the


things I have done since then is take a very keen interest in cardio


health and services for people with heart disease. I was shocked to find


that before 1997, it was not uncommon for people to die waiting


for heart treatment, often people would be waiting to 18 months for


heart treatment. This party in government changed


that. We changed that. We made it a matter of weeks. We have saved


countless lives as a consequence. And so, when people say that the


Labour Party did not do a good job with the NHS, or members opposite


try to imply that we somehow have this fake do we eyed sentimental


attachment to the NHS but they are completely wrong to do so. We will


fight for the NHS. We did create it, but we also did a good job running


it in government. We saved lives, cut waiting times, put in targets,


it made a difference, it was better for patients, and it will never be


any other case stated in here or outside.


I am afraid that it is rather unfair on those that have waited all day


and have not yet spoken. But some people have taken way over seven


minutes, and I'm afraid that I now have two reduced the time limit to


five minutes. I would like to pay tribute to all


those that work in our National Health Service. And welcome this


important debate. I hear the Secretary of State not blaming but


looking for solutions. And actually, I think that's more what we should


be about. I have called for an honest debate about the National


Health Service since I came to this place, because it is 70 years old


next year. Actually, if it is going to get to 100, we need to look after


it. But I want to start with the positives. My own hospital, West


Suffolk Hospital, has seen a 20% increase between Christmas and New


Year in the number of patients admitted. Those patients have been


poorly, very poorly, which was a point made earlier in the House.


They made a resilience plan for 5% uplift in patient numbers, and


actually, they have coped spectacularly.


People coming into A, and I point to the honourable member for tooting


who is no longer there, they have people coming in with ingrowing


toenails, and with dry skin. And it is important that we do something


about making sure we see the poorly as people in the most appropriate


way, and use was also is most effectively.


My constituency is the second oldest constituency, by age, in the


country. An ageing population:, comb morbidity


The allocation of resources as we go forward is important. But my


hospital has been one of the most resilient in the east, at 85%, and


its resilience is in most part due to its fantastic staff. West Suffolk


Hospital has been innovative. In January, it will be doing a bridging


care service with the councils, improvement will come through


prevention and integration, and not always by shouting for more money.


The honourable member for Faversham, mid Kent, stated that it is good


integration that we need, good working in Suffolk needs to be


copied. STPs, as the honourable member for Wales and Central


Ayrshire said, they need to be looked at as a force for good, and I


would urge the party opposite, don't knock it, work with it. A clinician


led. That is what everybody was asking for. We can't have


everything, we never can. We need an honest conversation. With rising


expectations, an ageing publishing, the private sector has been in use


in the NHS since 1948. If we are going to get more bang for our buck,


we may be should look at parts of the private sector, in order to


enhance what we get through these critical periods. Yes, certainly.


She is absolutely right on the need for a grown-up debate about


integrating, and about learning from best practice. But she share my


concern that as the party opposite fans the flames of indignation, all


they are doing is proving yet again that they are either unwilling, ill


equipped... ? I would agree in that since we last


debated this on November 23 with the opposition, apart from asking for


700 million to be brought forward, actually, there is very little


tangible other plans that are being put forward. And it is important,


and this is everybody we are talking about, so slinging bows and arrows


across this chamber is not going to get us to the solution that we need.


If it's about money, how come some areas do better than others? It is


about the allocation of resources and good leadership. There are three


letters about good health care I've had, a resident in my constituency,


the GP on the 28th October, the consultant on the 8th of November,


operated on on the 29th, that was actually at my District General


Hospital that use the private facility locally in order to enhance


that patient experience. We need a long-term solution, I am


pleased that the Prime Minister has spoken about tackling the


difficulties of mental health, something that the honourable member


for North Norfolk has championed, and with me shares a mental health


trust. I am pleased to see another 49,000 people being treated for


cancer, something that I came to this place to champion. Another


822,000 people being treated, seeing specialist cancer patients. We have


seen huge increases in demand, and we need to actually admit that we


can't just carry on. Advances in drugs, co-morbiditys and an ageing


population, we need to understand what is wrong, and we will do that


by better data throughout the system. The Richmond group wrote in


support of my Private members Bill that information held in health care


records has a huge potential to provide better care, improve health


service delivery. Paramedics have asked me for better access to data


to understand that when they find someone on the floor what measures


they are on and what beneficial treatment they can give them. GPs


want their information to flow through the system, to help social


care and to help the hospital sector. Pharmacies need to be able


to read and write, and social care need to look at somebody's pathway.


