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health. I beg to move. The question is, as on the order paper. I call | :00:00. | :00:00. | |
the children of the health select committee. Thank you. Today's debate | :00:00. | :00:11. | |
on the supplementary Estimates and the financial position of health and | :00:12. | :00:14. | |
social care matters first and foremost because of the impact of | :00:15. | :00:18. | |
that financial position on patient care. I would like to start by | :00:19. | :00:23. | |
playing tribute to our health and care staff across the country and at | :00:24. | :00:27. | |
this particular time to note and thank those have who work in this | :00:28. | :00:35. | |
country from across the EU. The financial position is a great | :00:36. | :00:39. | |
concern. As a result of the wider academic downturn we're now in a 70 | :00:40. | :00:43. | |
of the longest financial squeeze in the history of the NHS. Although the | :00:44. | :00:48. | |
Department of Health budget has of course been protected in relation to | :00:49. | :00:53. | |
many others, we cannot escape from the fact that over the last | :00:54. | :00:56. | |
parliament the average annual increase was 1.1%, far lower than | :00:57. | :01:03. | |
the increase in demand, and of course far lower than the historic | :01:04. | :01:09. | |
increase since the late 1970s of 3.8%. All of that is also in the | :01:10. | :01:15. | |
context of an extremely challenging position for social care. What we've | :01:16. | :01:21. | |
seen is a 10% real terms reduction in social care spending by local | :01:22. | :01:29. | |
authorities between 2009 to ten and 2014 to 15. All of this in the face | :01:30. | :01:32. | |
of an extraordinary increase in demand. Not only from a rising | :01:33. | :01:37. | |
population but because of our changing demographics. Just to put | :01:38. | :01:41. | |
this in context, over the decade 2015, there was a 31% increase in | :01:42. | :01:51. | |
people living to 85 and beyond. We estimate of the next 20 years we | :01:52. | :01:56. | |
will see a 60% increase in the number of individuals who rely on | :01:57. | :02:01. | |
social care. There has been an abject failure of governments over | :02:02. | :02:09. | |
the years to plan for this. This was entirely predictable. But we | :02:10. | :02:14. | |
absolutely can't keep ducking this question. Not only do we need to | :02:15. | :02:18. | |
address the immediate financial problems they've think health and | :02:19. | :02:22. | |
social care, we absolutely have to come together as a house to address | :02:23. | :02:27. | |
the problems for the future. Of course. I am grateful for you giving | :02:28. | :02:33. | |
way. It is not a uniquely British problem but also a global problem. | :02:34. | :02:36. | |
One of the things I've been trying to find out is where best is social | :02:37. | :02:39. | |
care delivered in the rest of the world and can we learn anything from | :02:40. | :02:45. | |
those countries. My honourable friend makes a very important point. | :02:46. | :02:49. | |
We are all looking forward to the publication of the House of Lords | :02:50. | :02:52. | |
report on the future sustainability because of course we have much to | :02:53. | :02:58. | |
learn from other systems. However, I would say, in welcoming that point | :02:59. | :03:05. | |
but also paid tribute to the Public Accounts Committee which publishes | :03:06. | :03:07. | |
today their report on the financial sustainability of NHS. We have also | :03:08. | :03:13. | |
seen the final position of trust is at the end of the last quarter, and | :03:14. | :03:17. | |
we know that 135 providers ended that quarter in deficit. We are on | :03:18. | :03:25. | |
course, just finish this then give way, we are on course for a | :03:26. | :03:32. | |
financial deficit of between ?750 million and 850 million in trusts. I | :03:33. | :03:38. | |
give way. I'm grateful forgiving way. In terms of the seriousness of | :03:39. | :03:42. | |
what we're talking about, she will know that over the past five we had | :03:43. | :03:46. | |
a down weight trend of falling death rates. New research shows that after | :03:47. | :03:52. | |
2011 that reverses and more people died in 2015 and 2014. With these | :03:53. | :03:59. | |
tests are coring in the context of a massive disinvestment in health and | :04:00. | :04:03. | |
social care, would you agree these cuts are likely to have been | :04:04. | :04:07. | |
implicated in that otherwise unprecedented rate in deaths? I have | :04:08. | :04:12. | |
seen the study to which you refer and I think it is something the | :04:13. | :04:15. | |
Department of Health needs to look at carefully. I give way to the | :04:16. | :04:19. | |
honourable gentleman. If you look at it in general terms, for example, | :04:20. | :04:26. | |
you have a situation where you have bed walking, the local authority | :04:27. | :04:28. | |
cannot deal with that because it does not have the order authorities. | :04:29. | :04:35. | |
If you look at worst to the National horrors of the whole have to find | :04:36. | :04:41. | |
cuts of 250 billion and creates an insoluble problem if we are not | :04:42. | :04:45. | |
careful. Thank you viewpoint. I think we should use the term delayed | :04:46. | :04:50. | |
discharges rather than bed blocking, because that term can leave older | :04:51. | :04:55. | |
people in that position feeling somehow as if they are to blame. But | :04:56. | :04:59. | |
I take the point that he is seeking to make. The estimates memorandum | :05:00. | :05:08. | |
before us today seeks a ?1.2 billion transfer to trap pop-up revenue from | :05:09. | :05:12. | |
the capital departmental expenditure limit. It also seeks a 23 million | :05:13. | :05:20. | |
transfer from domestic's Treasury reserve and ?58.5 million transfer | :05:21. | :05:24. | |
from other Government departments and ?6 million transfer to the | :05:25. | :05:28. | |
capital from other departments. I'm afraid again we are seeing an | :05:29. | :05:32. | |
unsustainable position here. That has been pointed out by the | :05:33. | :05:38. | |
controller general. I am following closely as ever, wise remarks. Does | :05:39. | :05:44. | |
she share my concern that if we are transferring money from capital to | :05:45. | :05:49. | |
revenue it means the sustainability and transformation plans, most of | :05:50. | :05:53. | |
which imply a certain level of capital investment to save revenue | :05:54. | :05:57. | |
long-term, will not be possible? I absolutely agree with my honourable | :05:58. | :06:02. | |
friend and I myself will be drawing on that later on. The point about | :06:03. | :06:07. | |
the rates to capital budgets over the years is that this is the third | :06:08. | :06:12. | |
year in which this has happened, that we have seen transfers from | :06:13. | :06:18. | |
capital to resource budgets, -- revenue budgets, we're talking about | :06:19. | :06:21. | |
keeping facilities up-to-date, essential repairs, rolling out new | :06:22. | :06:24. | |
technologies and putting off those and investments actually means they | :06:25. | :06:30. | |
cost more down the line. This is a false economy and simply an | :06:31. | :06:34. | |
unsustainable ongoing mechanism. I know the Department of Health has | :06:35. | :06:36. | |
indicated they would like see an end to this by 2020, but both the Public | :06:37. | :06:43. | |
Accounts Committee and the health committee have called on this to | :06:44. | :06:45. | |
stop immediately because we feel this is a false economy. As my | :06:46. | :06:52. | |
honourable friends pointed out, it is not only grades to capital | :06:53. | :06:58. | |
budgets but raids to across the sustainability and trust translation | :06:59. | :07:00. | |
fund. What we're seeing increasingly is that becoming all about propping | :07:01. | :07:06. | |
up the sustainability rather than putting in place essential | :07:07. | :07:10. | |
transformation. I give way. Thank you. She is making some excellent | :07:11. | :07:20. | |
points. In west Yorkshire the sustainability and transmission plan | :07:21. | :07:24. | |
plans to take about ?1.1 billion out of our health system over the next | :07:25. | :07:30. | |
four years. ?700 million from the NHS and ?400 million from social | :07:31. | :07:34. | |
care services. As a result, centres like Hill Street health centre are | :07:35. | :07:40. | |
set to close putting more pressure on overpriced accident and emergency | :07:41. | :07:46. | |
departments. Does she agree with me that this type of pressure coming in | :07:47. | :07:52. | |
and forcing even more pressure is on AMD departments gives the word | :07:53. | :07:55. | |
sustainability and transformation a bad name? I agree with the | :07:56. | :08:03. | |
honourable lady, absolutely. It is undermining public confidence in | :08:04. | :08:05. | |
sustainability and transformation. I will come to that in more detail | :08:06. | :08:10. | |
later. The financial position is starting to create a perfect storm | :08:11. | :08:14. | |
of delayed discharges, rising waiting times in accident and | :08:15. | :08:18. | |
emergency, rising so-called trolley waits the patients as they are | :08:19. | :08:22. | |
waiting to be transferred to the wards, and that has quite serious | :08:23. | :08:24. | |
implications for their safety within those departments. Unsustainable | :08:25. | :08:33. | |
levels of bed occupancy. We are increasingly hearing stories of not | :08:34. | :08:36. | |
only routine surgery but being cancelled but also of urgent surgery | :08:37. | :08:41. | |
and very worryingly to cases of urgent dialogical procedures | :08:42. | :08:47. | |
actually not taking place, and that resulting in the deaths of two | :08:48. | :08:51. | |
patients. This is extremely serious. I give way. Does she also agree that | :08:52. | :08:58. | |
when we look at to beating my via councils on the formulaic, we can't | :08:59. | :09:03. | |
just look at deprivation which tends to be highly weighted and is | :09:04. | :09:10. | |
important, in a more affluent area we have the problem of people living | :09:11. | :09:14. | |
longer and there being more demand for service because of that? My | :09:15. | :09:19. | |
friend makes an important point. It's not just about the overall | :09:20. | :09:23. | |
budget but also about distribution. And yes across this house we would | :09:24. | :09:27. | |
all agree that deprivation must be properly weighted. He is right that | :09:28. | :09:34. | |
one of the key drivers is actually the age and the need for services, | :09:35. | :09:39. | |
and it probably isn't adequately reflected in the way resources are | :09:40. | :09:44. | |
distributed. As I say, there is undoubted evidence of the impact on | :09:45. | :09:49. | |
the financial position now on patient care, and unfortunately, as | :09:50. | :09:54. | |
we see this whorl of hospitals having to cancel routine procedures, | :09:55. | :10:00. | |
that has a further impact on their ability to meet their financial | :10:01. | :10:03. | |
targets because of the reduction in cat in income. I hope ministers will | :10:04. | :10:09. | |
look at this not only as a short-term issue but all more | :10:10. | :10:14. | |
importantly to take a look at how we are going to sustainably farmed this | :10:15. | :10:18. | |
in the future. And also not also just to look at health and social | :10:19. | :10:22. | |
care in their separate silos, but to see them as a single system and | :10:23. | :10:27. | |
genuinely to look at how we are going to look at how we're going to | :10:28. | :10:32. | |
take this forward. I'm afraid if we don't address this problem we need | :10:33. | :10:35. | |
to be honest with our constituents about the consequences. People talk | :10:36. | :10:41. | |
about a collapse in the NHS, I don't believe that will happen. But what | :10:42. | :10:46. | |
we will see is a continuing deterioration in performance, with a | :10:47. | :10:50. | |
real impact on the quality of care, and putting lives at risk. And the | :10:51. | :10:54. | |
safety the Department of Health has proved prioritised is increasingly | :10:55. | :11:00. | |
in danger of slipping. It is essential to our patients. A number | :11:01. | :11:06. | |
of members have commented on sustainability and transmission | :11:07. | :11:10. | |
plans. In principle I think these are extremely important. Not only as | :11:11. | :11:13. | |
a way of acting as a road back for the five-year forward view, but as | :11:14. | :11:18. | |
asked being able to return to a much more logical way of planning for | :11:19. | :11:25. | |
integrated health and care, getting away from endless contracting rounds | :11:26. | :11:26. | |
to genuine planning. But Ford has undermined this is | :11:27. | :11:40. | |
inadequate planning. And crucially, inadequate funding. If we do not | :11:41. | :11:46. | |
have adequate funding for the transformation of services, we will | :11:47. | :11:51. | |
see these plans feel. They are being seen as a vehicle for cups, rather | :11:52. | :11:56. | |
than a vehicle for what they should be seen as. We have a genuine | :11:57. | :12:02. | |
opportunity to see this as a transformative process, but they are | :12:03. | :12:06. | |
being undermined by a number of critical points. Would my honourable | :12:07. | :12:18. | |
friend agree that what is missing is the bit that enables us to get the | :12:19. | :12:23. | |
money to move to the new system. There is no money for the | :12:24. | :12:31. | |
transition. I agree. She will know that we have seen not only cuts and | :12:32. | :12:40. | |
the closure of much loved community hospitals, but not only the loss of | :12:41. | :12:44. | |
these beds, but the local trust wanting to cut 32 acute beds at a | :12:45. | :12:54. | |
time when the occupancy is already running up to 94%. Communities can | :12:55. | :13:00. | |
genuinely see the changing this undermines this. They are planning | :13:01. | :13:07. | |
for port 40 man, rather than actual demand. I thank the honourable lady | :13:08. | :13:16. | |
for her point. I thank her to for her listening to me when I have | :13:17. | :13:23. | |
brought forward problems and talked me through the options. We need to | :13:24. | :13:32. | |
enable people to fully engage and have trust in the trusts involved. | :13:33. | :13:39. | |
She is right. It is not just the evidence available to others. It is | :13:40. | :13:44. | |
the evidence available to the communities and the idea that | :13:45. | :13:47. | |
consultation is a genuine process. We know, time and again, we have | :13:48. | :13:56. | |
reports which demonstrate that co-producing new services results in | :13:57. | :14:04. | |
much better service in the long run. It is not only the cups to trusts | :14:05. | :14:17. | |
themselves, but to CCGs. They are being asked to hold back ?800 | :14:18. | :14:23. | |
million of the budget to offset deficits in trusts. This is about | :14:24. | :14:31. | |
patient care being cut back. We have seen cuts to NHS England and to | :14:32. | :14:40. | |
education in England. To have the idea that we have health services on | :14:41. | :14:46. | |
a sustainable footing is simply not true. I asked ministers to look at | :14:47. | :14:51. | |
this transformation and ask the Chancellor in the forthcoming budget | :14:52. | :14:58. | |
to address this urgently and give a lifeline to social care. As well as | :14:59. | :15:09. | |
announcing that lifeline, of which I hope he will give the better tear | :15:10. | :15:20. | |
fund more money, care cash fund, but I hope we will have a review of | :15:21. | :15:25. | |
sustainable future funding for health and social care. Rather than | :15:26. | :15:34. | |
as having this normal Contra confrontational debate, we want this | :15:35. | :15:42. | |
to all work together for the benefit of our constituents to have a | :15:43. | :15:50. | |
sustainable future for the NHS in social Kier. Care --. Could I pay | :15:51. | :16:01. | |
tribute to the cheer of the health committee for her work. If the | :16:02. | :16:09. | |
committees are united in our view that we need a new agenda for health | :16:10. | :16:21. | |
and social care and that it is at the forefront of government | :16:22. | :16:25. | |
thinking. It is unusual for three committees to agree so much. We are | :16:26. | :16:39. | |
clear that integration of health and social care is necessary. We were | :16:40. | :16:48. | |
looking at the first phase of the Better Care Fund. The head of the | :16:49. | :16:55. | |
NHS England said that there was no feel you're in the Better Care Fund. | :16:56. | :17:05. | |
If that does not undermine the challenges that we have with the | :17:06. | :17:09. | |
sustainability of on-board funding, I do not know what does. We do need | :17:10. | :17:16. | |
a long-term generational shift in how we deal with this. We cannot | :17:17. | :17:24. | |
just watch from crisis to crisis. The current funding situation cannot | :17:25. | :17:29. | |
go on. We looked very closely at the accounts. We lap up the accounts of | :17:30. | :17:39. | |
different government departments. We were disappointed that the NHS | :17:40. | :17:50. | |
accounts, we realised that they were within target only by a smoke and | :17:51. | :17:59. | |
mirrors approach and short one-off measures to make sure the balanced. | :18:00. | :18:07. | |
The Public Accounts Committee, of which he is a former member, the | :18:08. | :18:14. | |
Dave the department the yellow card. The put them on warning. They said | :18:15. | :18:20. | |
that this similar one-off measures would not be accepted and they would | :18:21. | :18:26. | |
receive a red card. The issued an unprecedented warning in these | :18:27. | :18:32. | |
accounts audited by the committee, laying out serious concerns. He | :18:33. | :18:40. | |
talked to the permanent secretary at the Department of Health to view has | :18:41. | :18:44. | |
concerns about these one-off measures. We would like to know how | :18:45. | :18:49. | |
it was by some miracle the department managed to get the books | :18:50. | :18:55. | |
to balance last year. First of all, there was ?2.14 billion set aside | :18:56. | :19:01. | |
for sustainable transformation. ?1.8 billion was used for hospital trust | :19:02. | :19:09. | |
deficits. The Department of Health did not notify the Treasury of an | :19:10. | :19:15. | |
additional ?417 million of national insurance receipts they had got. | :19:16. | :19:21. | |
They said it was a one-off reporting error. It does not rear car, I am | :19:22. | :19:26. | |
heartened to see. There was a one-off super dividend of ?100 | :19:27. | :19:32. | |
million to the medical products agency, which the Department warns. | :19:33. | :19:40. | |
This helped it reach the final balance. The critical thing which is | :19:41. | :19:47. | |
becoming a long-term strategy, it appears, and I hope the Minister | :19:48. | :19:51. | |
will take this seriously and respond, we are seeing a trend of | :19:52. | :19:59. | |
capital funding pushed into revenue and the system capable in that way. | :20:00. | :20:04. | |
That is not sustainable. The Department of Health transferred | :20:05. | :20:12. | |
?915 million of capital. It shows the department will transfer about | :20:13. | :20:18. | |
?1.2 million of capital this year. More than ?250 million more than | :20:19. | :20:26. | |
last year. I will give way. I am interested in the PFI element of | :20:27. | :20:38. | |
capital funding. As our committee had a chance to look at that? We | :20:39. | :20:44. | |
have not directly, but we do know that the biggest revenue cost for a | :20:45. | :20:56. | |
hospital are stuffing. Then, it is financing a PFI deal. From | :20:57. | :21:07. | |
conversation I have had with auditors, the refinancing of these | :21:08. | :21:15. | |
deals can actually swamp the cost of potential savings. It is something | :21:16. | :21:20. | |
maybe ministers could go we look at further. There has been a lot of | :21:21. | :21:24. | |
technical work on this. If it could be spread out over a longer period | :21:25. | :21:30. | |
of time, for instance, that would reduce the day-to-day resource costs | :21:31. | :21:35. | |
for hospitals. The work I have done outside the committee rooms was | :21:36. | :21:47. | |
outside the remit of the committee. As the honourable gentleman said, if | :21:48. | :21:52. | |
we are looking at the transformation of the NHS, the sort of capital | :21:53. | :21:59. | |
expenditures are important to save money in the long. That could be | :22:00. | :22:04. | |
very short-sighted. If we look at how the trusts are managing in terms | :22:05. | :22:11. | |
of deficit, we see a trend. At the beginning of this financial year, | :22:12. | :22:14. | |
NHS England committed to us that they would produce a deficit not | :22:15. | :22:21. | |
exceeding ?580 million at the end of next month. It is now forecasting a | :22:22. | :22:31. | |
deficit of ?604 million. It is declining further to a deficit of | :22:32. | :22:37. | |
over ?800 million. That pledge does not amount to very much and it is | :22:38. | :22:41. | |
moving very much in the wrong direction. Through this financial | :22:42. | :22:48. | |
year, trusts have been overspending by about ?300 million per quarter. | :22:49. | :22:54. | |
If this continues, the overspend will be close to ?1.2 billion. Billy | :22:55. | :23:05. | |
is startling, the reality of the Department of Hill 's consolidated | :23:06. | :23:08. | |
course. I am picking a certain elements. We hear a lot of | :23:09. | :23:12. | |
discussion about how much money the government is putting into the NHS. | :23:13. | :23:20. | |
We had a committee hearing on January the love and support. On | :23:21. | :23:24. | |
that day there were anonymous briefings in the national press, | :23:25. | :23:30. | |
criticising himself and NHS England and defending himself and his | :23:31. | :23:36. | |
position in the committee. People do not want anonymous briefings. They | :23:37. | :23:43. | |
do not want to see an argument about the money. They want to know that | :23:44. | :23:47. | |
the people who are running the health service and those overseeing | :23:48. | :23:53. | |
it are actually committing to long-term patient care and the | :23:54. | :24:00. | |
long-term challenges of the future. Protecting the NHS England budget is | :24:01. | :24:03. | |
not the same as protecting the health budget. Health education is | :24:04. | :24:17. | |
being squeezed, as is NHS England. Funding has gone down 10% in the | :24:18. | :24:23. | |
last Parliament. This idea that tax precepts will make everything fine, | :24:24. | :24:27. | |
it is all money which could have gone somewhere else. It does not | :24:28. | :24:32. | |
solve this in the long-term. If we do not tackle this together, we will | :24:33. | :24:36. | |
have an unsustainable future. The is too much shifting money in the | :24:37. | :24:44. | |
budget from one place to another. It is not transparent to most people. | :24:45. | :24:54. | |
Very big numbers. I will give way. A very thoughtful speech. I want to | :24:55. | :25:02. | |
raise one point which is an issue not very often talked about, the | :25:03. | :25:09. | |
rise in physical attacks on staff within the NHS and the recognition | :25:10. | :25:16. | |
that protection in the budget deals with a lot of security issues. A lot | :25:17. | :25:23. | |
of those perpetrating those attacks are people with mental health | :25:24. | :25:29. | |
issues. We need to have the resources to deal with this. | :25:30. | :25:33. | |
Otherwise, it could be a situation which gets worse. It is important | :25:34. | :25:43. | |
that we protect staff. In the end, staff cost more than anything in the | :25:44. | :25:53. | |
NHS, but it is them who provide that care. I will touch on workforce | :25:54. | :25:57. | |
planning in a moment. I will give way for no. Some of those people who | :25:58. | :26:09. | |
have mental health problems, the Arab going to the A departments | :26:10. | :26:21. | |
and their views and problems are not being listened to. I get a lot of | :26:22. | :26:22. | |
that. And this a long-term system. In that | :26:23. | :26:36. | |
the support is the to stop the book going to any in the first place. I | :26:37. | :26:41. | |
will give way. Thank you for giving way. And thank you for the excellent | :26:42. | :26:45. | |
speech you are giving. I am really disturbed also when I hear from | :26:46. | :26:48. | |
Government about more money being put into mental health when just | :26:49. | :26:55. | |
received figures around Vale of York funding which will be cut, in a city | :26:56. | :27:01. | |
which has reeled challenges around mental health we are seeing the | :27:02. | :27:05. | |
budget drop, showing that services themselves are not catching up with | :27:06. | :27:08. | |
what the Government is insisting is trickling down into the system. The | :27:09. | :27:15. | |
honourable lady raises one of the real, puts a face on the real | :27:16. | :27:19. | |
challenge that many trusts and Commissioners are facing. They are | :27:20. | :27:22. | |
having to make choices about where they spend money and despite the | :27:23. | :27:34. | |
pledges, there is a squeeze on mental health funding. Growing | :27:35. | :27:37. | |
demand is outstripping the ability of the NHS to supply needs. This is | :27:38. | :27:42. | |
having a direct impact on patients. We're now seeing longer waiting | :27:43. | :27:45. | |
times for and I alert colleagues to our hearing on GP services in the | :27:46. | :27:51. | |
Public Accounts Committee. Any thoughts are welcome. They are | :27:52. | :27:55. | |
waiting longer to see specialists with the 16 week target being | :27:56. | :28:01. | |
reached and AMD targets are breached too often. We are seeing a real | :28:02. | :28:07. | |
challenge and NHS Improvement is a welcome body set up to encourage | :28:08. | :28:16. | |
best practice, and it is quite right that the NHS looks to perform as | :28:17. | :28:19. | |
efficiently as possible. But once again we are seeing improvements | :28:20. | :28:25. | |
mask what look like cuts. A 4% efficiency saving target is once | :28:26. | :28:37. | |
again being imposed, it was imposed last year by the then Chancellor of | :28:38. | :28:46. | |
the X. And it was acknowledged as particularly challenging. The | :28:47. | :28:51. | |
reality was everyone in this situation knew it was too | :28:52. | :28:57. | |
challenging but it was difficult for people to speak truth to power. We | :28:58. | :29:01. | |
see this over and over again. The head of NHS improvement was once at | :29:02. | :29:06. | |
that again acknowledged in our report that the 4% efficiency saving | :29:07. | :29:10. | |
required as part of the transformation programme are | :29:11. | :29:15. | |
challenging. We also see a worrying and real correlation between the | :29:16. | :29:21. | |
financial performance of trusts and their care emission quality rating. | :29:22. | :29:33. | |
Trusts that achieve lower quality rating had lower financial | :29:34. | :29:43. | |
performance. They had a net... We know that there is a real issue. I | :29:44. | :29:49. | |
want to touch on workforce planning before I draw to a close. We hear a | :29:50. | :29:55. | |
lot about the cost of locums. Very often I worry that in terms of some | :29:56. | :30:00. | |
of the national debate we end up fixating on smaller issues when we | :30:01. | :30:02. | |
need to look at the bigger picture. The cost of locums, we often hear | :30:03. | :30:11. | |
about high rates per hour or day. If someone is being paid several | :30:12. | :30:15. | |
thousand pounds a day for a shift that seems ludicrous. But the key | :30:16. | :30:20. | |
issue here is the sheer volume of locums needed. What happens eg is | :30:21. | :30:25. | |
the trust structures are set to meet the budget sent down to them by the | :30:26. | :30:31. | |
Department of Health. Tax money but not another. From the beginning they | :30:32. | :30:34. | |
are not set up well enough to meet demand. In order to meet the needs | :30:35. | :30:37. | |
of their population they have to buy in locums. This is not long-term | :30:38. | :30:41. | |
sustainable. We also see challenges in the middle of the last | :30:42. | :30:46. | |
parliament, a reduction in nursing places, we seen recently the loss of | :30:47. | :30:51. | |
the nursing bursary and we hope that does not see a writ loss of nurses | :30:52. | :30:57. | |
in the future. But in my own constituency I know how many women, | :30:58. | :31:05. | |
