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The Secretary of State mentioned health targets. If any of my constituents go to their local district general hospital because they want a new knee or hip, the wait is measured in weeks-perhaps 18 weeks, or a lot less in South Yorkshire at the moment depending on where they go. Not long ago, the wait was 18 months or more and the consultant in the hospital concerned-the same surgeon who would have done the operation on the NHS-would say to patients, "If you want to have a new knee, I can do it next week at a private hospital in Sheffield if you've got £3,500 lying around that you want to get rid of, or you can wait 18 months or two years with a poor quality of life because of the pain." Targets have been set to help all our constituents with
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their health needs, and we should ensure that if they are removed it is not to the detriment of the massive improvements that have been made in health care over the past 10 years.

Right up until the general election, the Conservative party was considering putting in place what was effectively private insurance cover for social care. The Health Committee published a report on adult social care and particularly care for the elderly. The idea expressed by the Conservatives only a few months ago was that people in my constituency who retired could find £8,000-or £16,000 for a couple-to pay into a scheme so that they would have their care needs met in future years, which is an unbelievable concept. The Health Committee did not exactly praise the previous Government, as my right hon. Friend the Member for Leigh (Andy Burnham) will remember. However, in the report on adult social care, we said that there needed to be a consensus about the way forward and how the system should be paid for so that it was fairer than the current system. I am pleased that the new coalition has said that it wants to set up a commission to achieve that, but it should not wait longer to deal with the matter than it has to. Let us get the matter sorted out in this Parliament and get some fairness into the system as soon as practicable, when the commission has met and reported. Without consensus across the House, the unfairness and inequity in social care in this country will carry on for ever and a day.

The National Institute for Health and Clinical Excellence has today made a recommendation on the minimum pricing of alcohol. I believe that the recommendation stands up well, and indeed, the Health Committee felt in most part that minimum pricing was the best way to deal with the alcohol problem. The recommendation has been made by an independent institution that has examined the effect that such a policy would have on alcohol consumption. It disagrees with what the alcohol industry has been saying in and around this place for many years-that minimum pricing will not stop binge drinking. I ask people, and especially Ministers, to read the NICE report. I am convinced, as were most members of the Health Committee in the previous Parliament, that the minimum pricing of a unit of alcohol is crucial if we are to take control of alcohol consumption in this country. There are other means of doing so, and people have argued that for some time.

The previous Government introduced regulations in April to stop the practice of students being invited into nightclubs where, for £10, they could drink all night. The Channel 4 News website says today:

People will always try to get round any new rules, but the market cannot get round price. It worked to reduce consumption of cigarettes, and we have a far healthier population as a result. This Government will need income at some stage, and a minimum price for a unit of alcohol is the way forward if we are to stop alcohol abuse. More than 1.3 million children suffer because of alcohol abuse, and we cannot carry on thinking that education will make any difference. We have tried that, but we have failed. We have failed the nation, especially those children, and action needs to be taken by this Government to ensure that we price alcohol sensibly to bring some common sense back to consumption.


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6.1 pm

Mark Lancaster (Milton Keynes North) (Con): It is a pleasure to be able to contribute to this debate. I am certainly seeing the benefits of the election, as I think that this is the first time that I have been called to speak before 9 pm in the five years that I have been here. It is also a pleasure to follow the right hon. Member for Rother Valley (Mr Barron), who was an excellent Chair of the Health Committee in the last Parliament. I regard him as a friend and he did a sterling job.

I wish to thank my right hon. Friend the Secretary of State for Health for coming to visit Milton Keynes hospital yesterday. I said during my election campaign that I would make health my priority and, in the past two years, we have had some particular problems in Milton Keynes at the maternity unit. It was very reassuring to have my right hon. Friend visit yesterday and to see that the hospital, which is desperately trying to do the right things to put matters right, will have the full support of the Department of Health in trying to deliver the positive change that we all want to see.

