6.39 pm

Karen Lumley (Redditch) (Con): I want to highlight some of the issues that people in Worcestershire are facing. Like many parts of the country, we are facing a joint services review of our acute trust.

For those who do not know Worcestershire, it has three hospitals, including a private finance initiative hospital, which is costing 5% of the total health spend in the county. The PFI deal was made under the Labour Government, who have admitted that there is a case for saying that they were poor at negotiating PFI contracts from the outset. In Worcestershire, not only were they poor at negotiating the contract; they also put the hospital in the wrong place. Our PFI hospital is in the south of the county, which is all very well for people who live there, but for the 200,000-plus people who live in the north of the county, it is extremely difficult to get to. For somebody who lives in Redditch, it is far easier to get to a hospital in Birmingham than to one in Worcester.

We are now undertaking yet another review. Once again, people in Redditch see that their hospital and their services, including A and E, maternity and children’s services, are under threat. I say once again because six years ago we were in the same position. I know that spending in our health economy has been increasing, but we in Worcestershire are paying for the overspends of the past few years and need to save money.

I put it on the record that the people of Redditch want to retain their A and E. As their Member of Parliament, I totally agree with them. We are in the early stages of the consultation, but I urge Ministers to look closely at this matter. The Secretary of State has visited the Alexandra hospital and seen for himself what a good hospital it is. Importantly, it was paid for and is owned by the NHS. I will be asking for a cross-party meeting in due course, which I hope my right hon. Friend will agree to, because the people of Redditch are once again working together. Apart from the Labour parliamentary candidate, people have put party politics aside to work together to save our A and E.

I know that many other Members want to speak in this debate. I just wanted to put the marker down that we in Redditch want our A and E and that I intend to fight for it.

6.41 pm

Frank Dobson (Holborn and St Pancras) (Lab): We all know that the massive top-down reorganisation of the national health service that the Government have pushed through had not a jot of public support, that no one voted for it and that it was not mentioned in the famous coalition agreement. Nevertheless, it was proceeded with.

We are now faced with something that was not in the election manifesto of either of the Government parties. Nor, I suspect, was it in any of the election literature of

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any of the MPs from those parties in the south-west. I do not think that any of them said, to use the phrase of the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns), “We admire you people in the health service so much that we have decided that you will have to pay more for your pension and work longer, and that your pension will be smaller.” I do not think that any of the Lib Dem or Tory candidates in the south-west put in their leaflets, “We admire you people in the national health service so much that we intend to reduce your pay.” None of them said, “We admire you so much that we are going to reduce your entitlement to leave.” None of them has said, at a time when there is rightly increasing concern about the standard of care in hospitals at the weekend, “We intend to reduce or get rid of your overtime pay at weekends.” I would not wish to be admired by a Health Minister, because something nasty would clearly appear shortly afterwards.

People in the national health service are sick to death of this massive reorganisation, of thousands of their colleagues being made redundant, of people having to reapply for their own jobs, and of being expected to do their day job while falling into line with the preposterous ideas in the major health legislation that went through this House. On top of that, they are now being told that they cannot be paid what they used to be paid. Apparently, people in the south-west say, “Pay down here tends to be lower, so let’s reduce the higher pay of people in the public sector, such as those in the hospitals, to the miserable levels that the private sector pays people here.” It is not likely that giving people even lower pay, which is always associated with poor health, will improve the public health of people in the south-west, which the hon. Member for Totnes (Dr Wollaston), who is herself a GP in the south-west, has talked about.

What the Government have done is disgraceful and is in clear breach of their manifesto commitments. They are now attacking people in the national health service. I laud and admire people who work in the national health service. There may be some bad ’uns—there are bad ’uns everywhere—but most of them work very hard and brilliantly on our behalf, none more so than those at University College hospital in my constituency and at the Kentish Town health centre, which I was happy to be at recently with Alan Bennett for the ceremony to celebrate 125 years of the Wigg practice, which serves people brilliantly. Believe me: when I talk to people at those two institutions, the main people who are denigrated are the Tory Ministers who have wished all this upon them. I join in that denigration.

6.45 pm

Stuart Andrew (Pudsey) (Con): I am extremely grateful for the opportunity to speak in this debate. The NHS is clearly important to all of us. I have seen it personally because I have had a number of operations and through my working life in the hospice movement, where I saw how the care that is provided is so important to the families we were looking after. Clearly, the dedication of the staff is great and I pay tribute to them.