people, welcome that ability to better themselves and contribute. We | :31:06. | :31:13. | |
need figures for hammy people are going into nursing and whether the | :31:14. | :31:19. | |
people going into it will stay and work in our NHS. In Northumbria | :31:20. | :31:27. | |
foundation trust my local hospital trust, we have taken to training our | :31:28. | :31:31. | |
own nurses so that local people who want to germ the profession can. | :31:32. | :31:35. | |
Knowing they can work in that local trust which has such a great | :31:36. | :31:39. | |
reputation and is leading the way in terms of financial and medical | :31:40. | :31:43. | |
changes we need to see. I agree. My own hospital does the same in health | :31:44. | :31:49. | |
care assistants. The challenge is without that bursary payment, how | :31:50. | :31:53. | |
many people will it put off. We did clear answer from the Minister about | :31:54. | :31:56. | |
what analysis was done about the impact on the workforce of that | :31:57. | :32:01. | |
change. That amount of money is relatively small compared with the | :32:02. | :32:04. | |
challenges and problems of not being able to provide a health service if | :32:05. | :32:06. | |
we don't have enough nurses in place it may well be a false economy. I | :32:07. | :32:19. | |
will give way. I thank you for giving way. The early figures that | :32:20. | :32:23. | |
have come out from NHS England suggest a 23% Jock drop in | :32:24. | :32:28. | |
applications, and that is a significant change. The key thing of | :32:29. | :32:33. | |
course is how that figure comes through the pipeline at how we | :32:34. | :32:37. | |
filled the gap. It would be helpful while the minister is on his feet at | :32:38. | :32:41. | |
the end of the debate today, if he could talk about what analysis the | :32:42. | :32:44. | |
Department of Health has done about the impact of Brexit and any changes | :32:45. | :32:50. | |
that may herald for our workforce, because a high percentage of fat NHS | :32:51. | :32:55. | |
workforce are from Europe. We are hearing the right sounds from | :32:56. | :32:57. | |
Government but yet no action about securing this future of those | :32:58. | :33:02. | |
European resident citizens who are currently resident in the UK. If he | :33:03. | :33:06. | |
is able to give us any comfort on that it would be very welcome. I'm | :33:07. | :33:10. | |
heartened that so many members are here today to discuss this important | :33:11. | :33:16. | |
issue and also this is another committee we've been working with is | :33:17. | :33:20. | |
the procedure committee to try to ensure we can discuss the financial | :33:21. | :33:24. | |
details of estimates in the house rather than just the general | :33:25. | :33:28. | |
principles. I have obviously strayed into a general principles to but | :33:29. | :33:33. | |
hopefully basing that in the actual figures. It is an edifying for the | :33:34. | :33:38. | |
public to have anonymous briefings and public argument. It does not | :33:39. | :33:42. | |
wash. We need to be on top of this so that we are holding the | :33:43. | :33:45. | |
Government's feet to the fire and making sure every step of the way | :33:46. | :33:49. | |
they know we are watching the budget and won't let them get away with | :33:50. | :33:53. | |
raiding the capital budget to fund the accounts. I will give way one | :33:54. | :33:59. | |
final time. She is making a very interesting speech. But one of the | :34:00. | :34:04. | |
things we should make much more use of is pharmacies. Especially in | :34:05. | :34:08. | |
order to try to take some pressure off the GPs. Secondly, to ask GPs to | :34:09. | :34:13. | |
go into pharmacies and be located there. He makes a good point. I | :34:14. | :34:20. | |
visited a local pharmacy a few weeks ago and saw first-hand the work they | :34:21. | :34:26. | |
do. To help ease pressure from GPs, where people are waiting from | :34:27. | :34:31. | |
appointments, and her any. I knows minister has taken a keen interest | :34:32. | :34:34. | |
in pharmacies but nonetheless there is a cut to their base budget. While | :34:35. | :34:37. | |
we were on that point, that base amount of money allowed pharmacies | :34:38. | :34:43. | |
to with certainty employment of spa to allow them to do those | :34:44. | :34:48. | |
appointment with patients. If they are just rely on revenue income they | :34:49. | :34:51. | |
were not sure if they could maintain the salary and a solid base of | :34:52. | :34:56. | |
funding was very important in a constituency like mine where, for | :34:57. | :35:01. | |
all sorts of regions, culturally and linguistically and convenience wise, | :35:02. | :35:04. | |
people will find their local fireman see more readily than they will find | :35:05. | :35:09. | |
their GP. The minister has things to answer on that point as well. But | :35:10. | :35:14. | |
can I say I was heartened when a group of us recently crossed party | :35:15. | :35:19. | |
met with the Prime Minister. She shoe polish there was a need to look | :35:20. | :35:23. | |
at the long-term issues around health and social care. She has made | :35:24. | :35:26. | |
a pledge that her adviser will meet with cross-party MPs to look at | :35:27. | :35:33. | |
this. I hope this heralds a change of attitude. We will see no more | :35:34. | :35:40. | |
bickering. We will see a concerted effort to ensure we future proof our | :35:41. | :35:46. | |
NHS and make sure it is a beacon to the world that we believe it is. It | :35:47. | :35:51. | |
will be obvious to the house that a great many people wish to speak this | :35:52. | :35:56. | |
evening. Of course we have plenty of time, but it is limited. If | :35:57. | :36:02. | |
honourable members take a self-denying ordinance and speak for | :36:03. | :36:07. | |
no more than nine minutes, then everyone who has indicated they | :36:08. | :36:10. | |
would like to speak will have an opportunity to do so. I hope not to | :36:11. | :36:16. | |
have to put on a formal time limit because nine minutes is actually a | :36:17. | :36:20. | |
very long time. If you can't say it in nine minutes then you have to go | :36:21. | :36:25. | |
away and practice! I know that no practice is needed here. Let's be | :36:26. | :36:35. | |
clear. Estimates are a serious business, they must be realistic. | :36:36. | :36:39. | |
Parliament every year votes on how much can be spent and if access is | :36:40. | :36:45. | |
needed you have to go back to the house, so getting the estimates | :36:46. | :36:49. | |
right is critical. The challenge I have with these estimates is that | :36:50. | :36:53. | |
they are based on assumptions for which I can find very little comfort | :36:54. | :37:04. | |
for being realistic. We look at what is assumed and as my honourable | :37:05. | :37:09. | |
friend has said there is an assumption that demand will go down. | :37:10. | :37:15. | |
As the population increases and as immigration increases, it seems that | :37:16. | :37:23. | |
is unrealistic. It seems to me that the Government needs to look long | :37:24. | :37:28. | |
and hard at the assumptions it has made, I for 1am not convinced it has | :37:29. | :37:34. | |
got it right. We also need to look at what this estimate is assuming in | :37:35. | :37:39. | |
terms of negatives. It is assuming that we can still keep on course if | :37:40. | :37:45. | |
we reduce public health spending. If you start reducing that which will | :37:46. | :37:53. | |
prevent the need for NHS intervention, which is the most | :37:54. | :37:56. | |
expensive form of intervention, are you really going to save money? It | :37:57. | :38:01. | |
seems to me you are not. The other assumption that is being made with | :38:02. | :38:05. | |
these estimates is that central administration will be cut. Given | :38:06. | :38:08. | |
the complexity of what is going on at the moment with 44 coming on | :38:09. | :38:18. | |
board we hope because they are in concept a good idea although I have | :38:19. | :38:23. | |
concerns about delivery, I am concerned that overall these | :38:24. | :38:29. | |
estimates are not based on realistic assumptions which the Government and | :38:30. | :38:32. | |
the ministers will need to seriously address. As my honourable friend who | :38:33. | :38:39. | |
leads the select committee, the Public Accounts Committee, has said, | :38:40. | :38:44. | |
and indeed my honourable friend for Totnes, you must take into account | :38:45. | :38:47. | |
when you make these estimates what you need for both health and social | :38:48. | :38:53. | |
care. Because if you cut health spending on social care or don't | :38:54. | :38:56. | |
adequately fund it you will increase spending within the NHS. | :38:57. | :39:02. | |
Underpinning all this is actually having measurements in place across | :39:03. | :39:09. | |
the whole system as was indicated so that you actually know what the full | :39:10. | :39:14. | |
scope of the demand is, you measure the results of the resource you put | :39:15. | :39:20. | |
in our, and what the outcomes are for the population as a whole. We | :39:21. | :39:26. | |
talk about measures around accident and emergency and the NHS. We talk | :39:27. | :39:34. | |
about waiting times. We talk about. The targets set are around reducing | :39:35. | :39:38. | |
waiting times will no one looks at the impact on care, an GPs, on | :39:39. | :39:46. | |
social care. We need it seems to me to look very carefully if an | :39:47. | :39:50. | |
estimate is to be right, as a whole system of measurement. I thank her | :39:51. | :39:57. | |
for giving way. She makes powerful points. Would she agree with me, my | :39:58. | :40:02. | |
local District Hospital had winter preparing less for a 5% uplift, they | :40:03. | :40:09. | |
had a 20% increase in demand. I had the exact same thing in social care | :40:10. | :40:13. | |
whether social care providers are telling me people are older and | :40:14. | :40:19. | |
earlier. We have increased demand across-the-board because of that. I | :40:20. | :40:25. | |
thank her for that helpful example. She is writing what you says. So, if | :40:26. | :40:31. | |
we look at the whole measurement system, it seems to me, and this was | :40:32. | :40:37. | |
acknowledged in one of the Public Accounts Committee sessions by the | :40:38. | :40:41. | |
Department of Health, that there is a limited measurement and that there | :40:42. | :40:46. | |
probably should be more. When I challenged the individual concerned | :40:47. | :40:49. | |
as to whether the Government would be looking at it he stood from one | :40:50. | :40:53. | |
foot to the other and could not give much of an answer. It seems to me | :40:54. | :40:57. | |
the estimates have to be based on proper measurement of need, of what | :40:58. | :41:04. | |
is actually operationally put into practice, and of the outcome for the | :41:05. | :41:07. | |
patient, and that is not there. We'll is only to look at the | :41:08. | :41:12. | |
differences between the NHS and social care in how the money is | :41:13. | :41:17. | |
allocated. The NHS, we have ring fencing will stop social care, we | :41:18. | :41:22. | |
don't. But the the two are linked that linked that means that unless | :41:23. | :41:25. | |
we look at the way each of those pots are managed, no matter how much | :41:26. | :41:31. | |
is in them, we give rise to problems for the future. Social care by | :41:32. | :41:34. | |
comparison is not ring fenced and while I'm sure a role great for for | :41:35. | :41:42. | |
the extra money is, they don't go far enough. The first Chang of money | :41:43. | :41:47. | |
may cover the living wage and the ability of local authorities to | :41:48. | :41:50. | |
increase the precept by 3% is welcome. But as my friend the leader | :41:51. | :41:58. | |
of our select committee said, that is taxpayer money. | :41:59. | :42:08. | |
Does she shear my concern about the 3% precept? It seems it is going | :42:09. | :42:19. | |
from general taxation onto property -based tax. It will disadvantage | :42:20. | :42:28. | |
communities that are worse off. That is a very fair point. He is | :42:29. | :42:34. | |
absolutely making the rate case. Many of the facilities here to | :42:35. | :42:41. | |
provide social care graph feeling because there is not an individual | :42:42. | :42:48. | |
to ensure that some of the care homes are alive and well. I am down | :42:49. | :42:53. | |
to just three in our constituency that is totally inadequate. We both | :42:54. | :43:00. | |
have constituencies with a large proportion of elderly people. Is | :43:01. | :43:09. | |
there not a double whammy because people who are over 85 came to stay | :43:10. | :43:22. | |
in hospital for longer. We are looking after them well, but need to | :43:23. | :43:26. | |
look after them better, but the daily in going from hospital to | :43:27. | :43:33. | |
social care is very costly and I do not think the estimates to take | :43:34. | :43:39. | |
proper account of that. My honourable friend makes a very good | :43:40. | :43:45. | |
point. The cost is not adequately taken into account. If you look at | :43:46. | :43:51. | |
the way the government measures outcomes, they are predicated on a | :43:52. | :43:57. | |
span of the population and predicated on the number of births | :43:58. | :44:05. | |
and the length of life. Because there are different areas, the lakes | :44:06. | :44:08. | |
of my constituency in Devon, where people live longer, is that we have | :44:09. | :44:16. | |
a lower number of live births. People tend to move into the area | :44:17. | :44:24. | |
when they are order. So there are basic fundamental flaws in the way | :44:25. | :44:27. | |
government and not just this government, this has gone on for | :44:28. | :44:33. | |
years, estimate the need for within a Navy. One of the biggest | :44:34. | :44:39. | |
challenges is in that regard. I will move on. Information is expected to | :44:40. | :44:48. | |
be the solution to all of our problems. There is no transition | :44:49. | :45:00. | |
funding so that is not allowable. There are not many pooled budgets. | :45:01. | :45:07. | |
These plans assume recruitment for individuals but we cannot recruit | :45:08. | :45:10. | |
will in the future. It does not take will in the future. It does not take | :45:11. | :45:16. | |
into account the training we will need. We are looking at the | :45:17. | :45:22. | |
population getting older, we need more specialist nurses. It has been | :45:23. | :45:29. | |
agreed by the experts, but has not been put into practice. There are so | :45:30. | :45:33. | |
many issues which will impact on this that I have my doubts that this | :45:34. | :45:38. | |
was the way forward, in terms of reducing cost. I am concerned that | :45:39. | :45:48. | |
this integration model, while welcome, has not been thought | :45:49. | :45:56. | |
through and the barriers to it being successful have an implication that | :45:57. | :46:00. | |
it will be an unbudgeted cost. My concern is that there is no evidence | :46:01. | :46:07. | |
for this option that the demand will decrease. There is no evidence that | :46:08. | :46:13. | |
integration is going to deliver savings. It seems to me that the | :46:14. | :46:19. | |
estimate can it really be sound. The real cost estimate is needed. My | :46:20. | :46:28. | |
final closing comment, what we have failed to address is at peace of | :46:29. | :46:34. | |
social care which is paid for privately. I will look at the report | :46:35. | :46:46. | |
briefly and the act, because we are looking at how the taxpayers money | :46:47. | :46:49. | |
is to be shared out between these two systems, but we should never | :46:50. | :46:57. | |
forget that social care is means tested, as opposed to the NHS, which | :46:58. | :47:01. | |
is free at the point of the envelope. If you do not take into | :47:02. | :47:06. | |
account that savings are required, then we will find on the NHS is | :47:07. | :47:14. | |
simply too great on the system to succeed than for the system, the new | :47:15. | :47:23. | |
system, to be valid. The select committee is currently undertaking | :47:24. | :47:29. | |
an enquiry into social care. The report has not been published yet, | :47:30. | :47:34. | |
so anything I say is my own so anything I say is my own | :47:35. | :47:40. | |
reflection, as opposed to directly to do with the findings. I hope it | :47:41. | :47:44. | |
will not be too long before we can provide the report with regard to | :47:45. | :47:51. | |
the immediate issues within social care. We will then look at the | :47:52. | :47:55. | |
longer term issues. We have taken expert analysis from many connected | :47:56. | :48:07. | |
parties. From people with an the care system and key providers. It is | :48:08. | :48:17. | |
not surprising to me to have heard what I have heard because | :48:18. | :48:25. | |
unfortunately, as an MP, we only get the tip of the iceberg of problems | :48:26. | :48:31. | |
which occur. The number of feelings end social care have undoubtedly | :48:32. | :48:37. | |
increased in the last two or three years. I look at fundamentally what | :48:38. | :48:42. | |
is happening. A council which is having to cut its budget on social | :48:43. | :48:50. | |
care is often doing that by going to the private sector and going out to | :48:51. | :48:58. | |
agencies. Replacing that with the service which the council used to | :48:59. | :49:03. | |
provide. Undoubtedly, the way the services our Kilvert, often people | :49:04. | :49:13. | |
are not travelling up and causing even more problems for patients in | :49:14. | :49:19. | |
the long-term. It is not surprising that the cheer of the hills select | :49:20. | :49:23. | |
committee said there was a 7% cut in real terms in social care in the | :49:24. | :49:33. | |
past seven years. Central government plans have been reduced by 57%. | :49:34. | :49:40. | |
Councils have tried to provide social care, but they have not been | :49:41. | :49:44. | |
able to protect it completely from the cuts. On top of that, not only | :49:45. | :49:48. | |
is the money going down, but the number of elderly people going to | :49:49. | :49:55. | |
require care is going up. On top of that, there is the Care Act, in | :49:56. | :50:04. | |
principle a great piece of legislation. Welcome measures, in | :50:05. | :50:12. | |
terms of trying to reward those properly for the excellent work they | :50:13. | :50:19. | |
do in social care, the entries in the minimum wage puts additional | :50:20. | :50:23. | |
burdens on the system. There was a very good article about social care | :50:24. | :50:35. | |
yesterday in which the council leader said the doing more for less, | :50:36. | :50:39. | |
something they have become very good at. But no, they have to admit they | :50:40. | :50:44. | |
are doing less for less. We should not blame councils for not being | :50:45. | :50:51. | |
able to provide a standard service. Even if every council did their | :50:52. | :50:55. | |
best, there would still be problems with the system. I asked the | :50:56. | :50:59. | |
Minister affair was a crisis. He did not want to use that word, but he | :51:00. | :51:06. | |
said the system was under stress. That was the words he used. I think | :51:07. | :51:10. | |
we would recognise this case is very obvious for all of us to see. 1.2 | :51:11. | :51:19. | |
million people estimated getting the care daily choir. That is 40% higher | :51:20. | :51:25. | |
than it was in 2010. We got evidence from people who said that they were | :51:26. | :51:34. | |
not getting the care Lee got in the past when the needs we are | :51:35. | :51:39. | |
increasing. People pulling out of contracts. Contracts not been | :51:40. | :51:48. | |
delivered property -- properly for the councils. People actually paid | :51:49. | :51:58. | |
for care actually subsidising local authorities. This did not seem fear | :51:59. | :52:04. | |
fear too many people. At the same time, you have the 27% turnover in | :52:05. | :52:15. | |
the south. You are getting people leaving with long-term experience | :52:16. | :52:20. | |
and there are much more demands on training. These are problems we | :52:21. | :52:22. | |
learned about in our evidence. We learned about in our evidence. We | :52:23. | :52:28. | |
come to one of which I hope they will reflect on. This was some of | :52:29. | :52:34. | |
the very compelling evidence that we received as part of that enquiry. In | :52:35. | :52:40. | |
the short-term, the government have done things. They brought in the | :52:41. | :52:45. | |
council tax precept. I brought in the fact that local authorities have | :52:46. | :52:51. | |
taken up on that. There are problems, of course, the fact that | :52:52. | :52:56. | |
it raises more money for some local authorities than it does for others. | :52:57. | :53:01. | |
The better clear from, which was meant to stabilise, is rather | :53:02. | :53:10. | |
backordered into the system. The new homes burnt his welcome, but that | :53:11. | :53:15. | |
causes problems for smaller district councils. He suddenly find the | :53:16. | :53:20. | |
budget position fundamentally altered. Going back to the article, | :53:21. | :53:29. | |
you have got a situation where government simply was not thinking | :53:30. | :53:33. | |
through in the longer term. They are moving money around in the system | :53:34. | :53:37. | |
without giving real thought to the end result. There was a lack of | :53:38. | :53:44. | |
thinking and funding between health and social care. There was not | :53:45. | :53:50. | |
really any understanding of what was happening to the money at the end of | :53:51. | :53:55. | |
the line. Local authorities are facing very difficult choices and | :53:56. | :53:59. | |
having to make decisions on the cuts that are being pressed onto them. | :54:00. | :54:04. | |
These are some of the issues we have and we will reflect on in the report | :54:05. | :54:06. | |
which will produce. The link between which will produce. The link between | :54:07. | :54:16. | |
health and social care is vitally important. It will be interesting to | :54:17. | :54:23. | |
see what comes out of the idea of the two being devolved together. Not | :54:24. | :54:27. | |
only the idea of discharging, but that there is nobody in the system | :54:28. | :54:34. | |
for preventative social care. The funding is for people in the highest | :54:35. | :54:41. | |
need. People not getting the attention in the early stages means | :54:42. | :54:44. | |
they are more likely to end up in hospital and more likely to end up | :54:45. | :54:51. | |
with long-term problems. We need longer-term arrangements. We need to | :54:52. | :54:57. | |
respond to the theatre no, because that is also important. There are | :54:58. | :55:03. | |
some people who if we do not deal with the here and now, there will be | :55:04. | :55:07. | |
some people who will not be around to see the long-term benefits. We | :55:08. | :55:12. | |
went to Germany and they told us that 20 years ago, they solve this | :55:13. | :55:16. | |
problem coming. We sat down with the cross-party committee and agreed on | :55:17. | :55:25. | |
long-term systems. That is what they decided to do. It has stood the test | :55:26. | :55:33. | |
of time for two decades. They have increased the social insurance | :55:34. | :55:40. | |
allowance. This has got cross-party agreement and virtually no public | :55:41. | :55:46. | |
opposition. This is not just funded by the taxpayer. There are private | :55:47. | :55:52. | |
contributions in it, as well. It is just an example. We need to sit down | :55:53. | :55:57. | |
a cross-party basis and work out solutions which stand the test of | :55:58. | :56:01. | |
time, regardless of what government is in power at the time. Does he | :56:02. | :56:08. | |
agree that fundamentally the issue is that countries in Europe, such as | :56:09. | :56:16. | |
Germany and France, they are spending a great deal more money | :56:17. | :56:22. | |
through either the system he described in Germany, or somehow we | :56:23. | :56:33. | |
are going to have to close that gap. It is highly likely the difference | :56:34. | :56:37. | |
in mortality and outcomes generally in this country is related to the | :56:38. | :56:44. | |
amount of money which is put into the system? | :56:45. | :56:56. | |
It is something we need to reflect on. But it is not simply a question | :56:57. | :57:06. | |
of public funding. There is an issue about where we get the Private | :57:07. | :57:09. | |
funding from, I don't think anyone has argued to us so far that the | :57:10. | :57:14. | |
whole of it can be publicly funded. How do we raise the Private money? | :57:15. | :57:19. | |
Should it be from individuals who near need care at that point or | :57:20. | :57:23. | |
should we ask people to pay more into some sort of insurance system, | :57:24. | :57:28. | |
and how do we putting more money from the public sector? Can we rely | :57:29. | :57:31. | |
on local authority funding alone, particularly if that is coming from | :57:32. | :57:34. | |
business rates when business rates are not going to grow at the same | :57:35. | :57:38. | |
percentage in future as the number of people who want social care? Can | :57:39. | :57:46. | |
I pass over to my, the honourable member? It is my pleasure to join | :57:47. | :57:51. | |
him on that visit with other members will stop does he feel it was all | :57:52. | :57:57. | |
the more pertinent that his example of the German system in that 20 | :57:58. | :58:03. | |
years ago they too had a system funded by local authorities, prior | :58:04. | :58:07. | |
to changing to social insurance in 1995, and find that system was not | :58:08. | :58:11. | |
fit for purpose and they discovered that 20 years ago, moved to this | :58:12. | :58:15. | |
system, which as he says has cross-party support, and is a | :58:16. | :58:20. | |
long-term sustainable solution? I just want us to have a process which | :58:21. | :58:24. | |
gets us to a similar position. If local authorities remain part of the | :58:25. | :58:28. | |
funding solution I don't think we can assume that the increase in | :58:29. | :58:33. | |
business rates and council tax will keep pace with the level of demand | :58:34. | :58:39. | |
will come in. Finally, I know you are trying to encourage us to keep | :58:40. | :58:42. | |
within a time limit, what I would say is... The honourable gentleman, | :58:43. | :58:50. | |
as chairman of the select committee, I don't apply the time limit so | :58:51. | :58:59. | |
strictly to him. I better not stray too far. Health and social car | :59:00. | :59:07. | |
working close together, of course. Let's see how Manchester develops. | :59:08. | :59:09. | |
It will be interesting to look at that. But the other thing that came | :59:10. | :59:13. | |
out of this it is not a panacea, it will not solve all the problems. I | :59:14. | :59:19. | |
in I agree with the chair of the select committee, they are going to | :59:20. | :59:27. | |
need some pump priming to make them effective, they have been done | :59:28. | :59:32. | |
properly in every area with full cooperation. If they are done | :59:33. | :59:36. | |
properly and looked at how we can better plan for the future, I think | :59:37. | :59:39. | |
they will make an important contribution. But in the end we have | :59:40. | :59:43. | |
to recognise this process will take time, it will need upfront funding | :59:44. | :59:48. | |
to make it work, and wheels have to recognise that there are big | :59:49. | :59:49. | |
differences in health and social differences in health and social | :59:50. | :59:53. | |
care, not merely in culture but in the funding arrangements. Health is | :59:54. | :00:00. | |
provided free at point of use and social care isn't and probably won't | :00:01. | :00:03. | |
be after any changes will stop they will be different funding | :00:04. | :00:06. | |
arrangements. There is fundamentally different accountability. Social | :00:07. | :00:12. | |
care is accountable to local councillors. Health is accountable | :00:13. | :00:18. | |
to the Secretary of State. If you want to the problems this creates, | :00:19. | :00:21. | |
see the evidence last health minister gave to the select | :00:22. | :00:26. | |
committee. I think it shows it isn't all quite worked out in Government | :00:27. | :00:29. | |
in a way you could pull a switch tomorrow and get it all operating | :00:30. | :00:33. | |
smoothly. I would say we have a lot of work to do in that direction and | :00:34. | :00:38. | |
I'm sure the local Government select committee will consider all the | :00:39. | :00:41. | |
