27/02/2017

:00:00. > :00:00.health. I beg to move. The question is, as on the order paper. I call

:00:00. > :00:11.the children of the health select committee. Thank you. Today's debate

:00:12. > :00:14.on the supplementary Estimates and the financial position of health and

:00:15. > :00:18.social care matters first and foremost because of the impact of

:00:19. > :00:23.that financial position on patient care. I would like to start by

:00:24. > :00:27.playing tribute to our health and care staff across the country and at

:00:28. > :00:35.this particular time to note and thank those have who work in this

:00:36. > :00:39.country from across the EU. The financial position is a great

:00:40. > :00:43.concern. As a result of the wider academic downturn we're now in a 70

:00:44. > :00:48.of the longest financial squeeze in the history of the NHS. Although the

:00:49. > :00:53.Department of Health budget has of course been protected in relation to

:00:54. > :00:56.many others, we cannot escape from the fact that over the last

:00:57. > :01:03.parliament the average annual increase was 1.1%, far lower than

:01:04. > :01:09.the increase in demand, and of course far lower than the historic

:01:10. > :01:15.increase since the late 1970s of 3.8%. All of that is also in the

:01:16. > :01:21.context of an extremely challenging position for social care. What we've

:01:22. > :01:29.seen is a 10% real terms reduction in social care spending by local

:01:30. > :01:32.authorities between 2009 to ten and 2014 to 15. All of this in the face

:01:33. > :01:37.of an extraordinary increase in demand. Not only from a rising

:01:38. > :01:41.population but because of our changing demographics. Just to put

:01:42. > :01:51.this in context, over the decade 2015, there was a 31% increase in

:01:52. > :01:56.people living to 85 and beyond. We estimate of the next 20 years we

:01:57. > :02:01.will see a 60% increase in the number of individuals who rely on

:02:02. > :02:09.social care. There has been an abject failure of governments over

:02:10. > :02:14.the years to plan for this. This was entirely predictable. But we

:02:15. > :02:18.absolutely can't keep ducking this question. Not only do we need to

:02:19. > :02:22.address the immediate financial problems they've think health and

:02:23. > :02:27.social care, we absolutely have to come together as a house to address

:02:28. > :02:33.the problems for the future. Of course. I am grateful for you giving

:02:34. > :02:36.way. It is not a uniquely British problem but also a global problem.

:02:37. > :02:39.One of the things I've been trying to find out is where best is social

:02:40. > :02:45.care delivered in the rest of the world and can we learn anything from

:02:46. > :02:49.those countries. My honourable friend makes a very important point.

:02:50. > :02:52.We are all looking forward to the publication of the House of Lords

:02:53. > :02:58.report on the future sustainability because of course we have much to

:02:59. > :03:05.learn from other systems. However, I would say, in welcoming that point

:03:06. > :03:07.but also paid tribute to the Public Accounts Committee which publishes

:03:08. > :03:13.today their report on the financial sustainability of NHS. We have also

:03:14. > :03:17.seen the final position of trust is at the end of the last quarter, and

:03:18. > :03:25.we know that 135 providers ended that quarter in deficit. We are on

:03:26. > :03:32.course, just finish this then give way, we are on course for a

:03:33. > :03:38.financial deficit of between ?750 million and 850 million in trusts. I

:03:39. > :03:42.give way. I'm grateful forgiving way. In terms of the seriousness of

:03:43. > :03:46.what we're talking about, she will know that over the past five we had

:03:47. > :03:52.a down weight trend of falling death rates. New research shows that after

:03:53. > :03:59.2011 that reverses and more people died in 2015 and 2014. With these

:04:00. > :04:03.tests are coring in the context of a massive disinvestment in health and

:04:04. > :04:07.social care, would you agree these cuts are likely to have been

:04:08. > :04:12.implicated in that otherwise unprecedented rate in deaths? I have

:04:13. > :04:15.seen the study to which you refer and I think it is something the

:04:16. > :04:19.Department of Health needs to look at carefully. I give way to the

:04:20. > :04:26.honourable gentleman. If you look at it in general terms, for example,

:04:27. > :04:28.you have a situation where you have bed walking, the local authority

:04:29. > :04:35.cannot deal with that because it does not have the order authorities.

:04:36. > :04:41.If you look at worst to the National horrors of the whole have to find

:04:42. > :04:45.cuts of 250 billion and creates an insoluble problem if we are not

:04:46. > :04:50.careful. Thank you viewpoint. I think we should use the term delayed

:04:51. > :04:55.discharges rather than bed blocking, because that term can leave older

:04:56. > :04:59.people in that position feeling somehow as if they are to blame. But

:05:00. > :05:08.I take the point that he is seeking to make. The estimates memorandum

:05:09. > :05:12.before us today seeks a ?1.2 billion transfer to trap pop-up revenue from

:05:13. > :05:20.the capital departmental expenditure limit. It also seeks a 23 million

:05:21. > :05:24.transfer from domestic's Treasury reserve and ?58.5 million transfer

:05:25. > :05:28.from other Government departments and ?6 million transfer to the

:05:29. > :05:32.capital from other departments. I'm afraid again we are seeing an

:05:33. > :05:38.unsustainable position here. That has been pointed out by the

:05:39. > :05:44.controller general. I am following closely as ever, wise remarks. Does

:05:45. > :05:49.she share my concern that if we are transferring money from capital to

:05:50. > :05:53.revenue it means the sustainability and transformation plans, most of

:05:54. > :05:57.which imply a certain level of capital investment to save revenue

:05:58. > :06:02.long-term, will not be possible? I absolutely agree with my honourable

:06:03. > :06:07.friend and I myself will be drawing on that later on. The point about

:06:08. > :06:12.the rates to capital budgets over the years is that this is the third

:06:13. > :06:18.year in which this has happened, that we have seen transfers from

:06:19. > :06:21.capital to resource budgets, -- revenue budgets, we're talking about

:06:22. > :06:24.keeping facilities up-to-date, essential repairs, rolling out new

:06:25. > :06:30.technologies and putting off those and investments actually means they

:06:31. > :06:34.cost more down the line. This is a false economy and simply an

:06:35. > :06:36.unsustainable ongoing mechanism. I know the Department of Health has

:06:37. > :06:43.indicated they would like see an end to this by 2020, but both the Public

:06:44. > :06:45.Accounts Committee and the health committee have called on this to

:06:46. > :06:52.stop immediately because we feel this is a false economy. As my

:06:53. > :06:58.honourable friends pointed out, it is not only grades to capital

:06:59. > :07:00.budgets but raids to across the sustainability and trust translation

:07:01. > :07:06.fund. What we're seeing increasingly is that becoming all about propping

:07:07. > :07:10.up the sustainability rather than putting in place essential

:07:11. > :07:20.transformation. I give way. Thank you. She is making some excellent

:07:21. > :07:24.points. In west Yorkshire the sustainability and transmission plan

:07:25. > :07:30.plans to take about ?1.1 billion out of our health system over the next

:07:31. > :07:34.four years. ?700 million from the NHS and ?400 million from social

:07:35. > :07:40.care services. As a result, centres like Hill Street health centre are

:07:41. > :07:46.set to close putting more pressure on overpriced accident and emergency

:07:47. > :07:52.departments. Does she agree with me that this type of pressure coming in

:07:53. > :07:55.and forcing even more pressure is on AMD departments gives the word

:07:56. > :08:03.sustainability and transformation a bad name? I agree with the

:08:04. > :08:05.honourable lady, absolutely. It is undermining public confidence in

:08:06. > :08:10.sustainability and transformation. I will come to that in more detail

:08:11. > :08:14.later. The financial position is starting to create a perfect storm

:08:15. > :08:18.of delayed discharges, rising waiting times in accident and

:08:19. > :08:22.emergency, rising so-called trolley waits the patients as they are

:08:23. > :08:24.waiting to be transferred to the wards, and that has quite serious

:08:25. > :08:33.implications for their safety within those departments. Unsustainable

:08:34. > :08:36.levels of bed occupancy. We are increasingly hearing stories of not

:08:37. > :08:41.only routine surgery but being cancelled but also of urgent surgery

:08:42. > :08:47.and very worryingly to cases of urgent dialogical procedures

:08:48. > :08:51.actually not taking place, and that resulting in the deaths of two

:08:52. > :08:58.patients. This is extremely serious. I give way. Does she also agree that

:08:59. > :09:03.when we look at to beating my via councils on the formulaic, we can't

:09:04. > :09:10.just look at deprivation which tends to be highly weighted and is

:09:11. > :09:14.important, in a more affluent area we have the problem of people living

:09:15. > :09:19.longer and there being more demand for service because of that? My

:09:20. > :09:23.friend makes an important point. It's not just about the overall

:09:24. > :09:27.budget but also about distribution. And yes across this house we would

:09:28. > :09:34.all agree that deprivation must be properly weighted. He is right that

:09:35. > :09:39.one of the key drivers is actually the age and the need for services,

:09:40. > :09:44.and it probably isn't adequately reflected in the way resources are

:09:45. > :09:49.distributed. As I say, there is undoubted evidence of the impact on

:09:50. > :09:54.the financial position now on patient care, and unfortunately, as

:09:55. > :10:00.we see this whorl of hospitals having to cancel routine procedures,

:10:01. > :10:03.that has a further impact on their ability to meet their financial

:10:04. > :10:09.targets because of the reduction in cat in income. I hope ministers will

:10:10. > :10:14.look at this not only as a short-term issue but all more

:10:15. > :10:18.importantly to take a look at how we are going to sustainably farmed this

:10:19. > :10:22.in the future. And also not also just to look at health and social

:10:23. > :10:27.care in their separate silos, but to see them as a single system and

:10:28. > :10:32.genuinely to look at how we are going to look at how we're going to

:10:33. > :10:35.take this forward. I'm afraid if we don't address this problem we need

:10:36. > :10:41.to be honest with our constituents about the consequences. People talk

:10:42. > :10:46.about a collapse in the NHS, I don't believe that will happen. But what

:10:47. > :10:50.we will see is a continuing deterioration in performance, with a

:10:51. > :10:54.real impact on the quality of care, and putting lives at risk. And the

:10:55. > :11:00.safety the Department of Health has proved prioritised is increasingly

:11:01. > :11:06.in danger of slipping. It is essential to our patients. A number

:11:07. > :11:10.of members have commented on sustainability and transmission

:11:11. > :11:13.plans. In principle I think these are extremely important. Not only as

:11:14. > :11:18.a way of acting as a road back for the five-year forward view, but as

:11:19. > :11:25.asked being able to return to a much more logical way of planning for

:11:26. > :11:26.integrated health and care, getting away from endless contracting rounds

:11:27. > :11:40.to genuine planning. But Ford has undermined this is

:11:41. > :11:46.inadequate planning. And crucially, inadequate funding. If we do not

:11:47. > :11:51.have adequate funding for the transformation of services, we will

:11:52. > :11:56.see these plans feel. They are being seen as a vehicle for cups, rather

:11:57. > :12:02.than a vehicle for what they should be seen as. We have a genuine

:12:03. > :12:06.opportunity to see this as a transformative process, but they are

:12:07. > :12:18.being undermined by a number of critical points. Would my honourable

:12:19. > :12:23.friend agree that what is missing is the bit that enables us to get the

:12:24. > :12:31.money to move to the new system. There is no money for the

:12:32. > :12:40.transition. I agree. She will know that we have seen not only cuts and

:12:41. > :12:44.the closure of much loved community hospitals, but not only the loss of

:12:45. > :12:54.these beds, but the local trust wanting to cut 32 acute beds at a

:12:55. > :13:00.time when the occupancy is already running up to 94%. Communities can

:13:01. > :13:07.genuinely see the changing this undermines this. They are planning

:13:08. > :13:16.for port 40 man, rather than actual demand. I thank the honourable lady

:13:17. > :13:23.for her point. I thank her to for her listening to me when I have

:13:24. > :13:32.brought forward problems and talked me through the options. We need to

:13:33. > :13:39.enable people to fully engage and have trust in the trusts involved.

:13:40. > :13:44.She is right. It is not just the evidence available to others. It is

:13:45. > :13:47.the evidence available to the communities and the idea that

:13:48. > :13:56.consultation is a genuine process. We know, time and again, we have

:13:57. > :14:04.reports which demonstrate that co-producing new services results in

:14:05. > :14:17.much better service in the long run. It is not only the cups to trusts

:14:18. > :14:23.themselves, but to CCGs. They are being asked to hold back ?800

:14:24. > :14:31.million of the budget to offset deficits in trusts. This is about

:14:32. > :14:40.patient care being cut back. We have seen cuts to NHS England and to

:14:41. > :14:46.education in England. To have the idea that we have health services on

:14:47. > :14:51.a sustainable footing is simply not true. I asked ministers to look at

:14:52. > :14:58.this transformation and ask the Chancellor in the forthcoming budget

:14:59. > :15:09.to address this urgently and give a lifeline to social care. As well as

:15:10. > :15:20.announcing that lifeline, of which I hope he will give the better tear

:15:21. > :15:25.fund more money, care cash fund, but I hope we will have a review of

:15:26. > :15:34.sustainable future funding for health and social care. Rather than

:15:35. > :15:42.as having this normal Contra confrontational debate, we want this

:15:43. > :15:50.to all work together for the benefit of our constituents to have a

:15:51. > :16:01.sustainable future for the NHS in social Kier. Care --. Could I pay

:16:02. > :16:09.tribute to the cheer of the health committee for her work. If the

:16:10. > :16:21.committees are united in our view that we need a new agenda for health

:16:22. > :16:25.and social care and that it is at the forefront of government

:16:26. > :16:39.thinking. It is unusual for three committees to agree so much. We are

:16:40. > :16:48.clear that integration of health and social care is necessary. We were

:16:49. > :16:55.looking at the first phase of the Better Care Fund. The head of the

:16:56. > :17:05.NHS England said that there was no feel you're in the Better Care Fund.

:17:06. > :17:09.If that does not undermine the challenges that we have with the

:17:10. > :17:16.sustainability of on-board funding, I do not know what does. We do need

:17:17. > :17:24.a long-term generational shift in how we deal with this. We cannot

:17:25. > :17:29.just watch from crisis to crisis. The current funding situation cannot

:17:30. > :17:39.go on. We looked very closely at the accounts. We lap up the accounts of

:17:40. > :17:50.different government departments. We were disappointed that the NHS

:17:51. > :17:59.accounts, we realised that they were within target only by a smoke and

:18:00. > :18:07.mirrors approach and short one-off measures to make sure the balanced.

:18:08. > :18:14.The Public Accounts Committee, of which he is a former member, the

:18:15. > :18:20.Dave the department the yellow card. The put them on warning. They said

:18:21. > :18:26.that this similar one-off measures would not be accepted and they would

:18:27. > :18:32.receive a red card. The issued an unprecedented warning in these

:18:33. > :18:40.accounts audited by the committee, laying out serious concerns. He

:18:41. > :18:44.talked to the permanent secretary at the Department of Health to view has

:18:45. > :18:49.concerns about these one-off measures. We would like to know how

:18:50. > :18:55.it was by some miracle the department managed to get the books

:18:56. > :19:01.to balance last year. First of all, there was ?2.14 billion set aside

:19:02. > :19:09.for sustainable transformation. ?1.8 billion was used for hospital trust

:19:10. > :19:15.deficits. The Department of Health did not notify the Treasury of an

:19:16. > :19:21.additional ?417 million of national insurance receipts they had got.

:19:22. > :19:26.They said it was a one-off reporting error. It does not rear car, I am

:19:27. > :19:32.heartened to see. There was a one-off super dividend of ?100

:19:33. > :19:40.million to the medical products agency, which the Department warns.

:19:41. > :19:47.This helped it reach the final balance. The critical thing which is

:19:48. > :19:51.becoming a long-term strategy, it appears, and I hope the Minister

:19:52. > :19:59.will take this seriously and respond, we are seeing a trend of

:20:00. > :20:04.capital funding pushed into revenue and the system capable in that way.

:20:05. > :20:12.That is not sustainable. The Department of Health transferred

:20:13. > :20:18.?915 million of capital. It shows the department will transfer about

:20:19. > :20:26.?1.2 million of capital this year. More than ?250 million more than

:20:27. > :20:38.last year. I will give way. I am interested in the PFI element of

:20:39. > :20:44.capital funding. As our committee had a chance to look at that? We

:20:45. > :20:56.have not directly, but we do know that the biggest revenue cost for a

:20:57. > :21:07.hospital are stuffing. Then, it is financing a PFI deal. From

:21:08. > :21:15.conversation I have had with auditors, the refinancing of these

:21:16. > :21:20.deals can actually swamp the cost of potential savings. It is something

:21:21. > :21:24.maybe ministers could go we look at further. There has been a lot of

:21:25. > :21:30.technical work on this. If it could be spread out over a longer period

:21:31. > :21:35.of time, for instance, that would reduce the day-to-day resource costs

:21:36. > :21:47.for hospitals. The work I have done outside the committee rooms was

:21:48. > :21:52.outside the remit of the committee. As the honourable gentleman said, if

:21:53. > :21:59.we are looking at the transformation of the NHS, the sort of capital

:22:00. > :22:04.expenditures are important to save money in the long. That could be

:22:05. > :22:11.very short-sighted. If we look at how the trusts are managing in terms

:22:12. > :22:14.of deficit, we see a trend. At the beginning of this financial year,

:22:15. > :22:21.NHS England committed to us that they would produce a deficit not

:22:22. > :22:31.exceeding ?580 million at the end of next month. It is now forecasting a

:22:32. > :22:37.deficit of ?604 million. It is declining further to a deficit of

:22:38. > :22:41.over ?800 million. That pledge does not amount to very much and it is

:22:42. > :22:48.moving very much in the wrong direction. Through this financial

:22:49. > :22:54.year, trusts have been overspending by about ?300 million per quarter.

:22:55. > :23:05.If this continues, the overspend will be close to ?1.2 billion. Billy

:23:06. > :23:08.is startling, the reality of the Department of Hill 's consolidated

:23:09. > :23:12.course. I am picking a certain elements. We hear a lot of

:23:13. > :23:20.discussion about how much money the government is putting into the NHS.

:23:21. > :23:24.We had a committee hearing on January the love and support. On

:23:25. > :23:30.that day there were anonymous briefings in the national press,

:23:31. > :23:36.criticising himself and NHS England and defending himself and his

:23:37. > :23:43.position in the committee. People do not want anonymous briefings. They

:23:44. > :23:47.do not want to see an argument about the money. They want to know that

:23:48. > :23:53.the people who are running the health service and those overseeing

:23:54. > :24:00.it are actually committing to long-term patient care and the

:24:01. > :24:03.long-term challenges of the future. Protecting the NHS England budget is

:24:04. > :24:17.not the same as protecting the health budget. Health education is

:24:18. > :24:23.being squeezed, as is NHS England. Funding has gone down 10% in the

:24:24. > :24:27.last Parliament. This idea that tax precepts will make everything fine,

:24:28. > :24:32.it is all money which could have gone somewhere else. It does not

:24:33. > :24:36.solve this in the long-term. If we do not tackle this together, we will

:24:37. > :24:44.have an unsustainable future. The is too much shifting money in the

:24:45. > :24:54.budget from one place to another. It is not transparent to most people.

:24:55. > :25:02.Very big numbers. I will give way. A very thoughtful speech. I want to

:25:03. > :25:09.raise one point which is an issue not very often talked about, the

:25:10. > :25:16.rise in physical attacks on staff within the NHS and the recognition

:25:17. > :25:23.that protection in the budget deals with a lot of security issues. A lot

:25:24. > :25:29.of those perpetrating those attacks are people with mental health

:25:30. > :25:33.issues. We need to have the resources to deal with this.

:25:34. > :25:43.Otherwise, it could be a situation which gets worse. It is important

:25:44. > :25:53.that we protect staff. In the end, staff cost more than anything in the

:25:54. > :25:57.NHS, but it is them who provide that care. I will touch on workforce

:25:58. > :26:09.planning in a moment. I will give way for no. Some of those people who

:26:10. > :26:21.have mental health problems, the Arab going to the A departments

:26:22. > :26:22.and their views and problems are not being listened to. I get a lot of

:26:23. > :26:36.that. And this a long-term system. In that

:26:37. > :26:41.the support is the to stop the book going to any in the first place. I

:26:42. > :26:45.will give way. Thank you for giving way. And thank you for the excellent

:26:46. > :26:48.speech you are giving. I am really disturbed also when I hear from

:26:49. > :26:55.Government about more money being put into mental health when just

:26:56. > :27:01.received figures around Vale of York funding which will be cut, in a city

:27:02. > :27:05.which has reeled challenges around mental health we are seeing the

:27:06. > :27:08.budget drop, showing that services themselves are not catching up with

:27:09. > :27:15.what the Government is insisting is trickling down into the system. The

:27:16. > :27:19.honourable lady raises one of the real, puts a face on the real

:27:20. > :27:22.challenge that many trusts and Commissioners are facing. They are

:27:23. > :27:34.having to make choices about where they spend money and despite the

:27:35. > :27:37.pledges, there is a squeeze on mental health funding. Growing

:27:38. > :27:42.demand is outstripping the ability of the NHS to supply needs. This is

:27:43. > :27:45.having a direct impact on patients. We're now seeing longer waiting

:27:46. > :27:51.times for and I alert colleagues to our hearing on GP services in the

:27:52. > :27:55.Public Accounts Committee. Any thoughts are welcome. They are

:27:56. > :28:01.waiting longer to see specialists with the 16 week target being

:28:02. > :28:07.reached and AMD targets are breached too often. We are seeing a real

:28:08. > :28:16.challenge and NHS Improvement is a welcome body set up to encourage

:28:17. > :28:19.best practice, and it is quite right that the NHS looks to perform as

:28:20. > :28:25.efficiently as possible. But once again we are seeing improvements

:28:26. > :28:37.mask what look like cuts. A 4% efficiency saving target is once

:28:38. > :28:46.again being imposed, it was imposed last year by the then Chancellor of

:28:47. > :28:51.the X. And it was acknowledged as particularly challenging. The

:28:52. > :28:57.reality was everyone in this situation knew it was too

:28:58. > :29:01.challenging but it was difficult for people to speak truth to power. We

:29:02. > :29:06.see this over and over again. The head of NHS improvement was once at

:29:07. > :29:10.that again acknowledged in our report that the 4% efficiency saving

:29:11. > :29:15.required as part of the transformation programme are

:29:16. > :29:21.challenging. We also see a worrying and real correlation between the

:29:22. > :29:33.financial performance of trusts and their care emission quality rating.

:29:34. > :29:43.Trusts that achieve lower quality rating had lower financial

:29:44. > :29:49.performance. They had a net... We know that there is a real issue. I

:29:50. > :29:55.want to touch on workforce planning before I draw to a close. We hear a

:29:56. > :30:00.lot about the cost of locums. Very often I worry that in terms of some

:30:01. > :30:02.of the national debate we end up fixating on smaller issues when we

:30:03. > :30:11.need to look at the bigger picture. The cost of locums, we often hear

:30:12. > :30:15.about high rates per hour or day. If someone is being paid several

:30:16. > :30:20.thousand pounds a day for a shift that seems ludicrous. But the key

:30:21. > :30:25.issue here is the sheer volume of locums needed. What happens eg is

:30:26. > :30:31.the trust structures are set to meet the budget sent down to them by the

:30:32. > :30:34.Department of Health. Tax money but not another. From the beginning they

:30:35. > :30:37.are not set up well enough to meet demand. In order to meet the needs

:30:38. > :30:41.of their population they have to buy in locums. This is not long-term

:30:42. > :30:46.sustainable. We also see challenges in the middle of the last

:30:47. > :30:51.parliament, a reduction in nursing places, we seen recently the loss of

:30:52. > :30:57.the nursing bursary and we hope that does not see a writ loss of nurses

:30:58. > :31:05.in the future. But in my own constituency I know how many women,

:31:06. > :31:13.people, welcome that ability to better themselves and contribute. We

:31:14. > :31:19.need figures for hammy people are going into nursing and whether the

:31:20. > :31:27.people going into it will stay and work in our NHS. In Northumbria

:31:28. > :31:31.foundation trust my local hospital trust, we have taken to training our

:31:32. > :31:35.own nurses so that local people who want to germ the profession can.

