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11 Dec 2008 : Column 732

Rather than taking a nanny state approach, or, as the hon. Member for Gainsborough (Mr. Leigh) has pointed out, taking steps that could push small village shops into closure, we should do things that are effective in helping people, and which will actually facilitate their giving up smoking.

Rob Marris: Does the hon. Gentleman agree that it is nonsense that in the European Union—of which the United Kingdom is a member state—there are still subsidies for tobacco producers? That is crazy.

Norman Lamb: I absolutely agree with that. It is remarkable that that still occurs in this day and age. This is why international action on such issues, and on finding much more effective ways of tackling tobacco smuggling, must be a real priority.

I shall finish by addressing some of the things that the Queen’s Speech does not deal with. It is a massive challenge to make the NHS secure, sustainable and more effective, particularly in tackling the very poor provision of care for elderly people, at a time when we are seeing rapidly rising costs in our health system. Costs are rising because of lifestyle conditions such as obesity and alcohol abuse, and also because of the dramatically ageing population and the availability of new medicines. Costs are also rising at a time when the likelihood of sustained real-terms increases in funding is surely at an end. The Secretary of State mentioned a real-terms increase for the forthcoming year, but that provision is likely to end in 2010-11, after which the position will become much more difficult. The state of the world economy, and the impact that that is having on this country, will surely mean that focusing on ensuring that our health system is sustainable must be our highest priority. Unless we can get better value for money, we will surely be heading for a crash.

The Secretary of State said that the Darzi review pointed to a direction in which prevention became the real priority, but simply stating that it is a priority, without providing any real mechanisms to make it happen, will not result in any meaningful change. Our approach involves dismantling the wasteful, secretive, central bureaucracy and creating real accountability and financial responsibility locally. It also involves getting the finances working—we are talking about spending about £100 billion a year—to achieve the objectives that we all want to see: prevention, better self-care and better health for our citizens. As Derek Wanless said when he made the case for increasing spending on the NHS, our health system will be sustainable in the long term only if we are much more effective at helping people to care for themselves and to improve their health. So far, we have failed to achieve any meaningful change.

There has been a massive increase in funds for the health service, but the increase has been particularly at the acute end—for repair services. Meanwhile, community care and social care have been under intense pressure. Over the years of funding increases, the NHS has had five times the increase in funding that social care has had—without any explanation as to why that should be the case. Yet if we get our preventive services right, we will reduce pressure on acute services.

Thirdly, then, we must surely look at ways of integrating health and social care. The silo approach that we have is crazy: the patient does not understand the difference
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between health and social care, yet the system divides up care and budgets according to those dividing lines. We must ensure that we get better integrated care. We need to reflect on areas such as Torbay, where health and social care have been brought together at a service level, in order to avoid the crisis admissions to hospital that are so costly for the NHS.

Fourthly, we must ensure that we have more effective use of funds in our acute hospitals. At the moment, without good enough commissioning of care from our primary care trusts, the payment by results tariff is sucking money through the system. With social care under intense pressure, as I have said, many acute hospitals are making surpluses. Surely that is crazy.

The NHS needs to be better at adopting innovation. I want to refer specifically to photodynamic therapy, in which I know the hon. Member for Norwich, North (Dr. Gibson) has shown some interest. Pioneered at University College hospital, London, this is a cancer therapy that avoids invasive surgery and means that the patient may be able to leave hospital within two days of treatment. It has been shown to be effective with many cancers and it has the potential to be effective with many more cancers. It was recommended for further analysis in the cancer strategy a year ago, yet a year later, that further analysis has not even started.

If photodynamic therapy realises its potential, it will be massively cheaper to the NHS than invasive surgery, chemotherapy and radiotherapy. Patients who have the good fortune to end up in UCH—if they have head or neck cancer, for example—will benefit enormously from this therapy. However, one of my constituents contacted me to ask why he was never told about the possible availability of photodynamic therapy. Surely these innovations going on in our hospitals should be spread around the country much more effectively.

Finally, it is important to put more power in the hands of patients, so that they can vote with their feet—empowered with information and support to make the right decisions about their care. The Secretary of State referred to the pilots for developing personal budgets. We support them, but we believe that they should go further, as they have enormous potential to give patients real power and put them in charge of determining what their priorities are, particularly when they are suffering from long-term chronic conditions.

So far, very little of the public debate has been about how to avoid the crash, with massively increasing costs at a time when no more money will be made available. It is always the most vulnerable who are affected if we fall into crisis. That has been the case in the past with long waiting times, and it will be the case in the future unless we get it right. Surely the Government have to start mapping out a way forward to make better use of the available £100 billion to invest in preventive services, to keep people healthy and to ensure that the NHS is sustainable in the future.

2.59 pm

Mr. Barry Sheerman (Huddersfield) (Lab/Co-op): It is a pleasure to be called to speak in this important debate.