Patient outcomes should be the thing that we are all talking about, but


we have to make decisions. At the centre of all this, we need to


support those colleagues who are working above and beyond at this


current time, and we need to behave in a grown-up, responsible way as


they are, caring for our NHS. That an organisation is highly rated


as the Red Cross would say what they have is shocking. It points to be


hot of the government's did provide a reliable, properly resourced,


national Health Service free at the point of need. It should be a source


of shame for this government. The reports last week that patients died


on trolleys and corridors, one having waited 35 hours is shocking.


Could this be the face of the NHS in 2017 under the Tories? It seems it


is will stop Health Secretary responded by suggesting that the


four hour target should only apply to the most urgent cases, and that


it was estimated that 30% of agents in ten won shouldn't be there. He


should hang his head in shame. -- in A In Cheshire and Merseyside, the


NHS has defined savings of ?1 billion. Nearly a third higher than


the original 9 million forecast. I would be interested to hear why this


curious request has been made. Patients in Wirral West are


concerned about the impact of these savings or cuts will have in general


practice will stop by our rights to be concerned. The biggest financial


squeeze in the history of the NHS 's puddings services at risk. --


putting. And NHS manager from my constituency


has written to me saying that STPs are pushing for a redesign of


services. Primary care and scale, the real punch line is there is no


funding to make these changes. They go on, locally there is talk about


and accountable care organisation for West Wirral, meetings being held


on almost a weekly basis to create a road map to do this with no money to


do it with. Having fragmented services, they are now making


services use what pitiful resources they have to try to put it all back


together again. I truly despair there will not be an NHS this time


next year. What a stark warning, a damning indictment on the


government's you. The Secretary of State should address the crisis by


giving the NHS funding they need to make up for the crisis of the


government's making about access to GP appointments, failure to train


enough nurses, I have long been aware of the Tory's gender for the


privatisation of the National Health Service, seen in the 2012 act, which


opened it up to the private sector, and allowing NHS hospitals to give


half their beds to private patients. I believe that this and previous


Tory government seek to move us to a two tier system, where those that


can afford it, paid private health insurance, and the rest are left


with a bargain basement NHS. Since the Thatcher period, this has been


shown. We appear to be reaching the end game. The government is cutting


the supply of health care in the Babic sector to create demand in the


private sector. -- in the public sector. It is an entirely different


concept, and in the process of trying to transfer us to that two


tier insurance -based model, did you not pause to think about the human


suffering he would unleash in the process with patients waiting for


hours on trolleys, anxious relatives waiting helplessly as they watch


what's happening, and stressed out day in, day out. Now is the time for


a decision. The government can review and it is not too late. It


can face the facts and admit to itself that actually engage people


would a state managed, state funded, National Health Service free at the


point of use, paid for, created by the Labour government after the


Second World War, the envy of the word, the government should swallow


its ideological pride and say, OK, we get it, we will fund the NHS,


anything else is a betrayal of all the NHS stands for.


Madam Deputy Speaker, thank you for calling me to speak. I believe we


need to look afresh at the entire health and social care pathway which


is why I'm delighted to contribute today. From visiting the pharmacist


to attending a GP appointment, to spending time in hospital, be it at


A or preplanned, and being able to reside beforehand and afterwards at


home or in a care home, we need to find the most efficient and


dignified way to treat and look after people. We must avoid using


one treatment centre as a default option, despite it not being the


best for the individual or for the financial purse, because it is the


only one which is available due to difficulties with individual


funding, opening hours or lack of accessibility to a better form of


provision. We must also, Madam Deputy Speaker, be encouraged to


speak freely about the pressures in the system and to provide ideas. For


years it frustrated me that anyone who thinks aloud with ideas which


can change health and social care for the better is denigrated as


seeking to harm it when the opposite is true. To this end I listened with


interest to be interviewed the Secretary of State gave to Radio 4


on Monday morning. It struck me as measured and thoughtful as to new


ideas. I was particularly interested by the ideas as to how we could


deliver more capacity in the GP system because an increasing number


of people attending A are either accident victims or needing


emergency treatment. They did, however, need some form of medical


intervention as the Secretary of State mentioned. It was thoroughly


depressing to read the Secretary of State's words taken out of context.


I hope he will continue to think outside the box and that all inside,


insiders has will recognise the benefits of him doing so. Talking


about ideas, I suggest the following for each of the treatment centres in


the health pathway. Pharmacists, in the event we have too many clusters


of pharmacies, I agree with the need to ensure they are spread out across


the country with the money saved being recycled. At the same time,


can we find ways to help pharmacies deliver more interventions in order


to free up capacity at GP surgeries. We must do more to signpost patients


to pharmacist before going to their GP. A recent report costed common


ailment treatment in community pharmacies at ?29 per patient. Four


GP practices that treatment cost rises to ?82 and four A ?147.