I shall address three issues-the funding formula, targets and waste. NHS funds are allocated to primary care trusts on the basis of a complex weighted capitation formula. The allocation is based mainly on the number and age distribution of a PCT's population and then adjusted for a large variety of other factors, including the type of population; deprivation; mortality rates; and, controversially, the difference between previous allocation and formula results.

The formula leads to a marked difference in per capita allocation by PCT across the country. For example, in the current year the PCT with the lowest funding was Leicestershire with £1,330 per head, and the highest was Liverpool with £2,140 per head. This year, Milton Keynes PCT received £1,410 per head, the 12th lowest in the country. In other words, if Milton Keynes, with a crude population of approximately 240,000, had received average national capitation, it would have an extra £51 million more than the £349 million it actually received, and had it been funded at the average rate of a northern PCT, it would have received £74 million pounds more. Just to underline this point at a regional level, South Central strategic health authority received £5.8 billion for its 4.1 million people. Had it received a typical northern per capita allocation, it would have received an extra £1.2 billion.

Given those numbers, perhaps it is not surprising that the NHS in the south of England struggles to make ends meet.

Caroline Flint (Don Valley) (Lab): What are deprivation levels like in the hon. Gentleman's constituency? How much longer do people in his constituency live compared with men in Doncaster, Liverpool, Newcastle and other northern areas? We recognise that there are health inequalities and we have to fund the necessary measures to ensure equality in living as long as possible.

Mark Lancaster: The right hon. Lady makes a valid point. The whole point is that we have the health formula to take those factors into account, but despite that the last Government artificially adjusted the funding to upgrade certain PCTs. If she listens to my speech, she will understand what I am trying to say.


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Northern SHAs have surpluses approximately three times the size of South Central. Yorkshire and Humberside enjoys a surplus of £49 per head. However, putting the inequality of this to one side, it means that the weaknesses of the current NHS structures are likely to appear first in the south rather than in the north of England. But given that the allocation formula attempts to fund broadly according to need, why have the funding formula at all if we are going to ignore it? The answer, in part, appears to lie in an extract from the Health Committee's report, "Health Inequalities", published in March 2009. Paragraph 96 says that

The development of the weighted capitation formula is continuously overseen by the independent Advisory Committee on Resource Allocation, or ACRA. Given the inequalities in funding that currently exist, I would like to suggest some minor changes of my own. First, the allocation formula should adequately address the costs of providing health care to the elderly, especially in areas with high life expectancy. Secondly, the allocation formula should adequately reflect the fact that the majority of an individual's lifetime costs of health care are incurred in the last two years of life, whatever the age of death, and-crucially-regardless of the local level of deprivation. Finally, the key area in which the formula could be improved-I make no apologies for the fact that as a very diverse community Milton Keynes would benefit from this change-is by basing allocations on individuals' health, rather than the blunt tool of populations being aggregated at the PCT level. However, I accept that the principal problem with that is getting sufficient data.

Process targets sometimes yield perverse incentives when coupled with the inappropriately named "payments by results" scheme, which actually seems to reward activity rather than results. I shall give just two brief examples. The first is the four-hour waiting time in accident and emergency. Say that after three hours 55 minutes a patient is waiting for a blood test result. The hospital will take them in as an in-patient-perhaps only for 10 minutes until the result arrives-so that it does not miss the target. That means that rather than being charged £70 for out-patient treatment, the PCT will be charged £700 for in-patient treatment. Is that really the best use of scarce financial resources?

Hospitals have no incentive to discharge people from out-patients as they are paid for activity. Indeed, in Milton Keynes, less than half of first out-patient appointments are the result of GP referrals. For example, lots of patients attending accident and emergency or the assessment unit will be given a hospital-initiated out-patient appointment rather than being discharged back to their GP. If a hospital can see a patient several times, generating a bill on each occasion, where is the incentive to organise care so that everything can be done at one visit if it can then only bill for that care once? I support limited targets, providing that they are
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based on clinical need and are not process driven-and do not lead, like the examples that I have just given, to scarce financial resources being squandered.