:31:36. > :31:39.Knowing they can work in that local trust which has such a great

:31:40. > :31:43.reputation and is leading the way in terms of financial and medical

:31:44. > :31:49.changes we need to see. I agree. My own hospital does the same in health

:31:50. > :31:53.care assistants. The challenge is without that bursary payment, how

:31:54. > :31:56.many people will it put off. We did clear answer from the Minister about

:31:57. > :32:01.what analysis was done about the impact on the workforce of that

:32:02. > :32:04.change. That amount of money is relatively small compared with the

:32:05. > :32:06.challenges and problems of not being able to provide a health service if

:32:07. > :32:19.we don't have enough nurses in place it may well be a false economy. I

:32:20. > :32:23.will give way. I thank you for giving way. The early figures that

:32:24. > :32:28.have come out from NHS England suggest a 23% Jock drop in

:32:29. > :32:33.applications, and that is a significant change. The key thing of

:32:34. > :32:37.course is how that figure comes through the pipeline at how we

:32:38. > :32:41.filled the gap. It would be helpful while the minister is on his feet at

:32:42. > :32:44.the end of the debate today, if he could talk about what analysis the

:32:45. > :32:50.Department of Health has done about the impact of Brexit and any changes

:32:51. > :32:55.that may herald for our workforce, because a high percentage of fat NHS

:32:56. > :32:57.workforce are from Europe. We are hearing the right sounds from

:32:58. > :33:02.Government but yet no action about securing this future of those

:33:03. > :33:06.European resident citizens who are currently resident in the UK. If he

:33:07. > :33:10.is able to give us any comfort on that it would be very welcome. I'm

:33:11. > :33:16.heartened that so many members are here today to discuss this important

:33:17. > :33:20.issue and also this is another committee we've been working with is

:33:21. > :33:24.the procedure committee to try to ensure we can discuss the financial

:33:25. > :33:28.details of estimates in the house rather than just the general

:33:29. > :33:33.principles. I have obviously strayed into a general principles to but

:33:34. > :33:38.hopefully basing that in the actual figures. It is an edifying for the

:33:39. > :33:42.public to have anonymous briefings and public argument. It does not

:33:43. > :33:45.wash. We need to be on top of this so that we are holding the

:33:46. > :33:49.Government's feet to the fire and making sure every step of the way

:33:50. > :33:53.they know we are watching the budget and won't let them get away with

:33:54. > :33:59.raiding the capital budget to fund the accounts. I will give way one

:34:00. > :34:04.final time. She is making a very interesting speech. But one of the

:34:05. > :34:08.things we should make much more use of is pharmacies. Especially in

:34:09. > :34:13.order to try to take some pressure off the GPs. Secondly, to ask GPs to

:34:14. > :34:20.go into pharmacies and be located there. He makes a good point. I

:34:21. > :34:26.visited a local pharmacy a few weeks ago and saw first-hand the work they

:34:27. > :34:31.do. To help ease pressure from GPs, where people are waiting from

:34:32. > :34:34.appointments, and her any. I knows minister has taken a keen interest

:34:35. > :34:37.in pharmacies but nonetheless there is a cut to their base budget. While

:34:38. > :34:43.we were on that point, that base amount of money allowed pharmacies

:34:44. > :34:48.to with certainty employment of spa to allow them to do those

:34:49. > :34:51.appointment with patients. If they are just rely on revenue income they

:34:52. > :34:56.were not sure if they could maintain the salary and a solid base of

:34:57. > :35:01.funding was very important in a constituency like mine where, for

:35:02. > :35:04.all sorts of regions, culturally and linguistically and convenience wise,

:35:05. > :35:09.people will find their local fireman see more readily than they will find

:35:10. > :35:14.their GP. The minister has things to answer on that point as well. But

:35:15. > :35:19.can I say I was heartened when a group of us recently crossed party

:35:20. > :35:23.met with the Prime Minister. She shoe polish there was a need to look

:35:24. > :35:26.at the long-term issues around health and social care. She has made

:35:27. > :35:33.a pledge that her adviser will meet with cross-party MPs to look at

:35:34. > :35:40.this. I hope this heralds a change of attitude. We will see no more

:35:41. > :35:46.bickering. We will see a concerted effort to ensure we future proof our

:35:47. > :35:51.NHS and make sure it is a beacon to the world that we believe it is. It

:35:52. > :35:56.will be obvious to the house that a great many people wish to speak this

:35:57. > :36:02.evening. Of course we have plenty of time, but it is limited. If

:36:03. > :36:07.honourable members take a self-denying ordinance and speak for

:36:08. > :36:10.no more than nine minutes, then everyone who has indicated they

:36:11. > :36:16.would like to speak will have an opportunity to do so. I hope not to

:36:17. > :36:20.have to put on a formal time limit because nine minutes is actually a

:36:21. > :36:25.very long time. If you can't say it in nine minutes then you have to go

:36:26. > :36:35.away and practice! I know that no practice is needed here. Let's be

:36:36. > :36:39.clear. Estimates are a serious business, they must be realistic.

:36:40. > :36:45.Parliament every year votes on how much can be spent and if access is

:36:46. > :36:49.needed you have to go back to the house, so getting the estimates

:36:50. > :36:53.right is critical. The challenge I have with these estimates is that

:36:54. > :37:04.they are based on assumptions for which I can find very little comfort

:37:05. > :37:09.for being realistic. We look at what is assumed and as my honourable

:37:10. > :37:15.friend has said there is an assumption that demand will go down.

:37:16. > :37:23.As the population increases and as immigration increases, it seems that

:37:24. > :37:28.is unrealistic. It seems to me that the Government needs to look long

:37:29. > :37:34.and hard at the assumptions it has made, I for 1am not convinced it has

:37:35. > :37:39.got it right. We also need to look at what this estimate is assuming in

:37:40. > :37:45.terms of negatives. It is assuming that we can still keep on course if

:37:46. > :37:53.we reduce public health spending. If you start reducing that which will

:37:54. > :37:56.prevent the need for NHS intervention, which is the most

:37:57. > :38:01.expensive form of intervention, are you really going to save money? It

:38:02. > :38:05.seems to me you are not. The other assumption that is being made with

:38:06. > :38:08.these estimates is that central administration will be cut. Given

:38:09. > :38:18.the complexity of what is going on at the moment with 44 coming on

:38:19. > :38:23.board we hope because they are in concept a good idea although I have

:38:24. > :38:29.concerns about delivery, I am concerned that overall these

:38:30. > :38:32.estimates are not based on realistic assumptions which the Government and

:38:33. > :38:39.the ministers will need to seriously address. As my honourable friend who

:38:40. > :38:44.leads the select committee, the Public Accounts Committee, has said,

:38:45. > :38:47.and indeed my honourable friend for Totnes, you must take into account

:38:48. > :38:53.when you make these estimates what you need for both health and social

:38:54. > :38:56.care. Because if you cut health spending on social care or don't

:38:57. > :39:02.adequately fund it you will increase spending within the NHS.

:39:03. > :39:09.Underpinning all this is actually having measurements in place across

:39:10. > :39:14.the whole system as was indicated so that you actually know what the full

:39:15. > :39:20.scope of the demand is, you measure the results of the resource you put

:39:21. > :39:26.in our, and what the outcomes are for the population as a whole. We

:39:27. > :39:34.talk about measures around accident and emergency and the NHS. We talk

:39:35. > :39:38.about waiting times. We talk about. The targets set are around reducing

:39:39. > :39:46.waiting times will no one looks at the impact on care, an GPs, on

:39:47. > :39:50.social care. We need it seems to me to look very carefully if an

:39:51. > :39:57.estimate is to be right, as a whole system of measurement. I thank her

:39:58. > :40:02.for giving way. She makes powerful points. Would she agree with me, my

:40:03. > :40:09.local District Hospital had winter preparing less for a 5% uplift, they

:40:10. > :40:13.had a 20% increase in demand. I had the exact same thing in social care

:40:14. > :40:19.whether social care providers are telling me people are older and

:40:20. > :40:25.earlier. We have increased demand across-the-board because of that. I

:40:26. > :40:31.thank her for that helpful example. She is writing what you says. So, if

:40:32. > :40:37.we look at the whole measurement system, it seems to me, and this was

:40:38. > :40:41.acknowledged in one of the Public Accounts Committee sessions by the

:40:42. > :40:46.Department of Health, that there is a limited measurement and that there

:40:47. > :40:49.probably should be more. When I challenged the individual concerned

:40:50. > :40:53.as to whether the Government would be looking at it he stood from one

:40:54. > :40:57.foot to the other and could not give much of an answer. It seems to me

:40:58. > :41:04.the estimates have to be based on proper measurement of need, of what

:41:05. > :41:07.is actually operationally put into practice, and of the outcome for the

:41:08. > :41:12.patient, and that is not there. We'll is only to look at the

:41:13. > :41:17.differences between the NHS and social care in how the money is

:41:18. > :41:22.allocated. The NHS, we have ring fencing will stop social care, we

:41:23. > :41:25.don't. But the the two are linked that linked that means that unless

:41:26. > :41:31.we look at the way each of those pots are managed, no matter how much

:41:32. > :41:34.is in them, we give rise to problems for the future. Social care by

:41:35. > :41:42.comparison is not ring fenced and while I'm sure a role great for for

:41:43. > :41:47.the extra money is, they don't go far enough. The first Chang of money

:41:48. > :41:50.may cover the living wage and the ability of local authorities to

:41:51. > :41:58.increase the precept by 3% is welcome. But as my friend the leader

:41:59. > :42:08.of our select committee said, that is taxpayer money.

:42:09. > :42:19.Does she shear my concern about the 3% precept? It seems it is going

:42:20. > :42:28.from general taxation onto property -based tax. It will disadvantage

:42:29. > :42:34.communities that are worse off. That is a very fair point. He is

:42:35. > :42:41.absolutely making the rate case. Many of the facilities here to

:42:42. > :42:48.provide social care graph feeling because there is not an individual

:42:49. > :42:53.to ensure that some of the care homes are alive and well. I am down

:42:54. > :43:00.to just three in our constituency that is totally inadequate. We both

:43:01. > :43:09.have constituencies with a large proportion of elderly people. Is

:43:10. > :43:22.there not a double whammy because people who are over 85 came to stay

:43:23. > :43:26.in hospital for longer. We are looking after them well, but need to

:43:27. > :43:33.look after them better, but the daily in going from hospital to

:43:34. > :43:39.social care is very costly and I do not think the estimates to take

:43:40. > :43:45.proper account of that. My honourable friend makes a very good

:43:46. > :43:51.point. The cost is not adequately taken into account. If you look at

:43:52. > :43:57.the way the government measures outcomes, they are predicated on a

:43:58. > :44:05.span of the population and predicated on the number of births

:44:06. > :44:08.and the length of life. Because there are different areas, the lakes

:44:09. > :44:16.of my constituency in Devon, where people live longer, is that we have

:44:17. > :44:24.a lower number of live births. People tend to move into the area

:44:25. > :44:27.when they are order. So there are basic fundamental flaws in the way

:44:28. > :44:33.government and not just this government, this has gone on for

:44:34. > :44:39.years, estimate the need for within a Navy. One of the biggest

:44:40. > :44:48.challenges is in that regard. I will move on. Information is expected to

:44:49. > :45:00.be the solution to all of our problems. There is no transition

:45:01. > :45:07.funding so that is not allowable. There are not many pooled budgets.

:45:08. > :45:10.These plans assume recruitment for individuals but we cannot recruit

:45:11. > :45:16.will in the future. It does not take will in the future. It does not take

:45:17. > :45:22.into account the training we will need. We are looking at the

:45:23. > :45:29.population getting older, we need more specialist nurses. It has been

:45:30. > :45:33.agreed by the experts, but has not been put into practice. There are so

:45:34. > :45:38.many issues which will impact on this that I have my doubts that this

:45:39. > :45:48.was the way forward, in terms of reducing cost. I am concerned that

:45:49. > :45:56.this integration model, while welcome, has not been thought

:45:57. > :46:00.through and the barriers to it being successful have an implication that

:46:01. > :46:07.it will be an unbudgeted cost. My concern is that there is no evidence

:46:08. > :46:13.for this option that the demand will decrease. There is no evidence that

:46:14. > :46:19.integration is going to deliver savings. It seems to me that the

:46:20. > :46:28.estimate can it really be sound. The real cost estimate is needed. My

:46:29. > :46:34.final closing comment, what we have failed to address is at peace of

:46:35. > :46:46.social care which is paid for privately. I will look at the report

:46:47. > :46:49.briefly and the act, because we are looking at how the taxpayers money

:46:50. > :46:57.is to be shared out between these two systems, but we should never

:46:58. > :47:01.forget that social care is means tested, as opposed to the NHS, which

:47:02. > :47:06.is free at the point of the envelope. If you do not take into

:47:07. > :47:14.account that savings are required, then we will find on the NHS is

:47:15. > :47:23.simply too great on the system to succeed than for the system, the new

:47:24. > :47:29.system, to be valid. The select committee is currently undertaking

:47:30. > :47:34.an enquiry into social care. The report has not been published yet,

:47:35. > :47:40.so anything I say is my own so anything I say is my own

:47:41. > :47:44.reflection, as opposed to directly to do with the findings. I hope it

:47:45. > :47:51.will not be too long before we can provide the report with regard to

:47:52. > :47:55.the immediate issues within social care. We will then look at the

:47:56. > :48:07.longer term issues. We have taken expert analysis from many connected

:48:08. > :48:17.parties. From people with an the care system and key providers. It is

:48:18. > :48:25.not surprising to me to have heard what I have heard because

:48:26. > :48:31.unfortunately, as an MP, we only get the tip of the iceberg of problems

:48:32. > :48:37.which occur. The number of feelings end social care have undoubtedly

:48:38. > :48:42.increased in the last two or three years. I look at fundamentally what

:48:43. > :48:50.is happening. A council which is having to cut its budget on social

:48:51. > :48:58.care is often doing that by going to the private sector and going out to

:48:59. > :49:03.agencies. Replacing that with the service which the council used to

:49:04. > :49:13.provide. Undoubtedly, the way the services our Kilvert, often people

:49:14. > :49:19.are not travelling up and causing even more problems for patients in

:49:20. > :49:23.the long-term. It is not surprising that the cheer of the hills select

:49:24. > :49:33.committee said there was a 7% cut in real terms in social care in the

:49:34. > :49:40.past seven years. Central government plans have been reduced by 57%.

:49:41. > :49:44.Councils have tried to provide social care, but they have not been

:49:45. > :49:48.able to protect it completely from the cuts. On top of that, not only

:49:49. > :49:55.is the money going down, but the number of elderly people going to

:49:56. > :50:04.require care is going up. On top of that, there is the Care Act, in

:50:05. > :50:12.principle a great piece of legislation. Welcome measures, in

:50:13. > :50:19.terms of trying to reward those properly for the excellent work they

:50:20. > :50:23.do in social care, the entries in the minimum wage puts additional

:50:24. > :50:35.burdens on the system. There was a very good article about social care

:50:36. > :50:39.yesterday in which the council leader said the doing more for less,

:50:40. > :50:44.something they have become very good at. But no, they have to admit they

:50:45. > :50:51.are doing less for less. We should not blame councils for not being

:50:52. > :50:55.able to provide a standard service. Even if every council did their

:50:56. > :50:59.best, there would still be problems with the system. I asked the

:51:00. > :51:06.Minister affair was a crisis. He did not want to use that word, but he

:51:07. > :51:10.said the system was under stress. That was the words he used. I think

:51:11. > :51:19.we would recognise this case is very obvious for all of us to see. 1.2

:51:20. > :51:25.million people estimated getting the care daily choir. That is 40% higher

:51:26. > :51:34.than it was in 2010. We got evidence from people who said that they were

:51:35. > :51:39.not getting the care Lee got in the past when the needs we are

:51:40. > :51:48.increasing. People pulling out of contracts. Contracts not been

:51:49. > :51:58.delivered property -- properly for the councils. People actually paid

:51:59. > :52:04.for care actually subsidising local authorities. This did not seem fear

:52:05. > :52:15.fear too many people. At the same time, you have the 27% turnover in

:52:16. > :52:20.the south. You are getting people leaving with long-term experience

:52:21. > :52:22.and there are much more demands on training. These are problems we

:52:23. > :52:28.learned about in our evidence. We learned about in our evidence. We

:52:29. > :52:34.come to one of which I hope they will reflect on. This was some of

:52:35. > :52:40.the very compelling evidence that we received as part of that enquiry. In

:52:41. > :52:45.the short-term, the government have done things. They brought in the

:52:46. > :52:51.council tax precept. I brought in the fact that local authorities have

:52:52. > :52:56.taken up on that. There are problems, of course, the fact that

:52:57. > :53:01.it raises more money for some local authorities than it does for others.

:53:02. > :53:10.The better clear from, which was meant to stabilise, is rather

:53:11. > :53:15.backordered into the system. The new homes burnt his welcome, but that

:53:16. > :53:20.causes problems for smaller district councils. He suddenly find the

:53:21. > :53:29.budget position fundamentally altered. Going back to the article,

:53:30. > :53:33.you have got a situation where government simply was not thinking

:53:34. > :53:37.through in the longer term. They are moving money around in the system

:53:38. > :53:44.without giving real thought to the end result. There was a lack of

:53:45. > :53:50.thinking and funding between health and social care. There was not

:53:51. > :53:55.really any understanding of what was happening to the money at the end of

:53:56. > :53:59.the line. Local authorities are facing very difficult choices and

:54:00. > :54:04.having to make decisions on the cuts that are being pressed onto them.

:54:05. > :54:06.These are some of the issues we have and we will reflect on in the report

:54:07. > :54:16.which will produce. The link between which will produce. The link between

:54:17. > :54:23.health and social care is vitally important. It will be interesting to

:54:24. > :54:27.see what comes out of the idea of the two being devolved together. Not

:54:28. > :54:34.only the idea of discharging, but that there is nobody in the system

:54:35. > :54:41.for preventative social care. The funding is for people in the highest

:54:42. > :54:44.need. People not getting the attention in the early stages means

:54:45. > :54:51.they are more likely to end up in hospital and more likely to end up

:54:52. > :54:57.with long-term problems. We need longer-term arrangements. We need to

:54:58. > :55:03.respond to the theatre no, because that is also important. There are

:55:04. > :55:07.some people who if we do not deal with the here and now, there will be

:55:08. > :55:12.some people who will not be around to see the long-term benefits. We

:55:13. > :55:16.went to Germany and they told us that 20 years ago, they solve this

:55:17. > :55:25.problem coming. We sat down with the cross-party committee and agreed on

:55:26. > :55:33.long-term systems. That is what they decided to do. It has stood the test

:55:34. > :55:40.of time for two decades. They have increased the social insurance

:55:41. > :55:46.allowance. This has got cross-party agreement and virtually no public

:55:47. > :55:52.opposition. This is not just funded by the taxpayer. There are private

:55:53. > :55:57.contributions in it, as well. It is just an example. We need to sit down

:55:58. > :56:01.a cross-party basis and work out solutions which stand the test of

:56:02. > :56:08.time, regardless of what government is in power at the time. Does he

:56:09. > :56:16.agree that fundamentally the issue is that countries in Europe, such as

:56:17. > :56:22.Germany and France, they are spending a great deal more money

:56:23. > :56:33.through either the system he described in Germany, or somehow we

:56:34. > :56:37.are going to have to close that gap. It is highly likely the difference

:56:38. > :56:44.in mortality and outcomes generally in this country is related to the

:56:45. > :56:56.amount of money which is put into the system?

:56:57. > :57:06.It is something we need to reflect on. But it is not simply a question

:57:07. > :57:09.of public funding. There is an issue about where we get the Private

:57:10. > :57:14.funding from, I don't think anyone has argued to us so far that the

:57:15. > :57:19.whole of it can be publicly funded. How do we raise the Private money?

:57:20. > :57:23.Should it be from individuals who near need care at that point or

:57:24. > :57:28.should we ask people to pay more into some sort of insurance system,

:57:29. > :57:31.and how do we putting more money from the public sector? Can we rely

:57:32. > :57:34.on local authority funding alone, particularly if that is coming from

:57:35. > :57:38.business rates when business rates are not going to grow at the same

:57:39. > :57:46.percentage in future as the number of people who want social care? Can

:57:47. > :57:51.I pass over to my, the honourable member? It is my pleasure to join

:57:52. > :57:57.him on that visit with other members will stop does he feel it was all

:57:58. > :58:03.the more pertinent that his example of the German system in that 20

:58:04. > :58:07.years ago they too had a system funded by local authorities, prior

:58:08. > :58:11.to changing to social insurance in 1995, and find that system was not

:58:12. > :58:15.fit for purpose and they discovered that 20 years ago, moved to this

:58:16. > :58:20.system, which as he says has cross-party support, and is a

:58:21. > :58:24.long-term sustainable solution? I just want us to have a process which

:58:25. > :58:28.gets us to a similar position. If local authorities remain part of the

:58:29. > :58:33.funding solution I don't think we can assume that the increase in

:58:34. > :58:39.business rates and council tax will keep pace with the level of demand

:58:40. > :58:42.will come in. Finally, I know you are trying to encourage us to keep

:58:43. > :58:50.within a time limit, what I would say is... The honourable gentleman,

:58:51. > :58:59.as chairman of the select committee, I don't apply the time limit so

:59:00. > :59:07.strictly to him. I better not stray too far. Health and social car

:59:08. > :59:09.working close together, of course. Let's see how Manchester develops.

:59:10. > :59:13.It will be interesting to look at that. But the other thing that came

:59:14. > :59:19.out of this it is not a panacea, it will not solve all the problems. I

:59:20. > :59:27.in I agree with the chair of the select committee, they are going to

:59:28. > :59:32.need some pump priming to make them effective, they have been done

:59:33. > :59:36.properly in every area with full cooperation. If they are done

:59:37. > :59:39.properly and looked at how we can better plan for the future, I think

:59:40. > :59:43.they will make an important contribution. But in the end we have

:59:44. > :59:48.to recognise this process will take time, it will need upfront funding

:59:49. > :59:49.to make it work, and wheels have to recognise that there are big

:59:50. > :59:53.differences in health and social differences in health and social

:59:54. > :00:00.care, not merely in culture but in the funding arrangements. Health is

:00:01. > :00:03.provided free at point of use and social care isn't and probably won't

:00:04. > :00:06.be after any changes will stop they will be different funding

:00:07. > :00:12.arrangements. There is fundamentally different accountability. Social

:00:13. > :00:18.care is accountable to local councillors. Health is accountable

:00:19. > :00:21.to the Secretary of State. If you want to the problems this creates,

:00:22. > :00:26.see the evidence last health minister gave to the select

:00:27. > :00:29.committee. I think it shows it isn't all quite worked out in Government

:00:30. > :00:33.in a way you could pull a switch tomorrow and get it all operating

:00:34. > :00:38.smoothly. I would say we have a lot of work to do in that direction and

:00:39. > :00:41.I'm sure the local Government select committee will consider all the

:00:42. > :00:47.evidence and produce reports on this range of issues. Thank you. It is a

:00:48. > :00:54.pleasure to follow the honourable gentleman. I think it is worth

:00:55. > :00:57.putting on the record, notwithstanding some of the issues

:00:58. > :01:00.which have already been drawn to your attention, the increase in

:01:01. > :01:09.money the Government is committing, the extra 10 billion by 2020, the

:01:10. > :01:15.extra doctors, nurses in the system, the near eradication of mixed sex

:01:16. > :01:21.wards and a huge reduction in hospital infections. I note also

:01:22. > :01:25.that health spending in England is almost 1% higher than the OECD

:01:26. > :01:30.average. I think it is worth putting that on the record. I'm sorry to

:01:31. > :01:35.intervene so early. Would he agree with me that the OECD average is

:01:36. > :01:42.probably a specious camp heiress and since it will consign countries like

:01:43. > :01:45.Mexico and Turkey and former Eastern Bloc countries which, laudable

:01:46. > :01:50.though they may be, are not countries which most people in this

:01:51. > :01:53.country would worth would wish to be compared in terms of health

:01:54. > :01:57.economies? I think that's a fair point. In the course of my remarks I

:01:58. > :02:06.will outline some areas where some more spending is necessary. I want

:02:07. > :02:11.to start by focusing in on an individual case, not from my

:02:12. > :02:13.constituency, which I think highlights many of the issues that

:02:14. > :02:22.have been raised so far this evening. It concerns a 98-year-old

:02:23. > :02:27.lady, admitted to a hospital on the 22nd of January. She unfortunately

:02:28. > :02:31.died in that hospital on the 31st. It was made clear to the hospital on

:02:32. > :02:38.the 25th of January that the nursing home she had come from, she had been

:02:39. > :02:46.in the residential part, had nursing facilities which were able to take

:02:47. > :02:49.her back and deal with the deterioration in her health. In

:02:50. > :02:56.spite of the hospital being made aware of that on the 25th of

:02:57. > :03:02.January, no action was taken to remove her back to that nursing

:03:03. > :03:08.home, which resulted in an extra six days of staying in that hospital.