Treatment results across all three were equally good regardless of


where they were treated. The research estimated 5% of GP


consultations for common ailments could be managed by community


pharmacies equating to more than 18 million GP consultations which could


be diverted. Turning to GPs, I was buoyed by the suggestion by the


Secretary of State that more GPs must be placed in A departments


and care homes. The new NHS requirement of GPs undertaking


weekly ward rounds in care homes is the right at the thinking to prevent


emergency treatment in our hospitals. I welcome GPs operating


on Sundays but practically we surely just need one surgery per area being


opened. I don't believe all GPs operating over seven days is a good


use of scarce resources, in the same way government funding of two


pharmacies across the road from each other is also not a good use of


scarce resources. I have long taken the view that we need to find ways


to free of our GPs so they might focus on patients who need them the


most. Because it is free there are too many wasted or cancelled GP


appointments. If there was a cost for unjustifiably keeping to an


appointment it might demonstrate how precious this resource is in the


same manner that an NHS dentist would charge for a missed


appointment when I was younger. Turning their forger A, some of


these reforms are about pharmacies and GPs but I designed to ensure


patients are only attending A if they have had an accident or it is


an emergency. Clearly this is not the case for some who are now


attending. We are also facing a demand on hospital places due to the


need to reform the way we look after an ageing population. Time does not


allow me to talk about social care, so important in my constituency, but


the delivery by the government of more social care funding before


Christmas was welcomed however it is crucial to question the operating


model in social care. The NHS benefits from a national funding


programme, social care is largely the responsibility of local


authorities and local rate players like payers in areas where


retirement may be high but employment and council tax receipts


are not. We have to think radically to ensure we get the best out of our


health and social care system. To do so will not only make resources


stretch further but deliver the innovation which will improve the


lives of the sick and infirm who are most in need of our care. Two days


ago the Health Secretary read out a statement in this chamber on the


crisis in our NHS and his answer to his Government's failure to meet A


waiting time targets is to downgrade those targets rather than seeking to


take any action to treat the Mall is at the heart of our NHS. The Health


Secretary heaped fulsome praise on our hard-working and dedicated NHS


staff, praise they richly deserved but it will ring hollow with many of


them. I speak from years of experience working in the NHS as a


clinical scientist. Having worked with staff of all grades, skills and


experience. The simple truth is that NHS staff are demoralised. As I said


two days ago, the reason they continue to work with care and


compassion is in spite of, not because of, any action taken by this


Health Secretary. Since that statement I have been inundated with


health service staff wanting to tell me their stories of how the service


they were once proud to work in is now in perpetual crisis, of the


strain of wanting to do their best for their patients but being


prevented from doing so because of short staffing, because of


overcrowding, because of delayed discharge, and because of


underfunding. Of the e-mails they get from ministers demanding to know


what they're going to do about failing to meet targets, and then


listening to the very same ministers telling the public that the NHS


doesn't have a problem. Health managers are saying that we have a


perfect storm of ageing patients needing more care just at the time


when social care has been cut to the bone leading hospitals to pick up


the pieces. An Aimi doctor at Manchester Royal Infirmary said to


me crisis is the new normal and it has become usual to have ten


patients waiting in the corridor -- A Doctor. In my own constituency


of Heywood Andy Little. Michael Middleton the hospital that serves


my constituency has been the subject of a damning report revealing


appalling neglect in maternity care and leading to the avoidable deaths


of mothers and babies. Pennine acute trusts have the highest number of 12


hour A waits in October and the second-highest number of cancelled


urgent operations in November. In December it was forced to divert


ambulances 14 times in total, one of the highest figures in the country.


Social care across Greater Manchester races collapse and this


is borne out by the delayed discharge figures for Greater


Manchester, which doubled in the year to October. Greater Manchester


asked for ?200 million for social care in the Autumn Statement, but


this issue was not even referred to. Some C Greater Manchester's devolved


health care system as a solution, but even the chief officer John


Rouse, says while devolution can help close working, it is not magic


dust. I want to remind the Health Secretary about the NHS Constitution


for England, which was updated in October 2015, which establishes the


principles and values of the NHS in England. It sets out rights to which


patients, public and staff are entitled and pledges, which the NHS


is committed to achieve. And enshrined in the Constitution is the


patient's right to be cared for in a clean, safe, secure and suitable


environment and the right to be protected from abuse and neglect,


not an A corridor. Patients and the public have a right to be


involved in the planning of health care services and in changes in the


way health care services are provided and in decisions to be made


affecting the operation of the services. And for NHS staff, one of


the pledges is to engage staff in decisions that affect them and the


services they provide. And yet I seek precious little evidence of


staff or patients or the public having any input at all into the 44


sustainability and transformation plans covering the regions England,


which appear to have been drawn up behind closed doors and are shrouded


in secrecy. Yet their impact on health care could be huge. But where


is the public involvement? Patients are being failed under this


Government's watch and their rights to save care are being neglected.