evidence and produce reports on this range of issues. Thank you. It is a | :00:42. | :00:47. | |
pleasure to follow the honourable gentleman. I think it is worth | :00:48. | :00:54. | |
putting on the record, notwithstanding some of the issues | :00:55. | :00:57. | |
which have already been drawn to your attention, the increase in | :00:58. | :01:00. | |
money the Government is committing, the extra 10 billion by 2020, the | :01:01. | :01:09. | |
extra doctors, nurses in the system, the near eradication of mixed sex | :01:10. | :01:15. | |
wards and a huge reduction in hospital infections. I note also | :01:16. | :01:21. | |
that health spending in England is almost 1% higher than the OECD | :01:22. | :01:25. | |
average. I think it is worth putting that on the record. I'm sorry to | :01:26. | :01:30. | |
intervene so early. Would he agree with me that the OECD average is | :01:31. | :01:35. | |
probably a specious camp heiress and since it will consign countries like | :01:36. | :01:42. | |
Mexico and Turkey and former Eastern Bloc countries which, laudable | :01:43. | :01:45. | |
though they may be, are not countries which most people in this | :01:46. | :01:50. | |
country would worth would wish to be compared in terms of health | :01:51. | :01:53. | |
economies? I think that's a fair point. In the course of my remarks I | :01:54. | :01:57. | |
will outline some areas where some more spending is necessary. I want | :01:58. | :02:06. | |
to start by focusing in on an individual case, not from my | :02:07. | :02:11. | |
constituency, which I think highlights many of the issues that | :02:12. | :02:13. | |
have been raised so far this evening. It concerns a 98-year-old | :02:14. | :02:22. | |
lady, admitted to a hospital on the 22nd of January. She unfortunately | :02:23. | :02:27. | |
died in that hospital on the 31st. It was made clear to the hospital on | :02:28. | :02:31. | |
the 25th of January that the nursing home she had come from, she had been | :02:32. | :02:38. | |
in the residential part, had nursing facilities which were able to take | :02:39. | :02:46. | |
her back and deal with the deterioration in her health. In | :02:47. | :02:49. | |
spite of the hospital being made aware of that on the 25th of | :02:50. | :02:56. | |
January, no action was taken to remove her back to that nursing | :02:57. | :03:02. | |
home, which resulted in an extra six days of staying in that hospital. | :03:03. | :03:08. | |
The relatives which drew this true case to my attention asked me to | :03:09. | :03:14. | |
raise the following two points. First, they thought it wasn't good | :03:15. | :03:17. | |
enough that the hospital concerned did not have a good knowledge of the | :03:18. | :03:23. | |
fact that the nursing home this lady came from had nursing facilities in | :03:24. | :03:29. | |
addition to residential facilities she had come from, which would have | :03:30. | :03:33. | |
been able to care for her and free up a hospital bed. Secondly, they | :03:34. | :03:39. | |
were also disappointed that because her period in hospital spanned a | :03:40. | :03:43. | |
weekend they were told by several of the nursing staff that no doctor was | :03:44. | :03:48. | |
available to make a decision to move her back to the nursing floor of the | :03:49. | :03:53. | |
home which she had come from, which is where she had always wanted to | :03:54. | :03:59. | |
end her days. I think that story illustrates some of the issues which | :04:00. | :04:02. | |
I know ministers are aware of in terms of making sure the knowledge | :04:03. | :04:07. | |
of what residential and nursing facilities are available in the | :04:08. | :04:11. | |
community to elderly people that come into hospital, and also the | :04:12. | :04:15. | |
issue of weekend cover so that appropriate decisions can be taken. | :04:16. | :04:22. | |
So the beds are not taken up unnecessarily within hospitals. | :04:23. | :04:25. | |
Couple of weeks ago I sat down with a number of social care providers | :04:26. | :04:34. | |
within Bedfordshire, covering both residential and domiciliary care, | :04:35. | :04:39. | |
and I asked them what they thought it was they actually needed in order | :04:40. | :04:44. | |
to attract enough people into the care profession. The chairman has | :04:45. | :04:52. | |
just told us there is a 27% turnover and I learned they cannot always | :04:53. | :04:56. | |
attract the calibre of people they would like. In terms of domiciliary | :04:57. | :05:01. | |
care, I was told very clearly that the ability to offer a 16 to ?18,000 | :05:02. | :05:10. | |
a year salary rather than paying people on an hourly basis when they | :05:11. | :05:16. | |
provided care, would go a long way to attracting the right sort of | :05:17. | :05:21. | |
people into this profession. This domiciliary care provider was one of | :05:22. | :05:27. | |
the better ones in my area, and paid 30p a mile for travel costs. All of | :05:28. | :05:35. | |
us as members of Parliament get paid 45p a mile when we travel in our | :05:36. | :05:39. | |
constituencies, and I find it an affront that there is this division | :05:40. | :05:43. | |
between different rates for travel within the public sector. Social | :05:44. | :05:48. | |
care staff do an incredibly important job and it is not right | :05:49. | :05:54. | |
that they are lucky to be offered 30p a mile when members of | :05:55. | :06:00. | |
Parliament are offered 45p a mile. I am not just asking for local | :06:01. | :06:04. | |
authorities to put it up to that straightaway in terms of what they | :06:05. | :06:09. | |
pay, we have to be realistic. We have to actually decide that that | :06:10. | :06:13. | |
comes with a price tag which has to be provided through taxation. I | :06:14. | :06:20. | |
fully recognise that point. But a salary to ?16,000 to ?18,000 over | :06:21. | :06:25. | |
and above this Barony rates of pay which don't include travel time and | :06:26. | :06:32. | |
that travel paid for at a miserly rate compared with what other people | :06:33. | :06:36. | |
get in the public sector, I think would go a long way. In the | :06:37. | :06:42. | |
estimates before us today, one of the issues which has not been | :06:43. | :06:46. | |
highlighted so far is the revaluation of the NHS litigation | :06:47. | :06:52. | |
costs and increase of some ?8 billion which is a fairly large | :06:53. | :06:57. | |
figure. It is worth focusing on that because litigation costs mean and | :06:58. | :07:02. | |
thing is, firstly that patients do not have the right quality of care | :07:03. | :07:07. | |
first time around and secondly that it is money going out of the door of | :07:08. | :07:12. | |
the NHS, often to lawyers, which could better be used to doing the | :07:13. | :07:17. | |
job correctly first time. In that regard, I make no apologies for | :07:18. | :07:22. | |
again drawing the house's attention to the getting it right first time | :07:23. | :07:27. | |
initiative, which seeks to embed quality of clinical care across the | :07:28. | :07:32. | |
NHS. Something which quite often I find we don't seem to focus | :07:33. | :07:37. | |
sufficiently on within this house stop the variability in terms of | :07:38. | :07:42. | |
infection rates, in terms of rates of revision surgery requires very | :07:43. | :07:46. | |
significant across the NHS, and if we could raise the quality of | :07:47. | :07:49. | |
clinical care to the level of the best across the NHS we could that | :07:50. | :07:54. | |
litigation amount down very substantially. I was very pleased to | :07:55. | :08:04. | |
join a meeting held a couple of weeks ago on the manifesto for a | :08:05. | :08:10. | |
healthy and health creating society, led by the former permanent | :08:11. | :08:14. | |
secretary of the Department of Health and other colleagues in the | :08:15. | :08:18. | |
House of Lords and indeed others. Although this may seem quite a | :08:19. | :08:21. | |
long-term approach to the acute problems we are facing today, and | :08:22. | :08:26. | |
the chair of the local Government select committee is right to say we | :08:27. | :08:29. | |
need action now, because not everyone will be around in the | :08:30. | :08:36. | |
longer term, but nonetheless I think it is incredibly important that we | :08:37. | :08:40. | |
take seriously a lot of the ideas within this report in terms of | :08:41. | :08:45. | |
trying to reduce the strains on the NHS and create a healthier | :08:46. | :08:51. | |
population in the years to come. There are already some very good | :08:52. | :08:55. | |
examples of that, the Saint Paul's way transformation project in | :08:56. | :08:59. | |
popular in the east end is already doing sterling work and the well | :09:00. | :09:05. | |
north initiative supported by Public Health England is focusing on ten | :09:06. | :09:08. | |
cities in the North of England which have poor health outcomes, bad | :09:09. | :09:13. | |
levels of health and health inequality. It is all about creating | :09:14. | :09:16. | |
what they called vibrant and well-connected communities where you | :09:17. | :09:22. | |
deal with issues like debt, jobs, training, poor housing and | :09:23. | :09:31. | |
loneliness, an issue many of us are determined to carry on working on. | :09:32. | :09:38. | |
This sort of long-term preventative work to increase the health | :09:39. | :09:43. | |
resilience and increase the health of society is absolutely firm under | :09:44. | :09:47. | |
mental to all the issues we are talking about tonight. In terms of | :09:48. | :09:52. | |
the sustainability and transformation plans, in having | :09:53. | :09:57. | |
spent time with both GPs and hospital staff in the past couple of | :09:58. | :10:03. | |
weeks, I observed that clinicians in hospitals often pointed to the work | :10:04. | :10:07. | |
that they thought should have been done by GPs and had not and when I | :10:08. | :10:11. | |
spent time with GPs it was pointed out to me that they were doing quite | :10:12. | :10:14. | |
a lot of work that in the past they would have expected hospitals to | :10:15. | :10:21. | |
undertake. And I think that as sustainability and transformation | :10:22. | :10:23. | |
plans move forward there would be some merit in making sure that in | :10:24. | :10:29. | |
time they do turn into accountable care organisations so we can get a | :10:30. | :10:32. | |
proper join up between the different parts of the system, so that that | :10:33. | :10:39. | |
sort of finger-pointing between different parts of the system | :10:40. | :10:42. | |
becomes a thing of the past. The last area I want to talk about | :10:43. | :10:50. | |
quickly is just the issue of beds. Was I totally understand the | :10:51. | :10:55. | |
Government focus to shift more care to the community, the fact that we | :10:56. | :11:03. | |
have a thousand fewer beds than five years ago while the occupancy rate | :11:04. | :11:10. | |
has gone up from 84 to 87% and sometimes operating theatres are | :11:11. | :11:14. | |
remaining idle, is something I would like reflected on. | :11:15. | :11:22. | |
Sadly, it has the feel of rearranging the debt chairs on the | :11:23. | :11:29. | |
Titanic. Bringing this matter before the House today highlights the | :11:30. | :11:34. | |
extensive range of issues facing the NHS. From my involvement in health | :11:35. | :11:38. | |
issues in West Lancashire, from individual constituencies' cases to | :11:39. | :11:44. | |
the commission of multi-billion pound contract, it is a microcosm of | :11:45. | :11:48. | |
the issues that the multitude of bodies within the NHS need to start | :11:49. | :11:54. | |
finding answers for. In West Lancashire, my constituents can wait | :11:55. | :11:58. | |
up to a week by telephone conversation with a GP to assess | :11:59. | :12:02. | |
whether they actually need an appointment and then a further wait | :12:03. | :12:05. | |
for that appointment. Is it any wonder people turn to AMD and minor | :12:06. | :12:11. | |
injuries units? While clinical experience at the top is laudable | :12:12. | :12:17. | |
and to be welcomed, there is a shortage of GPs, there is also lost | :12:18. | :12:21. | |
capacity because of the time GP spent on clinical commissioning | :12:22. | :12:26. | |
groups governing bodies. Where as in the case of West The Lancashire, | :12:27. | :12:30. | |
they have handed community health and urging cares services contracts | :12:31. | :12:34. | |
to private providers, especially threatening the future of the NHS | :12:35. | :12:40. | |
tossed there by removing services and essential financing turnover. | :12:41. | :12:46. | |
The chair of the CCG is a local GP who spent three days a week on CCTV | :12:47. | :12:52. | |
business under five further GPs with executive lead responsibilities. | :12:53. | :12:56. | |
Besides the loss of capacity, there are also the financial | :12:57. | :13:01. | |
considerations of GPs being remunerated for their work on the | :13:02. | :13:06. | |
governing body. Now the GB owning over ?100,000 for a three-day week | :13:07. | :13:09. | |
alongside a cheap accountable officer also an approximately | :13:10. | :13:15. | |
?100,000 a week. There is also a fundamental lack of direct | :13:16. | :13:19. | |
accountability of clinical commissioning groups which I | :13:20. | :13:22. | |
understand is the responsibility of NHS England. So we have got GPs | :13:23. | :13:28. | |
handing out contracts to private providers in the face of significant | :13:29. | :13:32. | |
and substantial local opposition in West Lancashire and no is for | :13:33. | :13:38. | |
meaningful accountability about how those GPs are spending taxpayers | :13:39. | :13:42. | |
money. My constituents did not get to vote on whether Gale -- on who | :13:43. | :13:54. | |
represents them on the CCG. The question also arises whether NHS | :13:55. | :13:59. | |
England and NHS improvement have enough resources to deal with the | :14:00. | :14:03. | |
increasingly complex contracts and structures they are supposed to | :14:04. | :14:10. | |
supervise within the NHS. Threats to the smaller acute trusts besides | :14:11. | :14:15. | |
coming from local GPs also come from the sustainability and | :14:16. | :14:19. | |
transformation process. The name of which is being increasingly becoming | :14:20. | :14:25. | |
a misnomer. These plans were quietly generated by small groups of people | :14:26. | :14:30. | |
without the involvement of both the those who need their services or the | :14:31. | :14:34. | |
public representatives of their public representatives both local | :14:35. | :14:41. | |
and national. Some of us have missed strategic health Authority. I would | :14:42. | :14:45. | |
be very interested to hear from the ministers if the process will | :14:46. | :14:50. | |
actually provide capital resources to enable hospital trusts to develop | :14:51. | :14:57. | |
transformational change projects. Increasingly, NHS improvement and | :14:58. | :15:01. | |
NHS England cannot agree on these currents eight of NHS finances. NHS | :15:02. | :15:07. | |
forecast for this financial year has worsened each financial quarter. | :15:08. | :15:11. | |
Currently quarter three is standing at the deficit of 873 million was | :15:12. | :15:19. | |
NHS England appears confident that the final deficit figure will be no | :15:20. | :15:23. | |
more than 580 million. I took a deeper look at the figures. The | :15:24. | :15:32. | |
figures for NHS trusts quarter three figures and a huge question over | :15:33. | :15:36. | |
those deficit figures appears when you look at the sustainability and | :15:37. | :15:39. | |
transformation fund money the government has given trust. | :15:40. | :15:46. | |
Admittedly, trusts only have the allocated funding if the trust trees | :15:47. | :15:52. | |
certain financial targets at the end of the financial year. If they do | :15:53. | :15:56. | |
not, this extra funding will disappear like snow in July. The | :15:57. | :16:02. | |
system deficit could be even greater. In fact, much greater. It | :16:03. | :16:06. | |
is not just the Department of Health's funding of the NHS that has | :16:07. | :16:12. | |
a consequential impact on services, we are witnessing savage cuts to | :16:13. | :16:16. | |
local authority budgets. Lancashire County Council is the provider of | :16:17. | :16:20. | |
social care and despair is personally close to being bankrupt | :16:21. | :16:25. | |
in the next five years based on the current funding projections. We talk | :16:26. | :16:30. | |
about health and social care absolutely as if they are | :16:31. | :16:33. | |
intertwined these days. Yet the government allows this competitive | :16:34. | :16:37. | |
existence between the two services to continue. ASBOs systems seek to | :16:38. | :16:44. | |
survive financially, each body makes decisions to minimise their area of | :16:45. | :16:55. | |
expenditure. -- ASBOs systems. Hospitals urgently seek to discharge | :16:56. | :17:00. | |
a medically fit patient. I have a great fear that as each day passes, | :17:01. | :17:04. | |
the struggle for survival due to the ever tightening financial structures | :17:05. | :17:11. | |
imposed by government and a lack of any solutions means that patients | :17:12. | :17:15. | |
are actually getting lost. Organisational for and financial | :17:16. | :17:22. | |
considerations mean that patients are a distant third on the priority | :17:23. | :17:26. | |
list. I do not know if creating chaos and turmoil within the system | :17:27. | :17:30. | |
is part of a longer term strategy to lead us to a new health care system, | :17:31. | :17:36. | |
one of private providers and health insurance. The Secretary of State | :17:37. | :17:40. | |
will have to answer that one. What I see from the estimates provided for | :17:41. | :17:44. | |
the transfer of money between budgets is that this is not just | :17:45. | :17:49. | |
tinkering at the edges, sorry, this is just tinkering at the edges of a | :17:50. | :17:52. | |
system that needs to be properly financed. Not shoving a few pennies | :17:53. | :17:57. | |
in the left hand while taking away pounds and pounds from the right | :17:58. | :18:02. | |
hand. Our NHS, our constituents deserve so much better. | :18:03. | :18:09. | |
Thank you. It is a pleasure to speak after the honourable member. She has | :18:10. | :18:12. | |
made some interesting points about fundamental reform. There is no | :18:13. | :18:21. | |
doubt that members of both side of the House alludes to this, we are | :18:22. | :18:26. | |
having this debate, setting up some background against huge demand and | :18:27. | :18:31. | |
in many way decreasing supply, particularly in the area of adult | :18:32. | :18:35. | |
social care which is where I am going to restrict my comments to in | :18:36. | :18:40. | |
that this is, I have been very interested to take part in the | :18:41. | :18:44. | |
inquiry on social care and the select committee which the cherub is | :18:45. | :18:48. | |
said to earlier in his remarks. -- the chair. 33% increase in the | :18:49. | :18:57. | |
population of people aged 80 and over the last ten years, 100% | :18:58. | :19:01. | |
projected increase of that population over the next 20 years, | :19:02. | :19:06. | |
50% increase in the 60,000 over over the next 20 years, interestingly | :19:07. | :19:13. | |
enough, only a 4% increase in the numbers of people of the population | :19:14. | :19:17. | |
of this country below 65 over the next 20 years which is in dynamic of | :19:18. | :19:21. | |
who is going to provide the care needed for all these people who are | :19:22. | :19:27. | |
getting older. The other area we have not touched on in adult social | :19:28. | :19:32. | |
care, those with learning disabilities. Increasing very | :19:33. | :19:35. | |
rapidly and is due to increase again over the next 20 years, more | :19:36. | :19:40. | |
profound challenges for our health and adult social care services. | :19:41. | :19:47. | |
Against the backdrop of decreasing supply provision, understandably, | :19:48. | :19:52. | |
when you look at everyone is going to take part in making sure the | :19:53. | :19:59. | |
books are balanced. Reducing the deficit from a a year in 2010 to | :20:00. | :20:04. | |
around ?68 billion this year is no mean feat. We have to understand | :20:05. | :20:09. | |
that there is no bottomless pit, we have to make difficult decisions in | :20:10. | :20:15. | |
where our spending is allocated to. Local authorities have borne the | :20:16. | :20:19. | |
brunt of this, 37% reduction in overall spending, 25% after council | :20:20. | :20:28. | |
tax increases. Adult social care accounts for around 33% of local | :20:29. | :20:32. | |
authority discretion or spend. It is inevitable that this is going to | :20:33. | :20:37. | |
come into focus when local authority managers try to balance the book. | :20:38. | :20:42. | |
Other competing pressures, around the National Living Wage, that is | :20:43. | :20:45. | |
soaking up a lot of the action money that is being allocated into this | :20:46. | :20:51. | |
area. It is not just about local authorities, it is the providers as | :20:52. | :20:54. | |
well but are under huge pressure. 59% of care homes in this country | :20:55. | :21:00. | |
are losing money, below profitability is threshold. Some of | :21:01. | :21:07. | |
those homes are closing and providers sometimes are returning | :21:08. | :21:09. | |
contracts to local authorities. Other elements as well in what we | :21:10. | :21:17. | |
recall a well functioning health and social care service, other | :21:18. | :21:21. | |
reductions such as community nurses, 28% reduction in community nurses | :21:22. | :21:25. | |
which again can provide key services to stop people going into the health | :21:26. | :21:31. | |
and social care system. In my constituency, simple things like | :21:32. | :21:38. | |
sitting services or local dementia clubs, they have all closed, or been | :21:39. | :21:43. | |
reduced over recent weeks and months which puts more pressure on the | :21:44. | :21:53. | |
system. The discharge, has an impact on the NHS, something members know | :21:54. | :21:57. | |
far more about than I do, Simon Stephens when he came to give | :21:58. | :22:02. | |
evidence to committee, estimated at ?2 billion on extra spent on the NHS | :22:03. | :22:05. | |
because of delayed discharges. There is an impact on whole system. The | :22:06. | :22:11. | |
government has responded to a great extent, ?2 billion more in 2010. The | :22:12. | :22:19. | |
adult social care preset, Betty care funding, adding 3.5 to ?4 billion by | :22:20. | :22:24. | |
2020 but I think there is no doubt that all the evidence we have heard | :22:25. | :22:30. | |
from a number of different sources, there is a one to ?2 billion | :22:31. | :22:34. | |
shortfall in the system for investment that we need at the | :22:35. | :22:39. | |
moment. We do need a cross-party conversation. I am happy to give | :22:40. | :22:45. | |
way. On that issue of the shortfall, does he agree with me that time has | :22:46. | :22:50. | |
come for us to bite the bullet and increase social care funding? Doing | :22:51. | :22:54. | |
that in the short would provide the financial headroom to achieve the | :22:55. | :23:00. | |
meaningful reconfiguration of services through the STB 's that | :23:01. | :23:02. | |
will reflect the changing health prior to the Democratic? He makes a | :23:03. | :23:13. | |
strong point. -- demographics. I'm sure this is in the Chancellor's | :23:14. | :23:18. | |
budget calculation is on the 8th of March. In the short term, to plug | :23:19. | :23:23. | |
the gap, we need some more money. In the longer term, we need to have a | :23:24. | :23:27. | |
cross-party, across the House conversation on how we solve this | :23:28. | :23:31. | |
problem and select committee has been an excellent forum so that on | :23:32. | :23:35. | |
this issue and many others as the chair mentioned in his remarks, we | :23:36. | :23:39. | |
went to Germany to see their system. It was very enlightening. It was | :23:40. | :23:44. | |
particular say that in 1995 when they moved one system to another, | :23:45. | :23:47. | |
they made from a local government funded system which just did not | :23:48. | :23:51. | |
work, they clearly saw this coming before we did. They moved to a | :23:52. | :23:56. | |
social insurance system. I think in Germany they are more used to that | :23:57. | :24:02. | |
system, they have similar systems in place for health, pensions, employer | :24:03. | :24:04. | |
and insurance and accident insurance, it works very well, it is | :24:05. | :24:11. | |
cross-party. Around 1.175% of salary contribution, it is a bit like auto | :24:12. | :24:21. | |
enrolment. It is mandatory. When people need care, they have a pot to | :24:22. | :24:25. | |
call on. It is independently assessed so big at the level of | :24:26. | :24:28. | |
prisoners and that suits their needs. They can go to family members | :24:29. | :24:39. | |
to look after those people do these times which again I think as a | :24:40. | :24:45. | |
social benefit as well as being clearly a sustainable system that | :24:46. | :24:48. | |
works in the longer term. It is one of the things that we should look | :24:49. | :24:52. | |
at, it is not the only thing that I reiterate and I new member still be | :24:53. | :24:55. | |
same on both side of the House, we should look at this cross-party in a | :24:56. | :24:59. | |
way that is sustainable for the long-term. I'm very happy to give | :25:00. | :25:07. | |
way. I am very much enjoying his speech. Will he agree with me that | :25:08. | :25:10. | |
the current way we fund local government does not help? My own | :25:11. | :25:18. | |
constituency that has got a lot of over 85, the demographics are not | :25:19. | :25:20. | |
properly reflected and the challenges of coastal communities | :25:21. | :25:27. | |
face are not reflected? He makes a very good point. The evidence we | :25:28. | :25:33. | |
have seen that the current method of funding adult social care do not | :25:34. | :25:37. | |
correlate to those in those those areas. This is what we need to look | :25:38. | :25:44. | |
at and take a strategic look at it. Just on that point, see the | :25:45. | :25:47. | |
government now is moving towards a different way of funding towards | :25:48. | :25:54. | |
2020. A key part of that is the fact that we look at a new fair funding, | :25:55. | :26:00. | |
how it is allocated, absolutely critical that need is first and | :26:01. | :26:05. | |
foremost and cost rivals so it is need and cost delivering the | :26:06. | :26:09. | |
services. We get a fair and transparent system. One other thing | :26:10. | :26:17. | |
to mention, in terms of the early point about adult social care and | :26:18. | :26:23. | |
disabilities, one of the most enlightening examples of we saw in a | :26:24. | :26:29. | |
way to deliver this in a different way is rather the look at this from | :26:30. | :26:33. | |
a single viewpoint was the village shared lives concept where people | :26:34. | :26:38. | |
look after each other, co-workers and people in need of the car. A | :26:39. | :26:41. | |
fantastic and inspirational scheme. I shall touch on a few small points, | :26:42. | :26:53. | |
such as how domiciliary care is charged, how people are accessed for | :26:54. | :26:58. | |
their financial assessments are different in domiciliary care than | :26:59. | :27:01. | |
they are in residential care and I think there is some money in the | :27:02. | :27:04. | |
system they're potentially. It doesn't make much sense to me that | :27:05. | :27:07. | |
the government fund one thing one way and another thing another. There | :27:08. | :27:11. | |
is money to be taken out of the system, or people could contribute | :27:12. | :27:16. | |
potentially if there are houses were taken into account for the | :27:17. | :27:21. | |
assessment for domiciliary care. The second point is code terminal city. | :27:22. | :27:25. | |
There are so many different services provided by so many different ages. | :27:26. | :27:31. | |
It is working really well in Sheffield where all the agencies | :27:32. | :27:34. | |
work together very effectively but in my area it is completely | :27:35. | :27:39. | |
different and a mishmash of different providers, different | :27:40. | :27:40. | |
geographical areas which is difficult when to provide a joined | :27:41. | :27:44. | |
up service. With those remarks I will conclude in pass on to provide | :27:45. | :27:47. | |
a joined up service. With those remarks I will conclude in pass onto | :27:48. | :27:52. | |