:03:09. > :03:14.The relatives which drew this true case to my attention asked me to

:03:15. > :03:17.raise the following two points. First, they thought it wasn't good

:03:18. > :03:23.enough that the hospital concerned did not have a good knowledge of the

:03:24. > :03:29.fact that the nursing home this lady came from had nursing facilities in

:03:30. > :03:33.addition to residential facilities she had come from, which would have

:03:34. > :03:39.been able to care for her and free up a hospital bed. Secondly, they

:03:40. > :03:43.were also disappointed that because her period in hospital spanned a

:03:44. > :03:48.weekend they were told by several of the nursing staff that no doctor was

:03:49. > :03:53.available to make a decision to move her back to the nursing floor of the

:03:54. > :03:59.home which she had come from, which is where she had always wanted to

:04:00. > :04:02.end her days. I think that story illustrates some of the issues which

:04:03. > :04:07.I know ministers are aware of in terms of making sure the knowledge

:04:08. > :04:11.of what residential and nursing facilities are available in the

:04:12. > :04:15.community to elderly people that come into hospital, and also the

:04:16. > :04:22.issue of weekend cover so that appropriate decisions can be taken.

:04:23. > :04:25.So the beds are not taken up unnecessarily within hospitals.

:04:26. > :04:34.Couple of weeks ago I sat down with a number of social care providers

:04:35. > :04:39.within Bedfordshire, covering both residential and domiciliary care,

:04:40. > :04:44.and I asked them what they thought it was they actually needed in order

:04:45. > :04:52.to attract enough people into the care profession. The chairman has

:04:53. > :04:56.just told us there is a 27% turnover and I learned they cannot always

:04:57. > :05:01.attract the calibre of people they would like. In terms of domiciliary

:05:02. > :05:10.care, I was told very clearly that the ability to offer a 16 to ?18,000

:05:11. > :05:16.a year salary rather than paying people on an hourly basis when they

:05:17. > :05:21.provided care, would go a long way to attracting the right sort of

:05:22. > :05:27.people into this profession. This domiciliary care provider was one of

:05:28. > :05:35.the better ones in my area, and paid 30p a mile for travel costs. All of

:05:36. > :05:39.us as members of Parliament get paid 45p a mile when we travel in our

:05:40. > :05:43.constituencies, and I find it an affront that there is this division

:05:44. > :05:48.between different rates for travel within the public sector. Social

:05:49. > :05:54.care staff do an incredibly important job and it is not right

:05:55. > :06:00.that they are lucky to be offered 30p a mile when members of

:06:01. > :06:04.Parliament are offered 45p a mile. I am not just asking for local

:06:05. > :06:09.authorities to put it up to that straightaway in terms of what they

:06:10. > :06:13.pay, we have to be realistic. We have to actually decide that that

:06:14. > :06:20.comes with a price tag which has to be provided through taxation. I

:06:21. > :06:25.fully recognise that point. But a salary to ?16,000 to ?18,000 over

:06:26. > :06:32.and above this Barony rates of pay which don't include travel time and

:06:33. > :06:36.that travel paid for at a miserly rate compared with what other people

:06:37. > :06:42.get in the public sector, I think would go a long way. In the

:06:43. > :06:46.estimates before us today, one of the issues which has not been

:06:47. > :06:52.highlighted so far is the revaluation of the NHS litigation

:06:53. > :06:57.costs and increase of some ?8 billion which is a fairly large

:06:58. > :07:02.figure. It is worth focusing on that because litigation costs mean and

:07:03. > :07:07.thing is, firstly that patients do not have the right quality of care

:07:08. > :07:12.first time around and secondly that it is money going out of the door of

:07:13. > :07:17.the NHS, often to lawyers, which could better be used to doing the

:07:18. > :07:22.job correctly first time. In that regard, I make no apologies for

:07:23. > :07:27.again drawing the house's attention to the getting it right first time

:07:28. > :07:32.initiative, which seeks to embed quality of clinical care across the

:07:33. > :07:37.NHS. Something which quite often I find we don't seem to focus

:07:38. > :07:42.sufficiently on within this house stop the variability in terms of

:07:43. > :07:46.infection rates, in terms of rates of revision surgery requires very

:07:47. > :07:49.significant across the NHS, and if we could raise the quality of

:07:50. > :07:54.clinical care to the level of the best across the NHS we could that

:07:55. > :08:04.litigation amount down very substantially. I was very pleased to

:08:05. > :08:10.join a meeting held a couple of weeks ago on the manifesto for a

:08:11. > :08:14.healthy and health creating society, led by the former permanent

:08:15. > :08:18.secretary of the Department of Health and other colleagues in the

:08:19. > :08:21.House of Lords and indeed others. Although this may seem quite a

:08:22. > :08:26.long-term approach to the acute problems we are facing today, and

:08:27. > :08:29.the chair of the local Government select committee is right to say we

:08:30. > :08:36.need action now, because not everyone will be around in the

:08:37. > :08:40.longer term, but nonetheless I think it is incredibly important that we

:08:41. > :08:45.take seriously a lot of the ideas within this report in terms of

:08:46. > :08:51.trying to reduce the strains on the NHS and create a healthier

:08:52. > :08:55.population in the years to come. There are already some very good

:08:56. > :08:59.examples of that, the Saint Paul's way transformation project in

:09:00. > :09:05.popular in the east end is already doing sterling work and the well

:09:06. > :09:08.north initiative supported by Public Health England is focusing on ten

:09:09. > :09:13.cities in the North of England which have poor health outcomes, bad

:09:14. > :09:16.levels of health and health inequality. It is all about creating

:09:17. > :09:22.what they called vibrant and well-connected communities where you

:09:23. > :09:31.deal with issues like debt, jobs, training, poor housing and

:09:32. > :09:38.loneliness, an issue many of us are determined to carry on working on.

:09:39. > :09:43.This sort of long-term preventative work to increase the health

:09:44. > :09:47.resilience and increase the health of society is absolutely firm under

:09:48. > :09:52.mental to all the issues we are talking about tonight. In terms of

:09:53. > :09:57.the sustainability and transformation plans, in having

:09:58. > :10:03.spent time with both GPs and hospital staff in the past couple of

:10:04. > :10:07.weeks, I observed that clinicians in hospitals often pointed to the work

:10:08. > :10:11.that they thought should have been done by GPs and had not and when I

:10:12. > :10:14.spent time with GPs it was pointed out to me that they were doing quite

:10:15. > :10:21.a lot of work that in the past they would have expected hospitals to

:10:22. > :10:23.undertake. And I think that as sustainability and transformation

:10:24. > :10:29.plans move forward there would be some merit in making sure that in

:10:30. > :10:32.time they do turn into accountable care organisations so we can get a

:10:33. > :10:39.proper join up between the different parts of the system, so that that

:10:40. > :10:42.sort of finger-pointing between different parts of the system

:10:43. > :10:50.becomes a thing of the past. The last area I want to talk about

:10:51. > :10:55.quickly is just the issue of beds. Was I totally understand the

:10:56. > :11:03.Government focus to shift more care to the community, the fact that we

:11:04. > :11:10.have a thousand fewer beds than five years ago while the occupancy rate

:11:11. > :11:14.has gone up from 84 to 87% and sometimes operating theatres are

:11:15. > :11:22.remaining idle, is something I would like reflected on.

:11:23. > :11:29.Sadly, it has the feel of rearranging the debt chairs on the

:11:30. > :11:34.Titanic. Bringing this matter before the House today highlights the

:11:35. > :11:38.extensive range of issues facing the NHS. From my involvement in health

:11:39. > :11:44.issues in West Lancashire, from individual constituencies' cases to

:11:45. > :11:48.the commission of multi-billion pound contract, it is a microcosm of

:11:49. > :11:54.the issues that the multitude of bodies within the NHS need to start

:11:55. > :11:58.finding answers for. In West Lancashire, my constituents can wait

:11:59. > :12:02.up to a week by telephone conversation with a GP to assess

:12:03. > :12:05.whether they actually need an appointment and then a further wait

:12:06. > :12:11.for that appointment. Is it any wonder people turn to AMD and minor

:12:12. > :12:17.injuries units? While clinical experience at the top is laudable

:12:18. > :12:21.and to be welcomed, there is a shortage of GPs, there is also lost

:12:22. > :12:26.capacity because of the time GP spent on clinical commissioning

:12:27. > :12:30.groups governing bodies. Where as in the case of West The Lancashire,

:12:31. > :12:34.they have handed community health and urging cares services contracts

:12:35. > :12:40.to private providers, especially threatening the future of the NHS

:12:41. > :12:46.tossed there by removing services and essential financing turnover.

:12:47. > :12:52.The chair of the CCG is a local GP who spent three days a week on CCTV

:12:53. > :12:56.business under five further GPs with executive lead responsibilities.

:12:57. > :13:01.Besides the loss of capacity, there are also the financial

:13:02. > :13:06.considerations of GPs being remunerated for their work on the

:13:07. > :13:09.governing body. Now the GB owning over ?100,000 for a three-day week

:13:10. > :13:15.alongside a cheap accountable officer also an approximately

:13:16. > :13:19.?100,000 a week. There is also a fundamental lack of direct

:13:20. > :13:22.accountability of clinical commissioning groups which I

:13:23. > :13:28.understand is the responsibility of NHS England. So we have got GPs

:13:29. > :13:32.handing out contracts to private providers in the face of significant

:13:33. > :13:38.and substantial local opposition in West Lancashire and no is for

:13:39. > :13:42.meaningful accountability about how those GPs are spending taxpayers

:13:43. > :13:54.money. My constituents did not get to vote on whether Gale -- on who

:13:55. > :13:59.represents them on the CCG. The question also arises whether NHS

:14:00. > :14:03.England and NHS improvement have enough resources to deal with the

:14:04. > :14:10.increasingly complex contracts and structures they are supposed to

:14:11. > :14:15.supervise within the NHS. Threats to the smaller acute trusts besides

:14:16. > :14:19.coming from local GPs also come from the sustainability and

:14:20. > :14:25.transformation process. The name of which is being increasingly becoming

:14:26. > :14:30.a misnomer. These plans were quietly generated by small groups of people

:14:31. > :14:34.without the involvement of both the those who need their services or the

:14:35. > :14:41.public representatives of their public representatives both local

:14:42. > :14:45.and national. Some of us have missed strategic health Authority. I would

:14:46. > :14:50.be very interested to hear from the ministers if the process will

:14:51. > :14:57.actually provide capital resources to enable hospital trusts to develop

:14:58. > :15:01.transformational change projects. Increasingly, NHS improvement and

:15:02. > :15:07.NHS England cannot agree on these currents eight of NHS finances. NHS

:15:08. > :15:11.forecast for this financial year has worsened each financial quarter.

:15:12. > :15:19.Currently quarter three is standing at the deficit of 873 million was

:15:20. > :15:23.NHS England appears confident that the final deficit figure will be no

:15:24. > :15:32.more than 580 million. I took a deeper look at the figures. The

:15:33. > :15:36.figures for NHS trusts quarter three figures and a huge question over

:15:37. > :15:39.those deficit figures appears when you look at the sustainability and

:15:40. > :15:46.transformation fund money the government has given trust.

:15:47. > :15:52.Admittedly, trusts only have the allocated funding if the trust trees

:15:53. > :15:56.certain financial targets at the end of the financial year. If they do

:15:57. > :16:02.not, this extra funding will disappear like snow in July. The

:16:03. > :16:06.system deficit could be even greater. In fact, much greater. It

:16:07. > :16:12.is not just the Department of Health's funding of the NHS that has

:16:13. > :16:16.a consequential impact on services, we are witnessing savage cuts to

:16:17. > :16:20.local authority budgets. Lancashire County Council is the provider of

:16:21. > :16:25.social care and despair is personally close to being bankrupt

:16:26. > :16:30.in the next five years based on the current funding projections. We talk

:16:31. > :16:33.about health and social care absolutely as if they are

:16:34. > :16:37.intertwined these days. Yet the government allows this competitive

:16:38. > :16:44.existence between the two services to continue. ASBOs systems seek to

:16:45. > :16:55.survive financially, each body makes decisions to minimise their area of

:16:56. > :17:00.expenditure. -- ASBOs systems. Hospitals urgently seek to discharge

:17:01. > :17:04.a medically fit patient. I have a great fear that as each day passes,

:17:05. > :17:11.the struggle for survival due to the ever tightening financial structures

:17:12. > :17:15.imposed by government and a lack of any solutions means that patients

:17:16. > :17:22.are actually getting lost. Organisational for and financial

:17:23. > :17:26.considerations mean that patients are a distant third on the priority

:17:27. > :17:30.list. I do not know if creating chaos and turmoil within the system

:17:31. > :17:36.is part of a longer term strategy to lead us to a new health care system,

:17:37. > :17:40.one of private providers and health insurance. The Secretary of State

:17:41. > :17:44.will have to answer that one. What I see from the estimates provided for

:17:45. > :17:49.the transfer of money between budgets is that this is not just

:17:50. > :17:52.tinkering at the edges, sorry, this is just tinkering at the edges of a

:17:53. > :17:57.system that needs to be properly financed. Not shoving a few pennies

:17:58. > :18:02.in the left hand while taking away pounds and pounds from the right

:18:03. > :18:09.hand. Our NHS, our constituents deserve so much better.

:18:10. > :18:12.Thank you. It is a pleasure to speak after the honourable member. She has

:18:13. > :18:21.made some interesting points about fundamental reform. There is no

:18:22. > :18:26.doubt that members of both side of the House alludes to this, we are

:18:27. > :18:31.having this debate, setting up some background against huge demand and

:18:32. > :18:35.in many way decreasing supply, particularly in the area of adult

:18:36. > :18:40.social care which is where I am going to restrict my comments to in

:18:41. > :18:44.that this is, I have been very interested to take part in the

:18:45. > :18:48.inquiry on social care and the select committee which the cherub is

:18:49. > :18:57.said to earlier in his remarks. -- the chair. 33% increase in the

:18:58. > :19:01.population of people aged 80 and over the last ten years, 100%

:19:02. > :19:06.projected increase of that population over the next 20 years,

:19:07. > :19:13.50% increase in the 60,000 over over the next 20 years, interestingly

:19:14. > :19:17.enough, only a 4% increase in the numbers of people of the population

:19:18. > :19:21.of this country below 65 over the next 20 years which is in dynamic of

:19:22. > :19:27.who is going to provide the care needed for all these people who are

:19:28. > :19:32.getting older. The other area we have not touched on in adult social

:19:33. > :19:35.care, those with learning disabilities. Increasing very

:19:36. > :19:40.rapidly and is due to increase again over the next 20 years, more

:19:41. > :19:47.profound challenges for our health and adult social care services.

:19:48. > :19:52.Against the backdrop of decreasing supply provision, understandably,

:19:53. > :19:59.when you look at everyone is going to take part in making sure the

:20:00. > :20:04.books are balanced. Reducing the deficit from a a year in 2010 to

:20:05. > :20:09.around ?68 billion this year is no mean feat. We have to understand

:20:10. > :20:15.that there is no bottomless pit, we have to make difficult decisions in

:20:16. > :20:19.where our spending is allocated to. Local authorities have borne the

:20:20. > :20:28.brunt of this, 37% reduction in overall spending, 25% after council

:20:29. > :20:32.tax increases. Adult social care accounts for around 33% of local

:20:33. > :20:37.authority discretion or spend. It is inevitable that this is going to

:20:38. > :20:42.come into focus when local authority managers try to balance the book.

:20:43. > :20:45.Other competing pressures, around the National Living Wage, that is

:20:46. > :20:51.soaking up a lot of the action money that is being allocated into this

:20:52. > :20:54.area. It is not just about local authorities, it is the providers as

:20:55. > :21:00.well but are under huge pressure. 59% of care homes in this country

:21:01. > :21:07.are losing money, below profitability is threshold. Some of

:21:08. > :21:09.those homes are closing and providers sometimes are returning

:21:10. > :21:17.contracts to local authorities. Other elements as well in what we

:21:18. > :21:21.recall a well functioning health and social care service, other

:21:22. > :21:25.reductions such as community nurses, 28% reduction in community nurses

:21:26. > :21:31.which again can provide key services to stop people going into the health

:21:32. > :21:38.and social care system. In my constituency, simple things like

:21:39. > :21:43.sitting services or local dementia clubs, they have all closed, or been

:21:44. > :21:53.reduced over recent weeks and months which puts more pressure on the

:21:54. > :21:57.system. The discharge, has an impact on the NHS, something members know

:21:58. > :22:02.far more about than I do, Simon Stephens when he came to give

:22:03. > :22:05.evidence to committee, estimated at ?2 billion on extra spent on the NHS

:22:06. > :22:11.because of delayed discharges. There is an impact on whole system. The

:22:12. > :22:19.government has responded to a great extent, ?2 billion more in 2010. The

:22:20. > :22:24.adult social care preset, Betty care funding, adding 3.5 to ?4 billion by

:22:25. > :22:30.2020 but I think there is no doubt that all the evidence we have heard

:22:31. > :22:34.from a number of different sources, there is a one to ?2 billion

:22:35. > :22:39.shortfall in the system for investment that we need at the

:22:40. > :22:45.moment. We do need a cross-party conversation. I am happy to give

:22:46. > :22:50.way. On that issue of the shortfall, does he agree with me that time has

:22:51. > :22:54.come for us to bite the bullet and increase social care funding? Doing

:22:55. > :23:00.that in the short would provide the financial headroom to achieve the

:23:01. > :23:02.meaningful reconfiguration of services through the STB 's that

:23:03. > :23:13.will reflect the changing health prior to the Democratic? He makes a

:23:14. > :23:18.strong point. -- demographics. I'm sure this is in the Chancellor's

:23:19. > :23:23.budget calculation is on the 8th of March. In the short term, to plug

:23:24. > :23:27.the gap, we need some more money. In the longer term, we need to have a

:23:28. > :23:31.cross-party, across the House conversation on how we solve this

:23:32. > :23:35.problem and select committee has been an excellent forum so that on

:23:36. > :23:39.this issue and many others as the chair mentioned in his remarks, we

:23:40. > :23:44.went to Germany to see their system. It was very enlightening. It was

:23:45. > :23:47.particular say that in 1995 when they moved one system to another,

:23:48. > :23:51.they made from a local government funded system which just did not

:23:52. > :23:56.work, they clearly saw this coming before we did. They moved to a

:23:57. > :24:02.social insurance system. I think in Germany they are more used to that

:24:03. > :24:04.system, they have similar systems in place for health, pensions, employer

:24:05. > :24:11.and insurance and accident insurance, it works very well, it is

:24:12. > :24:21.cross-party. Around 1.175% of salary contribution, it is a bit like auto

:24:22. > :24:25.enrolment. It is mandatory. When people need care, they have a pot to

:24:26. > :24:28.call on. It is independently assessed so big at the level of

:24:29. > :24:39.prisoners and that suits their needs. They can go to family members

:24:40. > :24:45.to look after those people do these times which again I think as a

:24:46. > :24:48.social benefit as well as being clearly a sustainable system that

:24:49. > :24:52.works in the longer term. It is one of the things that we should look

:24:53. > :24:55.at, it is not the only thing that I reiterate and I new member still be

:24:56. > :24:59.same on both side of the House, we should look at this cross-party in a

:25:00. > :25:07.way that is sustainable for the long-term. I'm very happy to give

:25:08. > :25:10.way. I am very much enjoying his speech. Will he agree with me that

:25:11. > :25:18.the current way we fund local government does not help? My own

:25:19. > :25:20.constituency that has got a lot of over 85, the demographics are not

:25:21. > :25:27.properly reflected and the challenges of coastal communities

:25:28. > :25:33.face are not reflected? He makes a very good point. The evidence we

:25:34. > :25:37.have seen that the current method of funding adult social care do not

:25:38. > :25:44.correlate to those in those those areas. This is what we need to look

:25:45. > :25:47.at and take a strategic look at it. Just on that point, see the

:25:48. > :25:54.government now is moving towards a different way of funding towards

:25:55. > :26:00.2020. A key part of that is the fact that we look at a new fair funding,

:26:01. > :26:05.how it is allocated, absolutely critical that need is first and

:26:06. > :26:09.foremost and cost rivals so it is need and cost delivering the

:26:10. > :26:17.services. We get a fair and transparent system. One other thing

:26:18. > :26:23.to mention, in terms of the early point about adult social care and

:26:24. > :26:29.disabilities, one of the most enlightening examples of we saw in a

:26:30. > :26:33.way to deliver this in a different way is rather the look at this from

:26:34. > :26:38.a single viewpoint was the village shared lives concept where people

:26:39. > :26:41.look after each other, co-workers and people in need of the car. A

:26:42. > :26:53.fantastic and inspirational scheme. I shall touch on a few small points,

:26:54. > :26:58.such as how domiciliary care is charged, how people are accessed for

:26:59. > :27:01.their financial assessments are different in domiciliary care than

:27:02. > :27:04.they are in residential care and I think there is some money in the

:27:05. > :27:07.system they're potentially. It doesn't make much sense to me that

:27:08. > :27:11.the government fund one thing one way and another thing another. There

:27:12. > :27:16.is money to be taken out of the system, or people could contribute

:27:17. > :27:21.potentially if there are houses were taken into account for the

:27:22. > :27:25.assessment for domiciliary care. The second point is code terminal city.

:27:26. > :27:31.There are so many different services provided by so many different ages.