All that is asked is the occasional flurry of warm words yet the junior


doctors dispute showed his real attitude towards NHS staff. Aneurin


Bevan said no government that this, hopes to destroy the NHS can expect


the support of the people. That is from his essays. Sadly I think the


current secretary has managed to achieve replacing the fear. Thank


you, Madam Deputy Speaker. I want to start by paying tribute to our


hard-working staff in the NHS and those in the care sector. The best


way to help Dummett thank those health and care staff would be to


give them the resources they need to do the job we want them to do. I


welcome the contributions made by honourable member is today,


particularly the moving contribution by my honourable friend for


Chesterfield who told us about the personal catastrophe for him and his


family when his father was sent home from a pressured A sadly to die


from an aneurysm. My honourable friend from Workington was also able


to tell us about the happy death her father had with the end of life care


at the local Community Hospital. I want to mention the Honourable Lady


for Central Ayrshire, the Honourable Lady for Totnes, who emphasised the


complexity and verity of patients needing care in the winter months.


We should remember that in terms of the scale of pressures facing the HS


-- frailty of patients. Both honourable members supported the


four-hour target of the A as a barometer of the wider pressures in


the NHS guy a measure of managing the frail and convex patients. My


Right Honourable friend urged the government not to give the NHS of


Donaghy oppression of giving up on the four-hour target. It sends the


wrong message. There was a concern that parents might be discouraged


from taking their children to A Honourable member is opposite have


quoted Simon Stevens and Chris Hopson in support of claims on NHS


funding and I would like to update them because in the House this


afternoon Simon Stevens said on NHS funding: we got less than we asked


for. The Government are stretching it to claim the NHS got more. Simon


Stevens said it doesn't help anybody to pretend there are not financial


gambles. Chris Hopson of NHS Providers said: we do not believe


the NHS has all the money it needs and the NHS is not sustainable on


the current funding. I want to turn to the pressures caused by social


care. The crisis in our hospitals has been made much worse by the


government's continued failure to fund social care properly. The care


crisis is caused by insufficient funding in the face of growing


demand. Government ministers have ignored warnings from a wide group


of doctors and from leaders and professionals in the health and care


sectors. They fail to produce a Singleton any other extra funding


for social care in the autumn settlement. Then they told us extra


funding was made available for social care in the local government


funding settlement but this was not the extra funding needed from


central government. What ministers did was shift the burden onto


council taxpayers. This was made worse by the fact the ?240 million


adult and social care grant was actually money recycled within local


government budgets from the New Homes Bonus, and one third of


councils will be worse off as a result of this settlement. My own


local authority Salford will have ?2.3 million less in its budgets.


This is not a boost to social care. What health and social care leaders


have pleaded for was for ministers to bring forward funding to address


the current crisis in social care and that is what we have in our


motion today. This would provide some breathing space, and breathing


space is needed because the lack of social care means that thousands of


older people are stuck in hospital waiting for a care package in their


own home. That was the most common cause of delayed discharges due to


social care. More than a third of the record 200,000 delayed Dummett


delays reported were due to a lack of social care. Being stuck in


hospital can affect patient morale and patient mobility but also


increased the patient's risk of hospital acquired infections. We


know the major impact is the knock-on effect on people in A


waiting for a bed for an emergency admission. Health ministers like to


blame local authorities for the lack of social care but there are


problems with that. When NHS Chief Executive Simon Stevens was asked by


the DCLG committee chair in a recent Caerau on social care what extra


resources would be needed if every local authority performed as well as


the best local authority on delayed discharge, he said: even happen


Dummett having sorted that out if we have a the gap between the


availability of social care and the number of frail older people it will


show up as extra pressure on them, their families, carers and of course


the NHS. Of course we want to get to the position with a best practice in


tackling delays is spread across the country but ministers have to start


to reflect on what their government has done through the cuts they have


inflicted on local authority budgets. Figures from the Local


Government Association show the hardest hit local authority has had


cuts of 53% to its budget in the last five years. The average cut is


39%. Now the budget cuts for Surrey were at the lower end of the budget


cuts at 29%. Even so, the Cabinet member for social care in Surrey,


has talked in a letter to the Guardian about the issues the local


authority faces. He said: the Care Quality Commission is not the only


organisation with worries about inadequate adult social care funding


and the impact on already clocked up hospitals. He said while the social


care precept was a welcome move it falls many millions of pounds short


of what is needed now, let alone in the next two decades. I suggest the


Health Secretary and Chancellor talked to social care leaders to


understand the needs they see in local communities and the impact of


local social care on NHS hospitals. Ministers have been warned about the


impact of cuts on social care but ignored those warnings. The Royal


College of Emergency Medicine has said emergency care is on its knees,


mainly due to a lack of investment in both social and acute health care


beds. The BBC has reported that last week there were 18,000 trolley waits


over four hours. That is people waiting on a trolley in a hospital


corridor and there were 485 cases where patients waited over 12 hours.


