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The condition management programme, which is voluntary, is delivered by multidisciplinary health care professional teams to empower individuals to understand and manage their health conditions in order to return to work. We must recognise how difficult it is for some people in our communities to work. Employers must engage with adaptation, if necessary, or provide a different role in the workplace. We all know that working gives people not only a better income, but a better quality of life. As a nurse in the community and among my own
friends, I have witnessed how easy it is for people with chronic conditions to become isolated, especially if it is one of the dreadful inflammatory diseases involving joint disfigurement that can lead to embarrassment about the way that one looks.
Leadership has been mentioned, and it is so important. I will put my cards on the table about the call for a national MSK clinical lead. Many requests have been made for champions for various clinical areas. Hon. Members can imagine how many people want a clinical lead for their speciality. As we announced last year in "High quality care for all", we decided to set up a National Quality Board to advise on future clinical priorities and what steps might be taken, such as the appointment of clinical champions, to promote clinical quality in identified priority areas. The National Quality Board recently conducted a stakeholder engagement on the criteria and process for setting priorities and the initial list of topics for consideration. Relevant NHS patient and professional organisations have been invited to suggest possible topics and submit evidence.
We felt that that was the fairest way to manage huge demand. We recognise the difference that champions have made in cardiovascular, liver and neurological diseases and in cancer. I understand what people are saying, and I can only suggest that Members continue to take note of stakeholder groups. The organisations to which they belong, and in which they play such an important role, will help.
Anne Milton: I appreciate that everybody wants a clinical lead, but does the Minister agree that drawing media attention to musculoskeletal diseases is particularly difficult? She mentioned heart disease and cancer, which get quite a lot of attention. Musculoskeletal conditions are a specific concern, particularly bearing in mind that they have such a huge impact on our society.
Ann Keen: I agree. Because those conditions are not perceived as life threatening, they are not considered serious. This matter is complex, but as has been said so well in this debate, the pain has a significant effect on quality of life, whether that is working life, social life or the life of a child approaching adulthood. It is important to take such conditions seriously and to consider what sufferers' futures hold for them. I believe that this debate will progress that, which is why I again congratulate the hon. Member for Rochdale on securing it.
Graham Stringer: I am listening carefully to what my hon. Friend is saying. I realise that, unfortunately, she cannot change Government policy on her feet in this Chamber. However, if I understand what she is saying-I would be grateful if she corrected me-she agrees with us and wants us to keep shouting for a clinical director, because the case is made and the Government just need to change their policy. Is that what she is really saying?
That is a skilled way of using my words slightly differently. I laid my cards on the table and said what we were doing. I said that we were engaging with stakeholders. My hon. Friend will be able to engage with them and will, I am sure, continue to champion the issue in the way that he has demonstrated in this debate. He also mentioned the best and worst services in the country, possibly in relation to the King's Fund report.
We now have a constitution that must be followed and guidelines within the constitution on the practice of administration and the availability of new drug treatments and services. PCTs must be called to account to their own communities.
The 18-week time standard has significantly improved access to treatment for many patients, including those with MSK conditions. In August 2007, just 68 per cent. of non-admitted rheumatology patients received treatment within 18 weeks of referral. Hon. Members will be pleased to know that by October last year, that figure had jumped to 98 per cent. Personalised care plans are a new concept for patients with long-term conditions and their families. They allow people to take control of their own care instead of being dictated to by professionals, particularly in relation to their pain level. The patient's pain level is what the patient says it is.
We now have expert pain management clinics to help people live with chronic conditions. The hon. Member for Southport (Dr. Pugh) said that his mother puts up with hers, but the "mustn't grumble" days are over for people with such conditions. They must grumble-a lot of grumbling has been done in a managed and professional way in this debate. I believe that with the advent of the movement of long-term conditions into the community and away from a consultant-led, in-hospital approach, which uses serious resources inappropriately, we all need to consider quality, safety and the personalised care of patients with chronic conditions such as MSK, as we have a duty to do.