It is widely recognised that the NHS, in common with health care systems in every developed country, wastes possibly 20% or more of its resources on overuse, misuse and underuse of health care. Many feel that the current configuration of hospitals and community services in England does not readily allow clinicians to offer the highest quality of care at lowest unit costs.

There is an argument that the rigid demarcation between primary and secondary services and the role of the district general hospital needs to be allowed to evolve to meet the needs of the 21st century. That is particularly true where administrative boundaries and top-down planning have stifled local developments. For example, the Milton Keynes and south midlands growth area has a rapidly growing population. The growth area straddles three strategic health authorities and government regions. It has a population of nearly 2 million, but is served by several small hospitals close together, each of which is struggling both financially and to provide the quality and range of services that the population needs and expects. The challenge in and around Milton Keynes is to allow local communities and hospitals to think beyond and across artificial bureaucratic boundaries to find new ways of improving value for money and quality of care.

Taken together, if health services were held to account for the outcomes that they produce, rather than the numbers of patients treated, the services of the future, and particularly hospitals, might need to look very different from those of today. However, if we allow changes to be led by clinicians in consultation with the public-a bottom-up approach rather than the top-down approach advocated by the last Government-we can be confident that, most importantly, the services will be of a higher quality. I believe that the measures outlined in the Gracious Speech are a step in the right direction, and that we can achieve those aims.

In the final 20 seconds left to me, I simply want to wish all those about to give their maiden speeches the best of luck.

6.11 pm

Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op): It is a great pleasure to speak about a matter of vital importance to my constituents young and old. A focus on education matters a great deal in Hackney, where we have a multinational community and education is highly prized. Hackney is a poor borough in many ways, but it is also aspirant, and there is no lack of poverty in the desire to get educated and improve one's life. Education and skills training more widely, which I would like to touch on, are important to my constituents. They also help to tackle poverty and social exclusion.

Hackney's record is a good one. We have four brand-new city academies, with a further city academy on the way, and we have seen massive improvements to other secondary and primary schools. Hackney's record on educational attainment at 16 has massively improved. The results improved from 30% of pupils achieving five GCSEs at grades A* to C in 1997 to 70% doing so in 2009. In particular, we should thank Mossbourne city academy and its head teacher, Sir Michael Wilshaw, for last year
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having 83% of students achieving five GCSEs at A* to C, which is well above the national average, and this in a borough that in the past would not have been a byword for good education. There is still more to do, of course. Bridge, Petchey and City academies in Hackney, which are yet to have GCSE years, are all working to emulate the Mossbourne example. It would also be interesting to discuss with Ministers the establishment of a 14-to-18 academy in Hackney community college.

There is more to do. Around 48% of 16-year-olds still leave school without five GCSEs at A* to C. It is not the only measure of success, but it is an important one in any attempt to get young people into work and further education. We also need further improvement in our primary schools. Some good work has been done in the 12 new Sure Start centres in the constituency, which are of huge benefit to parents and under-fives across all social backgrounds. I am concerned at the suggestion that this Government plan to segregate support for the under-fives and focus only on those in greatest need. One of the strengths of Sure Start in Hackney is its comprehensive nature. I have a one-year-old, as well as other children, and I know that all parents, whatever their backgrounds, need the support.

Hackney's approach has been pivotal to how things have worked. We have an elected mayor and a council in Hackney, which have taken a can-do approach to what the Government have to offer. Hackney's focus across the board has been on practical results that change lives. We are not bound up in ideology; we want to ensure that what we do makes a difference. Mayor Pipe should be congratulated on his work, as should others on their work. We have taken what the Government have offered and made it work for Hackney, tailoring it to Hackney's needs and interests. Whatever the Government propose, we will continue to put Hackney children first in our schools system.

I am concerned about the free school proposal-I would love to talk more about it, but I do not have much time. How will it fit in with proper planning in local authorities? Is it not a distraction? Is not the proposal a policy for the few and not the many?