My honourable friend raised the issue we don't know the figures


waiting stomach for patients waiting on corridors, all been treated and


waiting on a chair due to lack of trolleys. The figures don't tell us


all about the misery for patients and for their family members waiting


with them. Last night a senior A consultant said on ITV that patients


can be left with absolutely no dignity during these weights. He


said: we have got patients with severe illnesses on chairs receiving


drips, antibiotics, medications and patients with cardiac problems on


chairs because there are no trolleys for them to go on to. The senior


doctor talked about patients who are left unable to move off their


trolleys or stuck on chairs. And he talked about a lack of shutters and


blinds, which means that patients can be left in full view of others


while they are being treated. He also reported patients who were


incontinent in front of relatives and strangers because hospital staff


could not reach them in time. He said: patients have no dignity left.


That is what it can lead to. What would we feel if that was our


relative? This situation may get worse with the expected cold weather


with more major incidents being declared and many hospitals on black


alert. Downgrading the four hour waiting


time targets for A misses the point. As we have discussed in this


debate, that for our target is a proxy for patient safety. It is


miserable for a sick patient to lose their dignity through being


incontinent during a trolley weight in a hospital corridor. But it is


also miserable and frightening for a vulnerable patient to be discharged


in the middle of the night to a cold home without a care package. That is


why in our motion today we repeat the call for the government to bring


forward ?700 million of funding promised to social care in 2019 to


how the NHS and social care systems cope with extra pressures this


winter. We also call for a new improved settlement for the NHS and


social care in the budget in March, so that we avoid this crisis in the


future. Staffing emergency departments are at the shop end of


saving lives. A staff are so directly in the front line of that.


Care staff with a working in caring homes, make a huge difference to the


lives of millions of older and vulnerable people. People with


disabilities, and people with mental health conditions. Though should be


the best jobs in the UK. But without the right investment in the funding


they need, those people doing those jobs feel undervalued and


overstretched. I urge members to vote for this motion tonight.


Matt Lund deputies beaker, I am pleased to follow the honourable


lady, and be able to close this debate. I would like to thank all 34


honourable members for their contributions, some of which mostly


on this side of the House have managed to rise above party politics


and make some constructive comments. I would like to start by joining my


right honourable friend the Secretary of State by thinking the


2.7 million staff working in our NHS and social care system. As the prime


Minster said earlier, we recognise they have never worked harder to


keep patients safe with a A working hard to see patients.


Regrettably through 5.5 hours of debate and criticism from the


benches opposite, we have heard little if anyway of providing


solutions to the challenges which we acknowledge our A face. The


opposition have again touted more funding as their only answer to


solve public sector challenges. In fact, the party opposite has


repeatedly pledged raising corporation tax eight times,


promising an unspecified amount from an unspecified source, this will not


help our NHS, and it will not fool the public.


There is a lot to do to protect the system and ensure a sustainable


future. What it is this government which has plans in place to get


through this extremely challenging period, and sustain the NHS for the


future. The shadow Secretary of State, the Member for Leicester


South, spoke for close to around three quarters of an hour without


making a single suggestion of what could be done to solve the problem


that are facing the NHS. Not one. He should have stayed to listen, he may


have done, and I apologise if I didn't pay enough attention to his


presence, but the Member for Doncaster Central that asked


specifically for community pharmacists to be paid for providing


minor ailment services, and I'm pleased to be able to tell the right


honourable lady that that is exactly what we are doing, and my honourable


friend the Minister for community health was discussing this only this


morning in Westminster Hall, and I regret to say not a single Labour


member was present to hear what he had to say.


Surely the House wants to hear the Minister after this long debate.


With courtesy, Minister. Thank you Madam Deputy Speaker. We


have heard a number of comments from opposition members, and I am pleased


to say they were outnumbered in this debate by members of the government


backbenchers. Rehearsing tired phrases to mislead the public over


alleged increasing independent provision within the health service.


And also, misrepresenting what my right honourable friend the


Secretary of State was saying in his remarks about A targets, but I


would, having said that, like to pay tribute as the honourable lady did


to the honourable gentleman from Chesterfield, who I can't see in his


place, but he is, and the honourable lady for Workington, who both showed


considerable personal courage in explaining the circumstances around


the deaths of each of their fathers, and I think they did so in an


entirely honourable and sensible way. I am grateful to them for


sharing that. I would also like to congratulate my honourable friend,


the Member for Faversham and Mid Kent, for managing to get her son


into hospital to have his appendix treated on Boxing Day. Clearly, as


she said, that service was working well.