another honourable member. Often, Mr Speaker, the NHS estimates to be a | :27:53. | :28:01. | |
rather perfunctory affair but this year we are entitled to ask what on | :28:02. | :28:08. | |
earth is happening to our NHS and social care system? Can be any | :28:09. | :28:11. | |
longer afford the extraordinary complacency of this government. As | :28:12. | :28:17. | |
an opposition MP I sometimes worry that either by design or simply | :28:18. | :28:22. | |
collect -- neglect we will finally fulfil many of our worst fears, that | :28:23. | :28:26. | |
the Tory party is destined to destroy the NHS. I don't think I | :28:27. | :28:33. | |
need any lectures on cross-party dialogue from the party of the death | :28:34. | :28:38. | |
tax and the ?8 billion financial fib. In Birmingham we have seen 28 | :28:39. | :28:46. | |
million of cuts to the budget for social care, bringing the service to | :28:47. | :28:51. | |
its knees. Elderly people being treated like cattle, lying around on | :28:52. | :28:56. | |
trolleys, waiting in corridors, dispatched from hospital in the | :28:57. | :29:01. | |
middle of the night. Everywhere we look we see our hospitals, GPs and | :29:02. | :29:08. | |
social care services collapsing under the strain. The Secretary of | :29:09. | :29:12. | |
State is quite happy to flex his muscles when it comes to bullying | :29:13. | :29:17. | |
junior doctors but it is always someone else's fault when it comes | :29:18. | :29:23. | |
to resources, management and administration of the NHS. There was | :29:24. | :29:28. | |
a time when the deal was simple, in return for the red box and | :29:29. | :29:32. | |
ministerial salary ministers took responsibility. The buck stopped | :29:33. | :29:39. | |
with them. But no more. I have lost track of how many parliamentary | :29:40. | :29:44. | |
answers begin with the words the department does not collect that | :29:45. | :29:49. | |
data centrally, or it would not be cost-effective to provide | :29:50. | :29:53. | |
information in that format. Basically ministers don't know don't | :29:54. | :29:58. | |
want to know and don't want us to know what is really happening. They | :29:59. | :30:05. | |
are no longer presiding over a genuinely national Health Service, | :30:06. | :30:09. | |
whether it is the postcode lottery that characterises the provision of | :30:10. | :30:14. | |
IVF, with Clinical Commissioning Group is ignoring guidelines and | :30:15. | :30:19. | |
making up their own criteria as they go along, or children's dentistry, | :30:20. | :30:22. | |
where there is a growing crisis and the heavy reliance on hospital | :30:23. | :30:28. | |
emergency surgery because of the lack of provision and monitoring of | :30:29. | :30:33. | |
proper dental services for children. All this government wants to do is | :30:34. | :30:39. | |
hide behind and blame others for their shambolic decisions. The | :30:40. | :30:44. | |
latest disaster is the business rates revaluation, which imbibing is | :30:45. | :30:50. | |
estimated will see a rise for the Queen Elizabeth you HP Hospital from | :30:51. | :30:56. | |
2.8 million two 6.9 million a year. Talk about robbing Peter to pay | :30:57. | :31:02. | |
Paul. And yet ministers from the DC LG and health haven't even met to | :31:03. | :31:08. | |
discuss this problem. I do know that private hospitals get an 80% | :31:09. | :31:13. | |
reduction because they are registered as charities. In my own | :31:14. | :31:16. | |
constituency of filioque we have been fighting a battle to save a | :31:17. | :31:22. | |
centre for several years, we have had stop/ go consultations, money | :31:23. | :31:27. | |
wasted, explanations and excuses that vary from month to month, | :31:28. | :31:32. | |
consultations announced and then scrapped, and now we have the | :31:33. | :31:37. | |
sustainability and transformation plan that sadly, as has been | :31:38. | :31:42. | |
acknowledged, has turned into a secret strategy, drawn up by | :31:43. | :31:46. | |
non-elected bureaucrats, from which the public and their elected | :31:47. | :31:50. | |
representatives have been largely excluded. It seems that Katie red is | :31:51. | :31:55. | |
now caught up in this fiasco and with its contract scheduled to | :31:56. | :32:00. | |
finish on the 31st of next month we still don't know what is happening, | :32:01. | :32:05. | |
although if rumours are true more money that ought to be spent on | :32:06. | :32:09. | |
health care in the Birmingham is about to be siphoned off to rescue | :32:10. | :32:15. | |
bankrupt neighbours. Only the other week I discovered that the contract | :32:16. | :32:21. | |
for South Maple GP services is to be counselled, apparently it is no | :32:22. | :32:25. | |
longer cost-effective. Not cost-effective to provide GP | :32:26. | :32:31. | |
services to the sick and elderly, only under this secretary of state | :32:32. | :32:37. | |
could the NHS have come to this. I will give way. In my own remarks I | :32:38. | :32:44. | |
spoke about a cross-party consultation. If we have this kind | :32:45. | :32:51. | |
of con so -- the conversation I can easily point to the fact that | :32:52. | :32:58. | |
between 20112014 there was a 8.6% drop on health spending in Wales | :32:59. | :33:02. | |
under a Labour administration while there was a 4% increase in England. | :33:03. | :33:06. | |
Would you be better having a constructive conversation that how | :33:07. | :33:11. | |
we take the NHS of the front page of the tabloids and try and work out a | :33:12. | :33:17. | |
solution together. It is always desirable to have that conversation | :33:18. | :33:19. | |
when the Tories are in power but when Labour is in power then we talk | :33:20. | :33:27. | |
about death tax regimes and funding bids. The argument always changes | :33:28. | :33:32. | |
when they are responsible. As I was saying, Mr Speaker, they are about | :33:33. | :33:36. | |
to withdraw the contract for South Maple GP services. I found out not | :33:37. | :33:40. | |
when the Clinical Commissioning Group, who it turns out have been | :33:41. | :33:44. | |
ruminating on this since November, told me, but when I was contacted by | :33:45. | :33:49. | |
anxious constituents who had just found out they were being given | :33:50. | :33:54. | |
eight weeks to find a new GP. Many of them are elderly people. Some | :33:55. | :33:59. | |
have long-term conditions and rely on regular medication that they are | :34:00. | :34:04. | |
dismissed, as if they don't matter. The loss of their GP services is | :34:05. | :34:10. | |
treated like the closure of a local hairdresser or a petrol station. | :34:11. | :34:15. | |
They are told they should shop around. Apparently the CCG thinks | :34:16. | :34:20. | |
there are enough GPs in the area, enough at any rate to satisfy their | :34:21. | :34:26. | |
little diagrams and tables on their secret little plans. Reducing demand | :34:27. | :34:30. | |
for acute care is one of the governments plans ease pressures in | :34:31. | :34:37. | |
the NHS. Exactly how do we achieve that by closing walk-in centres and | :34:38. | :34:43. | |
GP surgeries? Isn't that the fastest route to the already overstretched a | :34:44. | :34:46. | |
and E departments? It is not just the estimates which are at issue | :34:47. | :34:53. | |
here, it is a proper long-term plan for the NHS and social care. This | :34:54. | :34:59. | |
secretary of state has failed us. His stewardship is a disaster and | :35:00. | :35:03. | |
rather than accept more of it this house should be calling for a motion | :35:04. | :35:10. | |
of censure. This is a government and secretary of state who are presiding | :35:11. | :35:14. | |
over the steady dismantling of the country's greatest peacetime | :35:15. | :35:21. | |
achievement. It is a total disgrace. Thank you, Mr Speaker, I would like | :35:22. | :35:25. | |
to start by paying tribute to the many thousands of health and social | :35:26. | :35:30. | |
care workers that support day to day some of the most vulnerable people | :35:31. | :35:34. | |
in our society. Today what we are talking about is how we make the | :35:35. | :35:39. | |
books balance. The NHS five-year forward view identified that if the | :35:40. | :35:44. | |
trajectory of health care spending continued at the same rate as just a | :35:45. | :35:48. | |
couple of years ago, an extra ?30 billion would be needed by 2020. It | :35:49. | :35:54. | |
was also stated in the forward view that over ?20 billion could be | :35:55. | :35:57. | |
identified in savings and efficiency measures over that time period. That | :35:58. | :36:02. | |
is why the government is allocating an additional ?10 billion by 2021, | :36:03. | :36:11. | |
and we can quibble whether it is 8 billion 10 billion, but what must be | :36:12. | :36:14. | |
recognised is that it is NHS England that ask for the ?8 billion and this | :36:15. | :36:18. | |
government is delivering that. What hasn't happened yet is to some | :36:19. | :36:22. | |
extent the other side of the bargain, finding the savings of ?22 | :36:23. | :36:27. | |
billion. Perhaps it was never possible. Perhaps the timescale over | :36:28. | :36:31. | |
which has to be delivered was too short. Next year we will be | :36:32. | :36:37. | |
celebrating 70 years of the NHS and to change the way it works in less | :36:38. | :36:41. | |
than five years is probably too big and ask. There are not many areas of | :36:42. | :36:46. | |
the NHS where -- there are many areas of the NHS where savings are | :36:47. | :36:50. | |
being made changes are happening but it does take time. I would like to | :36:51. | :36:54. | |
use a couple of examples to illustrate where savings can be | :36:55. | :36:58. | |
made. It may be costs upfront, but it is long-term savings. Prior to | :36:59. | :37:01. | |
being elected to this place I spent a lot of time and energy promoting | :37:02. | :37:06. | |
diagnostic tests that could be carried out at patient bedsides or | :37:07. | :37:10. | |
in GP surgeries or even in the patient's home and possibly in | :37:11. | :37:16. | |
community form as well. This type of testing is used extensively in | :37:17. | :37:19. | |
Scandinavia and other European countries and we are definitely | :37:20. | :37:24. | |
lagging behind. I feel that if we adopted such tests more widely there | :37:25. | :37:29. | |
are many savings to be made. More importantly it is better for the | :37:30. | :37:33. | |
patient and surely that should be the key determinant. Let me talk | :37:34. | :37:37. | |
about one example. The point of care test that measures a protein, fast. | :37:38. | :37:42. | |
The protein is raised when someone is suffering from a bacterial | :37:43. | :37:47. | |
infection but it is not raised if the infection is caused by a virus. | :37:48. | :37:52. | |
Without this test patients may be prescribed unnecessary antibiotics. | :37:53. | :37:55. | |
This is not good for the patient or the NHS budget. In some instances | :37:56. | :38:01. | |
patients are admitted to hospital unnecessarily. All that is needed is | :38:02. | :38:07. | |
a type of test that I am talking about, which is a small device and a | :38:08. | :38:12. | |
drop of blood. I know from personal experience that it's such tests were | :38:13. | :38:16. | |
readily available for GPs to carry out within their surgeries all the | :38:17. | :38:21. | |
patient's home, it would have saved a five-day hospital stay for my | :38:22. | :38:27. | |
mother. That is savings to the health service and it would also | :38:28. | :38:30. | |
have been better for my mother to be kept at home at that time of her | :38:31. | :38:34. | |
illness. We cannot continue to do what we have done and expect to have | :38:35. | :38:40. | |
different outcomes. I will give way. I would like to thank the Honourable | :38:41. | :38:44. | |
lady for giving way, she talks a lot of sense. Would she also agree that | :38:45. | :38:49. | |
the NHS should make the mistakes of the past by going down the route of | :38:50. | :38:53. | |
more disastrous PFI deals. She may know my local CCG is currently | :38:54. | :38:58. | |
developing a business case to bulldoze Huddersfield Royal | :38:59. | :39:00. | |
Infirmary, replace it with a small plant care unit, moved everything to | :39:01. | :39:05. | |
Halifax, including A, but come forward for ?280 million for this. | :39:06. | :39:07. | |
If they don't it from the main funds they | :39:08. | :39:37. | |
are going to go down a PFI route and the trust is actually already being | :39:38. | :39:40. | |
crippled because of the disastrous PFI at Halifax which cost ?64 | :39:41. | :39:42. | |
million to build and will eventually cost ?774 million because of a | :39:43. | :39:44. | |
disastrous PFI. I thank my honourable friend for those very | :39:45. | :39:46. | |
pertinent comments and I actually did my training as a biomedical | :39:47. | :39:48. | |
scientist at Halifax General Ho spital Royal Infirmary in Halifax so | :39:49. | :39:51. | |
I know the area very disastrous PFI agreements. Today we are debating | :39:52. | :39:53. | |
health and social... On the point that the honourable lady was making | :39:54. | :39:56. | |
about tests which are not being deployed and which could save money | :39:57. | :39:58. | |
if they were, I have for long been concerned that yes, we need to make | :39:59. | :40:01. | |
sure we don't go down more disastrous PFI agreements. Today we | :40:02. | :40:03. | |
are debating health and social... On the point that the honourable lady | :40:04. | :40:06. | |
was making about tests which are not being deployed and which could save | :40:07. | :40:09. | |
money if they were, I have long been concerned that don't are at risk of | :40:10. | :40:12. | |
ovarian who are at risk of which is definitive, but which nevertheless | :40:13. | :40:14. | |
helps in the early identification of a cancer, which if it is early | :40:15. | :40:18. | |
identified, can actually with a CAA 125 test, which isn't definitive, | :40:19. | :40:20. | |
but which nevertheless helps in the early identification of a cancer, | :40:21. | :40:23. | |
which if it is early identified, can actually save does she agree with me | :40:24. | :40:26. | |
that one of the things that we need from the top on clinical issues like | :40:27. | :40:33. | |
this is to ensure that short-term savings decided by an individual CCG | :40:34. | :40:40. | |
do not put a patient's health at NHS on clinical issues like this is to | :40:41. | :40:42. | |
ensure that short-term savings decided by an individual CCG do not | :40:43. | :40:44. | |
put a patient's health at the topic of prevention | :40:45. | :40:57. | |
and screening could take up another whole debate but you make a very | :40:58. | :41:03. | |
good point there. The two are linked, and yet funded in different | :41:04. | :41:08. | |
ways. Too often budgets, these budgets, are only casted in the two | :41:09. | :41:14. | |
are linked, and yet funded in different ways. Too often budgets, | :41:15. | :41:20. | |
these budgets, are only casted in from back to me. I recently met a | :41:21. | :41:24. | |
young man who if we take treating some stroke patients as another | :41:25. | :41:26. | |
example, there was quite a new technique now available called | :41:27. | :41:28. | |
mechanical from back to me. I recently met a young man who was to | :41:29. | :41:34. | |
be near one of the few centres in the UK that carried out this | :41:35. | :41:36. | |
procedure when he had a massive stroke. That is if you he was in. | :41:37. | :41:41. | |
But he can now lead a full life instead been disabled for the rest | :41:42. | :41:45. | |
of his life and possibly being dependent on fortunate in this | :41:46. | :41:48. | |
situation he was in. But he can now lead a full life instead of being | :41:49. | :41:50. | |
disabled for the rest of his life and possibly being dependent on | :41:51. | :41:55. | |
social this procedure cannot yet be rolled out across the country due to | :41:56. | :41:57. | |
limited funding to train specialists to carry out and the procedure | :41:58. | :42:03. | |
itself. What are the patients who don't get that procedure and other | :42:04. | :42:06. | |
similar procedures? That is a respectable personal cost | :42:07. | :42:15. | |
It's far too slow to spread new and best practise. | :42:16. | :42:22. | |
Locally, in my efficiency, a Vanguard site. Whether it one of its | :42:23. | :42:29. | |
actions is ward rounds in residential nursing homes. There is | :42:30. | :42:33. | |
already strong evidence to show this is reducing hospital admissions for | :42:34. | :42:37. | |
these elderly people. Yet, this is not rolled out quick huff to other | :42:38. | :42:42. | |
areas. So, I don't believe that throwing more money at the NHS and | :42:43. | :42:46. | |
social care is the answer. If we want different results, we need to | :42:47. | :42:51. | |
do things differently. And that's what sustainability and tan | :42:52. | :43:00. | |
formation plans aim to do. I have read the Derbyshire plan in | :43:01. | :43:04. | |
department. There is little information about how the plan will | :43:05. | :43:10. | |
be implemented. My concerns are around work balance, capacity in the | :43:11. | :43:16. | |
community and stakeholder buying. I hope I am wrong, because better | :43:17. | :43:19. | |
integration and bold action is what is really needed. Mr Speaker, it is | :43:20. | :43:24. | |
important that we do not shy away from the hard and difficult | :43:25. | :43:25. | |
decisions that lie ahead. It is a real pleasure to follow the | :43:26. | :43:37. | |
honourable lady and I think she's made a characteristically well | :43:38. | :43:41. | |
informed and thoughtful speech. Mr Speaker, you don't need to be a | :43:42. | :43:45. | |
brain surgeon to have worked out that the NHS and care system is | :43:46. | :43:50. | |
currently under enormous pressure. Anyone who has recently visited a | :43:51. | :43:55. | |
hospital, sought a GP's appointment or tried to arrange support for an | :43:56. | :43:59. | |
elderly relative will tell you the whole system is struggling. | :44:00. | :44:03. | |
Inadequate funding, a workforce crisis and a failure to reshape | :44:04. | :44:08. | |
services quickly enough to meet the needs of our ageing population means | :44:09. | :44:13. | |
that the men and women who care for our loved ones are simply running to | :44:14. | :44:19. | |
standstill. This winter, we have seen the front-pages of national | :44:20. | :44:24. | |
newspapers, covered by images of frail older people, stuck on | :44:25. | :44:29. | |
trolleys in hospital corridors. And a poorly toddler led on plastic | :44:30. | :44:34. | |
chairs, pushed together to make and create a bed. Mr Speaker, if you | :44:35. | :44:40. | |
happen to watch BBC Two on a Wednesday night in January or | :44:41. | :44:45. | |
February, you would have seen the documentary Hospital, which showed | :44:46. | :44:50. | |
the reality of people working on the front line and taking really | :44:51. | :44:55. | |
difficult decisions about patients, beds and operations in a big and | :44:56. | :45:00. | |
busy hospital. It was captivating viewing and left me, as a | :45:01. | :45:04. | |
politician, feeling sad and frustrated that we are failing to | :45:05. | :45:09. | |
create the conditions in which the NHS can thrive. Many of the current | :45:10. | :45:13. | |
problems plaguing our health and care system relate to a lack of | :45:14. | :45:17. | |
money. It's not the only problem, but it's a major one. Whilst the NHS | :45:18. | :45:23. | |
budget has inched up in recent years, it has been outstripped by | :45:24. | :45:29. | |
rocketing demand. Next year, NHS funding per head of the population | :45:30. | :45:35. | |
will fall in real terms. Social care Budgets have been slashed, meaning | :45:36. | :45:39. | |
that the support available to the elderly and disabled in the | :45:40. | :45:43. | |
community has been reduced. And even with the changes that the Government | :45:44. | :45:47. | |
have made to the better care fund and the social care present, the | :45:48. | :45:52. | |
Local Government Association still predict a shortfall of ?2.6 billion | :45:53. | :45:57. | |
by the end of this Parliament. We cannot escape the fact that our | :45:58. | :46:01. | |
population is growing and we are ageing. It is a fact that there are | :46:02. | :46:07. | |
now more people retired in the UK than there are children in our | :46:08. | :46:13. | |
schools. And as the decades pass, medicine advances, we keep more | :46:14. | :46:19. | |
babies alive who are born with complicated medical conditions, we | :46:20. | :46:21. | |
successfully treat more and more people who have cancer. We perform | :46:22. | :46:25. | |
ever more complex operations, which can give people many happy years of | :46:26. | :46:29. | |
life, but which contribute to the fact that as we age, many more of us | :46:30. | :46:35. | |
have underlying frailties and multiple health needs. This isn't a | :46:36. | :46:38. | |
situation that has come about overnight. And it's one that every | :46:39. | :46:44. | |
recent Government has had to manage. But this Government isn't managing | :46:45. | :46:49. | |
it and that's the difference. This Government has had its head in the | :46:50. | :46:56. | |
sand. Between 1997-2010, the last Labour Government increased real | :46:57. | :47:01. | |
term spending on the NHS by an annual average of 5.7%. The | :47:02. | :47:06. | |
equivalent figure for the coalition Government was 0.8%. The lowest | :47:07. | :47:11. | |
increase of any Government since World War II. And the figure for the | :47:12. | :47:18. | |
present Government is 1.75%. The Government might talk a good game on | :47:19. | :47:23. | |
NHS spending, but the truth is, we are in the middle of a decade of au | :47:24. | :47:30. | |
ter ritty. Add to that a slash and burn approach to local Government | :47:31. | :47:33. | |
and the social care services it is responsible for and it is little | :47:34. | :47:38. | |
wonder we find ourselves in the current predicament. What now? As | :47:39. | :47:42. | |
the chair of the Health Select Committee has said, we have to be | :47:43. | :47:44. | |
honest about the scale of the challenge. When it comes to NHS | :47:45. | :47:48. | |
spending, this year is meant to be the year of plenty. The one year in | :47:49. | :47:53. | |
this Parliament when there is a relatively significant increase in | :47:54. | :47:57. | |
available funds. But these funds have already been used to pay off | :47:58. | :48:01. | |
the debts from last year. Money which is meant to be used to repair | :48:02. | :48:07. | |
buildings and buy new equipment is in effect being used to pay | :48:08. | :48:11. | |
salaries. Funds to transform services are being used to deal with | :48:12. | :48:17. | |
the flow of people arriving at A Hospitals are likely to end this | :48:18. | :48:23. | |
year in deficit again. More clinical commissioning groups are | :48:24. | :48:26. | |
overshooting their budgets. NHS England is struggling to stay within | :48:27. | :48:31. | |
their spending limits for specialised services. So called | :48:32. | :48:37. | |
efficiency savings really equate to freezing staff pay. People who work | :48:38. | :48:41. | |
in the NHS and care system need to be honest about their ability to | :48:42. | :48:46. | |
cope. The junior doctors were last year and it is now time for others | :48:47. | :48:50. | |
to do the same. NHS managers need to be honest about the time it will | :48:51. | :48:57. | |
take to transform services and the funding that transformation | :48:58. | :49:00. | |
requires. You can't close hospital beds if services in the community | :49:01. | :49:05. | |
aren't already up and running and have been proven to reduce the | :49:06. | :49:09. | |
demand for in-patient care. So, we need to be honest, but we also need | :49:10. | :49:14. | |
action. The Government needs to provide direct support to local | :49:15. | :49:19. | |
authorities with funding for social care in the Budget. How the | :49:20. | :49:23. | |
Government pays for this is obviously for the Government to | :49:24. | :49:30. | |
decide, but it cannot continue to shove partial, so-called solutions | :49:31. | :49:33. | |
on to local Government and wash its hands of the problem. If it doesn't | :49:34. | :49:37. | |
address the long-term problems in social care, it will simply leave | :49:38. | :49:43. | |
the NHS to pick up the pieces. But even if Government is persuaded of | :49:44. | :49:46. | |
the case for additional funding, we also need to think carefully about | :49:47. | :49:51. | |
where that money would be best spent. It's tempting to say simply | :49:52. | :49:57. | |
put it back into the things that have been taken away, the more | :49:58. | :50:02. | |
comprehensive care packages, provide social care to a wider group of | :50:03. | :50:07. | |
people, look at the cuts to community, health nurses, look at | :50:08. | :50:13. | |
the cuts in mental health trusts. I think it's more complicated than | :50:14. | :50:16. | |
that. This current short-term fix of taking money out of the capital | :50:17. | :50:21. | |
budget to prop up revenue is the wrong thing to do. New scanners are | :50:22. | :50:25. | |
less likely to need repair than old ones. Cutting waiting times and | :50:26. | :50:32. | |
improving outcomes. Well designed, well maintained buildings can | :50:33. | :50:35. | |
improve productivity and constituency. Compare the new cancer | :50:36. | :50:43. | |
centre to the buildings at the Princess Alexandra Hospital in | :50:44. | :50:45. | |
Harlow. You wouldment believe you're in the same country. We should | :50:46. | :50:49. | |
invest in new step down care facilities for people well enough to | :50:50. | :50:53. | |
come out of hospital, but for whom care in the home is yet to be | :50:54. | :50:56. | |
arranged. There is also a massive need to | :50:57. | :51:01. | |
invest in staff and build careers which people aspire to. This will | :51:02. | :51:05. | |
take time as well as money. Perhaps we do need to consider new roles in | :51:06. | :51:11. | |
community health services which provide holistic care to older | :51:12. | :51:15. | |
people in the home. Perhaps we need more GPs who are paid to dedicate | :51:16. | :51:23. | |
time to residential homes, spotting problems amongst the elderly would | :51:24. | :51:26. | |
otherwise end up in a hospital addition. Perhaps the social care | :51:27. | :51:31. | |
workforce needs a re-think. I never forget the conversation I had a | :51:32. | :51:36. | |
senior A nurse who told me that the half term holidays always result | :51:37. | :51:40. | |
in more older people coming into hospital because the mums who do the | :51:41. | :51:45. | |
part-time zero hours jobs in home care were looking after their | :51:46. | :51:49. | |
children instead. I fundamentally feel that the whole system needs to | :51:50. | :51:55. | |
focus on how we provide care in the broadest sense to older people. The | :51:56. | :52:00. | |
one in four people in hospital beds with dementia, the three in four | :52:01. | :52:05. | |
people in care homes with dementia as well. We should focus on the real | :52:06. | :52:11. | |
weekend effect. The one where if you happen to be in hospital on a Friday | :52:12. | :52:17. | |
night you are unlucky to make it out until Monday lunch time at the | :52:18. | :52:21. | |
earliest. Why do doctors talk about how it takes three minutes to admit | :52:22. | :52:26. | |
a patient but three days to discharge one? Mr Speaker, I will | :52:27. | :52:32. | |
end by saying this, the Government maybe absorbed by the complex task | :52:33. | :52:38. | |
of trying to take us out of the European Union, but if it doesn't do | :52:39. | :52:43. | |
something to address the scale of underfunding in the NHS and care | :52:44. | :52:48. | |
system, the public will not forgive it. We need real answers to the real | :52:49. | :52:56. | |
problems and we need it urgently. Thank you, Mr Speaker. It is a | :52:57. | :53:00. | |
pleasure to follow the honourable member for Lewisham East. She will | :53:01. | :53:04. | |
not be surprised to know that while I agree with some of the points she | :53:05. | :53:08. | |
made I don't agree with all of them. In the time I have I want to cover a | :53:09. | :53:14. | |
few points. I don't want to repeat much of the excellent statements | :53:15. | :53:17. | |
that many members have made across this House. But the time I do have I | :53:18. | :53:22. | |
want to go over just a few issues. Because while I do welcome the | :53:23. | :53:25. | |