Listening to the Opposition today, it is hard to take them seriously. We can see from their actions in Wales what they would do with the NHS if they were in power. They have cut the budget, resulting in an increase of 51% in the number of patients waiting to start treatment

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and an increase of 156% in the number of those waiting for more than 26 weeks. All the bad news from the Opposition is therefore difficult to swallow.

I will give a couple of examples from my area. I recently met some GPs and clinicians to talk about the work they are doing to redesign musculoskeletal services. They have brought in innovative ways of ensuring that the patient knows exactly what will happen to them. Clinicians across primary care, community services and secondary care are working together to ensure that the patient has a clear understanding of the care that they will receive. They use map displays, which show a clear pathway, offer educational content for GPs to ensure that patients get the highest standard of care, and ensure that information is available for the patient.

I am proud to say that on Friday, one of the surgeries in my constituency will open a new well-being centre, which will provide a place where health care, social care and the third sector can come together to provide better ways to improve health and well-being in the town.

Jim Shannon (Strangford) (DUP): Does the hon. Gentleman share the concerns of many Members, as I believe he does, over the closure of surgical units for children in the middle counties of England? If so, what is he doing to prevent it in his constituency?

Stuart Andrew: The hon. Gentleman pre-empts the next part of my speech and I am grateful to him for that.

As this is a health debate, I am sure that my right hon. Friend the Secretary of State would expect me to talk about the safe and sustainable review of children’s heart units. Like other Members, I have received a number of e-mails from various organisations today. One of them said that some MPs should seek to reignite the debate and that I should think about the children because if I had children, I would move heaven and earth to ensure that the service was the very best. Frankly, throughout the campaign on children’s heart units, I have only ever thought about the children. Of course I want the very best service for them, as do the right hon. and hon. Members from all parts of the House who have worked on the campaign. I have always accepted that there is a need for change. That is why I want to discuss a few related points this evening. I know that I will have an opportunity to raise it in greater detail tomorrow, but it is important that I speak about it tonight.

Access and travel times are incredibly important to the families who use children’s heart services. Logical health planning surely dictates that services should be based according to where the population lies. The British Congenital Cardiac Association states:

“Where possible, the location of units providing paediatric cardiac surgery should reflect the distribution of the population to minimise disruption and strain on families.”

Andrew Percy: That is exactly the point that Members who represent Yorkshire and northern Lincolnshire are concerned about. The proposals will mean that patients will have to travel, and expecting families in northern Lincolnshire to get to Newcastle is simply not acceptable.

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Stuart Andrew: I thank my hon. Friend, who brings me to my next point. Independent analysis of patient flows showed that the majority of people in the Doncaster, Leeds, Sheffield and Wakefield area would not go to Newcastle; they would probably choose centres in Liverpool, Birmingham or even London. The NHS constitution states that patients have the right to make choices about their NHS care, yet the joint committee of primary care trusts has asserted that Newcastle could reach the minimum number of procedures if parents were “properly managed”. That flies in the face of patient choice.

Furthermore, the review has ignored the views of the people. I do not think there has ever been a petition as large as the one from Yorkshire, with more than 600,000 people’s signatures, but it counted as only one representation in the meeting at which the decision was made. I will raise a number of issues tomorrow to do with the scoring process that was used in the review, but I believe that the change will provide a poorer quality of service for Yorkshire and Humber families. Clinical experts from the BCCA, the Bristol inquiry, the Paediatric Intensive Care Society and the Association of Cardiothoracic Anaesthetists say that paediatric services should all be under one roof. In Leeds, we have a dedicated children’s hospital with all the services under one roof, so it is ready-made.

I urge Ministers to look into the process of the review and see whether they believe it was properly run. Given the closeness of the scores for Leeds and Newcastle, and considering the outcry that has come from Yorkshire and the Humber, I hope that they will give both centres an opportunity, until April 2014, to demonstrate that they can comply with all the standards that the clinicians on the safe and sustainable steering group have recommended. If one or both centres fail to meet any of those standards, the decision should be reviewed.

This is a very important issue for my constituents. The number of letters that I and my colleagues from around Yorkshire and the Humber are receiving shows how strongly people feel about it, and I urge Ministers to listen to our concerns.