The opposition sought to adopt a posture of moral high ground in this


debate, and I have to say that the honourable lady for Dewsbury, who


challenged members on this side as to whether they had visited


hospitals over the Christmas period other than on official visits, and


it was completely punctured by the honourable Member for Lewes, who


pointed out she was doing a night shift between business and New Year


in her role as a nurse, not on an official visit.


We have had some impressive contributions, and I would like to


thank the chairman of the select committee, who was supportive of a


new nuanced target for A, and for her calm and generally constructive


comments. And my right honourable friend, the Member for Chelmsford,


for his support for the success of regime in Essex, and pointing out


that it is not closing any of the three A departments in the


hospitals there. Also, my honourable friend, the Member for Crawley, who


made a thoughtful speech welcoming the opening of an assessment unit in


Crawley to believe pressure on the unis nearby. -- A


Of course, we do recognise on this side, and in government, that our


NHS faces pressures, both the immediate pressures of the colder


weather and the wider pressures of an ageing and growing population.


There were nearly 9 million more visits last year to our A when


compared to the year before the four hour commitment was made. More than


2 million a A compared, I won't give way, the


honourable lady didn't give way, I have a short time. When compared to


when the party came into office in May, 2010, in 2015-16, there were


2.4 million more A attendances, and this is in the context of a much


busier NHS overall. The NHS is delivering 5.9 million more


diagnostic tests, 822,000 more people seen by a specialist for


suspected cancer, and 49,000 more patients starting treatment for


cancer every year, compared to the year before we came into office also


it is therefore the case that a government of any colour would be


faced by the same problems, but it is this government that is committed


to funding the NHS's plan for a sustainable future. Had we followed


Labour's and, the NHS would have 1.3 billion a year less, equivalent of


13,000 fewer doctors or 30,000 fewer nurses. We remain committed to the


vital for our accident and emergency promise for those patients who need


to be there. We're proud to be the only country in the world to commit


to all patients that we will sort out any urgent health need within


four hours, only three other countries, New Zealand, Australia,


and Canada, have similar national standards, but none of these are as


stringent as ours. Today, it is the Conservative Party


that is the party of the NHS. This is why we pledged more than


Labour did, and why we are delivering more funding with a


higher proportion of total government spending going into


health in each year since 2010. Funding for the NHS will rise in


real terms by ?10 billion by 2020-21, compared to 2014-15, front


loaded with ?6 billion delivered by the end of this year as the NHS


asked for. It was this government that


established an independent NHS with an independent chief executive. It


was this NHS which came up with its own plan, and we were the only party


to back it. Madam Deputy 's Beagle, we agree


that the NHS and social care are facing huge pressures, and there is


more for us as a government to do, but I can say to the House -- Madam


Deputy Speaker, we enter winter with a more comment of planned than ever


before. We have confidence the plans are in place to cope with both the


current pressures we face, winter, A, and delayed discharges, and


also to sustain the future of the system. I would like to conclude by


saying a huge thank you to the 1.3 million staff in the NHS, and the


1.4 million people who provide social care. They are the ones who


continue to make this possible. We are aware of the pressures they are


under, especially during winter. We have increased the number of doctors


and nurses as my right honourable friend the Secretary of State said


earlier, especially in A We have launched plans to recruit more, both


doctors and nurses. Without them we would not have a national health


service that provides such a high level of care.


Opinions say iMac. On the contrary, no.


The ayes have it. The question is that the original words stand part


of the question, as many of that opinions say aye. On the contrary,


no. Clear the lobby! Order. The question is that the


original word standard part of the question.


Tellers for the noes, Christopher Pincher at.


The ayes to the right, 209. The noes to the left, 295. Their eyes to the


date, 209. The noes to the left, 295. Then nose have it. Then nose


habits. The question is that the proposed words be added. Those of


that opinion they ayes. On the contrary, no. I think their eyes


have it. The question as amended to be agreed.


We now come to point of order, Margaret Greenwood. If people wish


to have a conversation, they should go somewhere else. The honourable


lady is making a point of order. Thank you. The Minister told a House


there were no Labour backbenchers, in actual fact he has inadvertently


misled the House because I spoke in the debate and was a member that


lack and the Member for Google spoke in the debate. I just wanted to set


the record straight. I understand her point of order. I understand why


she wishes to make the point. It looks as if the Minister would like


to say something to that point of order. I am very grateful for


complete clarity with their eyes. There were two members present in


interventions but made no speeches interventions but made no speeches


or substantial contributions from Labour members present. I am sure


the House are thankful to the Minister or clarifying what he said


in his speech and to the honourable lady for clarifying higher position.