Government's extra funding and the ?6 billion this year in particular, | :53:26. | :53:32. | |
with the changes in national insurance contributions, pension | :53:33. | :53:35. | |
contributions, the costs of running the NHS are going up all the time. | :53:36. | :53:40. | |
That extra money is being swallowed up without it necessarily going to | :53:41. | :53:43. | |
front line staff. I do particularly agree with the honourable member for | :53:44. | :53:48. | |
Newton Abbott, when she said that in an estimates debate we shouldn't | :53:49. | :53:51. | |
just be talking about the money that we need to spend, but we also need | :53:52. | :53:55. | |
to look at the demand and the type of services that we need to fund, | :53:56. | :53:59. | |
because there's no doubt that demand for the NHS services and social care | :54:00. | :54:05. | |
is increasing. So even by providing extra funding, we are just really | :54:06. | :54:09. | |
standing still in terms of the services that we are providing. We | :54:10. | :54:13. | |
know there's an increase in numbers across the country. We know, as has | :54:14. | :54:18. | |
been said by others, there are new treatments which need providing and | :54:19. | :54:25. | |
we know that patients are changing. In years gone past they would have | :54:26. | :54:29. | |
been admitted with one illness, treated and go home. Now when they | :54:30. | :54:34. | |
are admitted they are many illnesses which are not sod easy to treat. | :54:35. | :54:38. | |
That is why discharges are often delayed. If you look at the data | :54:39. | :54:45. | |
provided, we know there's around a 7% increase in terms of demand for | :54:46. | :54:50. | |
services across the board. A 7% increase in the number of ambulance | :54:51. | :54:54. | |
calls made. A 3% increase made in the number of A visits. We know | :54:55. | :54:58. | |
that the Tuesday after Christmas was the busiest day in the history of | :54:59. | :55:02. | |
the NHS ever. And that takes extra money to be able to deliver. That we | :55:03. | :55:07. | |
know for diagnostic tests there is a 6% increase. We know that cob | :55:08. | :55:11. | |
sulant-led treatments are up -- consultant-led treatments are up by | :55:12. | :55:15. | |
6%. Demand is rising. The extra money is welcome, there's no doubt | :55:16. | :55:20. | |
about. That but it's not actually dealing the level of service that is | :55:21. | :55:24. | |
required. But one point I would like to make | :55:25. | :55:28. | |
and this is just a plea, as someone who still works in the health | :55:29. | :55:32. | |
service and still sees and works with colleagues across the NHS nstz | :55:33. | :55:38. | |
on a regular basis. While there is a lot of pressure that the services | :55:39. | :55:42. | |
are under and there's a lot that we can be concerned about, there is | :55:43. | :55:45. | |
some amazing work that's going on in our NHS. And I welcome the NHS | :55:46. | :55:50. | |
England's announcement only last week that it's going to start to a | :55:51. | :55:56. | |
fund General Secretary ond stem-cell transplants. We had debates in this | :55:57. | :56:03. | |
place about how important that is to those patients whose first | :56:04. | :56:05. | |
transplant actually fails. We know there'll be new treatments for | :56:06. | :56:09. | |
kidney disease and for high per tension. All are really welcomed | :56:10. | :56:13. | |
announcements. We must recognise there is some great work happening | :56:14. | :56:17. | |
there on the front line. I'm particularly pleased that the | :56:18. | :56:21. | |
Government once again, the Department of Health gave ?1 | :56:22. | :56:26. | |
million, I would love ?1 billion, ?1 million to the British Heart | :56:27. | :56:29. | |
Foundation to provide defibrillators up and down the country. That will | :56:30. | :56:34. | |
make a tremendous difference when we know that 12 young people a week die | :56:35. | :56:40. | |
in this country from cardiac arrest. There's work, ground-breaking work | :56:41. | :56:44. | |
in cancer care. In my old hospital, the Royal Marsden in London we are | :56:45. | :56:49. | |
making strides in Cancer Research which are not just innovative in | :56:50. | :56:53. | |
Europe but making world-wide break throughs. We are often leading the | :56:54. | :56:57. | |
field in research on a global level and it is something we should be | :56:58. | :57:02. | |
extremely proud of. Now, in response to the Health Select Committee's | :57:03. | :57:06. | |
report, the Government made a number of recommendations in how to tackle | :57:07. | :57:10. | |
some of the problems facing the NHS and facing social care. And I just | :57:11. | :57:14. | |
want to touch on two of them. The first was to try and arrive at a | :57:15. | :57:19. | |
type of financial discipline in the health service because for years | :57:20. | :57:24. | |
now, there have been problems in terms of financial mismanagement. I | :57:25. | :57:28. | |
know, as someone who has worked in the health service, how | :57:29. | :57:31. | |
heartbreaking it is to see money being squandered. We have talked | :57:32. | :57:36. | |
about the PFI deals here, which have touched many parts of the country. | :57:37. | :57:40. | |
There was the IT system which cost billions of pounds which never saw | :57:41. | :57:45. | |
the light of day, which was suppose to move us from paperless records to | :57:46. | :57:50. | |
a paperless system. Today, the NHS is spending huge money still on | :57:51. | :57:56. | |
paper notes and storage, off-site storage facilities that hospitals | :57:57. | :58:01. | |
are having to pay for to keep patients' recordses. | :58:02. | :58:11. | |
to the, mainly imposed on social care, for those patients who don't | :58:12. | :58:14. | |
get that procedure and other similar procedures? That is a respect for | :58:15. | :58:22. | |
personal cost to the wasted opportunity and it cost the NHS | :58:23. | :58:26. | |
millions of the pay structure for staff and improve productivity was | :58:27. | :58:28. | |
meant to be improved but it just rearrange the deck chairs on the | :58:29. | :58:31. | |
ship and that was a huge wasted opportunity and it cost the NHS | :58:32. | :58:35. | |
millions when staff should have been given a well-deserved pay rise and | :58:36. | :58:37. | |
seen the same result. Financial discipline is important. If you look | :58:38. | :58:41. | |
at the big General hospitals in my constituency with the same financial | :58:42. | :58:46. | |
settlement and similar patients to look after, one hospital is in | :58:47. | :58:49. | |
special measures and struggling to cope with its discharges and another | :58:50. | :58:54. | |
less than five miles down the coast is rated as if you look at the big | :58:55. | :58:58. | |
general hospitals in my constituency with the same financial settlement | :58:59. | :59:00. | |
and similar patients to look after, one hospital is in special measures | :59:01. | :59:02. | |
and struggling to cope with its discharges and another less than | :59:03. | :59:05. | |
five miles down the coast is rated and able to provide excellent care | :59:06. | :59:07. | |
centre has to be something about the money that is given out on right | :59:08. | :59:10. | |
that one hospital done with that money that we need to be looking at | :59:11. | :59:13. | |
and sharing best practice because it cannot be right that one hospital | :59:14. | :59:15. | |
isable to manage its buzz -- budgets and another one isn't in my | :59:16. | :59:19. | |
experience in 20 years of working in the NHS there are lots of | :59:20. | :59:22. | |
opportunities and financial discipline should be about top | :59:23. | :59:26. | |
slicing but using your money as widely as possible. I would | :59:27. | :59:34. | |
recommend if the ministers wanted recommendations about how to make | :59:35. | :59:37. | |
financial savings they should speak to health care professionals because | :59:38. | :59:41. | |
they often have the answers and if they were asked on a more regular | :59:42. | :59:44. | |
basis they could provide some fantastic solutions. The other | :59:45. | :59:49. | |
recommendation that the government wanted to take forward was about | :59:50. | :59:53. | |
reducing demand and that is easier said than done. I started by saying | :59:54. | :00:00. | |
demand is on the increase by 6% a year but for too long we have been | :00:01. | :00:05. | |
so focused on hospitals and with no disrespect, I see my colleague, the | :00:06. | :00:09. | |
honourable member for Totnes sitting beside me, no disrespect to doctors, | :00:10. | :00:13. | |
we have been very medical focused in how we manage our NHS and we have | :00:14. | :00:18. | |
missed an opportunity looking at what other health care professionals | :00:19. | :00:24. | |
can offer. Pharmacists are highly educated and experienced and | :00:25. | :00:27. | |
qualified individuals and there is some ground-breaking work happening | :00:28. | :00:34. | |
in the community pharmacies. In Scotland they do simple things such | :00:35. | :00:37. | |
as having a register so patients register with the pharmacist as well | :00:38. | :00:41. | |
as a GP and that would make a tremendous difference to patients | :00:42. | :00:47. | |
lives. Why are pharmacists not contacted on discharge like we | :00:48. | :00:51. | |
contact GPs? I was talking to a pharmacist recently that said around | :00:52. | :00:56. | |
30% of readmissions are caused by patients not taking their medicine | :00:57. | :01:00. | |
properly on discharge. If the pharmacist was contacted, if they | :01:01. | :01:03. | |
had a list of chronically ill patients and they were in charge of | :01:04. | :01:07. | |
managing their medicine so many readmissions could be easily | :01:08. | :01:13. | |
avoided. Nurse practitioners we heard from my honourable friend who | :01:14. | :01:19. | |
talked about the role of nurse practitioners who are doing blood | :01:20. | :01:24. | |
tests to predict bacterial infections and who needs an | :01:25. | :01:27. | |
antibiotic and who doesn't but we need to be up skilling those health | :01:28. | :01:30. | |
care professionals so they can take on more roles. I really want to | :01:31. | :01:38. | |
finish really with other excellent examples of paramedics who are in | :01:39. | :01:43. | |
the community and going to people's homes instead of them being in A | :01:44. | :01:46. | |
and I want to finish by saying this is an estimate debate about how we | :01:47. | :01:50. | |
use the money but we need to properly forecast demand and use | :01:51. | :01:53. | |
existing resources better and we need to look at best practice to | :01:54. | :01:56. | |
shout the good work that is happening in our NHS. For backbench | :01:57. | :02:04. | |
would-be contributors remain and I would like to accommodate the more | :02:05. | :02:08. | |
but it might be helpful if I explain I would like to call the front | :02:09. | :02:13. | |
wind-up speakers, of whom there are three, no later than 928. If | :02:14. | :02:22. | |
possible, slightly earlier. It is a pleasure to be part of this debate | :02:23. | :02:27. | |
of so many informed members and it is very timely because if in case | :02:28. | :02:32. | |
members did not realise the Public Accounts Committee produced a report | :02:33. | :02:36. | |
today upon which I will bake so many of my comments. At the beginning of | :02:37. | :02:39. | |
the report we do ask that the years of arguing in public about the level | :02:40. | :02:45. | |
of funding of NHS does stop and particularly the department, the NHS | :02:46. | :02:48. | |
England and number ten Downing St could start working together in the | :02:49. | :02:53. | |
interest of patients and stop the bickering about the levels of | :02:54. | :02:57. | |
funding. The two issues I would particularly to highlight our one is | :02:58. | :03:03. | |
the work that has gone on around the NHS accounts behind-the-scenes and I | :03:04. | :03:07. | |
know, Mr Speaker, you are very keen supporter of the work of select | :03:08. | :03:10. | |
committees but this debate has been brought with the health committee | :03:11. | :03:13. | |
and the public accounts and DC LG and other honourable members working | :03:14. | :03:17. | |
alongside parliament but I would like to that the National Audit | :03:18. | :03:20. | |
Office for the help they have given myself and many honourable members | :03:21. | :03:22. | |
in understanding and really interrogating this year 's accounts, | :03:23. | :03:27. | |
particularly including a meeting in a very quiet portcullis house in the | :03:28. | :03:30. | |
middle of August when perhaps many other honourable members were on a | :03:31. | :03:35. | |
beach somewhere, but supporting us as members to really understand the | :03:36. | :03:39. | |
accounts and what they mean for our constituents is a very important and | :03:40. | :03:43. | |
often neglected part of what the public hear about parliament. This | :03:44. | :03:48. | |
year the National Audit Office report on the council is really | :03:49. | :03:51. | |
quite unprecedented and I think it is worth honourable members looking | :03:52. | :03:58. | |
at what was said about the accounts for last year. There are a number of | :03:59. | :04:02. | |
one-off actions that were taken this year to bring the Department within | :04:03. | :04:06. | |
its expenditure limit and somewhere really concerning and some are just | :04:07. | :04:10. | |
incredibly fortunate. The national Insurance contribution, the | :04:11. | :04:16. | |
inability of the Department to find the ?417 million that had been | :04:17. | :04:20. | |
wrongly placed within that department was really given the | :04:21. | :04:24. | |
amount of rigour given to the accounts issue really quite | :04:25. | :04:29. | |
extraordinary. It was ?100 million from the medical and health care | :04:30. | :04:33. | |
products agency and there were a lot of central readjustments and the | :04:34. | :04:37. | |
capital to revenue transfers we have talked about but I would also draw | :04:38. | :04:41. | |
attention to the guidance that the NHS providers were given by monitor | :04:42. | :04:46. | |
and the TDA and I use the word guidance carefully but really that | :04:47. | :04:49. | |
and the transaction reviews commissioned by the department | :04:50. | :04:53. | |
whereby to accountancy firms undertook a review of accountancy | :04:54. | :04:57. | |
policies and how they were adopted in order for essentially the results | :04:58. | :05:03. | |
to come out more favourably than they might otherwise have done. It | :05:04. | :05:06. | |
demonstrates the incredible effort with which the Department of Health | :05:07. | :05:10. | |
and all of its bodies this year when two to bring the accounts barely | :05:11. | :05:15. | |
within the expenditure limit voted by this house. It is clear from | :05:16. | :05:19. | |
whistle-blowing accounts and reports from health and care conferences and | :05:20. | :05:22. | |
the regional board papers, which some of us do, discussions with | :05:23. | :05:25. | |
chief executives, reports in the specialist media, that the pressure | :05:26. | :05:29. | |
on individuals within the service is immense and that is not good for | :05:30. | :05:33. | |
anybody. I would like to praise the staff that are involved in all parts | :05:34. | :05:38. | |
of the health service and the departments work, clinical staff and | :05:39. | :05:42. | |
managerial staff, which I am very proud to be won for many years | :05:43. | :05:47. | |
myself but the pressure now, particular finance directors, to | :05:48. | :05:49. | |
produce the right result and the right answer is deeply concerning. | :05:50. | :05:54. | |
It is concerning because of the effect on safety and only a few | :05:55. | :05:59. | |
weeks ago we had the intervention of Sir Robert Francis, himself, from | :06:00. | :06:03. | |
his own previous work, really now raising concerns about clinical | :06:04. | :06:08. | |
safety in our health service. The international comparisons on funding | :06:09. | :06:10. | |
a very clear and they have been touched upon earlier. We're probably | :06:11. | :06:13. | |
spending the money to be like Mexico but not to be like France or Germany | :06:14. | :06:18. | |
and my constituents expect to be treated in the same way as their | :06:19. | :06:23. | |
European opposites. What ever the right level of funding is there has | :06:24. | :06:26. | |
to be agreement on that level and crucially what it can provide. In | :06:27. | :06:31. | |
the Public Accounts Committee in the last year we have had 11 or 12 | :06:32. | :06:36. | |
sessions now about what is being promised to be delivered by the | :06:37. | :06:39. | |
service for the money that is available. It really takes me to my | :06:40. | :06:45. | |
second point. We are now in the realm of political choices and that, | :06:46. | :06:50. | |
as MPs, is our responsibility. The tax payer, the voter, the patient | :06:51. | :06:54. | |
are not different people, they are one and the same person and they are | :06:55. | :06:58. | |
very wise people, they understand you get what you pay for. They have | :06:59. | :07:02. | |
to be informed and currently the scrappy and ill informed debate that | :07:03. | :07:06. | |
goes on in public and the identifying blame game is not | :07:07. | :07:08. | |
informing them, it is letting them down. It is clear to me and many | :07:09. | :07:13. | |
honourable members that the government is not imply to fund the | :07:14. | :07:16. | |
service to the standards that we have become used to, that we expect | :07:17. | :07:21. | |
that the NHS Constitution gives us the right to expect and our | :07:22. | :07:25. | |
universal that European neighbours have so I think the government has | :07:26. | :07:28. | |
to be clear about the trade-offs about the choices. The FTP process | :07:29. | :07:32. | |
in my view allows this to happen and I listened closely to members | :07:33. | :07:36. | |
opposite who also chaired the Prime Minister and the Secretary of State | :07:37. | :07:38. | |
when they say they have increased the money the NHS was given, while | :07:39. | :07:43. | |
the NHS has been given what they asked for and they made a very | :07:44. | :07:46. | |
passionate plea for their Community Hospital all services in the area, | :07:47. | :07:50. | |
as in there want. This brings into sharp focus now the trade-off | :07:51. | :07:55. | |
between finance and quality and I defend quality -- define quality in | :07:56. | :07:58. | |
terms of the patient experience, clinical effectiveness and | :07:59. | :08:01. | |
efficiency. It gives us a very clear trade-off between the money and the | :08:02. | :08:06. | |
mandate. I hope that the refresh of the NHS funding that we are | :08:07. | :08:10. | |
expecting in March, as discussed in the Public Accounts Committee, in a | :08:11. | :08:14. | |
five-year for the review will be very clear and the public will be | :08:15. | :08:18. | |
able to have that information at their fingertips because currently | :08:19. | :08:21. | |
patients do not have the information and they should. They should know | :08:22. | :08:25. | |
where the best run and the worst run hospitals are. I agree with the | :08:26. | :08:30. | |
honourable member for Lewis, it is unacceptable that a hospital with | :08:31. | :08:34. | |
virtually the same population a few miles apart are creating -- treated | :08:35. | :08:37. | |
completely differently. Patients need to know where the outcomes are | :08:38. | :08:41. | |
the best. It is not good enough to hold the information nationally and | :08:42. | :08:51. | |
hide it from patients for well-informed people to interrogate | :08:52. | :08:53. | |
board papers and find out the answers. I do believe that the way | :08:54. | :08:56. | |
forward is actually very clear, waiting times will continue to | :08:57. | :08:58. | |
increase, we will go back to the days of the 1990s of longest and | :08:59. | :09:01. | |
access to GPs and other professionals will continue to | :09:02. | :09:03. | |
decrease and the service will become a largely emergency one and families | :09:04. | :09:06. | |
where people have them will be increasingly bearing the cost and | :09:07. | :09:08. | |
responsibility of social care and access will continue to be | :09:09. | :09:12. | |
restricted. I believe the government does now have to be really honest | :09:13. | :09:17. | |
not just about the costs but access, that there isn't any more money, | :09:18. | :09:21. | |
there is going to be any, and what that means in terms of expectation, | :09:22. | :09:25. | |
particularly in regard to the NHS Constitution and I look forward to | :09:26. | :09:30. | |
the response from the Minister. Thank you, Mr Speaker, it is a | :09:31. | :09:35. | |
pleasure to carry on from my honourable friend for Bristol South. | :09:36. | :09:40. | |
We are here today to debate the financial sustainability of the | :09:41. | :09:41. | |
health and adult social care sectors, although health and adult | :09:42. | :09:46. | |
social care are almost inseparable, for brevity 's sake I will focus my | :09:47. | :09:51. | |
remarks on adult social care. I focus on adult social care because | :09:52. | :09:55. | |
although acute care and adult social care sector is facing similar | :09:56. | :09:59. | |
unprecedented pressures adult social care is different in one important | :10:00. | :10:11. | |
way. Unlike the NHS, which has the ear of the Chancellor and the | :10:12. | :10:13. | |
Treasury, adult social care certainly does not. All the evidence | :10:14. | :10:16. | |
in recent months has only served to confirm this. The Chancellor 's | :10:17. | :10:18. | |
decision to not make one extra penny of new money available in his Autumn | :10:19. | :10:23. | |
Statement was met with all most universal criticism across the | :10:24. | :10:27. | |
health and local government sectors. The recent decision of this | :10:28. | :10:30. | |
Chancellor to introduce the adult social care precept is damning | :10:31. | :10:36. | |
evidence that desperately outdated view of funding remains strong in | :10:37. | :10:40. | |
the Treasury. Adult social care delivered locally by local | :10:41. | :10:44. | |
authorities and its funding is viewed as a locally devolved issue | :10:45. | :10:48. | |
by this Chancellor. This government 's decision to pass the blame to | :10:49. | :10:53. | |
local councils, to underfund adult social care, is nothing short of | :10:54. | :10:57. | |
moral cowardice. Adult social care is being deliberately underfunded by | :10:58. | :11:01. | |
this government in my home city of Bradford. What is most desperate, Mr | :11:02. | :11:06. | |
Speaker, is this government 's abandonment of the hundreds of | :11:07. | :11:09. | |
thousands of old and vulnerable people who are day in day out | :11:10. | :11:12. | |
reliant on these vital adult social care services. We are not talking | :11:13. | :11:18. | |
about hypotheticals, we are talking about the care happening today, | :11:19. | :11:23. | |
right now. Real people struggling to get by in my constituency Bradford | :11:24. | :11:27. | |
South. Bradford is a relatively young city but nevertheless the | :11:28. | :11:30. | |
number of people in Bradford over the age of 65 has grown | :11:31. | :11:36. | |
substantially. Between 2012 and 2015 and extra four and a half thousand | :11:37. | :11:39. | |
people are living in the district and a number of people within | :11:40. | :11:44. | |
Bradford with complex physical disabilities has grown by 400. My | :11:45. | :11:48. | |
local council, Bradford, agreed its budget last Thursday. Like many | :11:49. | :11:54. | |
others Bradford Council had the task of agreeing swingeing cuts to scores | :11:55. | :11:57. | |
of community services. In recent years Bradford council has | :11:58. | :12:09. | |
reduced its budget. By 2020, a further ?82 million in cuts will | :12:10. | :12:14. | |
have to be made. Adult social care is the biggest service overseen by | :12:15. | :12:18. | |
Bradford council, faces the lion's share of these looming cuts. A | :12:19. | :12:22. | |
further ?19 million in cuts will fall on the city's adult social care | :12:23. | :12:27. | |
sector. And this Government is washing its hands of any | :12:28. | :12:30. | |
responsibility. By 2020, the primary source of | :12:31. | :12:35. | |
central Government funding to Bradford council, the revenue | :12:36. | :12:39. | |
support ground will drop to zero, absolutely nothing. This Government, | :12:40. | :12:44. | |
half baked answer, it is the adult social care present. In the next two | :12:45. | :12:51. | |
years the adult social care present is expected to rise in Bradford. | :12:52. | :12:56. | |
But, Mr Speaker, this extra money is dwarfed by the huge cuts to Bradford | :12:57. | :13:00. | |
council's revenue support grant. More to the point, this extra ?6.6 | :13:01. | :13:06. | |
million is not even enough to meet the increased costs of adult social | :13:07. | :13:10. | |
care flowing from this Government's so-called national living wage. | :13:11. | :13:14. | |
These bruising budget cuts are only the tip of the funding shortfall, | :13:15. | :13:18. | |
due to the unprecedented increases in demand. The cost of increasing | :13:19. | :13:24. | |
and supporting increasing numbers of older people coupled with larger | :13:25. | :13:27. | |
numbers of working age people, living with disables, is expected to | :13:28. | :13:32. | |
shoulder Bradford council with an extra ?1.5 million each and every | :13:33. | :13:35. | |
year. I am nearly at the end of my | :13:36. | :13:39. | |
remarks. You've had your turn. What is beyond doubt is this Chancellor | :13:40. | :13:45. | |
must act in the upcoming Budget. This Chancellor faces his greatest | :13:46. | :13:48. | |
test in this Parliament. I hope he and his Government do not | :13:49. | :13:51. | |
disappoint. Time will tell. Thank you very much Mr Speaker. | :13:52. | :13:58. | |
I am very pleased to follow my friend from Bradford South who spoke | :13:59. | :14:05. | |
about the needs of her constituent with great feeling. I think if my | :14:06. | :14:10. | |
constituents were here and saw the estimates today they might be a bit | :14:11. | :14:14. | |
disappointed. I had a very interesting public meeting a few | :14:15. | :14:18. | |
weeks ago with them. They said to me, Helen, it's marvellous, because | :14:19. | :14:23. | |
of Brexit we're going to get ?350 million extra every week for the | :14:24. | :14:29. | |
NHS. And our A department can be reopened. There doesn't seem to be | :14:30. | :14:34. | |
any mention of this in these estimates today. But what is going | :14:35. | :14:44. | |
on is a proposal under our sustainability and transformation | :14:45. | :14:52. | |
plan to close the A department at Darlington hospital and for my | :14:53. | :14:57. | |
constituents this would be an unutterable disaster. We are told | :14:58. | :15:05. | |
continuously that this STP is to improve services. I relie wish the | :15:06. | :15:13. | |
local NHS -- really wish the local NHS managers would stop pretending. | :15:14. | :15:16. | |
They have told us by 2020 there'll be a shortfall in funding of ?281 | :15:17. | :15:21. | |
million. So nobody believes that this is | :15:22. | :15:27. | |
about improving services. Everybody believes it is about managing on | :15:28. | :15:32. | |
limited resources. And of course I approachiate that | :15:33. | :15:37. | |
pressures are -- appreciate that pressures are going up on the health | :15:38. | :15:41. | |
service because of the ageing population, but I feel this level of | :15:42. | :15:46. | |
austerity in the health service is unnecessary. The British economy is | :15:47. | :15:50. | |
bigger than it has ever been. It is 14% bigger than it was in 2010. | :15:51. | :15:54. | |
Other honourable members have pointed to the disparity between | :15:55. | :16:03. | |
spending in the UK, which is ?3.254 -- $2.3,000 a year. Where in Germany | :16:04. | :16:10. | |
it is $4,# 00. Hospital beds in the UK are 2.8 per 1,000. In Germany | :16:11. | :16:16. | |
8.3. It doesn't need to be like. This I want to focus particularly on | :16:17. | :16:23. | |
the needs of rural communities. We haven't talked about this evening | :16:24. | :16:28. | |
and were the A department in Darlington to close, this would be | :16:29. | :16:32. | |
an extremely serious problem for people to the west of Darlington and | :16:33. | :16:38. | |
at the top of tease deal. Already people are travelling 30 miles to | :16:39. | :16:43. | |
get to the hospital. And the response times of the | :16:44. | :16:48. | |