Sometimes we on the Back Benches wish that there were a curb on Front-Bench speeches. The hon. Member for North Norfolk (Norman Lamb) spoke for 35 minutes. I almost lost the will to live. I say that because half of the debate time today has been taken up by Front-Bench
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spokesmen. No wonder the Chamber is so sparsely attended on an important debate on education and health, when Back Benchers turn up and have to wait so long to make a short contribution. It is disappointing sometimes to see the way in which those on the Back Benches are treated. I make that as a general point, Madam Deputy Speaker. You know that I can get irritable, because a long time ago you were one of my students and knew that I was an irritable lecturer. However, I will get on with my speech and try to make it reasonably lively.

Twenty years ago, we had the Education Reform Act 1988, which most of us associate with the person who is now Lord Baker. Some important reforms were introduced: testing and assessment, which is taken very seriously, the national curriculum, and the inspection service. The Select Committee on Children, Schools and Families, which I have the privilege to chair, is going through them. We have conducted a major inquiry on testing and assessment, have come to the end of an inquiry into the national curriculum, and are going to take a thorough look at inspection. In a sense, I always try to use the Queen’s Speech debate to say what is happening in terms of the progress that we have made over the past 20 years. Too often in the Chamber, we make party political points against one another, but if we took a more historical view, we would see that we agree on quite a lot of issues—but not all of them. We fundamentally disagree on some of them, and I shall come back to that.

It is part of a Select Committee’s job to attempt to establish the value for taxpayers’ money and the progress that is made over a longer period. It is with great interest that we look at this Queen’s Speech. It is quite thin, but it does include a portmanteau education Bill. There is an awful lot in it to do with education: from training and apprenticeships to the reform of the Qualifications and Curriculum Authority; measures to promote equality; the introduction of primary legislation to enshrine the child poverty targets for 2020; and the general aim to help families and businesses. I make no apology for concentrating on families and children in my remarks.

The newish Select Committee that I chair is different. Being Chairman of a Select Committee was a simpler task in the past because the Chairman called one Department to account. The responsibility is much more complex with children, schools and families, which I am told span 10 different Departments, if we follow families and children across those arbitrary divisions. The needs of families and children do not pay any respect to those artificial divisions between, for example, health and education.

It would be wrong if, at this time, with the enormous public interest in the welfare of children—particularly the most vulnerable children in our society—I did not spend a little time talking about them. It happens that one of the Select Committee’s decisions was to show that we were taking our responsibility for children seriously, and for the past few months we have been looking intensively at the whole area of children in care—looked-after children. We have been taking that very seriously and have learned a great deal. As soon as one gets into this territory, the vocabulary and acronyms are different, and there is a tremendous learning curve, which members of the Committee have enjoyed.

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As we approached the end of the inquiry, we were hit by the awful tragedy of baby P. As we studied the ramifications of the baby P case, we learnt very quickly not just how many children become vulnerable each year, but how many children’s lives are ended when they are murdered by their parents or carers. The figures given to the Committee only yesterday by the chief inspector of schools were chilling indeed. During the early part of the debate about baby P, we were given figures from the National Society for the Prevention of Cruelty to Children stating that a child was murdered between once a week and once every 10 days; the chief inspector suggested that the figure was nearer to three children each week.

The issue is very serious, but it must be dealt with in a balanced way. When a tragedy such as this occurs, we need to establish what happened, and whether it is a one-off case or whether there are systemic problems to be addressed. The Secretary of State has moved very quickly in facing up to that responsibility. Unfortunately, we have seen yet another regrettable attempt by the British media to conduct a trial by television and newspapers even before the facts are known. I believe that we have a heavy responsibility to introduce some balance to that knee-jerk attitude to every crisis, and put it into perspective.

What went on in Haringey was not good. I have been given privileged access to some of the documents involved, and they are very disturbing indeed. What do we learn from this case? We certainly learn that the role of Ofsted needs to be re-evaluated. The evidence that we took yesterday caused me to worry about just how often inspectors enter local authority children’s departments, how close they get to those departments, how often they go to meetings, meet real people and discuss the issues across the table, and to what extent inspections are paper-based.

As I listened to the chief inspector’s evidence yesterday, I had the impression that Ofsted’s system, which is not bad for the purpose of evaluating schools, has been transported to child welfare, where it is less appropriate. I told the children’s commissioner that I found it surprising that, given that there are only 150 local authorities, there was not a member of the inspectorate in every one. It would not have to be a long-term arrangement, I said, but there should be a presence. A member of the inspectorate should regularly accompany social workers on difficult visits, and should sit in on case conferences.

Of course, we now live in the world of the e-mail. We all know organisations in which colleagues who are just across the corridor from each other do not knock on the door and speak, but e-mail instead. That disease exists in health and social services organisations in both the private and the public sector. I believe in the good old-fashioned presence of a person at a table, looking others in the eye and talking about a case—perhaps asking “When did you last see this family?”, “When did you last discuss the child?”, ”When did you last talk to the child on his or her own?” or, “When did you last ask whether there was a man in the house? Did you ask a neighbour whether there might be a man living in the house whom you had not known about?” That last question is a common theme in many difficult cases of this kind. In the context of the baby P case, I issue a plea for us to look very seriously at the systems.