:27:32. > :27:34.It is working really well in Sheffield where all the agencies

:27:35. > :27:39.work together very effectively but in my area it is completely

:27:40. > :27:40.different and a mishmash of different providers, different

:27:41. > :27:44.geographical areas which is difficult when to provide a joined

:27:45. > :27:47.up service. With those remarks I will conclude in pass on to provide

:27:48. > :27:52.a joined up service. With those remarks I will conclude in pass onto

:27:53. > :28:01.another honourable member. Often, Mr Speaker, the NHS estimates to be a

:28:02. > :28:08.rather perfunctory affair but this year we are entitled to ask what on

:28:09. > :28:11.earth is happening to our NHS and social care system? Can be any

:28:12. > :28:17.longer afford the extraordinary complacency of this government. As

:28:18. > :28:22.an opposition MP I sometimes worry that either by design or simply

:28:23. > :28:26.collect -- neglect we will finally fulfil many of our worst fears, that

:28:27. > :28:33.the Tory party is destined to destroy the NHS. I don't think I

:28:34. > :28:38.need any lectures on cross-party dialogue from the party of the death

:28:39. > :28:46.tax and the ?8 billion financial fib. In Birmingham we have seen 28

:28:47. > :28:51.million of cuts to the budget for social care, bringing the service to

:28:52. > :28:56.its knees. Elderly people being treated like cattle, lying around on

:28:57. > :29:01.trolleys, waiting in corridors, dispatched from hospital in the

:29:02. > :29:08.middle of the night. Everywhere we look we see our hospitals, GPs and

:29:09. > :29:12.social care services collapsing under the strain. The Secretary of

:29:13. > :29:17.State is quite happy to flex his muscles when it comes to bullying

:29:18. > :29:23.junior doctors but it is always someone else's fault when it comes

:29:24. > :29:28.to resources, management and administration of the NHS. There was

:29:29. > :29:32.a time when the deal was simple, in return for the red box and

:29:33. > :29:39.ministerial salary ministers took responsibility. The buck stopped

:29:40. > :29:44.with them. But no more. I have lost track of how many parliamentary

:29:45. > :29:49.answers begin with the words the department does not collect that

:29:50. > :29:53.data centrally, or it would not be cost-effective to provide

:29:54. > :29:58.information in that format. Basically ministers don't know don't

:29:59. > :30:05.want to know and don't want us to know what is really happening. They

:30:06. > :30:09.are no longer presiding over a genuinely national Health Service,

:30:10. > :30:14.whether it is the postcode lottery that characterises the provision of

:30:15. > :30:19.IVF, with Clinical Commissioning Group is ignoring guidelines and

:30:20. > :30:22.making up their own criteria as they go along, or children's dentistry,

:30:23. > :30:28.where there is a growing crisis and the heavy reliance on hospital

:30:29. > :30:33.emergency surgery because of the lack of provision and monitoring of

:30:34. > :30:39.proper dental services for children. All this government wants to do is

:30:40. > :30:44.hide behind and blame others for their shambolic decisions. The

:30:45. > :30:50.latest disaster is the business rates revaluation, which imbibing is

:30:51. > :30:56.estimated will see a rise for the Queen Elizabeth you HP Hospital from

:30:57. > :31:02.2.8 million two 6.9 million a year. Talk about robbing Peter to pay

:31:03. > :31:08.Paul. And yet ministers from the DC LG and health haven't even met to

:31:09. > :31:13.discuss this problem. I do know that private hospitals get an 80%

:31:14. > :31:16.reduction because they are registered as charities. In my own

:31:17. > :31:22.constituency of filioque we have been fighting a battle to save a

:31:23. > :31:27.centre for several years, we have had stop/ go consultations, money

:31:28. > :31:32.wasted, explanations and excuses that vary from month to month,

:31:33. > :31:37.consultations announced and then scrapped, and now we have the

:31:38. > :31:42.sustainability and transformation plan that sadly, as has been

:31:43. > :31:46.acknowledged, has turned into a secret strategy, drawn up by

:31:47. > :31:50.non-elected bureaucrats, from which the public and their elected

:31:51. > :31:55.representatives have been largely excluded. It seems that Katie red is

:31:56. > :32:00.now caught up in this fiasco and with its contract scheduled to

:32:01. > :32:05.finish on the 31st of next month we still don't know what is happening,

:32:06. > :32:09.although if rumours are true more money that ought to be spent on

:32:10. > :32:15.health care in the Birmingham is about to be siphoned off to rescue

:32:16. > :32:21.bankrupt neighbours. Only the other week I discovered that the contract

:32:22. > :32:25.for South Maple GP services is to be counselled, apparently it is no

:32:26. > :32:31.longer cost-effective. Not cost-effective to provide GP

:32:32. > :32:37.services to the sick and elderly, only under this secretary of state

:32:38. > :32:44.could the NHS have come to this. I will give way. In my own remarks I

:32:45. > :32:51.spoke about a cross-party consultation. If we have this kind

:32:52. > :32:58.of con so -- the conversation I can easily point to the fact that

:32:59. > :33:02.between 20112014 there was a 8.6% drop on health spending in Wales

:33:03. > :33:06.under a Labour administration while there was a 4% increase in England.

:33:07. > :33:11.Would you be better having a constructive conversation that how

:33:12. > :33:17.we take the NHS of the front page of the tabloids and try and work out a

:33:18. > :33:19.solution together. It is always desirable to have that conversation

:33:20. > :33:27.when the Tories are in power but when Labour is in power then we talk

:33:28. > :33:32.about death tax regimes and funding bids. The argument always changes

:33:33. > :33:36.when they are responsible. As I was saying, Mr Speaker, they are about

:33:37. > :33:40.to withdraw the contract for South Maple GP services. I found out not

:33:41. > :33:44.when the Clinical Commissioning Group, who it turns out have been

:33:45. > :33:49.ruminating on this since November, told me, but when I was contacted by

:33:50. > :33:54.anxious constituents who had just found out they were being given

:33:55. > :33:59.eight weeks to find a new GP. Many of them are elderly people. Some

:34:00. > :34:04.have long-term conditions and rely on regular medication that they are

:34:05. > :34:10.dismissed, as if they don't matter. The loss of their GP services is

:34:11. > :34:15.treated like the closure of a local hairdresser or a petrol station.

:34:16. > :34:20.They are told they should shop around. Apparently the CCG thinks

:34:21. > :34:26.there are enough GPs in the area, enough at any rate to satisfy their

:34:27. > :34:30.little diagrams and tables on their secret little plans. Reducing demand

:34:31. > :34:37.for acute care is one of the governments plans ease pressures in

:34:38. > :34:43.the NHS. Exactly how do we achieve that by closing walk-in centres and

:34:44. > :34:46.GP surgeries? Isn't that the fastest route to the already overstretched a

:34:47. > :34:53.and E departments? It is not just the estimates which are at issue

:34:54. > :34:59.here, it is a proper long-term plan for the NHS and social care. This

:35:00. > :35:03.secretary of state has failed us. His stewardship is a disaster and

:35:04. > :35:10.rather than accept more of it this house should be calling for a motion

:35:11. > :35:14.of censure. This is a government and secretary of state who are presiding

:35:15. > :35:21.over the steady dismantling of the country's greatest peacetime

:35:22. > :35:25.achievement. It is a total disgrace. Thank you, Mr Speaker, I would like

:35:26. > :35:30.to start by paying tribute to the many thousands of health and social

:35:31. > :35:34.care workers that support day to day some of the most vulnerable people

:35:35. > :35:39.in our society. Today what we are talking about is how we make the

:35:40. > :35:44.books balance. The NHS five-year forward view identified that if the

:35:45. > :35:48.trajectory of health care spending continued at the same rate as just a

:35:49. > :35:54.couple of years ago, an extra ?30 billion would be needed by 2020. It

:35:55. > :35:57.was also stated in the forward view that over ?20 billion could be

:35:58. > :36:02.identified in savings and efficiency measures over that time period. That

:36:03. > :36:11.is why the government is allocating an additional ?10 billion by 2021,

:36:12. > :36:14.and we can quibble whether it is 8 billion 10 billion, but what must be

:36:15. > :36:18.recognised is that it is NHS England that ask for the ?8 billion and this

:36:19. > :36:22.government is delivering that. What hasn't happened yet is to some

:36:23. > :36:27.extent the other side of the bargain, finding the savings of ?22

:36:28. > :36:31.billion. Perhaps it was never possible. Perhaps the timescale over

:36:32. > :36:37.which has to be delivered was too short. Next year we will be

:36:38. > :36:41.celebrating 70 years of the NHS and to change the way it works in less

:36:42. > :36:46.than five years is probably too big and ask. There are not many areas of

:36:47. > :36:50.the NHS where -- there are many areas of the NHS where savings are

:36:51. > :36:54.being made changes are happening but it does take time. I would like to

:36:55. > :36:58.use a couple of examples to illustrate where savings can be

:36:59. > :37:01.made. It may be costs upfront, but it is long-term savings. Prior to

:37:02. > :37:06.being elected to this place I spent a lot of time and energy promoting

:37:07. > :37:10.diagnostic tests that could be carried out at patient bedsides or

:37:11. > :37:16.in GP surgeries or even in the patient's home and possibly in

:37:17. > :37:19.community form as well. This type of testing is used extensively in

:37:20. > :37:24.Scandinavia and other European countries and we are definitely

:37:25. > :37:29.lagging behind. I feel that if we adopted such tests more widely there

:37:30. > :37:33.are many savings to be made. More importantly it is better for the

:37:34. > :37:37.patient and surely that should be the key determinant. Let me talk

:37:38. > :37:42.about one example. The point of care test that measures a protein, fast.

:37:43. > :37:47.The protein is raised when someone is suffering from a bacterial

:37:48. > :37:52.infection but it is not raised if the infection is caused by a virus.

:37:53. > :37:55.Without this test patients may be prescribed unnecessary antibiotics.

:37:56. > :38:01.This is not good for the patient or the NHS budget. In some instances

:38:02. > :38:07.patients are admitted to hospital unnecessarily. All that is needed is

:38:08. > :38:12.a type of test that I am talking about, which is a small device and a

:38:13. > :38:16.drop of blood. I know from personal experience that it's such tests were

:38:17. > :38:21.readily available for GPs to carry out within their surgeries all the

:38:22. > :38:27.patient's home, it would have saved a five-day hospital stay for my

:38:28. > :38:30.mother. That is savings to the health service and it would also

:38:31. > :38:34.have been better for my mother to be kept at home at that time of her

:38:35. > :38:40.illness. We cannot continue to do what we have done and expect to have

:38:41. > :38:44.different outcomes. I will give way. I would like to thank the Honourable

:38:45. > :38:49.lady for giving way, she talks a lot of sense. Would she also agree that

:38:50. > :38:53.the NHS should make the mistakes of the past by going down the route of

:38:54. > :38:58.more disastrous PFI deals. She may know my local CCG is currently

:38:59. > :39:00.developing a business case to bulldoze Huddersfield Royal

:39:01. > :39:05.Infirmary, replace it with a small plant care unit, moved everything to

:39:06. > :39:07.Halifax, including A, but come forward for ?280 million for this.

:39:08. > :39:37.If they don't it from the main funds they

:39:38. > :39:40.are going to go down a PFI route and the trust is actually already being

:39:41. > :39:42.crippled because of the disastrous PFI at Halifax which cost ?64

:39:43. > :39:44.million to build and will eventually cost ?774 million because of a

:39:45. > :39:46.disastrous PFI. I thank my honourable friend for those very

:39:47. > :39:48.pertinent comments and I actually did my training as a biomedical

:39:49. > :39:51.scientist at Halifax General Ho spital Royal Infirmary in Halifax so

:39:52. > :39:53.I know the area very disastrous PFI agreements. Today we are debating

:39:54. > :39:56.health and social... On the point that the honourable lady was making

:39:57. > :39:58.about tests which are not being deployed and which could save money

:39:59. > :40:01.if they were, I have for long been concerned that yes, we need to make

:40:02. > :40:03.sure we don't go down more disastrous PFI agreements. Today we

:40:04. > :40:06.are debating health and social... On the point that the honourable lady

:40:07. > :40:09.was making about tests which are not being deployed and which could save

:40:10. > :40:12.money if they were, I have long been concerned that don't are at risk of

:40:13. > :40:14.ovarian who are at risk of which is definitive, but which nevertheless

:40:15. > :40:18.helps in the early identification of a cancer, which if it is early

:40:19. > :40:20.identified, can actually with a CAA 125 test, which isn't definitive,

:40:21. > :40:23.but which nevertheless helps in the early identification of a cancer,

:40:24. > :40:26.which if it is early identified, can actually save does she agree with me

:40:27. > :40:33.that one of the things that we need from the top on clinical issues like

:40:34. > :40:40.this is to ensure that short-term savings decided by an individual CCG

:40:41. > :40:42.do not put a patient's health at NHS on clinical issues like this is to

:40:43. > :40:44.ensure that short-term savings decided by an individual CCG do not

:40:45. > :40:57.put a patient's health at the topic of prevention

:40:58. > :41:03.and screening could take up another whole debate but you make a very

:41:04. > :41:08.good point there. The two are linked, and yet funded in different

:41:09. > :41:14.ways. Too often budgets, these budgets, are only casted in the two

:41:15. > :41:20.are linked, and yet funded in different ways. Too often budgets,

:41:21. > :41:24.these budgets, are only casted in from back to me. I recently met a

:41:25. > :41:26.young man who if we take treating some stroke patients as another

:41:27. > :41:28.example, there was quite a new technique now available called

:41:29. > :41:34.mechanical from back to me. I recently met a young man who was to

:41:35. > :41:36.be near one of the few centres in the UK that carried out this

:41:37. > :41:41.procedure when he had a massive stroke. That is if you he was in.

:41:42. > :41:45.But he can now lead a full life instead been disabled for the rest

:41:46. > :41:48.of his life and possibly being dependent on fortunate in this

:41:49. > :41:50.situation he was in. But he can now lead a full life instead of being

:41:51. > :41:55.disabled for the rest of his life and possibly being dependent on

:41:56. > :41:57.social this procedure cannot yet be rolled out across the country due to

:41:58. > :42:03.limited funding to train specialists to carry out and the procedure

:42:04. > :42:06.itself. What are the patients who don't get that procedure and other

:42:07. > :42:15.similar procedures? That is a respectable personal cost

:42:16. > :42:22.It's far too slow to spread new and best practise.

:42:23. > :42:29.Locally, in my efficiency, a Vanguard site. Whether it one of its

:42:30. > :42:33.actions is ward rounds in residential nursing homes. There is

:42:34. > :42:37.already strong evidence to show this is reducing hospital admissions for

:42:38. > :42:42.these elderly people. Yet, this is not rolled out quick huff to other

:42:43. > :42:46.areas. So, I don't believe that throwing more money at the NHS and

:42:47. > :42:51.social care is the answer. If we want different results, we need to

:42:52. > :43:00.do things differently. And that's what sustainability and tan

:43:01. > :43:04.formation plans aim to do. I have read the Derbyshire plan in

:43:05. > :43:10.department. There is little information about how the plan will

:43:11. > :43:16.be implemented. My concerns are around work balance, capacity in the

:43:17. > :43:19.community and stakeholder buying. I hope I am wrong, because better

:43:20. > :43:24.integration and bold action is what is really needed. Mr Speaker, it is

:43:25. > :43:25.important that we do not shy away from the hard and difficult

:43:26. > :43:37.decisions that lie ahead. It is a real pleasure to follow the

:43:38. > :43:41.honourable lady and I think she's made a characteristically well

:43:42. > :43:45.informed and thoughtful speech. Mr Speaker, you don't need to be a

:43:46. > :43:50.brain surgeon to have worked out that the NHS and care system is

:43:51. > :43:55.currently under enormous pressure. Anyone who has recently visited a

:43:56. > :43:59.hospital, sought a GP's appointment or tried to arrange support for an

:44:00. > :44:03.elderly relative will tell you the whole system is struggling.

:44:04. > :44:08.Inadequate funding, a workforce crisis and a failure to reshape

:44:09. > :44:13.services quickly enough to meet the needs of our ageing population means

:44:14. > :44:19.that the men and women who care for our loved ones are simply running to

:44:20. > :44:24.standstill. This winter, we have seen the front-pages of national

:44:25. > :44:29.newspapers, covered by images of frail older people, stuck on

:44:30. > :44:34.trolleys in hospital corridors. And a poorly toddler led on plastic

:44:35. > :44:40.chairs, pushed together to make and create a bed. Mr Speaker, if you

:44:41. > :44:45.happen to watch BBC Two on a Wednesday night in January or

:44:46. > :44:50.February, you would have seen the documentary Hospital, which showed

:44:51. > :44:55.the reality of people working on the front line and taking really

:44:56. > :45:00.difficult decisions about patients, beds and operations in a big and

:45:01. > :45:04.busy hospital. It was captivating viewing and left me, as a

:45:05. > :45:09.politician, feeling sad and frustrated that we are failing to

:45:10. > :45:13.create the conditions in which the NHS can thrive. Many of the current

:45:14. > :45:17.problems plaguing our health and care system relate to a lack of

:45:18. > :45:23.money. It's not the only problem, but it's a major one. Whilst the NHS

:45:24. > :45:29.budget has inched up in recent years, it has been outstripped by

:45:30. > :45:35.rocketing demand. Next year, NHS funding per head of the population

:45:36. > :45:39.will fall in real terms. Social care Budgets have been slashed, meaning

:45:40. > :45:43.that the support available to the elderly and disabled in the

:45:44. > :45:47.community has been reduced. And even with the changes that the Government

:45:48. > :45:52.have made to the better care fund and the social care present, the

:45:53. > :45:57.Local Government Association still predict a shortfall of ?2.6 billion

:45:58. > :46:01.by the end of this Parliament. We cannot escape the fact that our

:46:02. > :46:07.population is growing and we are ageing. It is a fact that there are

:46:08. > :46:13.now more people retired in the UK than there are children in our

:46:14. > :46:19.schools. And as the decades pass, medicine advances, we keep more

:46:20. > :46:21.babies alive who are born with complicated medical conditions, we

:46:22. > :46:25.successfully treat more and more people who have cancer. We perform

:46:26. > :46:29.ever more complex operations, which can give people many happy years of

:46:30. > :46:35.life, but which contribute to the fact that as we age, many more of us

:46:36. > :46:38.have underlying frailties and multiple health needs. This isn't a

:46:39. > :46:44.situation that has come about overnight. And it's one that every

:46:45. > :46:49.recent Government has had to manage. But this Government isn't managing

:46:50. > :46:56.it and that's the difference. This Government has had its head in the

:46:57. > :47:01.sand. Between 1997-2010, the last Labour Government increased real

:47:02. > :47:06.term spending on the NHS by an annual average of 5.7%. The

:47:07. > :47:11.equivalent figure for the coalition Government was 0.8%. The lowest

:47:12. > :47:18.increase of any Government since World War II. And the figure for the

:47:19. > :47:23.present Government is 1.75%. The Government might talk a good game on

:47:24. > :47:30.NHS spending, but the truth is, we are in the middle of a decade of au

:47:31. > :47:33.ter ritty. Add to that a slash and burn approach to local Government

:47:34. > :47:38.and the social care services it is responsible for and it is little

:47:39. > :47:42.wonder we find ourselves in the current predicament. What now? As

:47:43. > :47:44.the chair of the Health Select Committee has said, we have to be

:47:45. > :47:48.honest about the scale of the challenge. When it comes to NHS

:47:49. > :47:53.spending, this year is meant to be the year of plenty. The one year in

:47:54. > :47:57.this Parliament when there is a relatively significant increase in

:47:58. > :48:01.available funds. But these funds have already been used to pay off

:48:02. > :48:07.the debts from last year. Money which is meant to be used to repair

:48:08. > :48:11.buildings and buy new equipment is in effect being used to pay

:48:12. > :48:17.salaries. Funds to transform services are being used to deal with

:48:18. > :48:23.the flow of people arriving at A Hospitals are likely to end this

:48:24. > :48:26.year in deficit again. More clinical commissioning groups are

:48:27. > :48:31.overshooting their budgets. NHS England is struggling to stay within

:48:32. > :48:37.their spending limits for specialised services. So called

:48:38. > :48:41.efficiency savings really equate to freezing staff pay. People who work

:48:42. > :48:46.in the NHS and care system need to be honest about their ability to

:48:47. > :48:50.cope. The junior doctors were last year and it is now time for others

:48:51. > :48:57.to do the same. NHS managers need to be honest about the time it will

:48:58. > :49:00.take to transform services and the funding that transformation

:49:01. > :49:05.requires. You can't close hospital beds if services in the community

:49:06. > :49:09.aren't already up and running and have been proven to reduce the

:49:10. > :49:14.demand for in-patient care. So, we need to be honest, but we also need

:49:15. > :49:19.action. The Government needs to provide direct support to local

:49:20. > :49:23.authorities with funding for social care in the Budget. How the

:49:24. > :49:30.Government pays for this is obviously for the Government to

:49:31. > :49:33.decide, but it cannot continue to shove partial, so-called solutions

:49:34. > :49:37.on to local Government and wash its hands of the problem. If it doesn't

:49:38. > :49:43.address the long-term problems in social care, it will simply leave

:49:44. > :49:46.the NHS to pick up the pieces. But even if Government is persuaded of

:49:47. > :49:51.the case for additional funding, we also need to think carefully about

:49:52. > :49:57.where that money would be best spent. It's tempting to say simply

:49:58. > :50:02.put it back into the things that have been taken away, the more

:50:03. > :50:07.comprehensive care packages, provide social care to a wider group of

:50:08. > :50:13.people, look at the cuts to community, health nurses, look at

:50:14. > :50:16.the cuts in mental health trusts. I think it's more complicated than

:50:17. > :50:21.that. This current short-term fix of taking money out of the capital

:50:22. > :50:25.budget to prop up revenue is the wrong thing to do. New scanners are

:50:26. > :50:32.less likely to need repair than old ones. Cutting waiting times and

:50:33. > :50:35.improving outcomes. Well designed, well maintained buildings can

:50:36. > :50:43.improve productivity and constituency. Compare the new cancer

:50:44. > :50:45.centre to the buildings at the Princess Alexandra Hospital in

:50:46. > :50:49.Harlow. You wouldment believe you're in the same country. We should

:50:50. > :50:53.invest in new step down care facilities for people well enough to

:50:54. > :50:56.come out of hospital, but for whom care in the home is yet to be

:50:57. > :51:01.arranged. There is also a massive need to

:51:02. > :51:05.invest in staff and build careers which people aspire to. This will

:51:06. > :51:11.take time as well as money. Perhaps we do need to consider new roles in

:51:12. > :51:15.community health services which provide holistic care to older

:51:16. > :51:23.people in the home. Perhaps we need more GPs who are paid to dedicate

:51:24. > :51:26.time to residential homes, spotting problems amongst the elderly would

:51:27. > :51:31.otherwise end up in a hospital addition. Perhaps the social care

:51:32. > :51:36.workforce needs a re-think. I never forget the conversation I had a

:51:37. > :51:40.senior A nurse who told me that the half term holidays always result

:51:41. > :51:45.in more older people coming into hospital because the mums who do the

:51:46. > :51:49.part-time zero hours jobs in home care were looking after their

:51:50. > :51:55.children instead. I fundamentally feel that the whole system needs to

:51:56. > :52:00.focus on how we provide care in the broadest sense to older people. The

:52:01. > :52:05.one in four people in hospital beds with dementia, the three in four

:52:06. > :52:11.people in care homes with dementia as well. We should focus on the real

:52:12. > :52:17.weekend effect. The one where if you happen to be in hospital on a Friday

:52:18. > :52:21.night you are unlucky to make it out until Monday lunch time at the

:52:22. > :52:26.earliest. Why do doctors talk about how it takes three minutes to admit

:52:27. > :52:32.a patient but three days to discharge one? Mr Speaker, I will

:52:33. > :52:38.end by saying this, the Government maybe absorbed by the complex task

:52:39. > :52:43.of trying to take us out of the European Union, but if it doesn't do

:52:44. > :52:48.something to address the scale of underfunding in the NHS and care

:52:49. > :52:56.system, the public will not forgive it. We need real answers to the real

:52:57. > :53:00.problems and we need it urgently. Thank you, Mr Speaker. It is a

:53:01. > :53:04.pleasure to follow the honourable member for Lewisham East. She will

:53:05. > :53:08.not be surprised to know that while I agree with some of the points she

:53:09. > :53:14.made I don't agree with all of them. In the time I have I want to cover a

:53:15. > :53:17.few points. I don't want to repeat much of the excellent statements

:53:18. > :53:22.that many members have made across this House. But the time I do have I

:53:23. > :53:25.want to go over just a few issues. Because while I do welcome the

:53:26. > :53:32.Government's extra funding and the ?6 billion this year in particular,

:53:33. > :53:35.with the changes in national insurance contributions, pension

:53:36. > :53:40.contributions, the costs of running the NHS are going up all the time.