Mr. Austin Mitchell (Great Grimsby) (Lab): I am delighted to initiate this debate, because manufacturing is crucial to our country's economy. Our future depends on the health of the manufacturing sector. The current political obsession with debts, deficits and borrowing is obscuring the importance of the manufacturing base, which is, and has been, shrinking. We have an opportunity to rebuild and expand it, because we are now more competitive. I urge people to seize this opportunity with both hands and rebalance the economy-which has become lopsided, with a bias towards an overwhelmingly heavy financial sector-back towards manufacturing so that we can pay our way in the world. The national mood, which has long been fairly hostile and cool towards manufacturing, is turning back towards being sympathetic to and supportive of it.
To my surprise, I have been deluged with representations from all sorts of manufacturing bodies, such as the Chemical Industries Association, the Engineering Employers Federation, the Food and Drink Federation and representatives of the aerospace industry, which have emphasised the importance of manufacturing and urged me to concentrate on their particular sector and its problems. I will not do that, because this is a general debate. The situation is well summed up by the Engineering Employers Federation pamphlet, "Manufacturing. Our future". It undoubtedly is the future; I agree with just about everything in that manufacturing manifesto.
Having burbled about debt and finance for over a decade, even the economic commentators-those great weather vanes-are coming back to recognising the importance of manufacturing. Messrs. Smith of The Sunday Times, Elliott of The Guardian, Keegan and Bootle-my main weather vane-are all writing about the importance of manufacturing and building up our manufacturing sector again. Even the Lord high Mandelson has said that we should be concerned with engineering, rather than financial engineering. If it has reached that level of recognition, it must be a successful doctrine.
Mr. Denis MacShane (Rotherham) (Lab): The First Secretary of State and Secretary of State for Business, Innovation and Skills, whom my hon. Friend mentioned, came to the Corus steelworks in Rotherham in the summer. I must say that since his visit, things have turned around. We are now narrowly in the black and the unions have worked co-operatively with the management. Mr. Stuart Sansome, the leader of the Corus steelworkers, made a presentation to the Corus board with the local management, which showed partnership at work. Let us place it on the record that Lord Mandelson, about whom my hon. Friend and I have made many comments over many years, might be on the side of the angels on this matter. He might help Britain's steel industry to have a future, which was far from certain this time last year.
Mr. Mitchell: I am grateful to know that the First Secretary has used his miraculous powers on the steel industry in Rotherham. Perhaps he could go to the north-east and help the Teesside steel industry.
Mr. Lindsay Hoyle (Chorley) (Lab): My hon. Friend has touched on the point I was going to make. We ought to mention Middlesbrough. Things may be good in Rotherham, but the situation is not quite as good in Middlesbrough. Does he agree that we are hearing a lot of fine words from the Secretary of State, but that actions speak much louder than words? What we need to see is action.
Mr. Mitchell: I agree absolutely. I am making a plea for action today, because manufacturing is important. It makes the greatest contribution to our balance of payments, with £194 billion coming from exports last year. That is three times the contribution made by the much-vaunted financial sector.
Bob Spink (Castle Point) (Ind): Does the hon. Gentleman agree that we must look carefully at patent protection to ensure that specialist and innovative manufacturers can take advantage of their innovations and manufacture their goods in this country, rather than have their patents stolen and the goods manufactured elsewhere? I have a meeting with Lord Mandelson on 2 February to discuss that point. Would the hon. Gentleman care to join me in that meeting with specialist manufacturers from my constituency?
Mr. Mitchell: The hon. Gentleman makes an important point. We are an innovative country. Although manufacturing has been badly battered, our manufacturing industry is still an innovative source of ideas. It must be able to follow those ideas through to profit, so the ideas must be patented and the patents safeguarded. I agree with that absolutely.
Trade is the main contributor towards this country paying its way in the world and most trade is in manufactured goods. Although the manufacturing sector has been making a strong contribution, its share has declined and it has been suffering. In the light of the experiences of developing countries, exports are the key to growth. For too long, our manufacturing has contributed only on the home market. We are now running a deficit in manufacturing trade.
