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I want to mention two other important matters. First, the Government have announced this afternoon that they will extend the swine flu vaccination programme to the main carers of those who are very vulnerable and living at home, which I welcome, and to children aged between six months and five years. I welcome that, too; indeed, I have been making it clear to the Secretary of State for some considerable time that, as has been the situation in America, there is a good case for extending the vaccination programme to young people on the grounds of the evidence that is emerging of the much higher likelihood of young people who do not have existing underlying health conditions having complications from swine flu. The debate continues, and the Secretary of State has advised that the Government do not-yet-support a school-based vaccination programme, but I none the less think it is right for us to proceed in this way for very young people and to give positive consideration as to whether in the new year, when the vaccine is available and the existing priority groups have been
substantially dealt with, we should move on to offer vaccination to young people up to the age of, let us say, 24 or 25, in recognition of how many of them are hospitalised when they have swine flu and the pressure that there is on paediatric intensive care. I also join the Government in hoping that those who are offered vaccination will take it up, especially those working in the NHS and social care, and pregnant women given what we know about the risk of complications for them. There has been much inappropriate comment about the speed at which this vaccine has been made available, when we know the technology on which it is based is a proven technology that has been used in seasonal flu vaccines over many years and that there is no reason for people to resist it on this basis.
The Queen's Speech proposes a personal care at home Bill. Last July, the Government, after having pursued for a very long time the idea that there should be a long-term consensus on social care-my colleagues and I had often made efforts to join in such a consensus, but the Government ignored that-published their Green Paper; they proceeded without such a consensus in place. What is subsequently astonishing is that, as Lord David Lipsey tellingly described it, they have even fired an Exocet at their own flagship. The Prime Minister has shot right through their own Green Paper by putting a further proposal forward that was not even in the Green Paper, and I understand that David Lipsey's view is that it runs counter to what ought to be the long-term consensus for a more comprehensive social care plan, because it would provide free personal care for a small minority of care users living at home with highest need, abandoning those with lesser care needs, but who, frankly, have seen local authority support to them diminishing. About 600,000 fewer people are now accessing local authority-arranged support in the moderate and lesser care need categories. So everything is being focused on the highest care need, but that does absolutely nothing for people in very high care need who go into long-term residential care.
The Prime Minister says, as Tony Blair did 13 years ago, that he does not want to live in a country where people have to sell their home to pay for care. Why does he think that happens? It happens because people go into long-term residential care when their home becomes at risk as a consequence of the means test, the cost of care rises dramatically and their homes have to be sold to pay for it. According to the latest estimate, 47,000 people a year still have to sell their homes to pay for care. Frankly, it is outrageous for the Prime Minister to publish an article suggesting that his proposal in the Queen's Speech yesterday will do anything about that; it will do nothing. Those going into long-term residential care will not be supported at all, and as David Lipsey rightly points out, sometimes it is necessary, right and in their own best interests for people to be admitted to long-term residential care.
We do need to establish a long-term consensus on social care. In the light of the speeches that I and my Conservative colleagues have made, not least to the national children and adult services conference in Harrogate, such a consensus is available. However, it is not available on the basis of scrapping attendance allowance and disability living allowance for those over 65, but on the basis of prevention. Yesterday's proposal-the Government followed us in proposing resources for reablement and
enablement through prevention-is a step in the right direction. We need to do more on assistive technologies and on home adaptations and prevention.
The second principle is personalisation of care. More than 2 million older people with disabilities and needs are receiving attendance allowance of £60 a week on average, or disability living allowance of £75 a week on average. The Government's Green Paper proposals would take that away in order to pay for their national care service. Frankly, that is not acceptable. If personalisation of care is right, and it is, such people need to maintain access to cash benefits that they can use to support their care needs as they see fit. In particular, that means cash benefits that they can use to support family and informal carers.
We support a national care service, which the Government are proposing; what we oppose is a nationalised care service. Instead of personal care and local authority involvement, the Government want to turn such a service into something driven only by bureaucracy and the state. As my colleagues made clear in their contributions, we have to listen to people; we have to let people make choices. We have to give patients, care users and parents the opportunity to control their public services. So we oppose the Government's nationalisation proposal; instead, we are in favour of creating a national care service through which people can access a common assessment that can be transferred around the country. That way, they will know they have support for keeping them independent at home and the ability to manage budgets on their own behalf, while getting the care they need. They will also know that, through our home protection scheme, they can buy into an insurance policy that means they genuinely will not necessarily face the threat of selling their homes to pay for long-term residential care.
The Government's "dividing lines" are an absurd political gimmick. What we actually have, as the Lord President of the Council and First Secretary of State-and grand panjandrum-describes it, is a choice. We have a choice between, on our part, ambitions for our national health service, or atrophy of reform on the Government's part. We have a choice between radical reform in education to deliver higher standards, or reactionary politicking by the Secretary of State. We have a choice between a future Government who are committed to our public services and to practical and workable solutions, and a Government who have run out of ideas and are using the public services as no more than a political football. We are committed to achieving the quality of public services that people have a right to expect, and not least to achieving the outcomes that will make our public services among the best in the world.