:53:41. > :53:43.That extra money is being swallowed up without it necessarily going to

:53:44. > :53:48.front line staff. I do particularly agree with the honourable member for

:53:49. > :53:51.Newton Abbott, when she said that in an estimates debate we shouldn't

:53:52. > :53:55.just be talking about the money that we need to spend, but we also need

:53:56. > :53:59.to look at the demand and the type of services that we need to fund,

:54:00. > :54:05.because there's no doubt that demand for the NHS services and social care

:54:06. > :54:09.is increasing. So even by providing extra funding, we are just really

:54:10. > :54:13.standing still in terms of the services that we are providing. We

:54:14. > :54:18.know there's an increase in numbers across the country. We know, as has

:54:19. > :54:25.been said by others, there are new treatments which need providing and

:54:26. > :54:29.we know that patients are changing. In years gone past they would have

:54:30. > :54:34.been admitted with one illness, treated and go home. Now when they

:54:35. > :54:38.are admitted they are many illnesses which are not sod easy to treat.

:54:39. > :54:45.That is why discharges are often delayed. If you look at the data

:54:46. > :54:50.provided, we know there's around a 7% increase in terms of demand for

:54:51. > :54:54.services across the board. A 7% increase in the number of ambulance

:54:55. > :54:58.calls made. A 3% increase made in the number of A visits. We know

:54:59. > :55:02.that the Tuesday after Christmas was the busiest day in the history of

:55:03. > :55:07.the NHS ever. And that takes extra money to be able to deliver. That we

:55:08. > :55:11.know for diagnostic tests there is a 6% increase. We know that cob

:55:12. > :55:15.sulant-led treatments are up -- consultant-led treatments are up by

:55:16. > :55:20.6%. Demand is rising. The extra money is welcome, there's no doubt

:55:21. > :55:24.about. That but it's not actually dealing the level of service that is

:55:25. > :55:28.required. But one point I would like to make

:55:29. > :55:32.and this is just a plea, as someone who still works in the health

:55:33. > :55:38.service and still sees and works with colleagues across the NHS nstz

:55:39. > :55:42.on a regular basis. While there is a lot of pressure that the services

:55:43. > :55:45.are under and there's a lot that we can be concerned about, there is

:55:46. > :55:50.some amazing work that's going on in our NHS. And I welcome the NHS

:55:51. > :55:56.England's announcement only last week that it's going to start to a

:55:57. > :56:03.fund General Secretary ond stem-cell transplants. We had debates in this

:56:04. > :56:05.place about how important that is to those patients whose first

:56:06. > :56:09.transplant actually fails. We know there'll be new treatments for

:56:10. > :56:13.kidney disease and for high per tension. All are really welcomed

:56:14. > :56:17.announcements. We must recognise there is some great work happening

:56:18. > :56:21.there on the front line. I'm particularly pleased that the

:56:22. > :56:26.Government once again, the Department of Health gave ?1

:56:27. > :56:29.million, I would love ?1 billion, ?1 million to the British Heart

:56:30. > :56:34.Foundation to provide defibrillators up and down the country. That will

:56:35. > :56:40.make a tremendous difference when we know that 12 young people a week die

:56:41. > :56:44.in this country from cardiac arrest. There's work, ground-breaking work

:56:45. > :56:49.in cancer care. In my old hospital, the Royal Marsden in London we are

:56:50. > :56:53.making strides in Cancer Research which are not just innovative in

:56:54. > :56:57.Europe but making world-wide break throughs. We are often leading the

:56:58. > :57:02.field in research on a global level and it is something we should be

:57:03. > :57:06.extremely proud of. Now, in response to the Health Select Committee's

:57:07. > :57:10.report, the Government made a number of recommendations in how to tackle

:57:11. > :57:14.some of the problems facing the NHS and facing social care. And I just

:57:15. > :57:19.want to touch on two of them. The first was to try and arrive at a

:57:20. > :57:24.type of financial discipline in the health service because for years

:57:25. > :57:28.now, there have been problems in terms of financial mismanagement. I

:57:29. > :57:31.know, as someone who has worked in the health service, how

:57:32. > :57:36.heartbreaking it is to see money being squandered. We have talked

:57:37. > :57:40.about the PFI deals here, which have touched many parts of the country.

:57:41. > :57:45.There was the IT system which cost billions of pounds which never saw

:57:46. > :57:50.the light of day, which was suppose to move us from paperless records to

:57:51. > :57:56.a paperless system. Today, the NHS is spending huge money still on

:57:57. > :58:01.paper notes and storage, off-site storage facilities that hospitals

:58:02. > :58:11.are having to pay for to keep patients' recordses.

:58:12. > :58:14.to the, mainly imposed on social care, for those patients who don't

:58:15. > :58:22.get that procedure and other similar procedures? That is a respect for

:58:23. > :58:26.personal cost to the wasted opportunity and it cost the NHS

:58:27. > :58:28.millions of the pay structure for staff and improve productivity was

:58:29. > :58:31.meant to be improved but it just rearrange the deck chairs on the

:58:32. > :58:35.ship and that was a huge wasted opportunity and it cost the NHS

:58:36. > :58:37.millions when staff should have been given a well-deserved pay rise and

:58:38. > :58:41.seen the same result. Financial discipline is important. If you look

:58:42. > :58:46.at the big General hospitals in my constituency with the same financial

:58:47. > :58:49.settlement and similar patients to look after, one hospital is in

:58:50. > :58:54.special measures and struggling to cope with its discharges and another

:58:55. > :58:58.less than five miles down the coast is rated as if you look at the big

:58:59. > :59:00.general hospitals in my constituency with the same financial settlement

:59:01. > :59:02.and similar patients to look after, one hospital is in special measures

:59:03. > :59:05.and struggling to cope with its discharges and another less than

:59:06. > :59:07.five miles down the coast is rated and able to provide excellent care

:59:08. > :59:10.centre has to be something about the money that is given out on right

:59:11. > :59:13.that one hospital done with that money that we need to be looking at

:59:14. > :59:15.and sharing best practice because it cannot be right that one hospital

:59:16. > :59:19.isable to manage its buzz -- budgets and another one isn't in my

:59:20. > :59:22.experience in 20 years of working in the NHS there are lots of

:59:23. > :59:26.opportunities and financial discipline should be about top

:59:27. > :59:34.slicing but using your money as widely as possible. I would

:59:35. > :59:37.recommend if the ministers wanted recommendations about how to make

:59:38. > :59:41.financial savings they should speak to health care professionals because

:59:42. > :59:44.they often have the answers and if they were asked on a more regular

:59:45. > :59:49.basis they could provide some fantastic solutions. The other

:59:50. > :59:53.recommendation that the government wanted to take forward was about

:59:54. > :00:00.reducing demand and that is easier said than done. I started by saying

:00:01. > :00:05.demand is on the increase by 6% a year but for too long we have been

:00:06. > :00:09.so focused on hospitals and with no disrespect, I see my colleague, the

:00:10. > :00:13.honourable member for Totnes sitting beside me, no disrespect to doctors,

:00:14. > :00:18.we have been very medical focused in how we manage our NHS and we have

:00:19. > :00:24.missed an opportunity looking at what other health care professionals

:00:25. > :00:27.can offer. Pharmacists are highly educated and experienced and

:00:28. > :00:34.qualified individuals and there is some ground-breaking work happening

:00:35. > :00:37.in the community pharmacies. In Scotland they do simple things such

:00:38. > :00:41.as having a register so patients register with the pharmacist as well

:00:42. > :00:47.as a GP and that would make a tremendous difference to patients

:00:48. > :00:51.lives. Why are pharmacists not contacted on discharge like we

:00:52. > :00:56.contact GPs? I was talking to a pharmacist recently that said around

:00:57. > :01:00.30% of readmissions are caused by patients not taking their medicine

:01:01. > :01:03.properly on discharge. If the pharmacist was contacted, if they

:01:04. > :01:07.had a list of chronically ill patients and they were in charge of

:01:08. > :01:13.managing their medicine so many readmissions could be easily

:01:14. > :01:19.avoided. Nurse practitioners we heard from my honourable friend who

:01:20. > :01:24.talked about the role of nurse practitioners who are doing blood

:01:25. > :01:27.tests to predict bacterial infections and who needs an

:01:28. > :01:30.antibiotic and who doesn't but we need to be up skilling those health

:01:31. > :01:38.care professionals so they can take on more roles. I really want to

:01:39. > :01:43.finish really with other excellent examples of paramedics who are in

:01:44. > :01:46.the community and going to people's homes instead of them being in A

:01:47. > :01:50.and I want to finish by saying this is an estimate debate about how we

:01:51. > :01:53.use the money but we need to properly forecast demand and use

:01:54. > :01:56.existing resources better and we need to look at best practice to

:01:57. > :02:04.shout the good work that is happening in our NHS. For backbench

:02:05. > :02:08.would-be contributors remain and I would like to accommodate the more

:02:09. > :02:13.but it might be helpful if I explain I would like to call the front

:02:14. > :02:22.wind-up speakers, of whom there are three, no later than 928. If

:02:23. > :02:27.possible, slightly earlier. It is a pleasure to be part of this debate

:02:28. > :02:32.of so many informed members and it is very timely because if in case

:02:33. > :02:36.members did not realise the Public Accounts Committee produced a report

:02:37. > :02:39.today upon which I will bake so many of my comments. At the beginning of

:02:40. > :02:45.the report we do ask that the years of arguing in public about the level

:02:46. > :02:48.of funding of NHS does stop and particularly the department, the NHS

:02:49. > :02:53.England and number ten Downing St could start working together in the

:02:54. > :02:57.interest of patients and stop the bickering about the levels of

:02:58. > :03:03.funding. The two issues I would particularly to highlight our one is

:03:04. > :03:07.the work that has gone on around the NHS accounts behind-the-scenes and I

:03:08. > :03:10.know, Mr Speaker, you are very keen supporter of the work of select

:03:11. > :03:13.committees but this debate has been brought with the health committee

:03:14. > :03:17.and the public accounts and DC LG and other honourable members working

:03:18. > :03:20.alongside parliament but I would like to that the National Audit

:03:21. > :03:22.Office for the help they have given myself and many honourable members

:03:23. > :03:27.in understanding and really interrogating this year 's accounts,

:03:28. > :03:30.particularly including a meeting in a very quiet portcullis house in the

:03:31. > :03:35.middle of August when perhaps many other honourable members were on a

:03:36. > :03:39.beach somewhere, but supporting us as members to really understand the

:03:40. > :03:43.accounts and what they mean for our constituents is a very important and

:03:44. > :03:48.often neglected part of what the public hear about parliament. This

:03:49. > :03:51.year the National Audit Office report on the council is really

:03:52. > :03:58.quite unprecedented and I think it is worth honourable members looking

:03:59. > :04:02.at what was said about the accounts for last year. There are a number of

:04:03. > :04:06.one-off actions that were taken this year to bring the Department within

:04:07. > :04:10.its expenditure limit and somewhere really concerning and some are just

:04:11. > :04:16.incredibly fortunate. The national Insurance contribution, the

:04:17. > :04:20.inability of the Department to find the ?417 million that had been

:04:21. > :04:24.wrongly placed within that department was really given the

:04:25. > :04:29.amount of rigour given to the accounts issue really quite

:04:30. > :04:33.extraordinary. It was ?100 million from the medical and health care

:04:34. > :04:37.products agency and there were a lot of central readjustments and the

:04:38. > :04:41.capital to revenue transfers we have talked about but I would also draw

:04:42. > :04:46.attention to the guidance that the NHS providers were given by monitor

:04:47. > :04:49.and the TDA and I use the word guidance carefully but really that

:04:50. > :04:53.and the transaction reviews commissioned by the department

:04:54. > :04:57.whereby to accountancy firms undertook a review of accountancy

:04:58. > :05:03.policies and how they were adopted in order for essentially the results

:05:04. > :05:06.to come out more favourably than they might otherwise have done. It

:05:07. > :05:10.demonstrates the incredible effort with which the Department of Health

:05:11. > :05:15.and all of its bodies this year when two to bring the accounts barely

:05:16. > :05:19.within the expenditure limit voted by this house. It is clear from

:05:20. > :05:22.whistle-blowing accounts and reports from health and care conferences and

:05:23. > :05:25.the regional board papers, which some of us do, discussions with

:05:26. > :05:29.chief executives, reports in the specialist media, that the pressure

:05:30. > :05:33.on individuals within the service is immense and that is not good for

:05:34. > :05:38.anybody. I would like to praise the staff that are involved in all parts

:05:39. > :05:42.of the health service and the departments work, clinical staff and

:05:43. > :05:47.managerial staff, which I am very proud to be won for many years

:05:48. > :05:49.myself but the pressure now, particular finance directors, to

:05:50. > :05:54.produce the right result and the right answer is deeply concerning.

:05:55. > :05:59.It is concerning because of the effect on safety and only a few

:06:00. > :06:03.weeks ago we had the intervention of Sir Robert Francis, himself, from

:06:04. > :06:08.his own previous work, really now raising concerns about clinical

:06:09. > :06:10.safety in our health service. The international comparisons on funding

:06:11. > :06:13.a very clear and they have been touched upon earlier. We're probably

:06:14. > :06:18.spending the money to be like Mexico but not to be like France or Germany

:06:19. > :06:23.and my constituents expect to be treated in the same way as their

:06:24. > :06:26.European opposites. What ever the right level of funding is there has

:06:27. > :06:31.to be agreement on that level and crucially what it can provide. In

:06:32. > :06:36.the Public Accounts Committee in the last year we have had 11 or 12

:06:37. > :06:39.sessions now about what is being promised to be delivered by the

:06:40. > :06:45.service for the money that is available. It really takes me to my

:06:46. > :06:50.second point. We are now in the realm of political choices and that,

:06:51. > :06:54.as MPs, is our responsibility. The tax payer, the voter, the patient

:06:55. > :06:58.are not different people, they are one and the same person and they are

:06:59. > :07:02.very wise people, they understand you get what you pay for. They have

:07:03. > :07:06.to be informed and currently the scrappy and ill informed debate that

:07:07. > :07:08.goes on in public and the identifying blame game is not

:07:09. > :07:13.informing them, it is letting them down. It is clear to me and many

:07:14. > :07:16.honourable members that the government is not imply to fund the

:07:17. > :07:21.service to the standards that we have become used to, that we expect

:07:22. > :07:25.that the NHS Constitution gives us the right to expect and our

:07:26. > :07:28.universal that European neighbours have so I think the government has

:07:29. > :07:32.to be clear about the trade-offs about the choices. The FTP process

:07:33. > :07:36.in my view allows this to happen and I listened closely to members

:07:37. > :07:38.opposite who also chaired the Prime Minister and the Secretary of State

:07:39. > :07:43.when they say they have increased the money the NHS was given, while

:07:44. > :07:46.the NHS has been given what they asked for and they made a very

:07:47. > :07:50.passionate plea for their Community Hospital all services in the area,

:07:51. > :07:55.as in there want. This brings into sharp focus now the trade-off

:07:56. > :07:58.between finance and quality and I defend quality -- define quality in

:07:59. > :08:01.terms of the patient experience, clinical effectiveness and

:08:02. > :08:06.efficiency. It gives us a very clear trade-off between the money and the

:08:07. > :08:10.mandate. I hope that the refresh of the NHS funding that we are

:08:11. > :08:14.expecting in March, as discussed in the Public Accounts Committee, in a

:08:15. > :08:18.five-year for the review will be very clear and the public will be

:08:19. > :08:21.able to have that information at their fingertips because currently

:08:22. > :08:25.patients do not have the information and they should. They should know

:08:26. > :08:30.where the best run and the worst run hospitals are. I agree with the

:08:31. > :08:34.honourable member for Lewis, it is unacceptable that a hospital with

:08:35. > :08:37.virtually the same population a few miles apart are creating -- treated

:08:38. > :08:41.completely differently. Patients need to know where the outcomes are

:08:42. > :08:51.the best. It is not good enough to hold the information nationally and

:08:52. > :08:53.hide it from patients for well-informed people to interrogate

:08:54. > :08:56.board papers and find out the answers. I do believe that the way

:08:57. > :08:58.forward is actually very clear, waiting times will continue to

:08:59. > :09:01.increase, we will go back to the days of the 1990s of longest and

:09:02. > :09:03.access to GPs and other professionals will continue to

:09:04. > :09:06.decrease and the service will become a largely emergency one and families

:09:07. > :09:08.where people have them will be increasingly bearing the cost and

:09:09. > :09:12.responsibility of social care and access will continue to be

:09:13. > :09:17.restricted. I believe the government does now have to be really honest

:09:18. > :09:21.not just about the costs but access, that there isn't any more money,

:09:22. > :09:25.there is going to be any, and what that means in terms of expectation,

:09:26. > :09:30.particularly in regard to the NHS Constitution and I look forward to

:09:31. > :09:35.the response from the Minister. Thank you, Mr Speaker, it is a

:09:36. > :09:40.pleasure to carry on from my honourable friend for Bristol South.

:09:41. > :09:41.We are here today to debate the financial sustainability of the

:09:42. > :09:46.health and adult social care sectors, although health and adult

:09:47. > :09:51.social care are almost inseparable, for brevity 's sake I will focus my

:09:52. > :09:55.remarks on adult social care. I focus on adult social care because

:09:56. > :09:59.although acute care and adult social care sector is facing similar

:10:00. > :10:11.unprecedented pressures adult social care is different in one important

:10:12. > :10:13.way. Unlike the NHS, which has the ear of the Chancellor and the

:10:14. > :10:16.Treasury, adult social care certainly does not. All the evidence

:10:17. > :10:18.in recent months has only served to confirm this. The Chancellor 's

:10:19. > :10:23.decision to not make one extra penny of new money available in his Autumn

:10:24. > :10:27.Statement was met with all most universal criticism across the

:10:28. > :10:30.health and local government sectors. The recent decision of this

:10:31. > :10:36.Chancellor to introduce the adult social care precept is damning

:10:37. > :10:40.evidence that desperately outdated view of funding remains strong in

:10:41. > :10:44.the Treasury. Adult social care delivered locally by local

:10:45. > :10:48.authorities and its funding is viewed as a locally devolved issue

:10:49. > :10:53.by this Chancellor. This government 's decision to pass the blame to

:10:54. > :10:57.local councils, to underfund adult social care, is nothing short of

:10:58. > :11:01.moral cowardice. Adult social care is being deliberately underfunded by

:11:02. > :11:06.this government in my home city of Bradford. What is most desperate, Mr

:11:07. > :11:09.Speaker, is this government 's abandonment of the hundreds of

:11:10. > :11:12.thousands of old and vulnerable people who are day in day out

:11:13. > :11:18.reliant on these vital adult social care services. We are not talking

:11:19. > :11:23.about hypotheticals, we are talking about the care happening today,

:11:24. > :11:27.right now. Real people struggling to get by in my constituency Bradford

:11:28. > :11:30.South. Bradford is a relatively young city but nevertheless the

:11:31. > :11:36.number of people in Bradford over the age of 65 has grown

:11:37. > :11:39.substantially. Between 2012 and 2015 and extra four and a half thousand

:11:40. > :11:44.people are living in the district and a number of people within

:11:45. > :11:48.Bradford with complex physical disabilities has grown by 400. My

:11:49. > :11:54.local council, Bradford, agreed its budget last Thursday. Like many

:11:55. > :11:57.others Bradford Council had the task of agreeing swingeing cuts to scores

:11:58. > :12:09.of community services. In recent years Bradford council has

:12:10. > :12:14.reduced its budget. By 2020, a further ?82 million in cuts will

:12:15. > :12:18.have to be made. Adult social care is the biggest service overseen by

:12:19. > :12:22.Bradford council, faces the lion's share of these looming cuts. A

:12:23. > :12:27.further ?19 million in cuts will fall on the city's adult social care

:12:28. > :12:30.sector. And this Government is washing its hands of any

:12:31. > :12:35.responsibility. By 2020, the primary source of

:12:36. > :12:39.central Government funding to Bradford council, the revenue

:12:40. > :12:44.support ground will drop to zero, absolutely nothing. This Government,

:12:45. > :12:51.half baked answer, it is the adult social care present. In the next two

:12:52. > :12:56.years the adult social care present is expected to rise in Bradford.

:12:57. > :13:00.But, Mr Speaker, this extra money is dwarfed by the huge cuts to Bradford

:13:01. > :13:06.council's revenue support grant. More to the point, this extra ?6.6

:13:07. > :13:10.million is not even enough to meet the increased costs of adult social

:13:11. > :13:14.care flowing from this Government's so-called national living wage.

:13:15. > :13:18.These bruising budget cuts are only the tip of the funding shortfall,

:13:19. > :13:24.due to the unprecedented increases in demand. The cost of increasing

:13:25. > :13:27.and supporting increasing numbers of older people coupled with larger

:13:28. > :13:32.numbers of working age people, living with disables, is expected to

:13:33. > :13:35.shoulder Bradford council with an extra ?1.5 million each and every

:13:36. > :13:39.year. I am nearly at the end of my

:13:40. > :13:45.remarks. You've had your turn. What is beyond doubt is this Chancellor

:13:46. > :13:48.must act in the upcoming Budget. This Chancellor faces his greatest

:13:49. > :13:51.test in this Parliament. I hope he and his Government do not

:13:52. > :13:58.disappoint. Time will tell. Thank you very much Mr Speaker.

:13:59. > :14:05.I am very pleased to follow my friend from Bradford South who spoke

:14:06. > :14:10.about the needs of her constituent with great feeling. I think if my

:14:11. > :14:14.constituents were here and saw the estimates today they might be a bit

:14:15. > :14:18.disappointed. I had a very interesting public meeting a few

:14:19. > :14:23.weeks ago with them. They said to me, Helen, it's marvellous, because

:14:24. > :14:29.of Brexit we're going to get ?350 million extra every week for the

:14:30. > :14:34.NHS. And our A department can be reopened. There doesn't seem to be

:14:35. > :14:44.any mention of this in these estimates today. But what is going

:14:45. > :14:52.on is a proposal under our sustainability and transformation

:14:53. > :14:57.plan to close the A department at Darlington hospital and for my

:14:58. > :15:05.constituents this would be an unutterable disaster. We are told

:15:06. > :15:13.continuously that this STP is to improve services. I relie wish the

:15:14. > :15:16.local NHS -- really wish the local NHS managers would stop pretending.

:15:17. > :15:21.They have told us by 2020 there'll be a shortfall in funding of ?281

:15:22. > :15:27.million. So nobody believes that this is

:15:28. > :15:32.about improving services. Everybody believes it is about managing on

:15:33. > :15:37.limited resources. And of course I approachiate that

:15:38. > :15:41.pressures are -- appreciate that pressures are going up on the health

:15:42. > :15:46.service because of the ageing population, but I feel this level of

:15:47. > :15:50.austerity in the health service is unnecessary. The British economy is

:15:51. > :15:54.bigger than it has ever been. It is 14% bigger than it was in 2010.

:15:55. > :16:03.Other honourable members have pointed to the disparity between

:16:04. > :16:10.spending in the UK, which is ?3.254 -- $2.3,000 a year. Where in Germany

:16:11. > :16:16.it is $4,# 00. Hospital beds in the UK are 2.8 per 1,000. In Germany

:16:17. > :16:23.8.3. It doesn't need to be like. This I want to focus particularly on

:16:24. > :16:28.the needs of rural communities. We haven't talked about this evening

:16:29. > :16:32.and were the A department in Darlington to close, this would be

:16:33. > :16:38.an extremely serious problem for people to the west of Darlington and

:16:39. > :16:43.at the top of tease deal. Already people are travelling 30 miles to

:16:44. > :16:48.get to the hospital. And the response times of the

:16:49. > :16:52.North-East Ambulance Service are not what they ought to be. People often

:16:53. > :16:59.wait 20-30 minutes. So that is an hour to get into the hospital. Now,

:17:00. > :17:02.one of my local councillors has done an absolutely brilliant piece of

:17:03. > :17:09.analysis, looking at the journey times that would be needed were

:17:10. > :17:14.people to have to go to the James kook in Middlesbrough. At the

:17:15. > :17:19.moment, if you live in Bishop Auckland, the journey time is 25

:17:20. > :17:23.minutes. It would go up to 39. If you live right up in the top of

:17:24. > :17:37.the dale, the journey time is 39 minutes. It would go up to 64

:17:38. > :17:45.minutes. The STP managers running the review say they want to treat

:17:46. > :17:49.cardio vascular and trauma patients in centres where staff can maintain

:17:50. > :17:55.their skills. Ork that sounds reasonable enough. When my

:17:56. > :18:01.constituent asked them, what proportion of emergency journeys are

:18:02. > :18:10.not cardio vascular or trauma cases, the answer was 94%. We have acute

:18:11. > :18:16.asthma. Apen thesies the. Meningitis, the list goes on and on

:18:17. > :18:20.and on. And for all of these, the fact is that there would be no

:18:21. > :18:27.benefit to being in a different specialised centre. But the extra

:18:28. > :18:34.mortality from the longer travel time goes up quite dramatically. In

:18:35. > :18:42.Bishop Auckland up by 2.4%. In bar fared castle up to by 3.4%. That's

:18:43. > :18:45.why the pretence this is about improving the quality of health care

:18:46. > :18:49.is not believed to by my constituents.