Tony Lloyd (Manchester, Central) (Lab): My hon. Friend is making an important speech. On exports, all the projections for the growth of the world economy show that growth will happen among the fast developing economies of Brazil, Russia, India and China-the so-called BRIC countries-and not in the traditional large economies. Britain has a very low market share in those countries, particularly in China. Does he agree that we must urge the Government to emphasise exports, particularly for small manufacturers in innovative sectors, which could make a real difference, but which cannot break into those markets at present?
I agree-it is amazing how many interventions I agree with. It is important that we make a contribution in that area. However, we must face the fact that much trade is in manufacturing sectors that use quite low technology. There are markets there too and we must not neglect them. We have been suffering in all markets. I am arguing that we have an opportunity to win back the share of trade we have lost, as we can now replicate the competitiveness of countries such as China because our exchange rate is more competitive,
which lowers our cost base compared with China and developing countries. We are much more competitive because of the fall in the value of the pound.
Cambridge university's studies on the economic future show that our trade deficit is going to grow unless we rebuild manufacturing to fill the gap. Oil is not going to fill the gap in the way that it has done; nor is the City, which is a busted flush. If we do not fill the gap by expanding manufacturing, we will have to borrow to pay for imports or import less and reduce our standard of living. The other option is that the world will eventually refuse Britain's credit card on international markets. That is the future unless we rebuild manufacturing.
The past 30 years have been disastrous for manufacturing. The Thatcher Government indulged in an orgy of destruction of manufacturing, particularly of our basic industries. Steel and coal are the classic examples. It was called "creative destruction", but it did not create, and only destroyed.
Chris Ruane (Vale of Clwyd) (Lab): I agree with my hon. Friend entirely. Does he agree that Wales was one of the places most affected by the closure programmes for steel and coal? Particularly disturbing was the fact that the Thatcher Government did not apply for European objective 1 funding for Wales, but let it wither on the vine.
Mr. Mitchell: Again, I agree. It was an orgy of destruction. It was not only Wales that was affected badly, but all the manufacturing areas of the country, including my area of Yorkshire and Humberside.
Instead of conserving the oil and investing its proceeds for the future like the Norwegians, Mrs. Thatcher used it as a cushion for an orgy of destruction of manufacturing. Unfortunately, that destruction continued under my Government-I say "my" in a proprietorial sense because clearly I strongly support them. Manufacturing continued to decline, and our concern has been the war against inflation, which is fought with a high exchange rate, which makes it cheap for overseas exporters to compete in the British market. Such an approach forces industry to cut costs and labour forces, in a kind of snowballing anaemia downhill. The figures show that manufacturing declined from 27 per cent. of gross domestic product in 1977, when the previous Labour Government were in power, to 20 per cent. in 1997 and about 11 per cent. in today's recession.
Employment has similarly declined. There were 6.9 million people employed in manufacturing in 1978, and there are now 2.8 million, which is only 10 per cent. of total employment. Greater de-industrialisation has taken place here than in any other country. In all countries, manufacturing will shrink comparatively as it becomes more productive, but not in the absolute way that it has here. I said that manufacturing makes up 11 per cent. of our GDP. In Germany and Japan, that figure is 20 per cent., because they have conserved, invested, rebuilt and reconstructed their manufacturing sectors. We have not done that; we have destroyed manufacturing, which is disastrous.
We must rebuild manufacturing because, first, it is the main-indeed, I would say the only-source of productivity gains; secondly, we cannot close the gap in the balance of payments unless we do so; thirdly, doing so will mean that manufacturing is the main source of
jobs, which are now at a premium in our economy; and fourthly, it will spread employment and activity around the country instead of focusing everything on London, which is a centre of wealth and speculation that is under the rule of the City and the financial sector.
Kelvin Hopkins (Luton, North) (Lab): My hon. Friend contrasted Germany with Britain. In many ways, those countries should be rather similar but, in fact, Germany has a massive trade surplus in manufacturing and we have a massive trade deficit. Germany is doing something that we are not.