6.52 pm

Mr Virendra Sharma (Ealing, Southall) (Lab): Thank you for giving me the opportunity to speak in this important debate, Mr Speaker. I wish to bring to the House’s attention some of the realities on the ground.

NHS North West London is currently conducting a flawed consultation, which is cynically being held during the Olympics and the summer months, on proposals for the reconfiguration of acute hospital services. The proposals would mean the closure of four out of nine accident and emergency departments, including Ealing’s, and the effective closure of Ealing hospital, my local hospital. My right hon. Friend the shadow Secretary of State recently described those shocking proposals, accurately, as “butchery”, not reconfiguration.

The proposals are put forward as clinically led, but that is far from the truth. At a recent meeting convened to discuss them, consultants at Ealing hospital and GPs from right across the London borough of Ealing voted unanimously against the proposal to close Ealing hospital. Other clinicians from right across north-west London are also opposed to the changes, and the hon. Member for Ealing Central and Acton (Angie Bray), who has just left the Chamber, has rightly said that they are

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financially driven. I take this opportunity to congratulate and thank the staff at Ealing hospital, who are working hard to provide services to patients during this time of uncertainty.

The Nicholson challenge means that across the country, £20 billion of savings must be found in the NHS by 2014, and £1 billion of that is earmarked to come from north-west London. It is clear that this is a top-down restructuring of hospital services, driven totally by financial considerations. The proposals are being railroaded through by the remnants of the old PCTs before they are abolished next April and replaced with clinical commissioning groups. That is a top-down reorganisation of local hospitals by an unaccountable body that, after making these major decisions, will no longer exist. That flies in the face of what the Prime Minister said to me at Prime Minister’s questions—that such a decision should have the support of local doctors and patients. Local GPs and patients are overwhelmingly against the proposals, so they should be withdrawn immediately. The Prime Minister has also repeatedly told me that there are no plans to close Ealing hospital. Given that after his visit to Ealing he said that he liked what he saw, I expect him to join me, local doctors, patients and all political parties in opposing the plans.

The Secretary of State, too, is on record as saying that there were no plans to close Ealing hospital’s A and E, and as asking where all the people who use it would go. Approximately 100,000 people a year attend there, of whom 55,000 use the urgent care centre and 45,000 are treated in the full A and E department. Where will all those people go for treatment if Ealing’s A and E is closed? Other A and E departments that are not proposed for closure are already under pressure from their own population and would not be able to cope with the extra numbers. Services would suffer, and waiting times would become intolerable.

The preferred option being consulted on also includes the closure of the Central Middlesex, Hammersmith and Charing Cross A and Es. That would be reckless and dangerous, and would leave a large swathe of west London without adequate A and E cover. Three London boroughs—Ealing, Brent and Hammersmith—would be left without any A and E. What would happen if there were a major incident similar to the Southall rail crash in Ealing or elsewhere in west London, or, God forbid, an air crash or terrorist incident?

The plan is opposed by clinicians, patients, politicians of all parties and members of the public, and it should be scrapped immediately. I will support the motion this evening.

6.57 pm

Andrew George (St Ives) (LD): It is a pleasure to follow the hon. Member for Ealing, Southall (Mr Sharma), a fellow member of the Health Committee. He makes a strong case on behalf of his constituents, and one hopes that any reconfiguration will be evidence-based and, above all, based on clinical governance and clinical safety.

This is an important debate—indeed, we cannot debate the future of the NHS enough, because it concerns many Members and their constituents. It draws passion and a great deal of interest, because it affects everyone’s lives. I therefore congratulate the Opposition on giving us the opportunity to debate it this evening.

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I apologise to the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), for not having heard his speech. I had to attend an urgent meeting with a Minister to discuss the closure of a Remploy factory in my constituency. My hon. Friend the Member for Southport (John Pugh) gave me a précis of the Minister’s wise remarks as best he could—without, of course, being able to convey fully his panache and oratorical dexterity. I understand that the Minister made a number of important remarks about one issue that I want to discuss, as a Member representing west Cornwall and the Isles of Scilly, which, apart from being the centre of the world, are in the far south-west. That issue is pay and conditions for staff. As I understand it, he emphasised the point that no such independent review of pay, conditions and the salaries of staff in such an area can proceed without the full involvement and support of the unions, and their engagement in the final decisions.