I want to touch briefly on extended schools. Schools in Hackney are leading the way in that respect, with provision usually provided from 8 am to 6 pm, and in secondary schools for far longer, with breakfast clubs, after-school clubs and, often, ESOL-type teaching-the teaching of English for speakers of other languages-for adults, as well as wider adult education. Such initiatives help to tackle poverty and social exclusion where it really matters: in the family, helping those parents to help their children get better educated. In many communities, the young children coming to school at both primary and secondary levels often go home to a household not only where no English is spoken-it is fine for them to have that mother tongue-but where the parents themselves are not very literate in their mother tongue. Addressing that is an important aspect of what primary schools in Hackney provide.

At the secondary level, we want to give young people the opportunities provided by extended schools well into the evening and before school. Those clubs are supported not only by schools, but by organisations such as the excellent Magic Breakfast, which provides young children with breakfast in schools. It was discovered that in Hackney, as well as in other boroughs, many
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young people turn up to school without food in their stomachs because of their chaotic family backgrounds. That meant that they were achieving less well. Thanks to Magic Breakfast and others, we have seen attainment increase.

I want to know that the Government are still committed to extended schools, because they are vital to working parents. If we want child poverty to be tackled and attainment increased, we need to see that input in the family-those role models in place and that income coming in-which is something that any Secretary of State for Education needs to see in the round, and as something that goes hand in hand with welfare support. It is all very well asking people to go back to work, but without the child care in place, that is challenging, and in Hackney that matters a great deal.

In the time remaining I want to talk about skills and training. I do not have the time to go into all the figures, but Hackney has one of the highest unemployment rates in London. However, we are fortunate to have a good further and adult education sector, in the form of Hackney community college, BSix and the sixth forms emerging in new schools for 18-year-olds. In particular, Hackney community college, organisations such as Working Links and Lifeline, and the jobcentre provide support to workless adults, focusing on the skills and education that they need to get off the dole and into work, supporting themselves and their families.

With 34% of Hackney households speaking English as a second language and 16% of adults in Hackney having no qualifications, which is above the London average, we need to ensure that this issue is tackled. Significantly, however, the figure for adults with no qualifications has gone down, from 25% to 16% in just three years, thanks to work by the community college and others. Significantly-this is directly linked to the work of Hackney community college, which should be congratulated-the number of young people not in education or training is down, from more than 12% to 6.4%, again in three years. That is evidence to back the argument that the college should be supported in being allowed to become a city academy in media and health, within the environs of the wider adult education that it provides.

Hackney community college is soon to receive an Ofsted report, which I do not doubt will be good. Because of its excellent reputation and work, the college deserves to have the freedom to decide how the money that it receives from the Government is spent, because what works in Surrey Heath might not work in Hackney. We need that flexibility between Government budgets to allow local priority setting, in order to ensure that ESOL, basic skills, work with 16 to 18-year-olds, as well as those who are 19-plus, Train to Gain and apprenticeships are judged by their results, rather than by the name attached to the money that is given to them. If the Government are serious about giving freedom to education providers, I hope that they will consider giving freedom to further education colleges to make their own choices about what works locally and be judged by the results, rather than the tick-box approach based on where the money comes from. I hope that the Government will consider meeting me and the principal of Hackney community college, Ian Ashman, to discuss that freedom, as well as setting up a city academy within the environs of the community college.


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6.18 pm

Robert Halfon (Harlow) (Con): Given that it has taken me 10 years and three elections to reach this place, I feel a real privilege and a sense of service in giving my maiden speech. Although I am the first Halfon to serve as a Member of Parliament, I am not the first to have a role in British politics. I understand that my ancestor Isaac Halfon, who was an expert on divorce legalities, was called on by King Henry VIII to discover the status of Judaic law regarding the King's proposed divorce from Catherine of Aragon. Fortunately for me, I am told that he gave the right answer. I am reminded of the quotation of the civil war poet, Robert Herrick, who said:


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