North-East Ambulance Service are not what they ought to be. People often | :16:49. | :16:52. | |
wait 20-30 minutes. So that is an hour to get into the hospital. Now, | :16:53. | :16:59. | |
one of my local councillors has done an absolutely brilliant piece of | :17:00. | :17:02. | |
analysis, looking at the journey times that would be needed were | :17:03. | :17:09. | |
people to have to go to the James kook in Middlesbrough. At the | :17:10. | :17:14. | |
moment, if you live in Bishop Auckland, the journey time is 25 | :17:15. | :17:19. | |
minutes. It would go up to 39. If you live right up in the top of | :17:20. | :17:23. | |
the dale, the journey time is 39 minutes. It would go up to 64 | :17:24. | :17:37. | |
minutes. The STP managers running the review say they want to treat | :17:38. | :17:45. | |
cardio vascular and trauma patients in centres where staff can maintain | :17:46. | :17:49. | |
their skills. Ork that sounds reasonable enough. When my | :17:50. | :17:55. | |
constituent asked them, what proportion of emergency journeys are | :17:56. | :18:01. | |
not cardio vascular or trauma cases, the answer was 94%. We have acute | :18:02. | :18:10. | |
asthma. Apen thesies the. Meningitis, the list goes on and on | :18:11. | :18:16. | |
and on. And for all of these, the fact is that there would be no | :18:17. | :18:20. | |
benefit to being in a different specialised centre. But the extra | :18:21. | :18:27. | |
mortality from the longer travel time goes up quite dramatically. In | :18:28. | :18:34. | |
Bishop Auckland up by 2.4%. In bar fared castle up to by 3.4%. That's | :18:35. | :18:42. | |
why the pretence this is about improving the quality of health care | :18:43. | :18:45. | |
is not believed to by my constituents. | :18:46. | :18:49. | |
They do, they are tired of being told that services should be nearer | :18:50. | :18:53. | |
to home when in fact they are being pushed further and further away. | :18:54. | :18:58. | |
There's a question mark over the cottage hospital, the Richardson. | :18:59. | :19:06. | |
The A at Bishop Auckland and the maternity services are taken out of | :19:07. | :19:09. | |
that hospital. When that was done, we were told it would be absolutely | :19:10. | :19:13. | |
fine because people would be able to go to the Darlington A But now | :19:14. | :19:19. | |
the Darlington A is under threat. This is a constant attrition that | :19:20. | :19:22. | |
people in rural communities are feeling. | :19:23. | :19:26. | |
Thank you. I have similar troubles in Devon, where the STP will lead to | :19:27. | :19:42. | |
long travel distances and as the ministers know that is something I | :19:43. | :19:45. | |
have brought up with them and in this House as well. Would she agree | :19:46. | :19:49. | |
with me that the challenges the STP is trying to look at haven't | :19:50. | :19:52. | |
happened in the last 18 months or the last six years, these are issues | :19:53. | :19:57. | |
which have built up over many years, over many different Governments? It | :19:58. | :20:03. | |
has been proposed that the Darlington A should be proposed. | :20:04. | :20:07. | |
That wasn't proposed under the coalition Government or the previous | :20:08. | :20:11. | |
Labour Government. So, this Government must take responsibility | :20:12. | :20:14. | |
for what is happening now. On Saturday, I went over to Cumbria. | :20:15. | :20:22. | |
They are also running a campaign. Their local hospital is threatened | :20:23. | :20:26. | |
with closure. Then they will have to go over to Carlisle, which is 34 | :20:27. | :20:32. | |
miles. 34 miles is a long way. It is especially a long way in Cumbria, | :20:33. | :20:36. | |
where the weather is terrible and the road is often blocked. So, this | :20:37. | :20:41. | |
is a big rural issue. And I think ministers need to take more account | :20:42. | :20:47. | |
of this. They are worried there'll be a cynical saving of the hospital | :20:48. | :20:52. | |
in Copeland and then they will face even bigger cuts. Perhaps we have an | :20:53. | :20:56. | |
assurance about that from the minister? The interaction with | :20:57. | :21:01. | |
social care is well understood. We all know that cuts to social care | :21:02. | :21:12. | |
mean worse quality and less time for individuals and also... I would | :21:13. | :21:15. | |
rather not because of the speaking limits. And it also means pressure | :21:16. | :21:24. | |
on the NHS. For example, in Durham, we've had really big cuts to our | :21:25. | :21:31. | |
social care. Between 2011-2017, Durham has been required to make | :21:32. | :21:38. | |
?186 million of savings. Because child and adult services comprise | :21:39. | :21:49. | |
63%, the adult social care cuts have ?55 million. The precept raises ?4 | :21:50. | :21:56. | |
million. We have another ?40 million of cuts to come. Even taking into | :21:57. | :22:04. | |
account the better care funding, cuts by 2019/20, will come to ?170 | :22:05. | :22:11. | |
million. And this means there are, the whole villages in my | :22:12. | :22:15. | |
constituency, where there is no social care. We are told that the | :22:16. | :22:18. | |
Chancellor is minded to do something about it. Will he make up the full | :22:19. | :22:24. | |
?4.6 billion which was cut in the last Parliament? Of course, we've | :22:25. | :22:32. | |
had some discussion about the long term. I think we need to think about | :22:33. | :22:36. | |
the long-term. The discussion about social insurance is important and it | :22:37. | :22:42. | |
is significant. But I think we should also think about which | :22:43. | :22:46. | |
institutions would we be asking people to put money into and to put | :22:47. | :22:51. | |
their savings into. Because there are a lot of private sector | :22:52. | :22:55. | |
organisations at the moment which are frankly ripping people off. Fees | :22:56. | :23:02. | |
of ?600. ?900. Even in my constituency n the north, where | :23:03. | :23:06. | |
costs are not the highest. And with fees like that, we do not see highly | :23:07. | :23:12. | |
trained people, with expertise in dementia. We see the same workers on | :23:13. | :23:17. | |
minimum wages, with low levels of training. So, I really think we need | :23:18. | :23:25. | |
to look at a stronger, mutual approach and cut these exploitive | :23:26. | :23:30. | |
private sector contractors out of adult social care. | :23:31. | :23:37. | |
THE SPEAKER: I just remain the next speaker the wind up needs to start | :23:38. | :23:44. | |
at 9. 28. We need spechs now to conclude relatively promptly -- | :23:45. | :23:47. | |
speeches now to conclude relatively promptly. Thank you. The debate of | :23:48. | :23:54. | |
course has been filled with trep decision and anticipation as members | :23:55. | :23:57. | |
and the wider public wait to see whether or not the House will be | :23:58. | :24:02. | |
debating any of the budget estimates in front of us. I think, in fact to | :24:03. | :24:08. | |
pay tribute to members they have, we've done not too badly. The | :24:09. | :24:14. | |
estimates document 946, all 753 pages of it. 3-and-a-half inches | :24:15. | :24:26. | |
thick and the order paper gives us an estimate of ?8 billion. Take | :24:27. | :24:32. | |
pages 137 to 151 of the document. The only line which includes | :24:33. | :24:38. | |
expenditure for the social and health centre known as NHS digital. | :24:39. | :24:44. | |
Which has 151 million of resource. That would maybe make for a | :24:45. | :24:49. | |
considerably shorter debate if they had not used their ingenuity to the | :24:50. | :24:53. | |
extent they have. We have debaiteded the ten detailed retort r ports and | :24:54. | :24:59. | |
-- debated the ten detailed reports. I congratulate the committees on the | :25:00. | :25:03. | |
time from the committee. It begs the question why are ten reports | :25:04. | :25:07. | |
squeezed into three-hour debate which is supposed to be about | :25:08. | :25:11. | |
supplying the Government with the resources that it needs. I | :25:12. | :25:15. | |
congratulate them on securing this time that perhaps these reports | :25:16. | :25:16. | |
ought to have time to themselves. The NHS is one of the biggest areas | :25:17. | :25:29. | |
of government spending, second only to pensions. There is no means | :25:30. | :25:32. | |
through the estimates process to seek to amend any of this in any | :25:33. | :25:36. | |
meaningful way and all we can do with amendments that might lower the | :25:37. | :25:40. | |
amount, whereas the theme of the entire debate today seems to be what | :25:41. | :25:43. | |
the NHS in England needs is more money, not less. Any change to the | :25:44. | :25:49. | |
NHS budget in England has some sort of Barnet consequential from | :25:50. | :25:52. | |
Scotland and I wonder if at any point today or anywhere in the | :25:53. | :25:55. | |
supply estimates we can find out what those balmy consequential czar, | :25:56. | :25:59. | |
I suspect that we cannot. Nevertheless I think a number of | :26:00. | :26:02. | |
important points have been made by members. The chairs of both the | :26:03. | :26:09. | |
committees spoke in detail about the different budget lines and the | :26:10. | :26:16. | |
departmental spending lines and the important spending of the capital | :26:17. | :26:19. | |
budget to the revenue budget in the long-term consequences on that. The | :26:20. | :26:23. | |
member for Newton Abbot spoke about the need for ring fencing certain | :26:24. | :26:28. | |
lines and the other member who is no longer in his place made important | :26:29. | :26:31. | |
points about the disaster that PFI has been in the health service and | :26:32. | :26:37. | |
that is true for North and South of the border. The member for Bishop | :26:38. | :26:41. | |
Auckland quite rightly asked whether ?350 million a week for the NHS was, | :26:42. | :26:46. | |
it certainly isn't in the supply documents brought to the house by | :26:47. | :26:51. | |
the government today. There is in fact a systematic underfunding in | :26:52. | :26:54. | |
the NHS in England under this Tory government and it has serious | :26:55. | :26:57. | |
implications for the NHS across the UK as a whole. As we have heard from | :26:58. | :27:02. | |
members across that Ross today that environment is only going to become | :27:03. | :27:05. | |
more challenging of the population ages and demographics continue to | :27:06. | :27:08. | |
change. The Scottish Government, as I am sure we will hear from my | :27:09. | :27:12. | |
honourable friend on the front bench shortly, is focused on these | :27:13. | :27:20. | |
challenges and building a health service that meets the demands for | :27:21. | :27:23. | |
the 21st century. It is not just investing in the NHS but reforming | :27:24. | :27:25. | |
it, integrating health and social care, engaging with communities to | :27:26. | :27:27. | |
bring about a sustainable and positive NHS reform and Sterz -- as | :27:28. | :27:31. | |
opposed to pressing ahead with hasty cost-cutting exercises which seem to | :27:32. | :27:34. | |
be a priority of the Tory government. Perhaps it suits them to | :27:35. | :27:37. | |
have a very chess in the crisis described by Labour members because | :27:38. | :27:42. | |
it gives them an excuse to bring in private capital, private management, | :27:43. | :27:44. | |
outsourcing are verses to private providers and that in turn would | :27:45. | :27:48. | |
have major consequences for the NHS budget England and consequential is | :27:49. | :27:53. | |
for the devolved budget which brings us back to the inadequacies of the | :27:54. | :27:57. | |
estimates and supply process in this house. The former leader of the | :27:58. | :28:02. | |
house promised us that these supply days, estimates days, were our | :28:03. | :28:05. | |
chance to scrutinise the government for things that we were otherwise | :28:06. | :28:11. | |
excluded from. Can I gently said he honourable gentleman that he is a | :28:12. | :28:15. | |
distinguished ornament of the procedure committee, which has | :28:16. | :28:19. | |
deliberated upon this matter. The question of the character of debates | :28:20. | :28:25. | |
on the estimates has been at this point decided by the house and the | :28:26. | :28:31. | |
honourable gentleman shouldn't use his opportunity to speak in this | :28:32. | :28:36. | |
debate, which he should guard jealously, to dilate on his | :28:37. | :28:40. | |
disapproval of the process. What he ought to do is focus on the subject | :28:41. | :28:47. | |
which has been chosen. It is no good him grinning at me like a Cheshire | :28:48. | :28:52. | |
cat, I trust that that means that he is acquiescing in the judgment that | :28:53. | :28:56. | |
has been reached and we always look forward to the mellifluous tones of | :28:57. | :28:59. | |
the honourable gentleman but they should focus on the subject that we | :29:00. | :29:03. | |
have chosen and not on that which he would prefer to have been chosen. I | :29:04. | :29:08. | |
don't intend to detain has very much further. I have demonstrated, at | :29:09. | :29:14. | |
least what I have been trying to demonstrate, is how the importance | :29:15. | :29:17. | |
of the health and social care budget in England and will also affect the | :29:18. | :29:20. | |
health and social care budget north of the border, the overall Scottish | :29:21. | :29:25. | |
Parliament budget, and I think we have precisely proved the point, | :29:26. | :29:28. | |
that we do not have the appropriate opportunities to scrutinise them in | :29:29. | :29:32. | |
this debate so the government has to live up to those promises and then | :29:33. | :29:35. | |
we will see whether it is prepared to allow the member is this has a | :29:36. | :29:39. | |
proper say over the spending of the NHS and social care or any other | :29:40. | :29:41. | |
budget lines included included in the estimates. Thank you very much, | :29:42. | :29:50. | |
Mr Speaker. I certainly welcome that in recent months the health select | :29:51. | :29:56. | |
committee and the Secretary of State for Health has stopped using the 10 | :29:57. | :30:02. | |
billion figure and recognise and recognises the 4.5 billion figure | :30:03. | :30:06. | |
that is closer to reality. Spending is normally allocated on the basis | :30:07. | :30:11. | |
of health spending, not just NHS England, and the increase in NHS | :30:12. | :30:15. | |
England was at the cost of significant cuts to public health, | :30:16. | :30:18. | |
even though we all recognise the need for prevention and cuts to | :30:19. | :30:22. | |
health education England, despite the attempts to have 1500 extra | :30:23. | :30:30. | |
doctors every year and extra nurses and 5000 extra GPs. This is kind of | :30:31. | :30:36. | |
rather a challenge. Last year, as has been said, was the good year, | :30:37. | :30:41. | |
before we come to the lean years. I won't go into the details of the | :30:42. | :30:46. | |
Pocklington was required to get anywhere close to the required | :30:47. | :30:52. | |
out-turn, which was missed by ?2.7 million as it has been so clearly | :30:53. | :30:56. | |
extolled by those of the Public Accounts Committee but what it does | :30:57. | :31:00. | |
result in is what the auditor general described as short termism, | :31:01. | :31:06. | |
people simply working to meet the bottom line, instead of lifting | :31:07. | :31:09. | |
their chins up and looking at what the real challenges are. There are | :31:10. | :31:16. | |
three big challenges. We have talked about the ageing population, we | :31:17. | :31:20. | |
recognise that we have significant workforce challenges, and we all | :31:21. | :31:24. | |
know that money is tight and doesn't grow on trees and these three things | :31:25. | :31:30. | |
create a conflict and what we are sometimes seeing is that people are | :31:31. | :31:33. | |
doing a short-term patch that is actually going to cost more money in | :31:34. | :31:39. | |
the end. I think that the providers across England can be recognised for | :31:40. | :31:43. | |
getting their agency costs down, although they are still more than | :31:44. | :31:47. | |
twice what they are in Scotland. What is lying ahead? How are we | :31:48. | :31:54. | |
going to avoid the challenge of providing work force after Brexit? | :31:55. | :32:00. | |
How will we avoid the challenge of not just people leave vacant but how | :32:01. | :32:05. | |
will we recruit in the future? The turnover at the level of nurse and | :32:06. | :32:10. | |
social care worker is about 25% and if you actually need a constant | :32:11. | :32:16. | |
stream, and is one of the members on the government benches mentioned, | :32:17. | :32:22. | |
the tiny proportion of population we have below 65 of working age is | :32:23. | :32:25. | |
exactly why we needed immigration in the first place. Are we going to end | :32:26. | :32:32. | |
up with more agency workers, or will the government actually take action | :32:33. | :32:37. | |
to make sure we can attract nurses, doctors and social care workers from | :32:38. | :32:43. | |
Europe? A lot of these problems are blamed on an ageing population and | :32:44. | :32:47. | |
in actual fact in Scotland our demographics are worse than yours. | :32:48. | :32:51. | |
Going through a hard winter as we have all faced we didn't meet our | :32:52. | :32:58. | |
A target either. But in Scotland the emergency Department for our | :32:59. | :33:06. | |
achievement was 92.6, and in England it was 79.3. The worst level since | :33:07. | :33:10. | |
records began. This shows that there is a real crisis. This is not meant | :33:11. | :33:17. | |
to be a measure for us to attack each other with and I have to say | :33:18. | :33:21. | |
that in general I think this has been a great debate tonight, rather | :33:22. | :33:25. | |
than what some of our debates are like. It is meant to be a | :33:26. | :33:30. | |
thermometer to take the temperature of the whole system, not just the | :33:31. | :33:35. | |
whole hospital system from A to discharge, but actually from home to | :33:36. | :33:41. | |
GP to A, to hospital and getting back home again, and that is where | :33:42. | :33:47. | |
the problem lies. The cuts that are outside the Department of Health, | :33:48. | :33:52. | |
but yet are in social care, and they have been significant. And obviously | :33:53. | :33:56. | |
patients require that support to be able to get back into the community | :33:57. | :34:01. | |
and preferably even to get back to their own homes. Despite our | :34:02. | :34:07. | |
demographics, why is it that we are managing to keep our nostrils above | :34:08. | :34:13. | |
water and in NHS England we are not? Part of that is because it Scotland | :34:14. | :34:20. | |
we have focused absolutely on integration rather than financial | :34:21. | :34:27. | |
competition. The convoluted system that now exists between CCG and | :34:28. | :34:31. | |
outsourcing contracts and bidding and tendering is estimated to take | :34:32. | :34:38. | |
five or ?10 billion out of NHS England budgets. That would be | :34:39. | :34:43. | |
enough to cover the deficit, it would be enough to plug the social | :34:44. | :34:47. | |
care whole but the Department of Health does not even keep data on | :34:48. | :34:53. | |
it. They are not keeping track of how these administration costs are | :34:54. | :34:59. | |
growing. There was no possibility of a cost benefit analysis, of bringing | :35:00. | :35:03. | |
in outside providers and causing what we have got, which is this | :35:04. | :35:06. | |
fragmentation instead of people being able to work together. In | :35:07. | :35:11. | |
Scotland we have gone down the route, as I said before, of | :35:12. | :35:16. | |
integrated joint boards between health and social care, taking money | :35:17. | :35:19. | |
from both sides so that you do not have the argument over whose purse | :35:20. | :35:25. | |
is funding a patient. We have used other innovative approaches such as | :35:26. | :35:29. | |
community pharmacies which we have debated here. Minor ailments units | :35:30. | :35:34. | |
within community pharmacies, and using those services. Because of | :35:35. | :35:39. | |
that the increase in attendances at a and E in Scotland has increased in | :35:40. | :35:47. | |
the last five years by 3.4%. In England it is 11.8, that is three | :35:48. | :35:52. | |
times the rate of attendances and with admissions it is similar. Our | :35:53. | :35:58. | |
admissions, our emergency emissions have increased by 4.6% while in | :35:59. | :36:03. | |
England they have increased by 14%. All of that is because the effort is | :36:04. | :36:09. | |
not being made in the community. There is a lot of talk all of the | :36:10. | :36:13. | |
time about the five-year forward view. Frankly we are halfway through | :36:14. | :36:19. | |
the five years. There is only a two and a half year few left. That is | :36:20. | :36:24. | |
not far enough ahead. In Scotland we did vision 2020 as well and we did | :36:25. | :36:29. | |
it back in 2011 and we are working on 2030. By which time the number of | :36:30. | :36:34. | |
people 85 and above will have doubled. That is what we need to be | :36:35. | :36:40. | |
thinking about, how do we design our social care services but also our | :36:41. | :36:44. | |
health services around the ageing population. Our Cabinet Secretary is | :36:45. | :36:52. | |
focused on what keeps people independent. You might think that is | :36:53. | :36:57. | |
because I am SNP but people being independent and living high quality | :36:58. | :37:02. | |
lives. What is it? It is hip replacements, it is knee | :37:03. | :37:06. | |
replacements, it is eye surgery. If you can't see and you can't walk you | :37:07. | :37:10. | |
are stuck in your house and you are lonely and we are going to have to | :37:11. | :37:15. | |
look after you. What we have invested in, and it is often laughed | :37:16. | :37:18. | |
at here, is free prescriptions, so people take their medication to | :37:19. | :37:23. | |
control their chronic illnesses. We have invested in having people | :37:24. | :37:28. | |
having free personal care in their own homes so that they are not | :37:29. | :37:34. | |
landing in hospital and they are not getting stuck there. That is why | :37:35. | :37:38. | |
delayed discharges for us last year went down 9%, while went up between | :37:39. | :37:46. | |
25 and 30% a year. The other one, the free bus passes that people are | :37:47. | :37:50. | |
fat, the member opposite who mentioned loneliness, obviously as | :37:51. | :37:55. | |
was championed by Jo Cox, as bigger killer as diabetes. Older people in | :37:56. | :38:00. | |
our community are out and about, yes, they are taking day trips, yes | :38:01. | :38:04. | |
they are going shopping, and they are loving it. They are not stuck in | :38:05. | :38:08. | |
their houses. It is actually starting with looking at the | :38:09. | :38:15. | |
population. F TP is the best chance going forward but at the moment they | :38:16. | :38:18. | |
are being handed a bottom line and being told to work back from it. It | :38:19. | :38:23. | |
cannot be Budget centred care, it must be patient centred care and all | :38:24. | :38:29. | |
of us across the house can recognise place -based planning for a | :38:30. | :38:34. | |
community is going to provide the best service to those patients, to | :38:35. | :38:38. | |
your constituents, and that is what we should be doing. Getting real | :38:39. | :38:44. | |
about public health and preventing that chronic ill health in later | :38:45. | :38:50. | |
life, and that means health in all policies. The thing that is really | :38:51. | :38:56. | |
bad in this house is that we look at individual decisions day by day that | :38:57. | :39:01. | |
completely contradict each other. And yet, if we were always thinking, | :39:02. | :39:05. | |
in every decision, will this make our citizens health and well-being | :39:06. | :39:12. | |
better or worse? If it is making it better in the end it will save | :39:13. | :39:17. | |
money, and that includes poverty, the biggest cause of ill health that | :39:18. | :39:22. | |
exists, so I call on us to look at the systems, to look at how we do | :39:23. | :39:27. | |
things, but we need to provide the care in the community before we take | :39:28. | :39:31. | |
it from the hospital, but let's also think a little bit broader in some | :39:32. | :39:39. | |
of the other decisions that we make. Thank you, the Honourable lady has | :39:40. | :39:46. | |
concluded. Thank you, Mr Speaker, I would like to thank the chair, | :39:47. | :39:50. | |
members of staff of the health committee and the Public Accounts | :39:51. | :39:52. | |
Committee for their work on the reports that we are debating today | :39:53. | :39:56. | |
and I have to say the two chairs for the excellent opening speeches. The | :39:57. | :40:02. | |
health select committee talked of a tight financial situation for health | :40:03. | :40:04. | |
and about the fact that deficits were blowing -- growing and | :40:05. | :40:07. | |
widespread and the Kings fund and the Nuffield trust reported in | :40:08. | :40:11. | |
November 20 16th that there was a net deficit for NHS trusts of | :40:12. | :40:23. | |
billion in 2015/ 16. Further they said that the 1.3% increased funding | :40:24. | :40:25. | |
for the NHS in 2017/18 would largely be absorbed by deficits. We have had | :40:26. | :40:28. | |
very many very useful contributions about the issues with trust deficits | :40:29. | :40:32. | |
but we are in the situation that NHS funding increases are going to be 0% | :40:33. | :40:42. | |
in 2018/90 9.3% in 2019/20 these are seen as inadequate and not enough to | :40:43. | :40:47. | |
maintain standards of care, meet rising demand from patients and | :40:48. | :40:50. | |
deliver the rising demand and services outlined in the five-year | :40:51. | :40:55. | |
forward view. I take the honourable ladies point that we are now halfway | :40:56. | :40:58. | |
through the five-year forward view so in fact it is only the 2.5 year | :40:59. | :41:03. | |
ahead view and if that is now it is inadequate then we have some issues. | :41:04. | :41:07. | |
On social care the health select committee said that increasing | :41:08. | :41:10. | |
numbers of people with genuine social care needs are no longer | :41:11. | :41:13. | |
receiving the care they need because of a lack of resource and we have | :41:14. | :41:19. | |
had very many contributions. The honourable lady, the chair of the | :41:20. | :41:21. | |
health select committee talked about increases in demand for social care. | :41:22. | :41:26. | |
The King 's fund and the Nuffield trust say that six years of | :41:27. | :41:29. | |
unprecedented budget reductions have led to a 26% fall in the number of | :41:30. | :41:39. | |
people aged over 65 accessing publicly funded social care, and | :41:40. | :41:41. | |
that is imposing significant human and financial costs on older people, | :41:42. | :41:43. | |
their families and carers, and as we know exacerbating pressure on the | :41:44. | :41:49. | |
NHS. They also estimate the social care system faces the prospect of a | :41:50. | :41:53. | |
?1.9 billion funding gap next year and a funding gap of at least ?2.3 | :41:54. | :41:55. | |
billion by 2020. As we have heard in this debate and | :41:56. | :42:06. | |
rightly focussed, the cuts mean 400,000 fewer older people receive | :42:07. | :42:10. | |
publicly funded public care packages than 2010. An Age UK report that 1.2 | :42:11. | :42:15. | |
million people do not receive the care and support they need, with | :42:16. | :42:20. | |
essential daily living activities. It is worth breaking it down. That | :42:21. | :42:26. | |
is nearly 700,000 older people not receiving enough help for their | :42:27. | :42:31. | |
daily care needs and 500,000 people receiving no help, not even from | :42:32. | :42:35. | |
family and friends. And taking into account tasks like shopping and | :42:36. | :42:39. | |
taking medication, which the honourable lady mentioned as an | :42:40. | :42:45. | |
important factor that older people need to be reminded, Age UK say 1.5 | :42:46. | :42:49. | |
million people are not getting the help they need day-to-day. Mr | :42:50. | :42:54. | |
Speaker, I think it's shocking that nearly one in eight of the entire | :42:55. | :43:00. | |
older population now live with some level of unmet need. Of course the | :43:01. | :43:04. | |
impact on the NHS of the crisis in social care funding is important.ly | :43:05. | :43:07. | |