4.54 pm
The Secretary of State for Health (Andy Burnham): We have heard many important contributions this afternoon and I shall respond to them in a moment. The hon. Member for South Cambridgeshire (Mr. Lansley) spoke very movingly about his constituent in Afghanistan. Speaking for the Government, I wish to share our condolences with him and his constituent's family. The hon. Gentleman talked of moral and political support being important and the best thing we could provide. I share that view wholeheartedly.
At the beginning of my contribution, I wish to set out the broad context for today's debate. Some 10 years ago, our crumbling hospitals and schools were a national embarrassment and were failing patients and parents, but today, after a decade of investment and reform, they are substantially rebuilt and provide a good service to the public; no longer are they the poor relation in Europe and the world; they instead receive accolades on the world stage. The respected US-based The Commonwealth Fund has tracked the progress in our NHS and, two weeks ago, it said that England had one of the best-if not the best-primary health care systems in the world. That is not only a huge tribute to all the staff who work in primary care in our constituencies and a particular tribute to the work of general practitioners-perhaps we do not praise them enough-but it is an endorsement of the Government's reform programme.
The UK and England were ranked first of the 11 countries surveyed, which included Australia, Canada, France, Germany, the Netherlands, New Zealand and the US, on the following criteria: low waiting times for specialist care; the use of multidisciplinary teams; the use of financial incentives to reward patient experience; the quality of clinical care; the management of chronic diseases; the use of data on patient experience; the reviewing of doctors' clinical performance; and the benchmarking of clinical performance. We were given that outstanding record of achievement in Washington.
The evidence for that transformation in primary health care can be found in my constituency; we had a world of too few GPs working out of terraced houses, but we now have modern premises with more GPs providing a wide range of services to the public. I am sure that my right hon. Friend the Secretary of State for Children, Schools and Families would agree when I say that primary education has undergone a similar transformation to that of primary health care services. Our schools are now a joy to visit and are unrecognisable from the shabby and depressing buildings of 15 years ago. The primary heads in Leigh tell me that they have resources that they could once have only dreamed of. Through investment and reform, our public services have gone from poor to good-now the challenge is to make them even better.
Bob Russell: Does the Secretary of State regard as a triumph for new Labour the fact that 12 years on 4 million children are living in poverty?
Andy Burnham: I consider it one of the finest achievements of this Government that we have taken 600,000 children out of poverty. That is what this party and this Government set out to do. Many of those children live in my constituency and the constituencies of hon. Members sitting on the Labour Benches today. Although it is one of our finest achievements, we will go further.
Andy Burnham:
I shall make some progress. I said that we wish to move services from being good to being great. That means building on the foundations we have laid in the past decade to create more personalised and more preventive services that are more responsive and are of higher quality. So we want to lock in the achievements of the past 10 years and to hand power to people-to
patients, pupils and parents. To do that, we are turning targets into rights and entitlements in order to guarantee the services and the standards that people expect and deserve.
The Children, Schools and Families Bill provides a range of guarantees to pupils and parents. It aims to help everyone reach their full potential, to make everyone aware of their entitlements and to allow everyone to seek redress if their expectations are not met. I particularly welcome the entitlements that will improve children's health. We propose that every five to 16-year-old should have access to five hours of high quality physical education and sport every week, in and out of the school day, and that every 16 to 19-year-old should have access to three hours of that. I also welcome our proposal that every pupil should have access to regular competitive sport, to coaching, to a choice of different sports and to help to lead and volunteer in sport. Furthermore, we propose that every pupil should go to a "Healthy School" that promotes healthy eating, an active lifestyle and emotional health and well-being. Those are genuine steps forward and I want to pay tribute to my right hon. Friend the Secretary of State for introducing them.
In essence, the Bill is about the right to a rounded education. As someone who was unlucky enough to spend his entire secondary school career in a northern comprehensive under Mrs. Thatcher, I have always felt passionate about this. I saw the after-school activities-music, culture and sport-dry up in the teachers' dispute of the mid-1980s, never to return. These new guarantees would prevent that from ever happening again.
In the NHS, there will be a similar shift in power to the public from professionals. In the next period of reform, as we move towards a service that is more preventive and people-centred, empowered patients and staff will lead change. The hon. Member for South Cambridgeshire mentioned the reform journey and the ideas. I was the one who promised to remove practice boundaries and to give patients more choice in primary care. He mentioned payment by results, and we are introducing a further reform to the tariff to link payment to the quality of services provided. Where is he in these debates? I am putting forward these proposals, and he comes to the House today and asks where the changes are.
The hon. Gentleman mentioned the commitment to making the NHS the preferred provider. As we will have more reform, not less, in the coming period we will have to take more work out of the hospital setting and we will have to ask NHS staff to work in different settings. That is precisely why we must give the NHS the chance, the space and the time to rise to the challenge, and to make those changes and to improve health care as a result.