Alison Seabeck (Plymouth, Moor View) (Lab): It is absolutely right that the trade unions should be involved, because this is an enormous issue, particularly for staff morale in the south-west. Does the hon. Gentleman not share my concern that thus far the consortium has shown no great desire to undertake that consultation in the south-west? That really has to change.

Andrew George: The hon. Lady makes an important point. Lezli Boswell, the chief executive of the Royal Cornwall Hospitals Trust, wrote to me on behalf of the consortium about concerns that have been raised, including by the unions, saying that once the national pay review has concluded under “Agenda for Change” it would then be appropriate, if it is at all appropriate, for any further local discussions to proceed. Without union involvement in the work of the consortium, I agree with the hon. Lady that the proposal is irrelevant and potentially disruptive and dangerous, given its impact on staff morale throughout the NHS in the south-west. My hon. Friends will be listening closely to this debate, and to the concerns that have been raised by many Members and, indeed, by staff across the south-west about the consequences for staff morale and the impact on NHS services. I certainly hope that the Secretary of State will address those issues when he concludes the debate.

A key issue is one that dare not speak its name—it affected staff morale under the previous Government as well—but it is the increasing pressure on front-line NHS staff. The staffing levels at the coal face have never been sufficient to provide a safe staff to patient ratio. Many people have been critical of nursing and care standards in the NHS, but they often overlook staffing ratios.

I have also expressed concerns about the out-of-hours service in Cornwall—I know that we will not have time to discuss that—and the Care Quality Commission will produce a report as a result of those concerns, which were also voiced by the hon. Member for Truro and Falmouth (Sarah Newton).

On pay for staff in the south-west, the chief executive of the Royal Cornwall Hospitals Trust said to me in a letter:

“In recent years NHS organisations have largely exhausted other avenues of potential cost-saving (including reducing reliance on bank or agency staff and implementing service improvement

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initiatives). Monitor…has also estimated that NHS organisations with a turnover of around £200m will need to produce savings of around £9m a year for each year until 2016/17 to remain in financial health.”

She goes on to say that the consortium, which consists of 20 organisations in the south-west,

“is looking at how pay costs may be reduced, whilst maintaining a transparent and fair system that is better able to reward high performance, incentivise the workforce and support the continued delivery of high quality healthcare.”

Does the Secretary of State agree with that, and how does he intend that that should proceed? How will he protect staff and staff morale, because the consequences will, I fear, derail national negotiations on “Agenda for Change” and drive down pay and morale, particularly in an area of very low wages? I hope that he is listening.

Barry Gardiner (Brent North) (Lab) rose

Alex Cunningham (Stockton North) (Lab) rose—

Mr Speaker: Order. The Front-Bench winding-up speeches will begin at 7.10 pm, so the two remaining colleagues can divide the time if they wish, but not if they do not. I call Mr Barry Gardiner.

7.4 pm

Barry Gardiner: Thank you, Sir. I shall try to respect your advice.

In November 2011, the following announcement appeared on the Central Middlesex hospital website:

“A and E at Central Middx Hospital is temporarily closing overnight between 7 pm and 8 am starting from Monday 14 November 2011.

The urgent care centre next to A and E will remain open 24 hrs a day 7 days a week to treat patients with minor injuries and illness.

We are making this temporary change to ensure we continue to provide a safe service to patients during the winter months.”

In those three paragraphs, we hear twice over that that overnight closure is temporary, which gave minimal comfort to my constituents in Brent who used the facility. The overnight closure is indeed temporary. On 2 July, a consultation entitled “Shaping a healthier future” was launched in north-west London, and residents can submit their views until 8 October this year. The consultation, promoted by a transitional body called NHS North West London, aims to centralise and rationalise hospital services in the area. Each proposal outlined in the consultation includes the closure of the A and E at Central Middlesex—not overnight provision, but the 24-hour facility—for good.

The motion speaks of

“the growing gap between Ministers’ statements and what is happening in the NHS”.

I may have trouble agreeing with that, because it depends on which Minister and which statements. The Minister of State, Department for Education, the hon. Member for Brent Central (Sarah Teather), received an e-mail from me today advising her that, if called to speak, I would quote her in this evening’s debate. I wanted to do so, because she made the following three statements. First:

“The Tories would be a disaster for the NHS, they plan a part privatised service”.