:18:50. > :18:53.They do, they are tired of being told that services should be nearer

:18:54. > :18:58.to home when in fact they are being pushed further and further away.

:18:59. > :19:06.There's a question mark over the cottage hospital, the Richardson.

:19:07. > :19:09.The A at Bishop Auckland and the maternity services are taken out of

:19:10. > :19:13.that hospital. When that was done, we were told it would be absolutely

:19:14. > :19:19.fine because people would be able to go to the Darlington A But now

:19:20. > :19:22.the Darlington A is under threat. This is a constant attrition that

:19:23. > :19:26.people in rural communities are feeling.

:19:27. > :19:42.Thank you. I have similar troubles in Devon, where the STP will lead to

:19:43. > :19:45.long travel distances and as the ministers know that is something I

:19:46. > :19:49.have brought up with them and in this House as well. Would she agree

:19:50. > :19:52.with me that the challenges the STP is trying to look at haven't

:19:53. > :19:57.happened in the last 18 months or the last six years, these are issues

:19:58. > :20:03.which have built up over many years, over many different Governments? It

:20:04. > :20:07.has been proposed that the Darlington A should be proposed.

:20:08. > :20:11.That wasn't proposed under the coalition Government or the previous

:20:12. > :20:14.Labour Government. So, this Government must take responsibility

:20:15. > :20:22.for what is happening now. On Saturday, I went over to Cumbria.

:20:23. > :20:26.They are also running a campaign. Their local hospital is threatened

:20:27. > :20:32.with closure. Then they will have to go over to Carlisle, which is 34

:20:33. > :20:36.miles. 34 miles is a long way. It is especially a long way in Cumbria,

:20:37. > :20:41.where the weather is terrible and the road is often blocked. So, this

:20:42. > :20:47.is a big rural issue. And I think ministers need to take more account

:20:48. > :20:52.of this. They are worried there'll be a cynical saving of the hospital

:20:53. > :20:56.in Copeland and then they will face even bigger cuts. Perhaps we have an

:20:57. > :21:01.assurance about that from the minister? The interaction with

:21:02. > :21:12.social care is well understood. We all know that cuts to social care

:21:13. > :21:15.mean worse quality and less time for individuals and also... I would

:21:16. > :21:24.rather not because of the speaking limits. And it also means pressure

:21:25. > :21:31.on the NHS. For example, in Durham, we've had really big cuts to our

:21:32. > :21:38.social care. Between 2011-2017, Durham has been required to make

:21:39. > :21:49.?186 million of savings. Because child and adult services comprise

:21:50. > :21:56.63%, the adult social care cuts have ?55 million. The precept raises ?4

:21:57. > :22:04.million. We have another ?40 million of cuts to come. Even taking into

:22:05. > :22:11.account the better care funding, cuts by 2019/20, will come to ?170

:22:12. > :22:15.million. And this means there are, the whole villages in my

:22:16. > :22:18.constituency, where there is no social care. We are told that the

:22:19. > :22:24.Chancellor is minded to do something about it. Will he make up the full

:22:25. > :22:32.?4.6 billion which was cut in the last Parliament? Of course, we've

:22:33. > :22:36.had some discussion about the long term. I think we need to think about

:22:37. > :22:42.the long-term. The discussion about social insurance is important and it

:22:43. > :22:46.is significant. But I think we should also think about which

:22:47. > :22:51.institutions would we be asking people to put money into and to put

:22:52. > :22:55.their savings into. Because there are a lot of private sector

:22:56. > :23:02.organisations at the moment which are frankly ripping people off. Fees

:23:03. > :23:06.of ?600. ?900. Even in my constituency n the north, where

:23:07. > :23:12.costs are not the highest. And with fees like that, we do not see highly

:23:13. > :23:17.trained people, with expertise in dementia. We see the same workers on

:23:18. > :23:25.minimum wages, with low levels of training. So, I really think we need

:23:26. > :23:30.to look at a stronger, mutual approach and cut these exploitive

:23:31. > :23:37.private sector contractors out of adult social care.

:23:38. > :23:44.THE SPEAKER: I just remain the next speaker the wind up needs to start

:23:45. > :23:47.at 9. 28. We need spechs now to conclude relatively promptly --

:23:48. > :23:54.speeches now to conclude relatively promptly. Thank you. The debate of

:23:55. > :23:57.course has been filled with trep decision and anticipation as members

:23:58. > :24:02.and the wider public wait to see whether or not the House will be

:24:03. > :24:08.debating any of the budget estimates in front of us. I think, in fact to

:24:09. > :24:14.pay tribute to members they have, we've done not too badly. The

:24:15. > :24:26.estimates document 946, all 753 pages of it. 3-and-a-half inches

:24:27. > :24:32.thick and the order paper gives us an estimate of ?8 billion. Take

:24:33. > :24:38.pages 137 to 151 of the document. The only line which includes

:24:39. > :24:44.expenditure for the social and health centre known as NHS digital.

:24:45. > :24:49.Which has 151 million of resource. That would maybe make for a

:24:50. > :24:53.considerably shorter debate if they had not used their ingenuity to the

:24:54. > :24:59.extent they have. We have debaiteded the ten detailed retort r ports and

:25:00. > :25:03.-- debated the ten detailed reports. I congratulate the committees on the

:25:04. > :25:07.time from the committee. It begs the question why are ten reports

:25:08. > :25:11.squeezed into three-hour debate which is supposed to be about

:25:12. > :25:15.supplying the Government with the resources that it needs. I

:25:16. > :25:16.congratulate them on securing this time that perhaps these reports

:25:17. > :25:29.ought to have time to themselves. The NHS is one of the biggest areas

:25:30. > :25:32.of government spending, second only to pensions. There is no means

:25:33. > :25:36.through the estimates process to seek to amend any of this in any

:25:37. > :25:40.meaningful way and all we can do with amendments that might lower the

:25:41. > :25:43.amount, whereas the theme of the entire debate today seems to be what

:25:44. > :25:49.the NHS in England needs is more money, not less. Any change to the

:25:50. > :25:52.NHS budget in England has some sort of Barnet consequential from

:25:53. > :25:55.Scotland and I wonder if at any point today or anywhere in the

:25:56. > :25:59.supply estimates we can find out what those balmy consequential czar,

:26:00. > :26:02.I suspect that we cannot. Nevertheless I think a number of

:26:03. > :26:09.important points have been made by members. The chairs of both the

:26:10. > :26:16.committees spoke in detail about the different budget lines and the

:26:17. > :26:19.departmental spending lines and the important spending of the capital

:26:20. > :26:23.budget to the revenue budget in the long-term consequences on that. The

:26:24. > :26:28.member for Newton Abbot spoke about the need for ring fencing certain

:26:29. > :26:31.lines and the other member who is no longer in his place made important

:26:32. > :26:37.points about the disaster that PFI has been in the health service and

:26:38. > :26:41.that is true for North and South of the border. The member for Bishop

:26:42. > :26:46.Auckland quite rightly asked whether ?350 million a week for the NHS was,

:26:47. > :26:51.it certainly isn't in the supply documents brought to the house by

:26:52. > :26:54.the government today. There is in fact a systematic underfunding in

:26:55. > :26:57.the NHS in England under this Tory government and it has serious

:26:58. > :27:02.implications for the NHS across the UK as a whole. As we have heard from

:27:03. > :27:05.members across that Ross today that environment is only going to become

:27:06. > :27:08.more challenging of the population ages and demographics continue to

:27:09. > :27:12.change. The Scottish Government, as I am sure we will hear from my

:27:13. > :27:20.honourable friend on the front bench shortly, is focused on these

:27:21. > :27:23.challenges and building a health service that meets the demands for

:27:24. > :27:25.the 21st century. It is not just investing in the NHS but reforming

:27:26. > :27:27.it, integrating health and social care, engaging with communities to

:27:28. > :27:31.bring about a sustainable and positive NHS reform and Sterz -- as

:27:32. > :27:34.opposed to pressing ahead with hasty cost-cutting exercises which seem to

:27:35. > :27:37.be a priority of the Tory government. Perhaps it suits them to

:27:38. > :27:42.have a very chess in the crisis described by Labour members because

:27:43. > :27:44.it gives them an excuse to bring in private capital, private management,

:27:45. > :27:48.outsourcing are verses to private providers and that in turn would

:27:49. > :27:53.have major consequences for the NHS budget England and consequential is

:27:54. > :27:57.for the devolved budget which brings us back to the inadequacies of the

:27:58. > :28:02.estimates and supply process in this house. The former leader of the

:28:03. > :28:05.house promised us that these supply days, estimates days, were our

:28:06. > :28:11.chance to scrutinise the government for things that we were otherwise

:28:12. > :28:15.excluded from. Can I gently said he honourable gentleman that he is a

:28:16. > :28:19.distinguished ornament of the procedure committee, which has

:28:20. > :28:25.deliberated upon this matter. The question of the character of debates

:28:26. > :28:31.on the estimates has been at this point decided by the house and the

:28:32. > :28:36.honourable gentleman shouldn't use his opportunity to speak in this

:28:37. > :28:40.debate, which he should guard jealously, to dilate on his

:28:41. > :28:47.disapproval of the process. What he ought to do is focus on the subject

:28:48. > :28:52.which has been chosen. It is no good him grinning at me like a Cheshire

:28:53. > :28:56.cat, I trust that that means that he is acquiescing in the judgment that

:28:57. > :28:59.has been reached and we always look forward to the mellifluous tones of

:29:00. > :29:03.the honourable gentleman but they should focus on the subject that we

:29:04. > :29:08.have chosen and not on that which he would prefer to have been chosen. I

:29:09. > :29:14.don't intend to detain has very much further. I have demonstrated, at

:29:15. > :29:17.least what I have been trying to demonstrate, is how the importance

:29:18. > :29:20.of the health and social care budget in England and will also affect the

:29:21. > :29:25.health and social care budget north of the border, the overall Scottish

:29:26. > :29:28.Parliament budget, and I think we have precisely proved the point,

:29:29. > :29:32.that we do not have the appropriate opportunities to scrutinise them in

:29:33. > :29:35.this debate so the government has to live up to those promises and then

:29:36. > :29:39.we will see whether it is prepared to allow the member is this has a

:29:40. > :29:41.proper say over the spending of the NHS and social care or any other

:29:42. > :29:50.budget lines included included in the estimates. Thank you very much,

:29:51. > :29:56.Mr Speaker. I certainly welcome that in recent months the health select

:29:57. > :30:02.committee and the Secretary of State for Health has stopped using the 10

:30:03. > :30:06.billion figure and recognise and recognises the 4.5 billion figure

:30:07. > :30:11.that is closer to reality. Spending is normally allocated on the basis

:30:12. > :30:15.of health spending, not just NHS England, and the increase in NHS

:30:16. > :30:18.England was at the cost of significant cuts to public health,

:30:19. > :30:22.even though we all recognise the need for prevention and cuts to

:30:23. > :30:30.health education England, despite the attempts to have 1500 extra

:30:31. > :30:36.doctors every year and extra nurses and 5000 extra GPs. This is kind of

:30:37. > :30:41.rather a challenge. Last year, as has been said, was the good year,

:30:42. > :30:46.before we come to the lean years. I won't go into the details of the

:30:47. > :30:52.Pocklington was required to get anywhere close to the required

:30:53. > :30:56.out-turn, which was missed by ?2.7 million as it has been so clearly

:30:57. > :31:00.extolled by those of the Public Accounts Committee but what it does

:31:01. > :31:06.result in is what the auditor general described as short termism,

:31:07. > :31:09.people simply working to meet the bottom line, instead of lifting

:31:10. > :31:16.their chins up and looking at what the real challenges are. There are

:31:17. > :31:20.three big challenges. We have talked about the ageing population, we

:31:21. > :31:24.recognise that we have significant workforce challenges, and we all

:31:25. > :31:30.know that money is tight and doesn't grow on trees and these three things

:31:31. > :31:33.create a conflict and what we are sometimes seeing is that people are

:31:34. > :31:39.doing a short-term patch that is actually going to cost more money in

:31:40. > :31:43.the end. I think that the providers across England can be recognised for

:31:44. > :31:47.getting their agency costs down, although they are still more than

:31:48. > :31:54.twice what they are in Scotland. What is lying ahead? How are we

:31:55. > :32:00.going to avoid the challenge of providing work force after Brexit?

:32:01. > :32:05.How will we avoid the challenge of not just people leave vacant but how

:32:06. > :32:10.will we recruit in the future? The turnover at the level of nurse and

:32:11. > :32:16.social care worker is about 25% and if you actually need a constant

:32:17. > :32:22.stream, and is one of the members on the government benches mentioned,

:32:23. > :32:25.the tiny proportion of population we have below 65 of working age is

:32:26. > :32:32.exactly why we needed immigration in the first place. Are we going to end

:32:33. > :32:37.up with more agency workers, or will the government actually take action

:32:38. > :32:43.to make sure we can attract nurses, doctors and social care workers from

:32:44. > :32:47.Europe? A lot of these problems are blamed on an ageing population and

:32:48. > :32:51.in actual fact in Scotland our demographics are worse than yours.

:32:52. > :32:58.Going through a hard winter as we have all faced we didn't meet our

:32:59. > :33:06.A target either. But in Scotland the emergency Department for our

:33:07. > :33:10.achievement was 92.6, and in England it was 79.3. The worst level since

:33:11. > :33:17.records began. This shows that there is a real crisis. This is not meant

:33:18. > :33:21.to be a measure for us to attack each other with and I have to say

:33:22. > :33:25.that in general I think this has been a great debate tonight, rather

:33:26. > :33:30.than what some of our debates are like. It is meant to be a

:33:31. > :33:35.thermometer to take the temperature of the whole system, not just the

:33:36. > :33:41.whole hospital system from A to discharge, but actually from home to

:33:42. > :33:47.GP to A, to hospital and getting back home again, and that is where

:33:48. > :33:52.the problem lies. The cuts that are outside the Department of Health,

:33:53. > :33:56.but yet are in social care, and they have been significant. And obviously

:33:57. > :34:01.patients require that support to be able to get back into the community

:34:02. > :34:07.and preferably even to get back to their own homes. Despite our

:34:08. > :34:13.demographics, why is it that we are managing to keep our nostrils above

:34:14. > :34:20.water and in NHS England we are not? Part of that is because it Scotland

:34:21. > :34:27.we have focused absolutely on integration rather than financial

:34:28. > :34:31.competition. The convoluted system that now exists between CCG and

:34:32. > :34:38.outsourcing contracts and bidding and tendering is estimated to take

:34:39. > :34:43.five or ?10 billion out of NHS England budgets. That would be

:34:44. > :34:47.enough to cover the deficit, it would be enough to plug the social

:34:48. > :34:53.care whole but the Department of Health does not even keep data on

:34:54. > :34:59.it. They are not keeping track of how these administration costs are

:35:00. > :35:03.growing. There was no possibility of a cost benefit analysis, of bringing

:35:04. > :35:06.in outside providers and causing what we have got, which is this

:35:07. > :35:11.fragmentation instead of people being able to work together. In

:35:12. > :35:16.Scotland we have gone down the route, as I said before, of

:35:17. > :35:19.integrated joint boards between health and social care, taking money

:35:20. > :35:25.from both sides so that you do not have the argument over whose purse

:35:26. > :35:29.is funding a patient. We have used other innovative approaches such as

:35:30. > :35:34.community pharmacies which we have debated here. Minor ailments units

:35:35. > :35:39.within community pharmacies, and using those services. Because of

:35:40. > :35:47.that the increase in attendances at a and E in Scotland has increased in

:35:48. > :35:52.the last five years by 3.4%. In England it is 11.8, that is three

:35:53. > :35:58.times the rate of attendances and with admissions it is similar. Our

:35:59. > :36:03.admissions, our emergency emissions have increased by 4.6% while in

:36:04. > :36:09.England they have increased by 14%. All of that is because the effort is

:36:10. > :36:13.not being made in the community. There is a lot of talk all of the

:36:14. > :36:19.time about the five-year forward view. Frankly we are halfway through

:36:20. > :36:24.the five years. There is only a two and a half year few left. That is

:36:25. > :36:29.not far enough ahead. In Scotland we did vision 2020 as well and we did

:36:30. > :36:34.it back in 2011 and we are working on 2030. By which time the number of

:36:35. > :36:40.people 85 and above will have doubled. That is what we need to be

:36:41. > :36:44.thinking about, how do we design our social care services but also our

:36:45. > :36:52.health services around the ageing population. Our Cabinet Secretary is

:36:53. > :36:57.focused on what keeps people independent. You might think that is

:36:58. > :37:02.because I am SNP but people being independent and living high quality

:37:03. > :37:06.lives. What is it? It is hip replacements, it is knee

:37:07. > :37:10.replacements, it is eye surgery. If you can't see and you can't walk you

:37:11. > :37:15.are stuck in your house and you are lonely and we are going to have to

:37:16. > :37:18.look after you. What we have invested in, and it is often laughed

:37:19. > :37:23.at here, is free prescriptions, so people take their medication to

:37:24. > :37:28.control their chronic illnesses. We have invested in having people

:37:29. > :37:34.having free personal care in their own homes so that they are not

:37:35. > :37:38.landing in hospital and they are not getting stuck there. That is why

:37:39. > :37:46.delayed discharges for us last year went down 9%, while went up between

:37:47. > :37:50.25 and 30% a year. The other one, the free bus passes that people are

:37:51. > :37:55.fat, the member opposite who mentioned loneliness, obviously as

:37:56. > :38:00.was championed by Jo Cox, as bigger killer as diabetes. Older people in

:38:01. > :38:04.our community are out and about, yes, they are taking day trips, yes

:38:05. > :38:08.they are going shopping, and they are loving it. They are not stuck in

:38:09. > :38:15.their houses. It is actually starting with looking at the

:38:16. > :38:18.population. F TP is the best chance going forward but at the moment they

:38:19. > :38:23.are being handed a bottom line and being told to work back from it. It

:38:24. > :38:29.cannot be Budget centred care, it must be patient centred care and all

:38:30. > :38:34.of us across the house can recognise place -based planning for a

:38:35. > :38:38.community is going to provide the best service to those patients, to

:38:39. > :38:44.your constituents, and that is what we should be doing. Getting real

:38:45. > :38:50.about public health and preventing that chronic ill health in later

:38:51. > :38:56.life, and that means health in all policies. The thing that is really

:38:57. > :39:01.bad in this house is that we look at individual decisions day by day that

:39:02. > :39:05.completely contradict each other. And yet, if we were always thinking,

:39:06. > :39:12.in every decision, will this make our citizens health and well-being

:39:13. > :39:17.better or worse? If it is making it better in the end it will save

:39:18. > :39:22.money, and that includes poverty, the biggest cause of ill health that

:39:23. > :39:27.exists, so I call on us to look at the systems, to look at how we do

:39:28. > :39:31.things, but we need to provide the care in the community before we take

:39:32. > :39:39.it from the hospital, but let's also think a little bit broader in some

:39:40. > :39:46.of the other decisions that we make. Thank you, the Honourable lady has

:39:47. > :39:50.concluded. Thank you, Mr Speaker, I would like to thank the chair,

:39:51. > :39:52.members of staff of the health committee and the Public Accounts

:39:53. > :39:56.Committee for their work on the reports that we are debating today

:39:57. > :40:02.and I have to say the two chairs for the excellent opening speeches. The

:40:03. > :40:04.health select committee talked of a tight financial situation for health

:40:05. > :40:07.and about the fact that deficits were blowing -- growing and

:40:08. > :40:11.widespread and the Kings fund and the Nuffield trust reported in

:40:12. > :40:23.November 20 16th that there was a net deficit for NHS trusts of

:40:24. > :40:25.billion in 2015/ 16. Further they said that the 1.3% increased funding

:40:26. > :40:28.for the NHS in 2017/18 would largely be absorbed by deficits. We have had

:40:29. > :40:32.very many very useful contributions about the issues with trust deficits

:40:33. > :40:42.but we are in the situation that NHS funding increases are going to be 0%

:40:43. > :40:47.in 2018/90 9.3% in 2019/20 these are seen as inadequate and not enough to

:40:48. > :40:50.maintain standards of care, meet rising demand from patients and

:40:51. > :40:55.deliver the rising demand and services outlined in the five-year

:40:56. > :40:58.forward view. I take the honourable ladies point that we are now halfway

:40:59. > :41:03.through the five-year forward view so in fact it is only the 2.5 year

:41:04. > :41:07.ahead view and if that is now it is inadequate then we have some issues.

:41:08. > :41:10.On social care the health select committee said that increasing

:41:11. > :41:13.numbers of people with genuine social care needs are no longer

:41:14. > :41:19.receiving the care they need because of a lack of resource and we have

:41:20. > :41:21.had very many contributions. The honourable lady, the chair of the

:41:22. > :41:26.health select committee talked about increases in demand for social care.