The matter is now closed. -- her position. We come to motion number


three on local government. The division is deferred until


Wednesday next. We come to motion number four on local government


Minister to move. The question is as the order paper, many of that


opinion say aye. The contrary, no. The ayes have it. The ayes have it.


Petition, Mary Craig. Thank you very much. Rise to make a petition 2000


residents of Wakefield on the future of the health centre in my


constituency, whose GP service is at threat of being withdrawn, a very


important issue for my constituents. I urge the government and Wakefield


clinical commissioning group to take all necessary steps to ensure King


Street health centre remains open and has current contracts for GP led


services extended to allow Wakefield residents continued access to health


care. Petition, the future of King Street


Health Centre, Wakefield. Petition. My petition comes from


dozens of residents in Salford. The humble petition of the residents


of Salford showing that they would prefer the inhabitants of some boats


moored on the River Avon to refrain from staying for long periods of


time. Your petitioners pray that your honourable house ask Her


Majesty 's government to consider the opinions of local residents and


boat owners in this. Petition, boat moorings on the River


Avon. I beg to move this House to an


allergen. The question is that this House do now adjourned.


Thank you, Madam Deputy Speaker. In the previous parliament, we took


action to empower local doctors, surgeons and clinicians to look at


how hospital services were going to be provided, to think about the


optimum weight to provide these services and ever-changing


circumstances, namely demographics, and other changes that are taking


place in our society. That was the right step to take, rather than


promote civil servants in Whitehall making these decisions, we wanted to


make sure that the people at the coal face of providing these


services, people who were providing services to our constituents, people


with medical expertise, people who have dedicated their lives to


improving the care and safety of others that they were empowered to


make these decisions. I stand by that decision that we took, and I


want to tell the Minister this evening some of the practical


problems that have ensued in Shropshire as a result of that


devolution of power. I want to raise it with the


Minister, because I believe in this process, and I want to ensure that


it is retained and protected for future programmes in the future. In


Shropshire, we have two orbitals, one in Shrewsbury, one in Telford.


-- two hospitals. They look after all the people throughout the whole


of Shropshire and mid Wales. I'm not going to go into all of the


specifics with the Minister here this evening, because as he will


know, I and the other Shropshire MPs have briefed him repeatedly over the


last few days, weeks and months about this process. I would like,


however, Madam Deputy Speaker, to thank, with genuine heart-throb way,


the health workers in Shropshire... Have been able to dedicate


themselves and to persevere despite many problems and obstacles in their


way in coming up with these proposals for a reconfiguration of


A services in Shropshire and mid Wales. A decision has been achieved


after three years, and ?3 million of taxpayers money being spent on this


process, a decision was achieved. And that decision was going to go to


public consultation. Unfortunately, it has been blocked by Telford CCG


and Telford Council. Telford CCG have been part of this process from


its inception, and they were consulted throughout, but at the


11th hour when the decision did not go the way they thought it would,


all the way that they wanted it to do, they decided to a man to vote


against the proposals. Although they were party to the whole methodology


and process. In addition to Telford CCG voting against these changes,


Telford Council, an esteemed body no doubt, but a body with I would argue


limited medical experience, has decided to threaten the programme


with a judicial review, if they dare allow the public to have this final


public consultation. Of course, in a democracy, Telford


Council has the right to challenge things. Of course, in a democracy,


Telford Council may even have the right to use taxpayer money to


instigate a judicial review come about what the Minister must


remember and retain from our own experience is these two parties were


part and parcel of the whole process from its inception. And I have a


real and genuine concern going forward about the integrity of this


process if we do not back the local clinicians and doctors. I give way


to my hard-working neighbour from Telford.


I think the honourable gentleman for bringing forward this debate, and I


have to say that I have tried also to get a similar it entitled debate.


Will he agree with me that the Telford clinicians have an absolute


right to express their views just the same way as the Shropshire


clinicians do, and the fact they did not come up with the same view is no


indication that the Shropshire clinicians came to the wrong view?


As I alluded in my earlier speech, of course they have the right to do


so, and may I take this opportunity of acknowledging the work that my


honourable friend has done since she became a member of Parliament to


campaign for Telford, and also to campaign very strongly and


effectively on this issue, but without being overtly political, and


without adversely personalising this like some other people have done so.


And I will come onto talking about the CCG a little bit later. My


concern, I have to say, is, and I will reiterate this, we all put our


cards on the table. We all went along with this process. This


decision could have gone against Shrewsbury. Ultimately, they have


decided that they want to have an urgent care centre in Telford, and


they want the main A service to be provided by Shrewsbury. It could


have gone the other way. That could have been for Telford. We would have


lost out. But at the end of the day, it shouldn't be about winning or


losing, and this is the biggest problem. My honourable friend from


North Shropshire has talked about the pillow fight that has existed


between Shrewsbury and Telford ever since he became an MP. Certainly,


over the last 11 years, I have lost more sleepless nights over it than


anything else, the constant fighting between Shrewsbury and Telford over


hospital services. At the end of the day, we are one county, we are one


county, and we must fight collectively as one county for all


of the people of Shropshire. And of course, our friends from across the


board in Wales, I give way to my honourable friend.