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The second quotation:

“These cuts will hit the poorest and most vulnerable hardest”.

The third quotation:

“The government must take urgent steps to safeguard our local NHS”.

Those three quotes date respectively from 2003, 2007 and 2007, when the hon. Lady was campaigning to keep open the accident and emergency centre at Central Middlesex hospital—campaigning for something which she, in her government, is now closing. No wonder her latest comment is:

“This flawed consultation, which does not allow residents to say that they want to save the A and E, is a kick in the teeth for all local people.”

I do not speak Parseltongue—I do not understand it—but I deplore the pretence of opposing a policy that you are pushing through in government. That is really disgraceful.

Mr Deputy Speaker (Mr Lindsay Hoyle): Mr Cunningham, you have until 7.10 pm before the Minister responds.

7.7 pm

Alex Cunningham (Stockton North) (Lab): Thank you, Mr Deputy Speaker.

Patients in my constituency of Stockton North are already feeling the pain from the Tories’ policies. The number of admitted patients who have waited longer than 18 weeks for an operation rose by a staggering 49% between May 2010 and November 2011, and I have no doubt that the figure is much higher now.

The North Tees and Hartlepool NHS Foundation Trust faces a drastic cut to its budget of £40 million over three years. Chief executive Alan Foster has said that that is the most difficult financial position that he has ever faced and has acknowledged that the cuts will undoubtedly lead to unpopular decisions to keep the trust afloat. The trust is trying very hard, and it has even resorted to car boot sales to try to balance the books. Some of those cuts could be achieved if the Government got behind the trust and did something to ensure that the two North Tees and Hartlepool university hospitals are replaced by one midway between the two communities.

My fear is that there will be no new hospital and the trust will be forced to close one of the existing hospitals if it is to have any chance at all of delivering £40 million cuts in the next few years. We could end up without any of the benefits of a new hospital, and the targets might still not be achievable. Such a cut would almost certainly cause irreparable damage to the trust’s ability to maintain the excellent range of high-quality services of which it is justly proud. It will undermine all the good work that has gone on in the trust over the past 10 years.

I know that the trust will keep patient safety, quality and performance at the top of its agenda as it goes through this difficult period, but it will not be easy to deliver services to the 350,000 people who depend on them, as they have in the past. The north-east already experiences far greater levels of poor health than the national average. It must be due to the heavy industries and resultant poor environment, as our region mined coal, built ships and made chemicals and steel. The budget cuts will only worsen this position.

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The last Labour Government worked hard to reduce the kind of health inequality faced in my constituency, where men can expect to live 14.8 years less in one part of the constituency than in another. Real progress was made to close the gap, but even so, it has proved painstakingly slow, as much work requires huge resources, which are now being denied. I feel the gap growing, even though I know that Stockton borough council has recently appointed a high-calibre person to head up public health. We will not be able to make the progress everyone wants if he and the NHS are starved of resources.

7.10 pm

Andrew Gwynne (Denton and Reddish) (Lab): We have had a good debate, albeit one slightly curtailed by statements. We have heard 10 speeches from Back-Bench Members and I would especially like to commend my right hon. Friends the Members for Greenwich and Woolwich (Mr Raynsford) and for Holborn and St Pancras (Frank Dobson) and my hon. Friends the Members for Easington (Grahame M. Morris), for Ealing, Southall (Mr Sharma), for Brent North (Barry Gardiner) and for Stockton North (Alex Cunningham) for their contributions. I also rightly want to pay tribute to the many thousands who work in our national health service, doing a tremendous job in often challenging and difficult circumstances.

As we have heard in the debate today, there are growing problems in the national health service. We know that two thirds of NHS acute trusts—65%—are reported to have fallen behind on their efficiency targets. As we have heard from right hon. and hon. Members, we are starting to see temporary ward and accident and emergency closures, while a quarter of walk-in centres are closing across England. Despite the “Through the Looking Glass” world of Ministers—one where the Secretary of State for Health closes a debate—we now have growing rationing across the national health service, with treatments—including cataracts, hip and knee replacements—being restricted or stopped altogether by one primary care trust or another.

John Pugh (Southport) (LD): Does the hon. Gentleman not acknowledge that the real weakness of this debate, as specified by the Select Committee Chairman, is that the Labour party has at no point spelled out how it would meet the £20 billion Nicholson challenge? Will he tell us?