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John Hemming: As the hon. Gentleman probably knows, I have been studying the systemic aspects, and trying to establish how many serious case reviews following a child’s death have occurred nationally. Ofsted has only been able to look at the figures since 1 April 2007, but the Government have instructed local authorities not to provide me with lists of serious case reviews prior to that date. Would the hon. Gentleman consider using the authority of his Committee to investigate the number of cases over the past few years since serious case reviews became more common, so that we can identify the systemic trends?

Mr. Sheerman: I know of and respect the hon. Gentleman’s work, and I will be as helpful as possible in my role as Chairman of the Committee.

We are looking for systemic problems, and we picked up on one yesterday that caused great shock: the records of the Ofsted investigations of children’s departments were not kept for longer than three months. Apparently, a lot of the original information about what went on in the inspection, such as who was met, what was said and who attended what meetings, disappears after three months. I ask the Secretary of State to look into that.

Mr. John Horam (Orpington) (Con): Did the hon. Gentleman’s Committee discover why there was such a practice?

Mr. Sheerman: The answer we got yesterday was that the volume of material would have been too great. I can understand that in terms of school inspections as there are thousands of schools, but I find it more difficult to accept in respect of 150 local authorities and children’s departments. Our role in this House must be to get the answers right, and we await with great interest the findings of the Laming inquiry, which is being carried out at the request of the Secretary of State.

I want Members to bear in mind that the social workers in this country do a wonderful job. They are underpaid, and in many ways they are under-trained. Before the baby P case, a chief executive of a London authority gave evidence to the Committee and said that he no longer trusts the training of social workers in our country and would prefer, as far as possible, only to hire social workers from Australia, South Africa and Canada. That was a remarkable comment, but the Secretary of State intends to look at the training of social workers, and also how they are used and managed. Earlier, a Member talked about accountability, and I agree that accountability is important, but so is good management. The management of a large children’s department is a very challenging job, and all of us know that merging social services with education has been difficult. There is a great tension in that. Some of us represent constituencies whose local authorities have an expert director of children’s services who came from social services; others have someone who came from education.

We must look at these matters very carefully. Although there have been criticisms of the director of Haringey social services, we should look a little more carefully at, and a little more kindly on, the stress of that job. We should sometimes be a little more objective and thoughtful about the comments we make about people before we know the full facts.

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David Taylor (North-West Leicestershire) (Lab/Co-op): Does my hon. Friend agree that the occasionally poor reputation that social workers have is rooted in their unfair treatment in the media, and would it not be a good idea if those in the broadcast and print media commenting on social issues of this kind were required to get some detailed knowledge of the pressures faced by people on the front line, because they are too quick to judge, condemn and excoriate the work of social workers, who are at arm’s length from us in doing a job we need to have done?

Mr. Sheerman: I entirely agree with my hon. Friend on that point. Social workers do a great job. Yes, we should look to see if we can improve their training and we should look at their management, but it is one of the hardest jobs in the world. If there is a tendency to take people off the front line quickly, and to promote them into the management and administration of the children’s department, we must find out how to combat that by encouraging people, and by giving them time away from the front line to rest them and then bringing them back. It is a very hard job and we must respect that. We must also respect the complexity of the management task faced by the 150 directors of children’s services, who have very large empires to manage. A little more humility is called for.

My hon. Friend is right about the media. For example, last week a study was published in The Lancet which said that 5 per cent. of children in developed countries were subject to abuse, either sexual or physical. When one looked at the full reports, it became apparent that the figure of 5 per cent. was never mentioned—it was only in the press reports. The media treatment of that report gave people in this country the wrong idea. For a start, hardly any of the original research was carried out in this country.

How many times do we hear on the BBC the words, “Research carried out by this programme”? We know what that consists of. Indeed, we had an example this weekend when it was claimed that research carried out by the BBC had found that a tiny number of MPs— 20 or 23—were unhappy with some aspects of the Speaker’s performance. That was not research. It was some kid in the office who had pestered MPs over the weekend. Too often, the media, especially the BBC, do such things; the “Today” programme loves to do it. Many members will have been rung up as part of that alleged research. I know what real research is, and that is not real research.

The amendment expresses the Opposition’s concern about international tables. We do not stress the good news enough, and the trends in international mathematics and science study, or TIMSS report, shows how extraordinarily well our children have done in mathematics. The performance of the 10 to 14 age group has improved dramatically, and those on both sides of the House should welcome that. The investment in early years education, children’s centres and Sure Start takes a long time to show results, and we are always in danger of making those issues a purely party political contest, with the Opposition saying that whatever the Government have done is wrong. Actually, as Chairman of the Select Committee, I see an enormous amount of good.

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