come on to talk about delayed discharges. But the real impact and | :43:08. | :43:12. | |
we must never forget it is on all of those older and vulnerable people | :43:13. | :43:17. | |
living without care. And cuts to social care budgets also hit the 6.5 | :43:18. | :43:23. | |
million unpaid family carers and the 1.4 million people in the care | :43:24. | :43:27. | |
workforce who provide care. Impacts on those groups of people are often | :43:28. | :43:33. | |
overlooked. The honourable member for South West Bedfordshire talked | :43:34. | :43:37. | |
about terms and conditions but cuts hit those 1.4 million people as | :43:38. | :43:42. | |
well. We have seen dreadful cuts to the terms and conditions. It is an | :43:43. | :43:46. | |
important job. It shouldn't happen. The Government's response on the | :43:47. | :43:50. | |
funding issues raised in these reports are inadequate. The | :43:51. | :43:55. | |
responses talk about the precept and the additional funding in the better | :43:56. | :43:58. | |
care fund, most of which is proving to be the case is a problem because | :43:59. | :44:05. | |
it is backloaded to 2019/20. The King's Fund has described using it | :44:06. | :44:09. | |
as an inadequate response which passes the problem to local | :44:10. | :44:11. | |
Government. I think that is a key factor. Also theed a quasys or | :44:12. | :44:19. | |
otherwise. The precept raised ?220 million and it will raise ?253 | :44:20. | :44:25. | |
million. Both less than the cost of the national lieing wage to be paid | :44:26. | :44:29. | |
by care providers. Sadly, this Government's inadequate funding of | :44:30. | :44:34. | |
social care was made worse by measures in the settlement. Having | :44:35. | :44:39. | |
passed the problem of funding to social care on to the council | :44:40. | :44:43. | |
taxpayer, ministers went on to make the problem worse by announcing the | :44:44. | :44:49. | |
ce ayes of the 240 million care grant recycle from the new homes | :44:50. | :44:54. | |
bonus. One third of cases providing social care will be worse off next | :44:55. | :44:58. | |
year as a result of this settlement. My own local authority Salford will | :44:59. | :45:04. | |
have ?2.3 million less in its budgets for social care and Tower | :45:05. | :45:07. | |
Hamlets is set to lose ?3.3 million. I ask the minister to think about | :45:08. | :45:12. | |
where he thinks we're going to find at this notice ?2.3 million in one | :45:13. | :45:16. | |
local authority budget. The answer is sadly it will be rationing. That | :45:17. | :45:21. | |
is not where we should be. The Public Accounts Committee published | :45:22. | :45:26. | |
a report on discharging people from acute property hospitals. -- acute | :45:27. | :45:32. | |
hospitals. 2016 a record number of bed days were lost as a result of | :45:33. | :45:36. | |
problems in social care. The number of days lost by 400,000 in the last | :45:37. | :45:40. | |
year. Over one-third of these delayed days were as a result of | :45:41. | :45:44. | |
social care. And I think we've got to take into account the proportion | :45:45. | :45:49. | |
attributed to social care has been increases. Giving the funding cuts | :45:50. | :45:53. | |
we should not be surprised. The chair of the public committees | :45:54. | :46:00. | |
committee said said it is damaging patients and the public purse. | :46:01. | :46:04. | |
Unnecessary long stays in hospital can affect patient morale and | :46:05. | :46:08. | |
mobility as well as increasing their risk of catching hospital-acquired | :46:09. | :46:13. | |
infections. Professor Young in 2014, said if the mobility effects of long | :46:14. | :46:19. | |
hospital stays, a wait of seven days is associated with a 10% decline in | :46:20. | :46:23. | |
muscle strength. Clearly not desirable. The funding crisis is a | :46:24. | :46:30. | |
theme across many of the reports we are debating today. The personal | :46:31. | :46:35. | |
care budgets express concerns that funding cuts and wage pressures will | :46:36. | :46:38. | |
make it hard for local authorities to fulfil their obligations under | :46:39. | :46:43. | |
the care act. A piece of legislation passed in 2014. It seems hard for | :46:44. | :46:47. | |
councils to fulfil their obligations. Indeed, the local | :46:48. | :46:53. | |
Government associate said this on underfunding in its recent budget | :46:54. | :46:56. | |
submission. Without bolder action, the Government will need to revalue | :46:57. | :46:59. | |
wait its offer and consider whether the legal, the set of legal rights | :47:00. | :47:04. | |
and responsibilities contained within the care act are appropriate | :47:05. | :47:10. | |
and achievable. The chair of the CLG Select Committee mentioned this too. | :47:11. | :47:15. | |
The Public Accounts Committee report described the ambition to improve | :47:16. | :47:19. | |
services as Lordable. But given the current pressures on the NHS budget | :47:20. | :47:27. | |
said, we are skepty Kabul about -- accept -- acceptable whether it is | :47:28. | :47:31. | |
affordable. It is a task for the whole of | :47:32. | :47:38. | |
Government. I trust that includes the member Mid Norfolk, who said | :47:39. | :47:41. | |
that disability benefits should go to really disabled people rather | :47:42. | :47:45. | |
than those taking pills at home who suffer from anxiety. And I should | :47:46. | :47:50. | |
say, Mr Speaker, this has been raised already today and I have | :47:51. | :47:56. | |
informed the member from Mid Norfolk I intended to mention that this | :47:57. | :48:00. | |
evening. The reason I want to raise this, comments like this re-enforce | :48:01. | :48:07. | |
stigma about mental health. They are profoundly disappointing from | :48:08. | :48:11. | |
someone who was until recently a Health Minister. They show how far | :48:12. | :48:15. | |
we and this Government has to go on parity. Underfunding of mental | :48:16. | :48:21. | |
health services by commissioners has dominated many of our debates here. | :48:22. | :48:24. | |
The Government has not dealt with the issue that funds meant for | :48:25. | :48:27. | |
mental health services have been used by the NHS for other | :48:28. | :48:31. | |
priorities. In the response the Government says it accepts all the | :48:32. | :48:34. | |
recommendations and has implemented them. I want to question that. The | :48:35. | :48:41. | |
Government response talks about the mental health five-year view, | :48:42. | :48:44. | |
publisheded 2015, monitoring key performance and outcomes data. In | :48:45. | :48:51. | |
December, the Royal College of Psychiatrists released figures on | :48:52. | :48:54. | |
child and adolescent mental health services. A vital issue. Now a | :48:55. | :48:59. | |
number of honourable members raised the scale of variation which came | :49:00. | :49:04. | |
out of the Royal College of Psychiatrist figures. It ranged from | :49:05. | :49:15. | |
?2 per an unanimo ?135 a year. The CCGs were reporting the data on | :49:16. | :49:19. | |
their spending differently. I say to the minister, it hardly helps | :49:20. | :49:24. | |
transapparently to report on their spending of mental health | :49:25. | :49:27. | |
differently. I wrote to the honourable member for Oxford West | :49:28. | :49:30. | |
about this, from her response I understand that further guidance has | :49:31. | :49:35. | |
been issued to CGGs. I would be grateful in his response if the | :49:36. | :49:39. | |
minister can tell the House if we can expect the actual spend and | :49:40. | :49:44. | |
planned spend on the services will be accurate and comparable. We've | :49:45. | :49:49. | |
had instances in speeches today of honourable members talking about | :49:50. | :49:54. | |
their local CGG decreasing spending on mental health. We hear that is | :49:55. | :49:57. | |
not the Government's intention. We cannot track this if CGGs don't | :49:58. | :50:04. | |
report Accraly. Given we know -- Accraly. Given we now one in four is | :50:05. | :50:09. | |
turned away from services, the Government should do all it can to | :50:10. | :50:12. | |
make sure young people can get the access. And prioritising mental | :50:13. | :50:17. | |
health should be spent as intended. Not on other priorities. Briefly on | :50:18. | :50:23. | |
the report on NHS specialised services, the committee said that | :50:24. | :50:26. | |
accountability to both patients and taxpayers is undermined by the lack | :50:27. | :50:30. | |
of transparency over NHS England's decision making and the committee | :50:31. | :50:34. | |
recommended that NHS England improve the transparency of its decision | :50:35. | :50:39. | |
making. On this issue, I note that 30 charities from the specialised | :50:40. | :50:42. | |
health care alliance have writ on the the Prime Minister to raise the | :50:43. | :50:48. | |
issue about NHS England restricting and rationing treatment because of | :50:49. | :50:51. | |
underfunding, for patients with rare and complex conditions. Now the | :50:52. | :50:55. | |
charities say this is taking place without sufficient public scrutiny. | :50:56. | :50:58. | |
Lack of transparency in decision making is a serious issue. I ask the | :50:59. | :51:02. | |
minister to address that in his response. Mr Speaker, there are many | :51:03. | :51:07. | |
issues raced in the committee reports in front of us on funding in | :51:08. | :51:11. | |
the NHS and social care. Media reports say the Chancellor is | :51:12. | :51:16. | |
considering a short-term ring-fence cash injection for social care worth | :51:17. | :51:25. | |
hundreds of millions for council adult service directors say they | :51:26. | :51:30. | |
need an injection of ?1 billion for social care to prevent the weakening | :51:31. | :51:33. | |
and collapse in some parts of the sector. As I have said, the funding | :51:34. | :51:38. | |
gap in social care will be ?1.9 to ?2.3 billion by 2020. I hope the | :51:39. | :51:42. | |
Government is not going to try in the Budget a quick fix which is too | :51:43. | :51:47. | |
little. The hundreds of thousands of vulnerable people who need social | :51:48. | :51:54. | |
care certainly deserve better. I thank you very much Mr Speaker. | :51:55. | :52:00. | |
The member that speaks for the SNP described this evening as being a | :52:01. | :52:04. | |
great debate. And I agree, it's been a very good debate. A number of | :52:05. | :52:07. | |
members on both sides of the House have spoken with a great deal of | :52:08. | :52:09. | |
Paddy With a great deal of passion. I join | :52:10. | :52:24. | |
the Shadow Minister by thanking the reports we are discussing today. | :52:25. | :52:30. | |
There's been an awful lot of comments made by members.ly do my | :52:31. | :52:34. | |
best to respond to the -- I will do my best to respond to the majority | :52:35. | :52:41. | |
of those. I start biceping and the Government accepts that these are | :52:42. | :52:44. | |
challenging times both for the NHS and for social care. Members have | :52:45. | :52:49. | |
talked, the Select Committee chair talked in length, that the | :52:50. | :52:52. | |
demographics in terms of the numbers of people and of the age of the | :52:53. | :52:59. | |
people is uncompromising. I was at a conference recently, a health check | :53:00. | :53:02. | |
conference. One of the speakers described the process we have been | :53:03. | :53:06. | |
through. We have been very successful at elongating, if you | :53:07. | :53:12. | |
like, quantity of life. Up until now, qualingty of life has not kept | :53:13. | :53:16. | |
-- quality of life has not kept up with that. Older people are living | :53:17. | :53:23. | |
with multiple long-term conditions. Not having one long-term condition | :53:24. | :53:29. | |
is becoming unusual, whether that's diabetes, COPD, heart disease or | :53:30. | :53:32. | |
whatever. It is a fact that we all have to face. It is one of the | :53:33. | :53:36. | |
reasons that we're so keen with the SDPs to address this. 70%, Mr | :53:37. | :53:41. | |
Speaker, of the total expenditure on the NHS is in terms of long-term | :53:42. | :53:46. | |
conditions. Frankly, if we were starting a blank piece of paper we | :53:47. | :53:50. | |
would not be starting with the NHS we have now. We would be organising | :53:51. | :53:53. | |
around those long-term conditions, which means more in the community | :53:54. | :53:57. | |
and all that goes with that. I will come on to talk about the SDP | :53:58. | :54:00. | |
process and how we're trying to achieve that. We know that we've got | :54:01. | :54:09. | |
the issue with demock graphy. There's a -- demography. The report | :54:10. | :54:18. | |
said in 1948, 50% of people lived over 65 years old. In 2017, 14% of | :54:19. | :54:25. | |
people, that is, die before they are 65. That is a massive demographic | :54:26. | :54:32. | |
change. We all need to step up to the mark to meet and we will do | :54:33. | :54:37. | |
that. There are drugs and treatments frankly are becoming more expensive. | :54:38. | :54:42. | |
You can do a lot more and we've seen the issues and the discussions | :54:43. | :54:45. | |
around the cancer drug fund as well. And the third driver of all of this, | :54:46. | :54:50. | |
is that patient expectations, rightly, are becoming higher, in a | :54:51. | :54:55. | |
way that people perhaps didn't necessarily expect decades ago. | :54:56. | :55:01. | |
Now, the Government response to that n the Spending Review was a ?10 | :55:02. | :55:06. | |
billion injection into the NHS budget. Front loaded, which | :55:07. | :55:14. | |
represents an 8% or 9%, depending on how you count. And I agree with the | :55:15. | :55:20. | |
chairman of the PDC we should not bicker. We can argue whether it is | :55:21. | :55:25. | |
enough or not. But the facts are that is a real increase over the | :55:26. | :55:28. | |
course of this Parliament. Now discussion to be had whether that | :55:29. | :55:31. | |
real increase is enough and I accept that. What I don't accept is some of | :55:32. | :55:36. | |
the things we have heard opposite about cuts. There's a very valid | :55:37. | :55:42. | |
discussion, Mr Speaker, to be had whether an 8% or 9% increase in real | :55:43. | :55:47. | |
terms is enough. And I gently say to the opposition at the last election, | :55:48. | :55:51. | |
their position was that they weren't in a position to fund more than | :55:52. | :55:56. | |
that. It is not right to talk, as we have heard from some of the speakers | :55:57. | :56:00. | |
opposite about this being in the context of cuts. Now at the time... | :56:01. | :56:11. | |
Mr Speaker, we do get into this repeatedly. The opposition had no | :56:12. | :56:15. | |
plans to cut ?5 billion out of social care. We had no plans to cut | :56:16. | :56:19. | |
the budgets of local councils. That is the difference between us. I | :56:20. | :56:23. | |
think given the majority of what we talked about is social care and the | :56:24. | :56:26. | |
cuts to social care, he ought to take that into account. | :56:27. | :56:31. | |
I will come onto social care. We have covered the NHS and during the | :56:32. | :56:37. | |
course of this Parliament there was an increase in real terms of eight | :56:38. | :56:41. | |
or 9% so we will accept that and move on. In terms of social care, | :56:42. | :56:44. | |
the increase, and this is not the budget, I don't know what is in the | :56:45. | :56:48. | |
budget, the increase that has already been put into place is to | :56:49. | :56:53. | |
make five or 6% in real terms of an increase in social care available. | :56:54. | :56:56. | |
Again, Mr Speaker, we can have an argument as to whether that is | :56:57. | :57:00. | |
enough in terms of the demographics but what we can't do is have an | :57:01. | :57:03. | |
argument in terms of whether it is right or not. I do want to spend a | :57:04. | :57:08. | |
bit of time on the international comparisons. We have heard some | :57:09. | :57:12. | |
discussion about that earlier this evening. This country spends 9.9% of | :57:13. | :57:24. | |
its GDP in 2014, that is an OECD number, on health. The OECD averages | :57:25. | :57:29. | |
9%, that is 1% more, but it is true that that average includes countries | :57:30. | :57:33. | |
such as Mexico which we wouldn't necessarily wish to be compared | :57:34. | :57:38. | |
with. The EU average, for the EU 15, that is not by and large the states | :57:39. | :57:47. | |
eastern part, the new estates, spends 9.8% of GDP on health care, | :57:48. | :57:54. | |
so we spend more than the EU average on health care, and that is in 2014. | :57:55. | :58:00. | |
It is true that we spend less than some countries that we think maybe | :58:01. | :58:03. | |
are our comparators, we spend less than France and Germany but it is | :58:04. | :58:07. | |
completely wrong to say that there is some massive between us and the | :58:08. | :58:13. | |
EU in terms of health care spend. In a sense we have to get to the | :58:14. | :58:22. | |
point... Yes. 2014 is three years ago and is it not the case that | :58:23. | :58:26. | |
we're heading towards a less than 7% GDP, which is going to put as 13th | :58:27. | :58:33. | |
out of 15 of the EU 15? 2014 is the most recent figures that are | :58:34. | :58:38. | |
available and in 2014 figures that I have just quoted don't include the | :58:39. | :58:41. | |
comparatively large settlement that was made in terms of their health | :58:42. | :58:45. | |
care in terms of the front-loaded money that came through from the | :58:46. | :58:50. | |
spending review. Health and social care, if I may I will make some | :58:51. | :58:53. | |
progress, and I will come back to her. On health and social care we | :58:54. | :59:00. | |
spend 1.2% of our GDP in terms of the government spends we spend | :59:01. | :59:06. | |
another 6.6% in terms of private. That is more than such as Germany | :59:07. | :59:13. | |
and the chairman of the DC LG committee talked about Germany who | :59:14. | :59:17. | |
spent 1.1%, that is more than Canada and more than Italy. Again it is | :59:18. | :59:22. | |
less than some countries, in particular an exemplar country in | :59:23. | :59:26. | |
terms of social care spenders Holland who spend considerably more | :59:27. | :59:28. | |
than that and there are choices to be made and I accept that but what I | :59:29. | :59:32. | |
want to say is that pretends that somehow we are massively out of | :59:33. | :59:37. | |
kilter with the sorts of countries that we would regard ourselves as | :59:38. | :59:42. | |
equivalent to is just wrong. I am very grateful to the Minister | :59:43. | :59:47. | |
forgiving way. Does he accept that if we continue on current rates of | :59:48. | :59:51. | |
spending as a proportion of GDP by the end of this Parliament we will | :59:52. | :59:55. | |
be spending less than countries such as Costa Rica and Iceland, does he | :59:56. | :00:01. | |
believe that that is the sort of health service that his constituents | :00:02. | :00:06. | |
aspire to? There are assumptions on that depending on our GDP growth, | :00:07. | :00:09. | |
their GDP growth and everything else so it is a difficult thing to answer | :00:10. | :00:14. | |
but I will repeat the point again, in the latest OECD figures that have | :00:15. | :00:18. | |
been produced for 2014 the numbers that I have just set before the | :00:19. | :00:23. | |
house are accurate. There is a valid debate to have, as to whether they | :00:24. | :00:26. | |
or enough, given the demographics and all of that, that is fair, but | :00:27. | :00:31. | |
what is not fair is to somehow implied that there is a massive | :00:32. | :00:36. | |
disparity between us and our EU neighbours and I think it is very | :00:37. | :00:39. | |
important... I have given way to the honourable lady once already and I | :00:40. | :00:40. | |
need to make some progress. It has been suggested that the 0.7% | :00:41. | :00:57. | |
of GNI eight budget could be somehow used to fund health and social care, | :00:58. | :01:02. | |
can he confirm that the government remains committed to that target and | :01:03. | :01:06. | |
that just by reading out the proportions of GNI spent on health | :01:07. | :01:10. | |
and social care shown how small that budget is by comparison. Well, Mr | :01:11. | :01:17. | |
Speaker, the .7% budget for overseas aid is not something that we are | :01:18. | :01:20. | |
discussing here today. It is not something that is in Mike | :01:21. | :01:25. | |
ministerial responsibility my department 's ministerial | :01:26. | :01:27. | |
responsibility. I am proud that we are one of the few countries in the | :01:28. | :01:31. | |
world that meets that commitment and indeed many of the other countries | :01:32. | :01:34. | |
that we have been talking about in terms of our EU 's partners do not | :01:35. | :01:39. | |
meet our commitment but I don't want to be diverted any further down that | :01:40. | :01:45. | |
today. In spite of that, of course we have seen that we have had a | :01:46. | :01:48. | |
difficult winter in the NHS and we know that the A targets are | :01:49. | :01:54. | |
something like 86%, not the 95% that we expected an ambulance 60%, not | :01:55. | :02:00. | |
75% and as we have heard delayed transfers of care, not bed blocking, | :02:01. | :02:05. | |
is probably doubled over the last three years. I will just make a | :02:06. | :02:10. | |
response to that, one point that I'm very keen to always make these sorts | :02:11. | :02:14. | |
of discussions, and that is that we don't talk enough about cancer, and | :02:15. | :02:20. | |
there are cancer metrics as well. Actually we should be proud of the | :02:21. | :02:23. | |
fact that in NHS England we are meeting seven of eight of our cancer | :02:24. | :02:27. | |
metrics, the actual trend is to meet them more easily than in the past | :02:28. | :02:31. | |
and we did hear quite a lot this evening about how well they are | :02:32. | :02:37. | |
doing in Scotland and I think in fairness just to redress the balance | :02:38. | :02:41. | |
about what we have heard in terms of A, I will make the point that they | :02:42. | :02:44. | |
are doing somewhat worse than we are in terms of those cancer metrics. I | :02:45. | :02:52. | |
regret to say it is a very disappointing response thus far | :02:53. | :02:55. | |
because I think we have had a very informed debate and we don't need to | :02:56. | :02:59. | |
regurgitate the figures. Would he comment on my comment earlier that | :03:00. | :03:03. | |
the money may be what it is but is it sufficient to deal with the | :03:04. | :03:08. | |
programme of care and support in the NHS that has been promised? That is | :03:09. | :03:12. | |
the subject of the reports every month since last January. Is there | :03:13. | :03:16. | |
money enough to do what has been promised? Mr Speaker, the money is | :03:17. | :03:23. | |
what we were asked to provide by NHS England's senior management. We have | :03:24. | :03:27. | |
provided that and at that time the chief executive of the NHS said that | :03:28. | :03:31. | |
the government has listened and acted, and that is what we did, and | :03:32. | :03:36. | |
that money is now available. Now, that is not the same as saying that | :03:37. | :03:41. | |
we accept that the system is under pressure in certain ways but we talk | :03:42. | :03:46. | |
about the money being spent in France and in Germany and in Munich | :03:47. | :03:52. | |
15 out of the 19 hospitals stopped taking people in over this winter. | :03:53. | :03:58. | |
The point is right across the world there are challenges in the NHS and | :03:59. | :04:02. | |
we need to work, in the health systems, and we need to work to make | :04:03. | :04:08. | |
that, to spend this money as effectively as possible. We know | :04:09. | :04:12. | |
that we have got ?120 billion in our health system in 2020. What this | :04:13. | :04:19. | |
government has to do and this ministerial team is doing is | :04:20. | :04:22. | |
ensuring that every penny is spent as effectively as possible. The STP | :04:23. | :04:29. | |
are a response to that we have talked about the five-year forward | :04:30. | :04:32. | |
view and I accept we are two years into that that we know that the | :04:33. | :04:39. | |
health system must tilt back towards community health and the STP is part | :04:40. | :04:42. | |
of making that happen. We need to get better and we are so far in | :04:43. | :04:46. | |
terms of mental health and some of the points made in terms of parity | :04:47. | :04:51. | |
of esteem are correct. I will give way. I think the SDP approach is | :04:52. | :04:55. | |
capable of being a very good approach but the point is when I go | :04:56. | :05:00. | |
to the chief executive of a teaching Hospital in Sheffield he tells me | :05:01. | :05:05. | |
that the process of transferring resources to the community won't | :05:06. | :05:08. | |
work unless there is some transitional upfront funding for the | :05:09. | :05:17. | |
whole can't stop what you are doing in the hospital to actually | :05:18. | :05:20. | |
transferring to the community. He is right about that and those STPs in | :05:21. | :05:26. | |
March April decide which STPs are high priority and will be invested | :05:27. | :05:30. | |
in and taken forward at speed. We heard the phrase earlier this | :05:31. | :05:34. | |
evening about accountable care organisations. It is the intention | :05:35. | :05:38. | |
of the government to make those high performing STPs, and it won't be all | :05:39. | :05:43. | |
of them because the standards are variable, they are locally driven, | :05:44. | :05:47. | |
and those high performing STPs that we go forward with will become in | :05:48. | :05:51. | |
time accountable care organisations. A part of it, and the Shadow | :05:52. | :05:57. | |
minister asked me to talk about social care, and I will talk about | :05:58. | :06:02. | |
social care. During the course of this parliament funding for social | :06:03. | :06:07. | |
care, accessible, is up by 6%. It did reduce in real terms, it did | :06:08. | :06:15. | |
reduce in the last Parliament. Where we are now if the last year 42% of | :06:16. | :06:23. | |
councils increased their social care budgets in real terms. 42% of | :06:24. | :06:24. | |
councils. In December ?900 million was taken | :06:25. | :06:43. | |
forward in terms of the new homes bonus and a precept, no, I won't | :06:44. | :06:51. | |
give way. I won't give way. Minister,. Minister, Mr Speaker, the | :06:52. | :06:57. | |
truth of the matter is that the Kerouac was brought in by this | :06:58. | :07:01. | |
government and it has transformed a social care. We accept, however, | :07:02. | :07:05. | |
that the system is under pressure and what is also not wrong to say is | :07:06. | :07:09. | |
that the delayed cancers -- transfers of care in Newcastle, St | :07:10. | :07:13. | |
Helens, Bedford and Nottingham, are zero. The chairman of the PAC made | :07:14. | :07:25. | |
the point earlier, said that she was told by Simon Stephens that if the | :07:26. | :07:30. | |
top performing councils were, in terms of the delayed transfers of | :07:31. | :07:33. | |
care, where emulated by all the rest, the consequence of that would | :07:34. | :07:37. | |
be very little. The truth of the matter is that there is a 30 times | :07:38. | :07:41. | |
difference between the top 10% councils and the bottom 10% | :07:42. | :07:46. | |
councils, in terms of that. I have given way to twice already Mr | :07:47. | :07:49. | |
Speaker and I need to finish in two minutes. I want to finish by saying | :07:50. | :07:54. | |
there are issues and challenges in both care and social care under | :07:55. | :08:00. | |
pressure. We accept that but we also know that we will need to make | :08:01. | :08:03. | |
progress in terms of mental health, and we are doing so. The parity of | :08:04. | :08:08. | |
esteem, we are going to have 5000 more doctors in general practice by | :08:09. | :08:13. | |
2020, 2000 pharmacists, and we've talked about pharmacy and the need | :08:14. | :08:17. | |
for that, and are visited upon the cysts practice in Perivale on Friday | :08:18. | :08:23. | |
and we can transform how GP practices work with and there will | :08:24. | :08:28. | |
be 3500 mental health therapist as well. Almost 3 million people Mr | :08:29. | :08:32. | |
Speaker work in the health care sector between the NHS and care, | :08:33. | :08:37. | |
many of those are remarkable people, frankly, doing remarkable things. | :08:38. | :08:43. | |
They deserve our support. It is very important that we don't weaponised | :08:44. | :08:48. | |