Andrew Gwynne: We set out the Nicholson challenge, but I notice that the hon. Gentleman does not defend the decisions being taken by his Government to restrict or stop these treatments.

It is becoming increasingly clear that there is a gap between Ministers’ statements on the NHS and people’s real experience of it on the ground. In opening, the Minister of State, Department of Health, the right hon. Member for Chelmsford (Mr Burns) incorrectly said that GP referrals have gone down. Figures published by the Department of Health on 13 July 2012 show that GP referrals are up by 1.9% year on year. Those are statistics from the Minister’s own Department’s. He is out of touch. Furthermore, the Minister said that NHS Hull is not restricting procedures on ganglia, but a freedom of information request we received says:

“NHS Hull will not routinely commission excision of ganglia”.

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That was in April 2012, and it is a fact, again showing that Ministers are out of touch. The Secretary of State claimed that there is no such evidence of treatments being restricted or decommissioned.

Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): Will the hon. Gentleman give way?

Andrew Gwynne: I will not, as I do not have time now.

In the Secretary of State’s annual report to Parliament, he dismissed restrictions on bariatric surgery as “meaningless” and continued to say:

“Time and again, he says”—

that is my right hon. Friend the Member for Leigh (Andy Burnham)—

‘“Oh, they are rationing.’ They are not”.—[Official Report, 4 July 2012; Vol. 547, c. 923.]

But Opposition Members all know the truth. Aside from the evidence presented by the Labour party and the GP magazine, verified by Full Fact, primary care trusts acknowledge that they are restricting access to bariatric surgery. The National Institute for Health and Clinical Excellence recommends surgery for anyone with a body mass index of 40 or a BMI of 35 and co-morbidity. Many PCTs, including NHS Stockport in my own constituency of Denton and Reddish, impose additional restrictions.

Recent freedom of information requests of PCTs and shadow clinical commissioning groups across England have revealed that 149 separate treatments, previously provided for free by the NHS, have been either restricted or stopped altogether in the last two years, with 41 of those being entirely stopped in some parts of the country. This provides the clearest evidence yet of random rationing across the NHS and of an accelerating postcode lottery, which appears to be part of a co-ordinated drive to shrink the level of NHS free provision. From our study, it is clear that many patients are facing difficulties in accessing routine treatments that were previously readily available, and there is evidence that some patients are being forced to consider private services in areas where the NHS has entirely stopped providing the treatment.

Of course, there has been a real reduction in the number of nurses working in the NHS. The Government have claimed that there are only 450 fewer nurses, and at Health questions last month, the Minister, the right hon. Member for Chelmsford said that the figure was “nowhere near 4,000”. But now we all know the truth: figures for the NHS work force in March 2012 showed clearly that there are 3,904 fewer nurses than in May 2010. We have seen broken promise after broken promise, including on reconfigurations.

It was this Government who, when in opposition, spent millions of pounds during the general election putting up posters throughout the country reassuring the electorate that under the Conservatives there would be a moratorium on hospital and A and E closures. Indeed, in opposition, they pledged to overturn some very difficult reconfiguration decisions taken by the previous Labour Government. Yet, as we have seen, the moratorium has not materialised, and there is now evidence of major changes to hospital services across the country.

It is worth remembering that the Prime Minister gave a firm pledge not to close services at Chase Farm hospital, but in September 2011, this Secretary of

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State accepted the recommendations and approved the downgrading and closure of services at Chase Farm. And there are several others, such as the Hartlepool, the King George hospital in Ilford, the East London, the Trafford General, the North London, the St Cross in Rugby and, as we have heard today, the West London, too, that have either closed or are set to close. What is becoming clear is that when it comes to reconfiguration, Ministers are hiding behind their new localism and are happy to blame the soon-to-be-abolished structures for the forthcoming closures.

In the brief time remaining, I want to deal with Government spending on the health service. As we have learned, actual Government spending on the NHS in 2011-12 fell by £26 million.

Mr Graham Stuart: Will the hon. Gentleman give way?

Andrew Gwynne: No, I will not.

This was the second successive real-terms reduction in NHS spending, following a reduction of £766 million in the Government’s first year in office. This is in clear breach of the commitment given by the Conservatives and Liberal Democrats in their coalition agreement.