:41:27. > :41:29.The King 's fund and the Nuffield trust say that six years of

:41:30. > :41:39.unprecedented budget reductions have led to a 26% fall in the number of

:41:40. > :41:41.people aged over 65 accessing publicly funded social care, and

:41:42. > :41:43.that is imposing significant human and financial costs on older people,

:41:44. > :41:49.their families and carers, and as we know exacerbating pressure on the

:41:50. > :41:53.NHS. They also estimate the social care system faces the prospect of a

:41:54. > :41:55.?1.9 billion funding gap next year and a funding gap of at least ?2.3

:41:56. > :42:06.billion by 2020. As we have heard in this debate and

:42:07. > :42:10.rightly focussed, the cuts mean 400,000 fewer older people receive

:42:11. > :42:15.publicly funded public care packages than 2010. An Age UK report that 1.2

:42:16. > :42:20.million people do not receive the care and support they need, with

:42:21. > :42:26.essential daily living activities. It is worth breaking it down. That

:42:27. > :42:31.is nearly 700,000 older people not receiving enough help for their

:42:32. > :42:35.daily care needs and 500,000 people receiving no help, not even from

:42:36. > :42:39.family and friends. And taking into account tasks like shopping and

:42:40. > :42:45.taking medication, which the honourable lady mentioned as an

:42:46. > :42:49.important factor that older people need to be reminded, Age UK say 1.5

:42:50. > :42:54.million people are not getting the help they need day-to-day. Mr

:42:55. > :43:00.Speaker, I think it's shocking that nearly one in eight of the entire

:43:01. > :43:04.older population now live with some level of unmet need. Of course the

:43:05. > :43:07.impact on the NHS of the crisis in social care funding is important.ly

:43:08. > :43:12.come on to talk about delayed discharges. But the real impact and

:43:13. > :43:17.we must never forget it is on all of those older and vulnerable people

:43:18. > :43:23.living without care. And cuts to social care budgets also hit the 6.5

:43:24. > :43:27.million unpaid family carers and the 1.4 million people in the care

:43:28. > :43:33.workforce who provide care. Impacts on those groups of people are often

:43:34. > :43:37.overlooked. The honourable member for South West Bedfordshire talked

:43:38. > :43:42.about terms and conditions but cuts hit those 1.4 million people as

:43:43. > :43:46.well. We have seen dreadful cuts to the terms and conditions. It is an

:43:47. > :43:50.important job. It shouldn't happen. The Government's response on the

:43:51. > :43:55.funding issues raised in these reports are inadequate. The

:43:56. > :43:58.responses talk about the precept and the additional funding in the better

:43:59. > :44:05.care fund, most of which is proving to be the case is a problem because

:44:06. > :44:09.it is backloaded to 2019/20. The King's Fund has described using it

:44:10. > :44:11.as an inadequate response which passes the problem to local

:44:12. > :44:19.Government. I think that is a key factor. Also theed a quasys or

:44:20. > :44:25.otherwise. The precept raised ?220 million and it will raise ?253

:44:26. > :44:29.million. Both less than the cost of the national lieing wage to be paid

:44:30. > :44:34.by care providers. Sadly, this Government's inadequate funding of

:44:35. > :44:39.social care was made worse by measures in the settlement. Having

:44:40. > :44:43.passed the problem of funding to social care on to the council

:44:44. > :44:49.taxpayer, ministers went on to make the problem worse by announcing the

:44:50. > :44:54.ce ayes of the 240 million care grant recycle from the new homes

:44:55. > :44:58.bonus. One third of cases providing social care will be worse off next

:44:59. > :45:04.year as a result of this settlement. My own local authority Salford will

:45:05. > :45:07.have ?2.3 million less in its budgets for social care and Tower

:45:08. > :45:12.Hamlets is set to lose ?3.3 million. I ask the minister to think about

:45:13. > :45:16.where he thinks we're going to find at this notice ?2.3 million in one

:45:17. > :45:21.local authority budget. The answer is sadly it will be rationing. That

:45:22. > :45:26.is not where we should be. The Public Accounts Committee published

:45:27. > :45:32.a report on discharging people from acute property hospitals. -- acute

:45:33. > :45:36.hospitals. 2016 a record number of bed days were lost as a result of

:45:37. > :45:40.problems in social care. The number of days lost by 400,000 in the last

:45:41. > :45:44.year. Over one-third of these delayed days were as a result of

:45:45. > :45:49.social care. And I think we've got to take into account the proportion

:45:50. > :45:53.attributed to social care has been increases. Giving the funding cuts

:45:54. > :46:00.we should not be surprised. The chair of the public committees

:46:01. > :46:04.committee said said it is damaging patients and the public purse.

:46:05. > :46:08.Unnecessary long stays in hospital can affect patient morale and

:46:09. > :46:13.mobility as well as increasing their risk of catching hospital-acquired

:46:14. > :46:19.infections. Professor Young in 2014, said if the mobility effects of long

:46:20. > :46:23.hospital stays, a wait of seven days is associated with a 10% decline in

:46:24. > :46:30.muscle strength. Clearly not desirable. The funding crisis is a

:46:31. > :46:35.theme across many of the reports we are debating today. The personal

:46:36. > :46:38.care budgets express concerns that funding cuts and wage pressures will

:46:39. > :46:43.make it hard for local authorities to fulfil their obligations under

:46:44. > :46:47.the care act. A piece of legislation passed in 2014. It seems hard for

:46:48. > :46:53.councils to fulfil their obligations. Indeed, the local

:46:54. > :46:56.Government associate said this on underfunding in its recent budget

:46:57. > :46:59.submission. Without bolder action, the Government will need to revalue

:47:00. > :47:04.wait its offer and consider whether the legal, the set of legal rights

:47:05. > :47:10.and responsibilities contained within the care act are appropriate

:47:11. > :47:15.and achievable. The chair of the CLG Select Committee mentioned this too.

:47:16. > :47:19.The Public Accounts Committee report described the ambition to improve

:47:20. > :47:27.services as Lordable. But given the current pressures on the NHS budget

:47:28. > :47:31.said, we are skepty Kabul about -- accept -- acceptable whether it is

:47:32. > :47:38.affordable. It is a task for the whole of

:47:39. > :47:41.Government. I trust that includes the member Mid Norfolk, who said

:47:42. > :47:45.that disability benefits should go to really disabled people rather

:47:46. > :47:50.than those taking pills at home who suffer from anxiety. And I should

:47:51. > :47:56.say, Mr Speaker, this has been raised already today and I have

:47:57. > :48:00.informed the member from Mid Norfolk I intended to mention that this

:48:01. > :48:07.evening. The reason I want to raise this, comments like this re-enforce

:48:08. > :48:11.stigma about mental health. They are profoundly disappointing from

:48:12. > :48:15.someone who was until recently a Health Minister. They show how far

:48:16. > :48:21.we and this Government has to go on parity. Underfunding of mental

:48:22. > :48:24.health services by commissioners has dominated many of our debates here.

:48:25. > :48:27.The Government has not dealt with the issue that funds meant for

:48:28. > :48:31.mental health services have been used by the NHS for other

:48:32. > :48:34.priorities. In the response the Government says it accepts all the

:48:35. > :48:41.recommendations and has implemented them. I want to question that. The

:48:42. > :48:44.Government response talks about the mental health five-year view,

:48:45. > :48:51.publisheded 2015, monitoring key performance and outcomes data. In

:48:52. > :48:54.December, the Royal College of Psychiatrists released figures on

:48:55. > :48:59.child and adolescent mental health services. A vital issue. Now a

:49:00. > :49:04.number of honourable members raised the scale of variation which came

:49:05. > :49:15.out of the Royal College of Psychiatrist figures. It ranged from

:49:16. > :49:19.?2 per an unanimo ?135 a year. The CCGs were reporting the data on

:49:20. > :49:24.their spending differently. I say to the minister, it hardly helps

:49:25. > :49:27.transapparently to report on their spending of mental health

:49:28. > :49:30.differently. I wrote to the honourable member for Oxford West

:49:31. > :49:35.about this, from her response I understand that further guidance has

:49:36. > :49:39.been issued to CGGs. I would be grateful in his response if the

:49:40. > :49:44.minister can tell the House if we can expect the actual spend and

:49:45. > :49:49.planned spend on the services will be accurate and comparable. We've

:49:50. > :49:54.had instances in speeches today of honourable members talking about

:49:55. > :49:57.their local CGG decreasing spending on mental health. We hear that is

:49:58. > :50:04.not the Government's intention. We cannot track this if CGGs don't

:50:05. > :50:09.report Accraly. Given we know -- Accraly. Given we now one in four is

:50:10. > :50:12.turned away from services, the Government should do all it can to

:50:13. > :50:17.make sure young people can get the access. And prioritising mental

:50:18. > :50:23.health should be spent as intended. Not on other priorities. Briefly on

:50:24. > :50:26.the report on NHS specialised services, the committee said that

:50:27. > :50:30.accountability to both patients and taxpayers is undermined by the lack

:50:31. > :50:34.of transparency over NHS England's decision making and the committee

:50:35. > :50:39.recommended that NHS England improve the transparency of its decision

:50:40. > :50:42.making. On this issue, I note that 30 charities from the specialised

:50:43. > :50:48.health care alliance have writ on the the Prime Minister to raise the

:50:49. > :50:51.issue about NHS England restricting and rationing treatment because of

:50:52. > :50:55.underfunding, for patients with rare and complex conditions. Now the

:50:56. > :50:58.charities say this is taking place without sufficient public scrutiny.

:50:59. > :51:02.Lack of transparency in decision making is a serious issue. I ask the

:51:03. > :51:07.minister to address that in his response. Mr Speaker, there are many

:51:08. > :51:11.issues raced in the committee reports in front of us on funding in

:51:12. > :51:16.the NHS and social care. Media reports say the Chancellor is

:51:17. > :51:25.considering a short-term ring-fence cash injection for social care worth

:51:26. > :51:30.hundreds of millions for council adult service directors say they

:51:31. > :51:33.need an injection of ?1 billion for social care to prevent the weakening

:51:34. > :51:38.and collapse in some parts of the sector. As I have said, the funding

:51:39. > :51:42.gap in social care will be ?1.9 to ?2.3 billion by 2020. I hope the

:51:43. > :51:47.Government is not going to try in the Budget a quick fix which is too

:51:48. > :51:54.little. The hundreds of thousands of vulnerable people who need social

:51:55. > :52:00.care certainly deserve better. I thank you very much Mr Speaker.

:52:01. > :52:04.The member that speaks for the SNP described this evening as being a

:52:05. > :52:07.great debate. And I agree, it's been a very good debate. A number of

:52:08. > :52:09.members on both sides of the House have spoken with a great deal of

:52:10. > :52:24.Paddy With a great deal of passion. I join

:52:25. > :52:30.the Shadow Minister by thanking the reports we are discussing today.

:52:31. > :52:34.There's been an awful lot of comments made by members.ly do my

:52:35. > :52:41.best to respond to the -- I will do my best to respond to the majority

:52:42. > :52:44.of those. I start biceping and the Government accepts that these are

:52:45. > :52:49.challenging times both for the NHS and for social care. Members have

:52:50. > :52:52.talked, the Select Committee chair talked in length, that the

:52:53. > :52:59.demographics in terms of the numbers of people and of the age of the

:53:00. > :53:02.people is uncompromising. I was at a conference recently, a health check

:53:03. > :53:06.conference. One of the speakers described the process we have been

:53:07. > :53:12.through. We have been very successful at elongating, if you

:53:13. > :53:16.like, quantity of life. Up until now, qualingty of life has not kept

:53:17. > :53:23.-- quality of life has not kept up with that. Older people are living

:53:24. > :53:29.with multiple long-term conditions. Not having one long-term condition

:53:30. > :53:32.is becoming unusual, whether that's diabetes, COPD, heart disease or

:53:33. > :53:36.whatever. It is a fact that we all have to face. It is one of the

:53:37. > :53:41.reasons that we're so keen with the SDPs to address this. 70%, Mr

:53:42. > :53:46.Speaker, of the total expenditure on the NHS is in terms of long-term

:53:47. > :53:50.conditions. Frankly, if we were starting a blank piece of paper we

:53:51. > :53:53.would not be starting with the NHS we have now. We would be organising

:53:54. > :53:57.around those long-term conditions, which means more in the community

:53:58. > :54:00.and all that goes with that. I will come on to talk about the SDP

:54:01. > :54:09.process and how we're trying to achieve that. We know that we've got

:54:10. > :54:18.the issue with demock graphy. There's a -- demography. The report

:54:19. > :54:25.said in 1948, 50% of people lived over 65 years old. In 2017, 14% of

:54:26. > :54:32.people, that is, die before they are 65. That is a massive demographic

:54:33. > :54:37.change. We all need to step up to the mark to meet and we will do

:54:38. > :54:42.that. There are drugs and treatments frankly are becoming more expensive.

:54:43. > :54:45.You can do a lot more and we've seen the issues and the discussions

:54:46. > :54:50.around the cancer drug fund as well. And the third driver of all of this,

:54:51. > :54:55.is that patient expectations, rightly, are becoming higher, in a

:54:56. > :55:01.way that people perhaps didn't necessarily expect decades ago.

:55:02. > :55:06.Now, the Government response to that n the Spending Review was a ?10

:55:07. > :55:14.billion injection into the NHS budget. Front loaded, which

:55:15. > :55:20.represents an 8% or 9%, depending on how you count. And I agree with the

:55:21. > :55:25.chairman of the PDC we should not bicker. We can argue whether it is

:55:26. > :55:28.enough or not. But the facts are that is a real increase over the

:55:29. > :55:31.course of this Parliament. Now discussion to be had whether that

:55:32. > :55:36.real increase is enough and I accept that. What I don't accept is some of

:55:37. > :55:42.the things we have heard opposite about cuts. There's a very valid

:55:43. > :55:47.discussion, Mr Speaker, to be had whether an 8% or 9% increase in real

:55:48. > :55:51.terms is enough. And I gently say to the opposition at the last election,

:55:52. > :55:56.their position was that they weren't in a position to fund more than

:55:57. > :56:00.that. It is not right to talk, as we have heard from some of the speakers

:56:01. > :56:11.opposite about this being in the context of cuts. Now at the time...

:56:12. > :56:15.Mr Speaker, we do get into this repeatedly. The opposition had no

:56:16. > :56:19.plans to cut ?5 billion out of social care. We had no plans to cut

:56:20. > :56:23.the budgets of local councils. That is the difference between us. I

:56:24. > :56:26.think given the majority of what we talked about is social care and the

:56:27. > :56:31.cuts to social care, he ought to take that into account.

:56:32. > :56:37.I will come onto social care. We have covered the NHS and during the

:56:38. > :56:41.course of this Parliament there was an increase in real terms of eight

:56:42. > :56:44.or 9% so we will accept that and move on. In terms of social care,

:56:45. > :56:48.the increase, and this is not the budget, I don't know what is in the

:56:49. > :56:53.budget, the increase that has already been put into place is to

:56:54. > :56:56.make five or 6% in real terms of an increase in social care available.

:56:57. > :57:00.Again, Mr Speaker, we can have an argument as to whether that is

:57:01. > :57:03.enough in terms of the demographics but what we can't do is have an

:57:04. > :57:08.argument in terms of whether it is right or not. I do want to spend a

:57:09. > :57:12.bit of time on the international comparisons. We have heard some

:57:13. > :57:24.discussion about that earlier this evening. This country spends 9.9% of

:57:25. > :57:29.its GDP in 2014, that is an OECD number, on health. The OECD averages

:57:30. > :57:33.9%, that is 1% more, but it is true that that average includes countries

:57:34. > :57:38.such as Mexico which we wouldn't necessarily wish to be compared

:57:39. > :57:47.with. The EU average, for the EU 15, that is not by and large the states

:57:48. > :57:54.eastern part, the new estates, spends 9.8% of GDP on health care,

:57:55. > :58:00.so we spend more than the EU average on health care, and that is in 2014.

:58:01. > :58:03.It is true that we spend less than some countries that we think maybe

:58:04. > :58:07.are our comparators, we spend less than France and Germany but it is

:58:08. > :58:13.completely wrong to say that there is some massive between us and the

:58:14. > :58:22.EU in terms of health care spend. In a sense we have to get to the

:58:23. > :58:26.point... Yes. 2014 is three years ago and is it not the case that

:58:27. > :58:33.we're heading towards a less than 7% GDP, which is going to put as 13th

:58:34. > :58:38.out of 15 of the EU 15? 2014 is the most recent figures that are

:58:39. > :58:41.available and in 2014 figures that I have just quoted don't include the

:58:42. > :58:45.comparatively large settlement that was made in terms of their health

:58:46. > :58:50.care in terms of the front-loaded money that came through from the

:58:51. > :58:53.spending review. Health and social care, if I may I will make some

:58:54. > :59:00.progress, and I will come back to her. On health and social care we

:59:01. > :59:06.spend 1.2% of our GDP in terms of the government spends we spend

:59:07. > :59:13.another 6.6% in terms of private. That is more than such as Germany

:59:14. > :59:17.and the chairman of the DC LG committee talked about Germany who

:59:18. > :59:22.spent 1.1%, that is more than Canada and more than Italy. Again it is

:59:23. > :59:26.less than some countries, in particular an exemplar country in

:59:27. > :59:28.terms of social care spenders Holland who spend considerably more

:59:29. > :59:32.than that and there are choices to be made and I accept that but what I

:59:33. > :59:37.want to say is that pretends that somehow we are massively out of

:59:38. > :59:42.kilter with the sorts of countries that we would regard ourselves as

:59:43. > :59:47.equivalent to is just wrong. I am very grateful to the Minister

:59:48. > :59:51.forgiving way. Does he accept that if we continue on current rates of

:59:52. > :59:55.spending as a proportion of GDP by the end of this Parliament we will

:59:56. > :00:01.be spending less than countries such as Costa Rica and Iceland, does he

:00:02. > :00:06.believe that that is the sort of health service that his constituents

:00:07. > :00:09.aspire to? There are assumptions on that depending on our GDP growth,

:00:10. > :00:14.their GDP growth and everything else so it is a difficult thing to answer

:00:15. > :00:18.but I will repeat the point again, in the latest OECD figures that have

:00:19. > :00:23.been produced for 2014 the numbers that I have just set before the

:00:24. > :00:26.house are accurate. There is a valid debate to have, as to whether they

:00:27. > :00:31.or enough, given the demographics and all of that, that is fair, but

:00:32. > :00:36.what is not fair is to somehow implied that there is a massive

:00:37. > :00:39.disparity between us and our EU neighbours and I think it is very

:00:40. > :00:40.important... I have given way to the honourable lady once already and I

:00:41. > :00:57.need to make some progress. It has been suggested that the 0.7%

:00:58. > :01:02.of GNI eight budget could be somehow used to fund health and social care,

:01:03. > :01:06.can he confirm that the government remains committed to that target and

:01:07. > :01:10.that just by reading out the proportions of GNI spent on health

:01:11. > :01:17.and social care shown how small that budget is by comparison. Well, Mr

:01:18. > :01:20.Speaker, the .7% budget for overseas aid is not something that we are

:01:21. > :01:25.discussing here today. It is not something that is in Mike

:01:26. > :01:27.ministerial responsibility my department 's ministerial

:01:28. > :01:31.responsibility. I am proud that we are one of the few countries in the

:01:32. > :01:34.world that meets that commitment and indeed many of the other countries

:01:35. > :01:39.that we have been talking about in terms of our EU 's partners do not

:01:40. > :01:45.meet our commitment but I don't want to be diverted any further down that

:01:46. > :01:48.today. In spite of that, of course we have seen that we have had a

:01:49. > :01:54.difficult winter in the NHS and we know that the A targets are

:01:55. > :02:00.something like 86%, not the 95% that we expected an ambulance 60%, not

:02:01. > :02:05.75% and as we have heard delayed transfers of care, not bed blocking,

:02:06. > :02:10.is probably doubled over the last three years. I will just make a

:02:11. > :02:14.response to that, one point that I'm very keen to always make these sorts

:02:15. > :02:20.of discussions, and that is that we don't talk enough about cancer, and

:02:21. > :02:23.there are cancer metrics as well. Actually we should be proud of the

:02:24. > :02:27.fact that in NHS England we are meeting seven of eight of our cancer

:02:28. > :02:31.metrics, the actual trend is to meet them more easily than in the past

:02:32. > :02:37.and we did hear quite a lot this evening about how well they are

:02:38. > :02:41.doing in Scotland and I think in fairness just to redress the balance

:02:42. > :02:44.about what we have heard in terms of A, I will make the point that they

:02:45. > :02:52.are doing somewhat worse than we are in terms of those cancer metrics. I

:02:53. > :02:55.regret to say it is a very disappointing response thus far

:02:56. > :02:59.because I think we have had a very informed debate and we don't need to

:03:00. > :03:03.regurgitate the figures. Would he comment on my comment earlier that

:03:04. > :03:08.the money may be what it is but is it sufficient to deal with the

:03:09. > :03:12.programme of care and support in the NHS that has been promised? That is

:03:13. > :03:16.the subject of the reports every month since last January. Is there

:03:17. > :03:23.money enough to do what has been promised? Mr Speaker, the money is

:03:24. > :03:27.what we were asked to provide by NHS England's senior management. We have

:03:28. > :03:31.provided that and at that time the chief executive of the NHS said that

:03:32. > :03:36.the government has listened and acted, and that is what we did, and

:03:37. > :03:41.that money is now available. Now, that is not the same as saying that

:03:42. > :03:46.we accept that the system is under pressure in certain ways but we talk

:03:47. > :03:52.about the money being spent in France and in Germany and in Munich

:03:53. > :03:58.15 out of the 19 hospitals stopped taking people in over this winter.

:03:59. > :04:02.The point is right across the world there are challenges in the NHS and

:04:03. > :04:08.we need to work, in the health systems, and we need to work to make

:04:09. > :04:12.that, to spend this money as effectively as possible. We know

:04:13. > :04:19.that we have got ?120 billion in our health system in 2020. What this

:04:20. > :04:22.government has to do and this ministerial team is doing is

:04:23. > :04:29.ensuring that every penny is spent as effectively as possible. The STP

:04:30. > :04:32.are a response to that we have talked about the five-year forward

:04:33. > :04:39.view and I accept we are two years into that that we know that the

:04:40. > :04:42.health system must tilt back towards community health and the STP is part

:04:43. > :04:46.of making that happen. We need to get better and we are so far in

:04:47. > :04:51.terms of mental health and some of the points made in terms of parity

:04:52. > :04:55.of esteem are correct. I will give way. I think the SDP approach is

:04:56. > :05:00.capable of being a very good approach but the point is when I go

:05:01. > :05:05.to the chief executive of a teaching Hospital in Sheffield he tells me

:05:06. > :05:08.that the process of transferring resources to the community won't

:05:09. > :05:17.work unless there is some transitional upfront funding for the

:05:18. > :05:20.whole can't stop what you are doing in the hospital to actually

:05:21. > :05:26.transferring to the community. He is right about that and those STPs in

:05:27. > :05:30.March April decide which STPs are high priority and will be invested

:05:31. > :05:34.in and taken forward at speed. We heard the phrase earlier this

:05:35. > :05:38.evening about accountable care organisations. It is the intention

:05:39. > :05:43.of the government to make those high performing STPs, and it won't be all

:05:44. > :05:47.of them because the standards are variable, they are locally driven,

:05:48. > :05:51.and those high performing STPs that we go forward with will become in

:05:52. > :05:57.time accountable care organisations. A part of it, and the Shadow

:05:58. > :06:02.minister asked me to talk about social care, and I will talk about

:06:03. > :06:07.social care. During the course of this parliament funding for social

:06:08. > :06:15.care, accessible, is up by 6%. It did reduce in real terms, it did

:06:16. > :06:23.reduce in the last Parliament. Where we are now if the last year 42% of

:06:24. > :06:24.councils increased their social care budgets in real terms. 42% of

:06:25. > :06:43.councils. In December ?900 million was taken

:06:44. > :06:51.forward in terms of the new homes bonus and a precept, no, I won't

:06:52. > :06:57.give way. I won't give way. Minister,. Minister, Mr Speaker, the

:06:58. > :07:01.truth of the matter is that the Kerouac was brought in by this

:07:02. > :07:05.government and it has transformed a social care. We accept, however,

:07:06. > :07:09.that the system is under pressure and what is also not wrong to say is

:07:10. > :07:13.that the delayed cancers -- transfers of care in Newcastle, St

:07:14. > :07:25.Helens, Bedford and Nottingham, are zero. The chairman of the PAC made

:07:26. > :07:30.the point earlier, said that she was told by Simon Stephens that if the

:07:31. > :07:33.top performing councils were, in terms of the delayed transfers of

:07:34. > :07:37.care, where emulated by all the rest, the consequence of that would

:07:38. > :07:41.be very little. The truth of the matter is that there is a 30 times

:07:42. > :07:46.difference between the top 10% councils and the bottom 10%

:07:47. > :07:49.councils, in terms of that. I have given way to twice already Mr

:07:50. > :07:54.Speaker and I need to finish in two minutes. I want to finish by saying

:07:55. > :08:00.there are issues and challenges in both care and social care under

:08:01. > :08:03.pressure. We accept that but we also know that we will need to make

:08:04. > :08:08.progress in terms of mental health, and we are doing so. The parity of

:08:09. > :08:13.esteem, we are going to have 5000 more doctors in general practice by

:08:14. > :08:17.2020, 2000 pharmacists, and we've talked about pharmacy and the need

:08:18. > :08:23.for that, and are visited upon the cysts practice in Perivale on Friday

:08:24. > :08:28.and we can transform how GP practices work with and there will

:08:29. > :08:32.be 3500 mental health therapist as well. Almost 3 million people Mr

:08:33. > :08:37.Speaker work in the health care sector between the NHS and care,

:08:38. > :08:43.many of those are remarkable people, frankly, doing remarkable things.