Mr. Mitchell: Germany is an example that we should follow. The way Germany has restructured and invested in its industry is an example to us all but, after successful adjustment, it is now strangled by the fact that the euro is too high. Until the introduction of the euro, Germany was concerned about keeping the deutschmark competitive-indeed, throughout the '60s and '70s, it resisted American pressure to up-value the deutschmark. I am curious that Germany has accepted that valuation with the euro because of concerns about inflation. That has been damaging for Germany's development, but it has also provided an opportunity for us.
John Mason (Glasgow, East) (SNP): On the question of exchange rates, the hon. Gentleman has welcomed the fact that the pound is lower at the moment. However, does he accept that that is a double-edged sword, because one of the signs of a weak economy is a low exchange rate? For most of my life, Italy was in poor shape and the lira was worth nothing. In Zimbabwe, a low exchange rate is a sign of that country's problems. Is it simply a great thing that we have such a low exchange rate?
Mr. Mitchell: I do not accept that. Zimbabwe is not an industrial economy. The exchange rate is crucial to manufacturing. It is interesting to note that all expanding countries-from Germany's rebuilding after the war right through to China today-have started with a low exchange rate that they have kept low and competitive to encourage export. That has meant such countries built up a big exporting sector in which economies of scale began to operate and that they entered a virtuous cycle of investment and increasing productivity. An enormous industrial strength was therefore built up on the back of a competitive exchange rate. A low exchange rate is crucial to manufacturing, rather than to the City, which wants a high and over-valued exchange rate to manipulate money around the world and buy assets overseas. Manufacturing needs a low and competitive exchange rate.
We have not done the same as other industrial countries, which have increased productivity. However, we have had occasional illustrations of what is achievable when devaluations have taken place in this country. For example, in 1949, 1967, 1971-under the Heath Government-and in 1992, when the big devaluation meant we left the exchange rate mechanism, there was a boost to manufacturing, growth and productivity on every occasion, and the economy was revived, which shows the importance of having a competitive exchange rate.
Mr. Mitchell: In 1967, it was the stringency of Roy Jenkins's budget, which has in a sense been paralleled today, that was responsible for the ejection of Labour from office in 1970. That happened because of the measures to tighten and toughen up the economy, rather than because of devaluation, which opened the way to greater prosperity and economic growth. We benefited from that devaluation.
Mr. Hoyle: My hon. Friend almost answered the question. Would it also be fair to consider how many people had real jobs then compared with now? This country was exporting all over the world at that time, which was the benefit. We built the economy on manufacturing at that time
Mr. Andrew Smith (Oxford, East) (Lab): Of course I agree that it is important to have the flexibility to have the right exchange rate. However, does my hon. Friend agree that, in a global economy where so many things are sourced from other countries, the competitive advantage that devaluation gives is offset by the higher costs of inputs? There cannot be a race to the bottom-cutting the exchange rate as a way of boosting manufacturing. The need for financial structures and the ability of firms to take a long-term view is one of the most important lessons we can take from Germany, not least in relation to the success of BMW in my constituency.
Mr. Mitchell: I am afraid that I do not agree with my right hon. Friend, because the question is about value added in this economy-what we add in value to what we import. That is the crucial test, and that is where we have been failing. The exchange rate translates our costs into a price on foreign markets. We have had a 25 per cent. devaluation-30 per cent. against the euro-and the opportunity we have now is to reduce our cost base. That is important because most manufacturing investment, particularly in low-technology manufacturing, can be made just anywhere. Such investment goes where the cost base is lowest, and it has not come to this country because the overvaluation of sterling has meant that our cost base has been high. It has simply not been profitable to invest in this country-it has not been possible to turn a profit on investments here-but devaluation gives us the opportunity to get round that.
The exchange rate is not a phallic symbol that we can be proud of when it is hard and be filled with post-imperial triste when it softens. It is essentially a market clearing mechanism, and a competitive exchange rate is one that clears markets in conditions of high employment and growth. That is what we need in this country.
Mr. Smith: I do not disagree with my hon. Friend. Of course, his comments on flexibility, market clearing and all that are correct. However, I invite him to accept that there are downsides to the depreciation of a currency. First, it makes inputs more expensive if they are imported from elsewhere. Secondly, it cuts the living standards of British workers-that is one way such an approach leads to competitiveness, and we do not advocate that.
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