Of course, a long line of professionals have come, one after the other, to express their concern about the damage that will be done to the health service if hospital is pitted against hospital, and doctor against doctor. That is where we start. The Health and Social Care Act 2012 now allows hospitals completely to change character over time. The Government have essentially set everybody on their own. Hospitals are being told, “You’re on your own. There’s no support from the centre any more; no more bail-outs.”

We know that there are problems with the NHS meeting efficiency targets. Indeed, a survey of NHS chief executives and chairmen found that one in four believe that the current financial pressures are the

“worst they have ever experienced”,

with a further 46% saying they were “very serious”. More than half of foundation trusts missed their savings plan targets, according to Monitor’s review of the last financial year.

Ministers have said that every penny saved will be a penny reinvested to the benefit of patient care, but in reality £1.4 billion of the £1.7 billion not spent by the Department of Health has been returned to the Treasury—more broken promises. It is therefore clear for all to see that there is an increasing gap between what the Government are saying and what is going on in the NHS, and the experience of ordinary patients on the ground.

The Government have increasingly broken their promises on the NHS. They promised no top-down reorganisation and a moratorium on hospital closures and they promised to maintain spending levels in the NHS. They have broken all those promises—they are the three biggest broken promises in the history of the NHS. There is clearly a yawning gap between what the Prime Minister and others say and the reality of patients’ experience.

During the general election, the Prime Minister said:

“I’ll cut the deficit, not the NHS.”

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It is now clear that the Government are cutting our NHS. The NHS is important for the people of our country, and they deserve better. I commend the motion to the House.

7.20 pm

The Secretary of State for Health (Mr Andrew Lansley): I was rather disappointed by the speech of the hon. Member for Denton and Reddish (Andrew Gwynne). Like the motion, the hon. Gentleman failed to say anything about NHS staff, or to reflect the admiration and respect we have for them. The motion and his speech were just another occasion for Labour to use the NHS as a political football, fuelled by nothing but distortions, inaccuracies and myths.

I always welcome such debates, because they give hon. Members an opportunity to raise constituency issues. Many did—I will respond to the points they made—but the right hon. Member for Leigh (Andy Burnham), the shadow Secretary of State, did not. When the Conservative Opposition raised debates on the NHS before the election, as we often did, we had an alternative policy to express and arguments to put forward. Like the motion, his speech was empty of argument and of fact, and he and the Labour party are empty of policy.

The right hon. Gentleman told us only that he wants to abolish the Health and Social Care Act 2012. If that happened, there would be no clinical commissioning in the NHS. In fact, nobody would be responsible for commissioning. He would abolish local authorities’ responsibilities for public health in their area, which they are embracing and acting on. He would abolish health and wellbeing boards, which are integrating health and social care more effectively. He would abolish the duties in the legislation for NHS bodies to act to reduce health inequalities, which rose under a Labour Government.

Let me address some of the points—

Grahame M. Morris: Will the Secretary of State give way?

Mr Lansley: No. I will address the points made in hon. Members’ speeches, including the hon. Gentleman’s. He was the first Back-Bencher to speak in the debate. He talked about more support for radiotherapy. He must recognise that we committed to £150 million additional support for radiotherapy in the cancer outcomes strategy. That will be available. He mentioned CyberKnife, which is a brand name for stereotactic beam therapy. That form of therapy is available in the NHS and will continue to be available. He neglected to mention that I announced during the past few months new plans for the establishment of two major centres for proton beam therapy in this country, which will mean that patients no longer have to go abroad to access it.

Grahame M. Morris: Will the Secretary of State give way?

Mr Lansley: No.

My right hon. Friend the Member for Charnwood (Mr Dorrell) made an important point on the Nicholson challenge, which a number of Opposition Members mentioned. At least one or two of them had the good

16 July 2012 : Column 747

grace to recognise that David Nicholson’s proposals were set out in May 2009, under, and endorsed by, a Labour Government. Labour Members now want nothing to do with the consequences of meeting that financial challenge. They fail to recognise, as my right hon. Friend said, that the challenge was against the background of an expectation that a Labour Government would not increase the NHS budget, and that the challenge would have to be achieved within three years. The Conservative Government have increased the budget for the NHS. Over the course of this Parliament, it will go up by £12.5 billion, which represents a 1.8% increase in real terms. The right hon. Member for Leigh and his party were against that.