Mr. John Baron (Billericay) (Con): According to the Select Committee on Health and other bodies outside this place, inequalities in cancer outcomes have widened in the past 10 years. Will the Health Secretary try to explain why that is the case?
Andy Burnham:
I do not believe that the hon. Gentleman can make such an argument. The Government have introduced the cancer plan and invested in cancer services,
and if he is genuinely saying that there has been no improvement in cancer services, I am afraid that I disagree with him profoundly.
To make the NHS even more preventive, I propose that the reform should go further still and that we have a right to an NHS health check every five years for every person aged between 40 and 74 to assess their risk of heart disease, stroke, diabetes and kidney disease. We must go further towards a more people-centred service. The hon. Member for South Cambridgeshire asked where the choice was in end-of-life care. I will tell him where the choice in end-of-life care is. I asked for consultation on a right for the public to choose to die at home. I think that that is a sensible choice to offer the public. I am consulting on it right now, so if the hon. Gentleman would care to read the odd thing that the Department puts out, he will see that we are ahead of the game and ahead of him on these issues.
Mr. Lansley: I am grateful to the Secretary of State for giving way, and I know precisely what he is consulting on. He is consulting on a right to die at home, but people need the ability to exercise choice in end-of-life care, including the right to choose to die in a hospice or, for some people, to die in hospital. The right to die at home is not the only choice. There are a range of choices, so why does the Secretary of State not give people choice?
Andy Burnham: A few minutes ago, the hon. Gentleman asked where the choice was in end-of-life care. I have launched a consultation on extending to people the right to die at home. Where was he before I proposed that right? I did not hear him calling for it. I have opened that consultation-if people want to make that argument I will listen to it, but it is the Government who are making the proposals. We are also saying that people should have the right to access a personal health budget and to have more control and power over their health care.
The NHS constitution, which was recognised in law just last week, sets out the rights of patients to guaranteed waiting times. Again, we are consulting on this. Waiting lists should be 18 weeks for elective treatment and two weeks to see a specialist for suspected cancers. Let me get a few things straight today. The Leader of the Opposition said yesterday from the Dispatch Box that the Conservative party first proposed the NHS constitution, but the first mention of it in any Tory document was in June 2007-a full nine months after I proposed the creation of an NHS constitution in a pamphlet in September 2006. Check the facts.
There have been complaints today that there is no NHS legislation. Only last week, the Health Act 2009 received Royal Assent. Let us take that further immediately, by taking patient rights further-the consultation I mentioned a moment ago.
Let us get to the main point: the complete and utter confusion on the Opposition Benches about our proposed patient rights. The shadow Health Secretary has constantly said that he opposes the targets that form the basis of our proposed rights-the 18-week target and the two-week cancer target-and has said that he prefers outcome targets. Right or wrong? He has consistently opposed those targets?
Andy Burnham: I shall take that as a yes.
Yesterday, the Leader of the Opposition stood at the Dispatch Box and said that our proposals to turn targets into rights were things that "everyone wants". We are told that the hon. Member for South Cambridgeshire is one of the favoured few who is guaranteed his job if the Tories win, but it does not look good for his boss to stand at the Dispatch Box, as he did yesterday, and rip up the hon. Gentleman's policies on the Floor of the House. It was staggering to watch.
Mr. Lansley: Now I can see the point that the Secretary of State was making. He suggests that our being in favour of maximum waiting times is the same thing as agreeing with his targets. It is not. We are in favour of patients having access to quality services. If a patient is admitted to hospital with a fractured neck or femur, 18 weeks is an irrelevance-they should be treated within 24 hours. If an acute stroke patient arrives at a hospital, they should have a CT scan within 24 hours maximum. Then there are patients with a cardiovascular condition, such as the hon. Member for Bolsover (Mr. Skinner). I have no doubt that there was a point when the hon. Gentleman needed treatment in much less than 18 weeks. Maximum waiting times make sense, but a single 18-week target does not.
Andy Burnham: I have never heard such rubbish in my entire life. The hon. Gentleman's thinking on the issue is completely and utterly confused. The patients he describes would be covered by the four-hour target. People with such conditions would get straight into hospital- [ Interruption. ]
Mr. Deputy Speaker (Sir Alan Haselhurst): Order. I am sorry to interrupt the Secretary of State, but there seems to be constant interchange of a secondary nature during the debate. It is now becoming distracting.
Andy Burnham: The hon. Member for South Cambridgeshire says that he opposes the four-hour target, too. He says that he supports guaranteed waiting times, so let us get this straight today. Does he support the new proposed right to care within 18 weeks, and two weeks to see a specialist for patients with suspected cancer? Does he support those patient rights, on which we are consulting now?
Mr. Lansley: What the Secretary of State is consulting on is the inclusion in the national constitution of a right phrased as follows:
"You have the right to access services within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of alternative providers if this is not possible. The waiting times are described in the Handbook to the NHS Constitution."
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