:08:44. > :08:48.They deserve our support. It is very important that we don't weaponised

:08:49. > :08:51.this entire discussion. It is very important, Mr Speaker, that we don't

:08:52. > :08:56.produce election leaflets talking about dead babies and all that that

:08:57. > :09:03.means. What I would like to finish by saying is that we would commend

:09:04. > :09:08.these estimates to the house. This health care system and the NHS

:09:09. > :09:13.deserve our support and this government is committed to ensuring

:09:14. > :09:16.that happens. To conclude, Meg Hillier. In my cry was going to rise

:09:17. > :09:20.and say it had been a good-natured and thoughtful debate and it is only

:09:21. > :09:27.a shame that such a usually thoughtful minister has resorted to

:09:28. > :09:32.the means of seemingly to blame NHS England for the situation. I think

:09:33. > :09:35.it is important to be clear about the budget situation. NHS England

:09:36. > :09:39.asked for a certain amount of money and the government has stretched

:09:40. > :09:42.that over another year so the money for five years has gone over six and

:09:43. > :09:46.it is important to get that on the record. It has been clearly laid out

:09:47. > :09:49.by members across the house of all parties that there are long-term

:09:50. > :09:53.financial challenges to our health system and we need to have a

:09:54. > :10:02.long-term national debate about how we fund a NHS fit for the 21st

:10:03. > :10:07.century. I want to finish on the estimate for today. Last year we saw

:10:08. > :10:10.that the accounts, through a series of one-off extraordinary measures,

:10:11. > :10:16.just about got to balance but we have raised concerns across the

:10:17. > :10:18.house today about this movement of capital to the expenditure,

:10:19. > :10:22.departmental expenditure limit from the capital to the resource side of

:10:23. > :10:24.the budget and this is going to be projected on the supplementary

:10:25. > :10:31.estimate that is in front of the house to increase to ?1.2 billion

:10:32. > :10:35.and it is an awful lot of money that is being taken out of the long-term

:10:36. > :10:38.future of the NHS to pay for day-to-day problems. It is not

:10:39. > :10:41.sustainable and it is a great shame that the minister did not address

:10:42. > :10:46.that and I hope the government looks at that is one symptom of the

:10:47. > :10:50.long-term challenges of funding. It is a sticking plaster, it will not

:10:51. > :10:53.solve the issue. I hope that we can move forward on a cross-party basis,

:10:54. > :11:00.despite the Minister 's final comments. Order! Order!. The

:11:01. > :11:05.question necessary to do dispose of a motion stands over until 7am

:11:06. > :11:10.tomorrow, understanding order number 50. Would come to a motion number

:11:11. > :11:21.two, on competition. As many as are of that opinion say aye, on the

:11:22. > :11:26.contrary, no. The ayes have it. As many as are of that opinion say aye,

:11:27. > :11:34.on the contrary, no. The ayes have it, the ayes have it. Motion number

:11:35. > :11:38.four on equality. I beg to move. As many as are of that opinion say aye,

:11:39. > :11:41.on the contrary, no. . The ayes have it. Motion number five on local

:11:42. > :11:46.government. The question, As many as are of that opinion say aye, on the

:11:47. > :11:51.contrary, no.. The ayes have it, the ayes have it. Order. We come out of

:11:52. > :11:54.the adjournment. I beg to move that is housed two now adjourned. Two the

:11:55. > :11:59.question is that this has do now adjourn.

:12:00. > :12:11.It is appropriate on this day that we have a debate on mining and

:12:12. > :12:16.miners' welfare, health and safety and the issues around the mine in my

:12:17. > :12:27.constituency. A constituency which has a proud heritage, in East

:12:28. > :12:35.Cleveland. Around the iron stone mines and villages around and the

:12:36. > :12:38.history of men such as John Shepherd, the first miners, the

:12:39. > :12:44.association union representative back in the 1870s, who helped

:12:45. > :12:50.establish the Labour movement in those mines, among the primitive

:12:51. > :12:54.Methodists who made up primarily the workforce there. It is appropriate

:12:55. > :12:57.for a party of miners that they be talked about on our party's

:12:58. > :13:02.birthday. I am grateful for the opportunity to

:13:03. > :13:05.debate an issue which matters to many me and my constituencies. I

:13:06. > :13:11.hope to raise the questions about the recent accidents on site, which

:13:12. > :13:16.my constituents need answers to and to highlight the challenges facing

:13:17. > :13:21.the mine. Mining has both a proud past, I believe, and also aviable

:13:22. > :13:27.future. Iron stone mining was and in other areas of the country the

:13:28. > :13:34.original economy. The booming mines of the late 19th century and early

:13:35. > :13:38.20th century brought in workers from across the country. Which we on

:13:39. > :13:43.these benches are humble representatives today. Mines closed

:13:44. > :13:48.throughout the last century due to the quality of the iron stone they

:13:49. > :13:54.were mining and imports coming in, which have less sulphur, but mining

:13:55. > :13:59.was not lost. And the pot ash mine in my constituency is still in

:14:00. > :14:02.operation. Despite the decline my constituency still currently and

:14:03. > :14:07.proudly has the highest number of miners in the United Kingdom. The

:14:08. > :14:14.Potash mine has been an important part of Cleveland since it was sunk

:14:15. > :14:19.in the 1970s by ICI. Families' destinies have been dependant, and

:14:20. > :14:24.the mine at its height employed over 1,000 in high-skilled jobs. Jobs

:14:25. > :14:30.unfortunately are too rare in the valley. Around 80% of the mines

:14:31. > :14:38.workforce living in a 12-mile radius of the site. Not only the people of

:14:39. > :14:43.East Cleveland that the site serves. Postah is used in fertilisers. The

:14:44. > :14:47.site is not without problems. I want to go into some history of safety

:14:48. > :14:52.concerns, some of which is far more recent.

:14:53. > :14:58.The mines's safety record is chequered. It is a deep mine. It is

:14:59. > :15:04.a dangerous place to work. In some places you are looking two miles

:15:05. > :15:12.under the North Sea. Temperatures of minus 50 degrees Celsius. Heavy

:15:13. > :15:22.equipment, massive vehicles. In the posash it is different than cool

:15:23. > :15:27.mining where you are -- Potash it is different than coal mining. In 2007,

:15:28. > :15:34.a worker down the mine was killed by a falling rock. In 2012, an employee

:15:35. > :15:40.suffered broken ribs and a punctured lung after a hose broke. A month

:15:41. > :15:48.later a worker was injured by falling debris. In 2014 a technician

:15:49. > :15:53.was fired after not making sure enough were trained safety workers.

:15:54. > :16:06.Worryingly he claimed at history bum this was

:16:07. > :16:13.He claimed this was accepted practise.

:16:14. > :16:20.In February 2016, a miner tragically took his own life in the mine. In

:16:21. > :16:26.April, an underground fire at the mine hospitalised seven employees.

:16:27. > :16:34.In June 2016, a worker respected by his managers was killed when the gas

:16:35. > :16:37.blew out on the site. In August, 144 redundancies were announced A

:16:38. > :16:43.contractor on site was airlifted to hospital after suffering burns from

:16:44. > :16:48.electry kugs and life-changing burns, I must add. In December, a

:16:49. > :16:52.mine tunnel flooded. Thankfully no-one was injured. Mr Speaker, the

:16:53. > :16:59.miningtry is difficult and dangerous. -- the mining industry is

:17:00. > :17:03.difficult and dangerous. This mine's record is not unblemished. The

:17:04. > :17:10.nature of this mine, second deepest in Europe, means it is a difficult

:17:11. > :17:13.place to mine and manage. Workers, ICL, their families and myself want

:17:14. > :17:18.this mine to be prosperous and succeed. I believe there are actions

:17:19. > :17:22.which must be taken on safety issues by ICL and Government in order for

:17:23. > :17:28.this to happen. One case in particular where a fire broke out

:17:29. > :17:32.underground, which I will not go into too much detail, pending legal

:17:33. > :17:36.action taking place at the moment, but men in that situation escaped

:17:37. > :17:42.with their lives due to their own actions. There was no health and

:17:43. > :17:46.safety process for that situation. Many of whom had written their wills

:17:47. > :17:50.at the time, believing they would not leave that mine. At some point

:17:51. > :17:54.in the future, Mr Speaker, I would like to go into more detail. Pending

:17:55. > :18:02.the legal implications I cannot go into the details. I would want it on

:18:03. > :18:05.the record. Workers at this mine must be ultimate I will be able to

:18:06. > :18:09.have confidence in the safety procedure in place and should have a

:18:10. > :18:13.say when they have concerned. I believe ICL should have closer

:18:14. > :18:19.working relations with the workers at the plant. I believe giving these

:18:20. > :18:23.unions input into the process will give workers a better opportunity to

:18:24. > :18:27.voice concerns they have. There are questions the Government and in

:18:28. > :18:38.particular the Health and Safety Executive must do more to answer.

:18:39. > :18:42.The Health and Safety Executive accepts that longer shift patterns

:18:43. > :18:47.increase the risk of error, accidents and injuries. I am

:18:48. > :18:50.concerned that some of the work injured in these incidents have

:18:51. > :18:54.returned to work before they have fully recovered due to the

:18:55. > :18:58.inadequate sick pay they received while off work. Thus increasing the

:18:59. > :19:01.risk of further accidents. Furthermore, the Government needs to

:19:02. > :19:09.revisit the issue of funding it gives to the Health and Safety

:19:10. > :19:13.Executive. Especially in relation to coal workplaces. If these steps are

:19:14. > :19:17.taken and safety is improved, there is more that needs to be done to

:19:18. > :19:22.ensure the future of ICL and the good jobs they provide. The main

:19:23. > :19:30.threat to the future of the mine is falling pot tash price. Potash

:19:31. > :19:36.price. ICL has taken action in response to

:19:37. > :19:41.this change in price. Slowing potash extraction and turning to a new

:19:42. > :19:46.product and minerals vital for fertilisers. ICL is competing with

:19:47. > :19:52.other producers around the world, some of which are not concerned

:19:53. > :19:57.about fair trail, Russia and Bella Russia, who have sought to undercut

:19:58. > :20:04.the world market and some who force prices down, such as China. The UK

:20:05. > :20:09.potash future will depend on our Brexit trade arrangements. While I

:20:10. > :20:15.welcome a commitment to free trade, I am concerned this Government's

:20:16. > :20:19.desire will leave our industries not exposed to free competition, which

:20:20. > :20:24.all industries understand is a reality of a globalised economy, but

:20:25. > :20:30.unfair dumping and market manipulation. We have seen the

:20:31. > :20:38.Government is unwilling to stand up to Chinaen oh steel dumping and

:20:39. > :20:42.seems to pay any prizes post Brexit. I -- any prices post Brexit. To

:20:43. > :20:49.provide ICL with a level playing field on which to compete. As well

:20:50. > :20:55.as the supply of potash and rock salt, the mine is key for several

:20:56. > :21:00.cutting-edge research projects. The mine is 1200 metres deep. It means

:21:01. > :21:05.it is among a handful of locations which offer the opportunity to

:21:06. > :21:10.conduct ultra low background and deep underground projects. This

:21:11. > :21:17.relates to radioactive substances, which as well as contributing to our

:21:18. > :21:21.position as leaders in science research, defence and environmental

:21:22. > :21:29.industries. There is the potential for it to be used for a joint

:21:30. > :21:33.American British defence, over nuclear states with proliferation,

:21:34. > :21:40.given the depth of the mine and its location to Hartlepool nuclear power

:21:41. > :21:48.station. The ICLpotash is not the only -- ICL Potash provides well

:21:49. > :21:56.paid jobs to our constituents. It has challenges, mainly on safety.

:21:57. > :21:59.Further action is demanded by ICL to ensure everything is being done to

:22:00. > :22:07.keep the people of East Cleveland safe. Brexit, while the fall in the

:22:08. > :22:11.pound has no doubt helped potash exports it poses challenges, not

:22:12. > :22:13.least it has the potential to expose the mine to unfair international

:22:14. > :22:25.competition. There are opportunities too. Linking the mine's future to a

:22:26. > :22:27.plan for the agriculture ral sector. Strengthing trade post Brexit and

:22:28. > :22:33.potentially improving market conditions. I hope the Government

:22:34. > :22:35.will do everything they can to help those whose communities are so

:22:36. > :22:50.linked to the potash mine. I congratulate the honourable member

:22:51. > :22:54.for Middlesbrough South and East Cleveland for securing this debate

:22:55. > :22:58.on such an important matter and also for the work that I have read as

:22:59. > :23:04.part of my preparation for this debate that he has done over a

:23:05. > :23:13.number of years to draw attention to some of the issues that he has

:23:14. > :23:16.raised tonight. Notably the very worrying health and safety record of

:23:17. > :23:21.the mine in recent years. I will return to the issue of health

:23:22. > :23:26.and safety a little bit later. But first to say that we recognise the

:23:27. > :23:33.importance of the potash industry to his constituency and to the wider

:23:34. > :23:39.region. And it is woven into the fabric of the North-East. As the

:23:40. > :23:42.honourable gentleman stated, the mine has faced difficult market

:23:43. > :23:50.conditions in recent years. Revenues and profits in the industry have

:23:51. > :23:53.been hit by low potash prices, mainly as a result of global

:23:54. > :23:58.competition in the market. Of course, as he mentions, some of that

:23:59. > :24:05.competition has not been what we would call free and fair. According

:24:06. > :24:09.to market experts, Ibis world analysis, exports form a quarter of

:24:10. > :24:15.the industry's revenue. So UK miners are exposed to global price

:24:16. > :24:18.volatility. And the situation has been exacerbated by over supply,

:24:19. > :24:24.which is unlikely to go away in the short-term.

:24:25. > :24:29.The job losses that he mentions at the mine since 2014 would clearly

:24:30. > :24:31.have come as a major blow to the employees concerned, their families

:24:32. > :24:37.and the communities in which they live. The rapid response service has

:24:38. > :24:42.delivered a number of redundancy briefing sessions to the employees,

:24:43. > :24:47.to help get the workers back into employment as quickly as possible.

:24:48. > :24:52.In addition, the national careers service delivered support with CV

:24:53. > :24:55.writing, job searching, interviewing skills and one-to-one appointments

:24:56. > :25:00.for rapid response funding applications.

:25:01. > :25:08.However, out put from UK is expected to expand in the next five years

:25:09. > :25:15.with the production of polyhalite emerging as a key product of the UK

:25:16. > :25:23.industry. I am pleased ICL, which he mentions operates the mine is

:25:24. > :25:27.planning over the next five years to expand its output of polyhalite.

:25:28. > :25:34.Seen as a superior fertiliser and highly sought after. I understand

:25:35. > :25:40.that the mine and areas to the south have a near monopoly of this mineral

:25:41. > :25:47.resource. I hope very much that will be of great advantage to the area in

:25:48. > :25:54.the coming years. In fact, polyhalite is expected to

:25:55. > :25:58.overtake potash after 2018. I hope this long-term commitment by ICL

:25:59. > :26:03.will result in a brighter long-term future for the mine and its

:26:04. > :26:10.employees. Yes, I will give way. On that point, she's correct that

:26:11. > :26:19.the market, the industry is looking towards polyhalite to overtake

:26:20. > :26:23.potasl. It is -- potash. It is a hard material to mine. It needs the

:26:24. > :26:28.extra help in marketing the product, as the industry adaptds to it. Has

:26:29. > :26:33.the minister taken on my comments into how it can be an industrial

:26:34. > :26:38.product to the world's agricultural producers?

:26:39. > :26:46.I certainly have taken that point on board and I appreciate that poly

:26:47. > :26:52.halide is only mined from a layer of rock over 1000 metres below the

:26:53. > :26:58.North Sea. Below the potash seem at the Baulby mine, making it very much

:26:59. > :27:03.more difficult to access, and I would welcome the industry 's

:27:04. > :27:06.contribution to discussions as to how the industrial strategy that we

:27:07. > :27:15.are developing with the north-east in mind could benefit that emerging

:27:16. > :27:18.sector. It's challenging sector and very much deserving of our attention

:27:19. > :27:33.as we rolled out the industrial strategy. If I may come on to talk a

:27:34. > :27:38.little bit about, just being selective here, I have quite a bit

:27:39. > :27:43.of information. I think I will come to the health and safety concerns

:27:44. > :27:48.now. I was very shocked at what I read, and I have spoken to the

:27:49. > :27:52.Health and Safety Executive, and we have a representative here among the

:27:53. > :27:56.officials in the box receiver who has travelled down from Bootle for

:27:57. > :28:00.this debate. The government takes health and safety at work very

:28:01. > :28:04.seriously and fully supports the Health and Safety Executive in its

:28:05. > :28:10.efforts to ensure that Great Britain remains one of the safest places to

:28:11. > :28:15.work in the world. There have been six significant incidents at the

:28:16. > :28:18.mine in the last two years, although hearing what the honourable

:28:19. > :28:24.gentleman says, if you go back a little further it is a longer record

:28:25. > :28:29.of safety concerns, resulting in the fatality that he mentioned, three

:28:30. > :28:33.serious injuries, and 14 workers being placed on potentially

:28:34. > :28:39.life-threatening situations. The Health and Safety Executive have

:28:40. > :28:43.found inadequate risk assessments, poor procedures, and the failure to

:28:44. > :28:49.implement procedures designed to tackle the root causes of the

:28:50. > :28:54.problems. I would like to take this opportunity to express my heartfelt

:28:55. > :28:59.condolences to the family of Mr John Anderson who was tragically killed

:29:00. > :29:03.while working at the mine on June 17 last year, and indeed to the other

:29:04. > :29:09.workers who have been injured or distressed as a result of accidents

:29:10. > :29:15.or incidents at this mine in recent years. All these incidents have

:29:16. > :29:23.been, some are still being, thoroughly investigated by the

:29:24. > :29:29.Health and Safety Executive minds has met. And calling on additional

:29:30. > :29:33.specialist input such as human factors where necessary. I should

:29:34. > :29:40.like to assure them that the appropriate action either has been

:29:41. > :29:43.taken or will be taken and should HSC 's current investigations

:29:44. > :29:49.provide evidence of management actions forming -- falling short of

:29:50. > :29:55.legally required standards HSC will not hesitate to prosecute ICL.

:29:56. > :29:58.Indeed I believe that HSC are preparing to launch prosecutions

:29:59. > :30:07.relating to the trapping incidents in April 2015, as one example. HSC

:30:08. > :30:10.and the industry will continue to work together to improve safety

:30:11. > :30:15.performance and the honourable gentleman mentioned the role of

:30:16. > :30:20.trade unions and I understand that they have been very constructive and

:30:21. > :30:25.very dedicated to improving the safety standards and they will be a

:30:26. > :30:30.vital partner in that process. I give way to the honourable

:30:31. > :30:34.gentleman. Rightfully she talks back cases in which we cannot really go

:30:35. > :30:37.into detail because they must be taken through official legal

:30:38. > :30:41.channels and dealt with them in that matter before we can deal with in

:30:42. > :30:48.that way. But my main concern is that there were minors involved in

:30:49. > :30:56.the cases who, pending legal action, the period of time for sick pay ran

:30:57. > :31:03.out and felt forced to go back to work in order to have income. My

:31:04. > :31:08.worry was that some of those miners may have been in states of Post

:31:09. > :31:10.traumatic stress, placing other workers at work in potential

:31:11. > :31:15.jeopardy as well because they had to go back as the breadwinners for

:31:16. > :31:18.their families. Whether the government can review that

:31:19. > :31:23.legislation, in order to make sure that pending legal action in those

:31:24. > :31:28.kind of workplaces aren't those kind of workers can seek sick pay for an

:31:29. > :31:31.elongated period of time. The honourable gentleman makes a very

:31:32. > :31:37.reasonable request. I cannot give him a direct answer from the

:31:38. > :31:44.dispatch box, but I am certainly prepared to take his request back to

:31:45. > :31:48.the Department and ask officials to review the matter, and I will write

:31:49. > :31:58.to him with any progress I am able to make. On that issue. It does seem

:31:59. > :32:03.to be that he describes a situation in which a bad situation is made

:32:04. > :32:10.worse and potentially putting others at risk and it does seem to be

:32:11. > :32:16.something that we ought to review and I will write to him health and

:32:17. > :32:20.safety law covering underground mining was brought up to date with

:32:21. > :32:25.the minds regulation act 2014 and all of the previous relevant to

:32:26. > :32:29.your, some of it 60 years old, drawing from even earlier

:32:30. > :32:33.requirements was modernised and request without producing any

:32:34. > :32:37.necessary protections which was no small task, and it would not have

:32:38. > :32:41.happened without the cooperation of the industry and, as I mentioned

:32:42. > :32:44.just now, the unions recommending the workers in Baulby. The law is

:32:45. > :32:48.now more straightforward and together with the associated

:32:49. > :32:53.guidance, which was also modernised, duty holders should be aware and

:32:54. > :32:59.understand what is expected of them when it comes to operating a safe

:33:00. > :33:04.mine. The new law places clear duties on mine operators to ensure

:33:05. > :33:08.sufficient and effective systems for the management and control of risks

:33:09. > :33:15.are both in place and being followed. We now have a single set

:33:16. > :33:20.of regulations covering the major hazards associated with underground

:33:21. > :33:24.mining, including ground control, shafts, winding equipment and

:33:25. > :33:29.operations, in rashes and fire and explosion, as well as effective

:33:30. > :33:34.arrangements for escape and rescue if controls fail. These hazards are

:33:35. > :33:41.far from new but they are well understood by the underground mining

:33:42. > :33:44.industry and as such I find it unacceptable that some of these

:33:45. > :33:51.standards have not been applied in a consistent manner in the management

:33:52. > :33:57.of this Baulby mine. The government and HSE will work together to ensure

:33:58. > :34:02.that duty holders recognise their potential for causing major harm,

:34:03. > :34:08.and control those associated risks. The honourable gentleman mentioned

:34:09. > :34:18.the fire underground and I understand that improvement notices

:34:19. > :34:22.were served on this EPL, and improvements to underground safe

:34:23. > :34:28.havens and improved communications facilities and water availability

:34:29. > :34:32.have now been put in place. HSC has an intervention plan for every

:34:33. > :34:38.underground mining Great Britain and this reflects the specific inherent

:34:39. > :34:44.hazards, and the mine 's previous health and safety performance, and

:34:45. > :34:48.the ball be plans for 2016/17, and for 20 17th/ 18th reflect the

:34:49. > :34:55.outcomes of the investigations associated with the recent incidents

:34:56. > :34:58.and HSE inspectors will base their interventions and oversight of the

:34:59. > :35:02.mind health and save to performance on these plans, which I know that

:35:03. > :35:13.the honourable gentleman has discussed with HSC. I think I have

:35:14. > :35:16.probably said all that I can say on the health and safe to aspects of

:35:17. > :35:24.running this mine. As I told the honourable gentleman I have talked

:35:25. > :35:29.to HSE about the issues that he has raised and also about my concerns

:35:30. > :35:35.when I read the individual case notes of some of the people who have

:35:36. > :35:42.had terrible injuries and been in fear of their lives, and it was

:35:43. > :35:48.clear to me from reading these notes that several of the incidents could

:35:49. > :35:53.have been possibly avoided, certainly could have been reduced in

:35:54. > :36:00.their effect had proper and robust safety procedures been observed and

:36:01. > :36:06.planned for and implemented at all times. And I was encouraged by the

:36:07. > :36:12.response that I received from HSE with regard to new management at the

:36:13. > :36:17.mine, with a far more robust outlook, and, indeed, informed by

:36:18. > :36:24.HSE by the trade unions and by the honourable gentleman himself, I

:36:25. > :36:27.think we can be optimistic that the future of Baulby mine, both

:36:28. > :36:33.economically, but even more importantly on a safety perspective

:36:34. > :36:40.will be brighter and I think we have got to get all of that absolutely

:36:41. > :36:45.right for the even more risky accessing of the new mineral

:36:46. > :36:53.resource, which has so much to offer his constituents and the mining

:36:54. > :37:02.community that is so important to his part of the world. Order. The

:37:03. > :37:05.question is that this house do now adjourned. As many as are of that

:37:06. > :37:12.opinion say aye, on the contrary, no.. The ayes have it, the ayes have

:37:13. > :37:36.it. Order! Order!. Subtitles will resume at 11.00pm

:37:37. > :37:47.with Monday In Parliament.