this entire discussion. It is very important, Mr Speaker, that we don't | :08:49. | :08:51. | |
produce election leaflets talking about dead babies and all that that | :08:52. | :08:56. | |
means. What I would like to finish by saying is that we would commend | :08:57. | :09:03. | |
these estimates to the house. This health care system and the NHS | :09:04. | :09:08. | |
deserve our support and this government is committed to ensuring | :09:09. | :09:13. | |
that happens. To conclude, Meg Hillier. In my cry was going to rise | :09:14. | :09:16. | |
and say it had been a good-natured and thoughtful debate and it is only | :09:17. | :09:20. | |
a shame that such a usually thoughtful minister has resorted to | :09:21. | :09:27. | |
the means of seemingly to blame NHS England for the situation. I think | :09:28. | :09:32. | |
it is important to be clear about the budget situation. NHS England | :09:33. | :09:35. | |
asked for a certain amount of money and the government has stretched | :09:36. | :09:39. | |
that over another year so the money for five years has gone over six and | :09:40. | :09:42. | |
it is important to get that on the record. It has been clearly laid out | :09:43. | :09:46. | |
by members across the house of all parties that there are long-term | :09:47. | :09:49. | |
financial challenges to our health system and we need to have a | :09:50. | :09:53. | |
long-term national debate about how we fund a NHS fit for the 21st | :09:54. | :10:02. | |
century. I want to finish on the estimate for today. Last year we saw | :10:03. | :10:07. | |
that the accounts, through a series of one-off extraordinary measures, | :10:08. | :10:10. | |
just about got to balance but we have raised concerns across the | :10:11. | :10:16. | |
house today about this movement of capital to the expenditure, | :10:17. | :10:18. | |
departmental expenditure limit from the capital to the resource side of | :10:19. | :10:22. | |
the budget and this is going to be projected on the supplementary | :10:23. | :10:24. | |
estimate that is in front of the house to increase to ?1.2 billion | :10:25. | :10:31. | |
and it is an awful lot of money that is being taken out of the long-term | :10:32. | :10:35. | |
future of the NHS to pay for day-to-day problems. It is not | :10:36. | :10:38. | |
sustainable and it is a great shame that the minister did not address | :10:39. | :10:41. | |
that and I hope the government looks at that is one symptom of the | :10:42. | :10:46. | |
long-term challenges of funding. It is a sticking plaster, it will not | :10:47. | :10:50. | |
solve the issue. I hope that we can move forward on a cross-party basis, | :10:51. | :10:53. | |
despite the Minister 's final comments. Order! Order!. The | :10:54. | :11:00. | |
question necessary to do dispose of a motion stands over until 7am | :11:01. | :11:05. | |
tomorrow, understanding order number 50. Would come to a motion number | :11:06. | :11:10. | |
two, on competition. As many as are of that opinion say aye, on the | :11:11. | :11:21. | |
contrary, no. The ayes have it. As many as are of that opinion say aye, | :11:22. | :11:26. | |
on the contrary, no. The ayes have it, the ayes have it. Motion number | :11:27. | :11:34. | |
four on equality. I beg to move. As many as are of that opinion say aye, | :11:35. | :11:38. | |
on the contrary, no. . The ayes have it. Motion number five on local | :11:39. | :11:41. | |
government. The question, As many as are of that opinion say aye, on the | :11:42. | :11:46. | |
contrary, no.. The ayes have it, the ayes have it. Order. We come out of | :11:47. | :11:51. | |
the adjournment. I beg to move that is housed two now adjourned. Two the | :11:52. | :11:54. | |
question is that this has do now adjourn. | :11:55. | :11:59. | |
It is appropriate on this day that we have a debate on mining and | :12:00. | :12:11. | |
miners' welfare, health and safety and the issues around the mine in my | :12:12. | :12:16. | |
constituency. A constituency which has a proud heritage, in East | :12:17. | :12:27. | |
Cleveland. Around the iron stone mines and villages around and the | :12:28. | :12:35. | |
history of men such as John Shepherd, the first miners, the | :12:36. | :12:38. | |
association union representative back in the 1870s, who helped | :12:39. | :12:44. | |
establish the Labour movement in those mines, among the primitive | :12:45. | :12:50. | |
Methodists who made up primarily the workforce there. It is appropriate | :12:51. | :12:54. | |
for a party of miners that they be talked about on our party's | :12:55. | :12:57. | |
birthday. I am grateful for the opportunity to | :12:58. | :13:02. | |
debate an issue which matters to many me and my constituencies. I | :13:03. | :13:05. | |
hope to raise the questions about the recent accidents on site, which | :13:06. | :13:11. | |
my constituents need answers to and to highlight the challenges facing | :13:12. | :13:16. | |
the mine. Mining has both a proud past, I believe, and also aviable | :13:17. | :13:21. | |
future. Iron stone mining was and in other areas of the country the | :13:22. | :13:27. | |
original economy. The booming mines of the late 19th century and early | :13:28. | :13:34. | |
20th century brought in workers from across the country. Which we on | :13:35. | :13:38. | |
these benches are humble representatives today. Mines closed | :13:39. | :13:43. | |
throughout the last century due to the quality of the iron stone they | :13:44. | :13:48. | |
were mining and imports coming in, which have less sulphur, but mining | :13:49. | :13:54. | |
was not lost. And the pot ash mine in my constituency is still in | :13:55. | :13:59. | |
operation. Despite the decline my constituency still currently and | :14:00. | :14:02. | |
proudly has the highest number of miners in the United Kingdom. The | :14:03. | :14:07. | |
Potash mine has been an important part of Cleveland since it was sunk | :14:08. | :14:14. | |
in the 1970s by ICI. Families' destinies have been dependant, and | :14:15. | :14:19. | |
the mine at its height employed over 1,000 in high-skilled jobs. Jobs | :14:20. | :14:24. | |
unfortunately are too rare in the valley. Around 80% of the mines | :14:25. | :14:30. | |
workforce living in a 12-mile radius of the site. Not only the people of | :14:31. | :14:38. | |
East Cleveland that the site serves. Postah is used in fertilisers. The | :14:39. | :14:43. | |
site is not without problems. I want to go into some history of safety | :14:44. | :14:47. | |
concerns, some of which is far more recent. | :14:48. | :14:52. | |
The mines's safety record is chequered. It is a deep mine. It is | :14:53. | :14:58. | |
a dangerous place to work. In some places you are looking two miles | :14:59. | :15:04. | |
under the North Sea. Temperatures of minus 50 degrees Celsius. Heavy | :15:05. | :15:12. | |
equipment, massive vehicles. In the posash it is different than cool | :15:13. | :15:22. | |
mining where you are -- Potash it is different than coal mining. In 2007, | :15:23. | :15:27. | |
a worker down the mine was killed by a falling rock. In 2012, an employee | :15:28. | :15:34. | |
suffered broken ribs and a punctured lung after a hose broke. A month | :15:35. | :15:40. | |
later a worker was injured by falling debris. In 2014 a technician | :15:41. | :15:48. | |
was fired after not making sure enough were trained safety workers. | :15:49. | :15:53. | |
Worryingly he claimed at history bum this was | :15:54. | :16:06. | |
He claimed this was accepted practise. | :16:07. | :16:13. | |
In February 2016, a miner tragically took his own life in the mine. In | :16:14. | :16:20. | |
April, an underground fire at the mine hospitalised seven employees. | :16:21. | :16:26. | |
In June 2016, a worker respected by his managers was killed when the gas | :16:27. | :16:34. | |
blew out on the site. In August, 144 redundancies were announced A | :16:35. | :16:37. | |
contractor on site was airlifted to hospital after suffering burns from | :16:38. | :16:43. | |
electry kugs and life-changing burns, I must add. In December, a | :16:44. | :16:48. | |
mine tunnel flooded. Thankfully no-one was injured. Mr Speaker, the | :16:49. | :16:52. | |
miningtry is difficult and dangerous. -- the mining industry is | :16:53. | :16:59. | |
difficult and dangerous. This mine's record is not unblemished. The | :17:00. | :17:03. | |
nature of this mine, second deepest in Europe, means it is a difficult | :17:04. | :17:10. | |
place to mine and manage. Workers, ICL, their families and myself want | :17:11. | :17:13. | |
this mine to be prosperous and succeed. I believe there are actions | :17:14. | :17:18. | |
which must be taken on safety issues by ICL and Government in order for | :17:19. | :17:22. | |
this to happen. One case in particular where a fire broke out | :17:23. | :17:28. | |
underground, which I will not go into too much detail, pending legal | :17:29. | :17:32. | |
action taking place at the moment, but men in that situation escaped | :17:33. | :17:36. | |
with their lives due to their own actions. There was no health and | :17:37. | :17:42. | |
safety process for that situation. Many of whom had written their wills | :17:43. | :17:46. | |
at the time, believing they would not leave that mine. At some point | :17:47. | :17:50. | |
in the future, Mr Speaker, I would like to go into more detail. Pending | :17:51. | :17:54. | |
the legal implications I cannot go into the details. I would want it on | :17:55. | :18:02. | |
the record. Workers at this mine must be ultimate I will be able to | :18:03. | :18:05. | |
have confidence in the safety procedure in place and should have a | :18:06. | :18:09. | |
say when they have concerned. I believe ICL should have closer | :18:10. | :18:13. | |
working relations with the workers at the plant. I believe giving these | :18:14. | :18:19. | |
unions input into the process will give workers a better opportunity to | :18:20. | :18:23. | |
voice concerns they have. There are questions the Government and in | :18:24. | :18:27. | |
particular the Health and Safety Executive must do more to answer. | :18:28. | :18:38. | |
The Health and Safety Executive accepts that longer shift patterns | :18:39. | :18:42. | |
increase the risk of error, accidents and injuries. I am | :18:43. | :18:47. | |
concerned that some of the work injured in these incidents have | :18:48. | :18:50. | |
returned to work before they have fully recovered due to the | :18:51. | :18:54. | |
inadequate sick pay they received while off work. Thus increasing the | :18:55. | :18:58. | |
risk of further accidents. Furthermore, the Government needs to | :18:59. | :19:01. | |
revisit the issue of funding it gives to the Health and Safety | :19:02. | :19:09. | |
Executive. Especially in relation to coal workplaces. If these steps are | :19:10. | :19:13. | |
taken and safety is improved, there is more that needs to be done to | :19:14. | :19:17. | |
ensure the future of ICL and the good jobs they provide. The main | :19:18. | :19:22. | |
threat to the future of the mine is falling pot tash price. Potash | :19:23. | :19:30. | |
price. ICL has taken action in response to | :19:31. | :19:36. | |
this change in price. Slowing potash extraction and turning to a new | :19:37. | :19:41. | |
product and minerals vital for fertilisers. ICL is competing with | :19:42. | :19:46. | |
other producers around the world, some of which are not concerned | :19:47. | :19:52. | |
about fair trail, Russia and Bella Russia, who have sought to undercut | :19:53. | :19:57. | |
the world market and some who force prices down, such as China. The UK | :19:58. | :20:04. | |
potash future will depend on our Brexit trade arrangements. While I | :20:05. | :20:09. | |
welcome a commitment to free trade, I am concerned this Government's | :20:10. | :20:15. | |
desire will leave our industries not exposed to free competition, which | :20:16. | :20:19. | |
all industries understand is a reality of a globalised economy, but | :20:20. | :20:24. | |
unfair dumping and market manipulation. We have seen the | :20:25. | :20:30. | |
Government is unwilling to stand up to Chinaen oh steel dumping and | :20:31. | :20:38. | |
seems to pay any prizes post Brexit. I -- any prices post Brexit. To | :20:39. | :20:42. | |
provide ICL with a level playing field on which to compete. As well | :20:43. | :20:49. | |
as the supply of potash and rock salt, the mine is key for several | :20:50. | :20:55. | |
cutting-edge research projects. The mine is 1200 metres deep. It means | :20:56. | :21:00. | |
it is among a handful of locations which offer the opportunity to | :21:01. | :21:05. | |
conduct ultra low background and deep underground projects. This | :21:06. | :21:10. | |
relates to radioactive substances, which as well as contributing to our | :21:11. | :21:17. | |
position as leaders in science research, defence and environmental | :21:18. | :21:21. | |
industries. There is the potential for it to be used for a joint | :21:22. | :21:29. | |
American British defence, over nuclear states with proliferation, | :21:30. | :21:33. | |
given the depth of the mine and its location to Hartlepool nuclear power | :21:34. | :21:40. | |
station. The ICLpotash is not the only -- ICL Potash provides well | :21:41. | :21:48. | |
paid jobs to our constituents. It has challenges, mainly on safety. | :21:49. | :21:56. | |
Further action is demanded by ICL to ensure everything is being done to | :21:57. | :21:59. | |
keep the people of East Cleveland safe. Brexit, while the fall in the | :22:00. | :22:07. | |
pound has no doubt helped potash exports it poses challenges, not | :22:08. | :22:11. | |
least it has the potential to expose the mine to unfair international | :22:12. | :22:13. | |
competition. There are opportunities too. Linking the mine's future to a | :22:14. | :22:25. | |
plan for the agriculture ral sector. Strengthing trade post Brexit and | :22:26. | :22:27. | |
potentially improving market conditions. I hope the Government | :22:28. | :22:33. | |
will do everything they can to help those whose communities are so | :22:34. | :22:35. | |
linked to the potash mine. I congratulate the honourable member | :22:36. | :22:50. | |
for Middlesbrough South and East Cleveland for securing this debate | :22:51. | :22:54. | |
on such an important matter and also for the work that I have read as | :22:55. | :22:58. | |
part of my preparation for this debate that he has done over a | :22:59. | :23:04. | |
number of years to draw attention to some of the issues that he has | :23:05. | :23:13. | |
raised tonight. Notably the very worrying health and safety record of | :23:14. | :23:16. | |
the mine in recent years. I will return to the issue of health | :23:17. | :23:21. | |
and safety a little bit later. But first to say that we recognise the | :23:22. | :23:26. | |
importance of the potash industry to his constituency and to the wider | :23:27. | :23:33. | |
region. And it is woven into the fabric of the North-East. As the | :23:34. | :23:39. | |
honourable gentleman stated, the mine has faced difficult market | :23:40. | :23:42. | |
conditions in recent years. Revenues and profits in the industry have | :23:43. | :23:50. | |
been hit by low potash prices, mainly as a result of global | :23:51. | :23:53. | |
competition in the market. Of course, as he mentions, some of that | :23:54. | :23:58. | |
competition has not been what we would call free and fair. According | :23:59. | :24:05. | |
to market experts, Ibis world analysis, exports form a quarter of | :24:06. | :24:09. | |
the industry's revenue. So UK miners are exposed to global price | :24:10. | :24:15. | |
volatility. And the situation has been exacerbated by over supply, | :24:16. | :24:18. | |
which is unlikely to go away in the short-term. | :24:19. | :24:24. | |
The job losses that he mentions at the mine since 2014 would clearly | :24:25. | :24:29. | |
have come as a major blow to the employees concerned, their families | :24:30. | :24:31. | |
and the communities in which they live. The rapid response service has | :24:32. | :24:37. | |
delivered a number of redundancy briefing sessions to the employees, | :24:38. | :24:42. | |
to help get the workers back into employment as quickly as possible. | :24:43. | :24:47. | |
In addition, the national careers service delivered support with CV | :24:48. | :24:52. | |
writing, job searching, interviewing skills and one-to-one appointments | :24:53. | :24:55. | |
for rapid response funding applications. | :24:56. | :25:00. | |
However, out put from UK is expected to expand in the next five years | :25:01. | :25:08. | |
with the production of polyhalite emerging as a key product of the UK | :25:09. | :25:15. | |
industry. I am pleased ICL, which he mentions operates the mine is | :25:16. | :25:23. | |
planning over the next five years to expand its output of polyhalite. | :25:24. | :25:27. | |
Seen as a superior fertiliser and highly sought after. I understand | :25:28. | :25:34. | |
that the mine and areas to the south have a near monopoly of this mineral | :25:35. | :25:40. | |
resource. I hope very much that will be of great advantage to the area in | :25:41. | :25:47. | |
the coming years. In fact, polyhalite is expected to | :25:48. | :25:54. | |
overtake potash after 2018. I hope this long-term commitment by ICL | :25:55. | :25:58. | |
will result in a brighter long-term future for the mine and its | :25:59. | :26:03. | |
employees. Yes, I will give way. On that point, she's correct that | :26:04. | :26:10. | |
the market, the industry is looking towards polyhalite to overtake | :26:11. | :26:19. | |
potasl. It is -- potash. It is a hard material to mine. It needs the | :26:20. | :26:23. | |
extra help in marketing the product, as the industry adaptds to it. Has | :26:24. | :26:28. | |
the minister taken on my comments into how it can be an industrial | :26:29. | :26:33. | |
product to the world's agricultural producers? | :26:34. | :26:38. | |
I certainly have taken that point on board and I appreciate that poly | :26:39. | :26:46. | |
halide is only mined from a layer of rock over 1000 metres below the | :26:47. | :26:52. | |
North Sea. Below the potash seem at the Baulby mine, making it very much | :26:53. | :26:58. | |
more difficult to access, and I would welcome the industry 's | :26:59. | :27:03. | |
contribution to discussions as to how the industrial strategy that we | :27:04. | :27:06. | |
are developing with the north-east in mind could benefit that emerging | :27:07. | :27:15. | |
sector. It's challenging sector and very much deserving of our attention | :27:16. | :27:18. | |
as we rolled out the industrial strategy. If I may come on to talk a | :27:19. | :27:33. | |
little bit about, just being selective here, I have quite a bit | :27:34. | :27:38. | |
of information. I think I will come to the health and safety concerns | :27:39. | :27:43. | |
now. I was very shocked at what I read, and I have spoken to the | :27:44. | :27:48. | |
Health and Safety Executive, and we have a representative here among the | :27:49. | :27:52. | |
officials in the box receiver who has travelled down from Bootle for | :27:53. | :27:56. | |
this debate. The government takes health and safety at work very | :27:57. | :28:00. | |
seriously and fully supports the Health and Safety Executive in its | :28:01. | :28:04. | |
efforts to ensure that Great Britain remains one of the safest places to | :28:05. | :28:10. | |
work in the world. There have been six significant incidents at the | :28:11. | :28:15. | |
mine in the last two years, although hearing what the honourable | :28:16. | :28:18. | |
gentleman says, if you go back a little further it is a longer record | :28:19. | :28:24. | |
of safety concerns, resulting in the fatality that he mentioned, three | :28:25. | :28:29. | |
serious injuries, and 14 workers being placed on potentially | :28:30. | :28:33. | |
life-threatening situations. The Health and Safety Executive have | :28:34. | :28:39. | |
found inadequate risk assessments, poor procedures, and the failure to | :28:40. | :28:43. | |
implement procedures designed to tackle the root causes of the | :28:44. | :28:49. | |
problems. I would like to take this opportunity to express my heartfelt | :28:50. | :28:54. | |
condolences to the family of Mr John Anderson who was tragically killed | :28:55. | :28:59. | |
while working at the mine on June 17 last year, and indeed to the other | :29:00. | :29:03. | |
workers who have been injured or distressed as a result of accidents | :29:04. | :29:09. | |
or incidents at this mine in recent years. All these incidents have | :29:10. | :29:15. | |
been, some are still being, thoroughly investigated by the | :29:16. | :29:23. | |
Health and Safety Executive minds has met. And calling on additional | :29:24. | :29:29. | |
specialist input such as human factors where necessary. I should | :29:30. | :29:33. | |
like to assure them that the appropriate action either has been | :29:34. | :29:40. | |
taken or will be taken and should HSC 's current investigations | :29:41. | :29:43. | |
provide evidence of management actions forming -- falling short of | :29:44. | :29:49. | |
legally required standards HSC will not hesitate to prosecute ICL. | :29:50. | :29:55. | |
Indeed I believe that HSC are preparing to launch prosecutions | :29:56. | :29:58. | |
relating to the trapping incidents in April 2015, as one example. HSC | :29:59. | :30:07. | |
and the industry will continue to work together to improve safety | :30:08. | :30:10. | |
performance and the honourable gentleman mentioned the role of | :30:11. | :30:15. | |
trade unions and I understand that they have been very constructive and | :30:16. | :30:20. | |
very dedicated to improving the safety standards and they will be a | :30:21. | :30:25. | |
vital partner in that process. I give way to the honourable | :30:26. | :30:30. | |
gentleman. Rightfully she talks back cases in which we cannot really go | :30:31. | :30:34. | |
into detail because they must be taken through official legal | :30:35. | :30:37. | |
channels and dealt with them in that matter before we can deal with in | :30:38. | :30:41. | |
that way. But my main concern is that there were minors involved in | :30:42. | :30:48. | |
the cases who, pending legal action, the period of time for sick pay ran | :30:49. | :30:56. | |
out and felt forced to go back to work in order to have income. My | :30:57. | :31:03. | |
worry was that some of those miners may have been in states of Post | :31:04. | :31:08. | |
traumatic stress, placing other workers at work in potential | :31:09. | :31:10. | |
jeopardy as well because they had to go back as the breadwinners for | :31:11. | :31:15. | |
their families. Whether the government can review that | :31:16. | :31:18. | |
legislation, in order to make sure that pending legal action in those | :31:19. | :31:23. | |
kind of workplaces aren't those kind of workers can seek sick pay for an | :31:24. | :31:28. | |
elongated period of time. The honourable gentleman makes a very | :31:29. | :31:31. | |
reasonable request. I cannot give him a direct answer from the | :31:32. | :31:37. | |
dispatch box, but I am certainly prepared to take his request back to | :31:38. | :31:44. | |
the Department and ask officials to review the matter, and I will write | :31:45. | :31:48. | |
to him with any progress I am able to make. On that issue. It does seem | :31:49. | :31:58. | |
to be that he describes a situation in which a bad situation is made | :31:59. | :32:03. | |
worse and potentially putting others at risk and it does seem to be | :32:04. | :32:10. | |
something that we ought to review and I will write to him health and | :32:11. | :32:16. | |
safety law covering underground mining was brought up to date with | :32:17. | :32:20. | |
the minds regulation act 2014 and all of the previous relevant to | :32:21. | :32:25. | |
your, some of it 60 years old, drawing from even earlier | :32:26. | :32:29. | |
requirements was modernised and request without producing any | :32:30. | :32:33. | |
necessary protections which was no small task, and it would not have | :32:34. | :32:37. | |
happened without the cooperation of the industry and, as I mentioned | :32:38. | :32:41. | |
just now, the unions recommending the workers in Baulby. The law is | :32:42. | :32:44. | |
now more straightforward and together with the associated | :32:45. | :32:48. | |
guidance, which was also modernised, duty holders should be aware and | :32:49. | :32:53. | |
understand what is expected of them when it comes to operating a safe | :32:54. | :32:59. | |
mine. The new law places clear duties on mine operators to ensure | :33:00. | :33:04. | |
sufficient and effective systems for the management and control of risks | :33:05. | :33:08. | |
are both in place and being followed. We now have a single set | :33:09. | :33:15. | |
of regulations covering the major hazards associated with underground | :33:16. | :33:20. | |
mining, including ground control, shafts, winding equipment and | :33:21. | :33:24. | |
operations, in rashes and fire and explosion, as well as effective | :33:25. | :33:29. | |
arrangements for escape and rescue if controls fail. These hazards are | :33:30. | :33:34. | |
far from new but they are well understood by the underground mining | :33:35. | :33:41. | |
industry and as such I find it unacceptable that some of these | :33:42. | :33:44. | |
standards have not been applied in a consistent manner in the management | :33:45. | :33:51. | |
of this Baulby mine. The government and HSE will work together to ensure | :33:52. | :33:57. | |
that duty holders recognise their potential for causing major harm, | :33:58. | :34:02. | |
and control those associated risks. The honourable gentleman mentioned | :34:03. | :34:08. | |
the fire underground and I understand that improvement notices | :34:09. | :34:18. | |
were served on this EPL, and improvements to underground safe | :34:19. | :34:22. | |
havens and improved communications facilities and water availability | :34:23. | :34:28. | |
have now been put in place. HSC has an intervention plan for every | :34:29. | :34:32. | |
underground mining Great Britain and this reflects the specific inherent | :34:33. | :34:38. | |
hazards, and the mine 's previous health and safety performance, and | :34:39. | :34:44. | |
the ball be plans for 2016/17, and for 20 17th/ 18th reflect the | :34:45. | :34:48. | |
outcomes of the investigations associated with the recent incidents | :34:49. | :34:55. | |
and HSE inspectors will base their interventions and oversight of the | :34:56. | :34:58. | |
mind health and save to performance on these plans, which I know that | :34:59. | :35:02. | |
the honourable gentleman has discussed with HSC. I think I have | :35:03. | :35:13. | |
probably said all that I can say on the health and safe to aspects of | :35:14. | :35:16. | |
running this mine. As I told the honourable gentleman I have talked | :35:17. | :35:24. | |
to HSE about the issues that he has raised and also about my concerns | :35:25. | :35:29. | |
when I read the individual case notes of some of the people who have | :35:30. | :35:35. | |
had terrible injuries and been in fear of their lives, and it was | :35:36. | :35:42. | |
clear to me from reading these notes that several of the incidents could | :35:43. | :35:48. | |
have been possibly avoided, certainly could have been reduced in | :35:49. | :35:53. | |
their effect had proper and robust safety procedures been observed and | :35:54. | :36:00. | |
planned for and implemented at all times. And I was encouraged by the | :36:01. | :36:06. | |
response that I received from HSE with regard to new management at the | :36:07. | :36:12. | |
mine, with a far more robust outlook, and, indeed, informed by | :36:13. | :36:17. | |
HSE by the trade unions and by the honourable gentleman himself, I | :36:18. | :36:24. | |
think we can be optimistic that the future of Baulby mine, both | :36:25. | :36:27. | |
economically, but even more importantly on a safety perspective | :36:28. | :36:33. | |
will be brighter and I think we have got to get all of that absolutely | :36:34. | :36:40. | |
right for the even more risky accessing of the new mineral | :36:41. | :36:45. | |
resource, which has so much to offer his constituents and the mining | :36:46. | :36:53. | |
community that is so important to his part of the world. Order. The | :36:54. | :37:02. | |
question is that this house do now adjourned. As many as are of that | :37:03. | :37:05. | |
opinion say aye, on the contrary, no.. The ayes have it, the ayes have | :37:06. | :37:12. | |
it. Order! Order!. Subtitles will resume at 11.00pm | :37:13. | :37:36. | |
with Monday In Parliament. | :37:37. | :37:47. |