I congratulate you for this debate. He is absolutely right. The


bickering between trees breathe and Telford has opened my nearly 20


years in Parliament. I thoroughly back FutureFit. We will get a ?300


million emergency care centre for my rule areas, but we will also gain


with care centres Imrul areas. What is utterly is spreading is the


indecision we have had. -- rural. I very much hope the end of this


debate will give us a clear recommendation for a decisive


mechanism to deliver the will of the local commissions.


I couldn't agree with my right honourable friend more. I would like


to pay tribute to him in the work that he has done on this over the


last few years. In order to continue, I would like the Minister


to intervene to ensure that the process allows for a decision. In


our case, what happened is that all the members of the Shropshire CCG,


six numbers of the Shropshire CCG, voted for the proposals. All the


members in Telford voted against. It was


The local two CCGs cannot come to an agreement, so I would like to hear


from him on that. I would like to appeal to constituents from the


whole of Shropshire and mid Wales to lobby Telford Council and others.


Let's start to get behind, as my right honourable friend said, let's


start to get behind the concept of all of us working together to lobby


the government more effectively for more resources, rather than fighting


one another in a rather parochial way as to where these services are


going to be. Let's not forget how close these hospitals are to one


another. We're not talking about 50 miles, we're not talking about 30


miles or 20 miles, somebody may correct me if I'm wrong, but I think


they are only 13 miles apart. 13 miles apart, these two hospitals. We


ought to think about how to improve and modernise the provision of


health care for all of the people of Shropshire and mid Wales going


forward. And listening to the proposals of these medical experts


who have done so much work to put these proposals forward. I give way


very quickly. A quick point, and I thank our


honourable friend for bringing this debate forward. I represent


constituents in Powys in Wales, who are without a General Hospital,


relying heavily on Telford and Shropshire. Shropshire is at the top


end of my constituency. I urge consideration for my constituents.


I thank my honourable friend for that intervention. He is absolutely


right. My honourable friend from just a cross the border, we almost


think of him as a solo paean, almost. Not quite. He does so much


to represent his constituents in Wales, and by the way, have two


already travel rather long distances to get to the Royal Shrewsbury


Hospital. My honourable friend may correct me if I'm wrong, but I think


some of his constituents from the extreme west of his constituency


already take over an hour to get to A services in Shrewsbury. Some are


even further away from Shrewsbury would be an acceptable for his


constituents. I give way very briefly for the last time.


I come from a peripheral position, but to congratulate the member onto


Cubist Dabiq. The importance of getting this right has an impact


further west. If the issue is resolved, it would impact on my


District Hospital in Aberystwyth. It is important this issue is


addressed. I completely concur with the


honourable gentleman. I am grateful for his intervention. I would like


to end because I want to give as much time as possible for the


Minister to answer these questions by saying, let's not forget that if


we get this right this could potentially result in an investment


of ?300 million into the NHS and Shropshire. I don't know about my


colleagues, I know my honourable friend from North Shropshire has


been an above Parliament longer than I, but I certainly don't remember a


time in my 11 years as a member of Parliament where we have had such an


investment in the local NHS. If we get this right, we could see an


investment of ?300 million in Shropshire in order to implement


these changes. There is more work to be done in terms of securing this


money. More work will have to be done in innovative ways, both


locally and nationally to secure all of the funding, but if we don't sort


ourselves out, we are going to be further hind. Other areas in the


United Kingdom, who are going through this process -- behind, in a


more cordial and mutually effective way of going to jump the queue.


Shropshire will be left right at the end. That's something I am not heard


to see happen. Finally, Madam Deputy Speaker. Telford Council would have


you believe, obviously, that as part of this programme, clearly, women


and children services have to be moved from Telford to Shrewsbury,


because the main A will have to have women and children services


next to the main A provider at the Royal Shrewsbury Hospital. They say,


and this is an important point, because the services were moved from


Shrewsbury to Telford a few years ago, such a move would lead to the


waist of ?28 million, and they repeatedly talk about that through


the local media. No, no, no. It is not a waste. The building will be


used for other purposes, and all of the equipment already in that


building, which is easily moved will be moved to the Royal Shrewsbury


Hospital. So I refused any proposals that there has been a waste of the


?28 million because of the changes that will take place. I give way,


finally, to my honourable friend. Subtitles will resume on


'Wednesday In Parliament' at 2300.


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