No Opposition Member recognised in the debate the simple fact that, in the first year of this Parliament, £4.3 billion of efficiency savings were achieved, and performance improved, across the NHS. That was not even in the time frame for the Nicholson challenge. We have now had one year of the challenge. The target was £5.9 billion of efficiency savings, and we achieved, across the NHS, £5.8 billion. Things are on track, which completely refutes the shadow Secretary of State’s argument that we cannot have reform and deliver on the financial challenge at the same time. Actually, we can do both, and in addition improve performance in the NHS.

The right hon. Member for Greenwich and Woolwich (Mr Raynsford) completely contradicted the hon. Member for Eltham (Clive Efford) on the South London Healthcare NHS trust. The latter said he was against changes at Queen Mary’s, Sidcup, but the former said that I did not get on with the changes soon enough. The hon. Member for Denton and Reddish complains from the Opposition Front Bench that I did not have a moratorium, but the right hon. Member for Greenwich and Woolwich complains because I did have one.

Let me be clear about this: I did introduce a moratorium, and the four tests. Reconfigurations that meet the four tests should go ahead, because they will improve clinical outcomes for patients, meet the needs of the people of that area, deliver on the intentions of local commissioners, and be in line with the views of the local public. If they meet the four tests, they should go ahead; if they do not, as my hon. Friend the Member for Redditch (Karen Lumley) made clear in respect of Worcestershire, they should not go ahead. That much is clear.

My hon. Friend the Member for Pudsey (Stuart Andrew) made good points on how clinical commissioning is bringing improvements in musculoskeletal services. He also rightly made it clear, as the right hon. Member for Leigh did not, that Wales does not meet anything like the same standards as England and is cutting its NHS budget by 8.4%. We are increasing resources for the NHS in England and improving it. It is expected that, by the end of this Parliament, expenditure per head for the NHS in Wales will be below that of England. That is what we get from a Labour Government.

Let me reiterate to the hon. Member for Ealing, Southall (Mr Sharma) and my hon. Friend the Member for Ealing Central and Acton (Angie Bray) a point I made a moment ago. The hon. Member for Ealing, Southall should admit that the plans being looked at in north-west London are entirely the same ones considered under a Labour Government before the election. I will insist that the plans are subjected to the four tests I have described. If they meet those four tests, they can go

16 July 2012 : Column 748

ahead; if not, they will not. I advise him to continue making speeches in the House, but also to ask the general practitioners and clinical commissioners in Ealing what they think is in the best interests of their patients—his constituents. That is a good basis to start with.

My hon. Friend the Member for St Ives (Andrew George), the right hon. Member for Holborn and St Pancras (Frank Dobson), and a number of other hon. Members, asked about the south-west pay consortium. When I went to the NHS pay review body just a couple of months or so ago, I made it very clear that the Government believe we should do everything we can to support NHS employers to have the flexibilities in the pay framework that are necessary for them to recruit, retain and motivate staff.

Frank Dobson: Meaning: pay staff less in the south-west.

Mr Lansley: The right hon. Gentleman should not interrupt from a sedentary position. I am answering the question. Members are interested in this. When I went to the pay review body, I made it clear that, in my view, we could achieve that through negotiations on the “Agenda for Change”. That continues to be my view, and the south-west pay consortium makes it clear in its documentation that it supports such a negotiation. It is right to pursue such a negotiation nationally and for local pay flexibilities to be used in the national pay framework. That is what most NHS employers do, with the exception of Southend.

I have made it clear, as the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns) has, that we are not proposing any reductions in pay as a consequence. I do not believe they are necessary or desirable in achieving the efficiency challenge.

Andy Burnham: I have a simple question for the Secretary of State. Is he therefore overruling the south-west consortium?

Mr Lansley: No, because the south-west consortium has made no such proposal. Its document is clear: it wants the “Agenda for Change” national pay framework to give it the necessary flexibilities. My view is that we should do that, and I hope that the Opposition, along with the trade unions and the staff side, will support it. As a consequence, no proposal for the reduction of pay or the dismissal and re-engagement of staff is, in my view, desirable or necessary. Indeed, when I went to the pay review body, I made the point that I did not believe reduction of pay in the NHS to be necessary.

Let me conclude. There was a lot that those of us in the Chamber did not hear from Opposition Members. Much of it was in the annual report that I published just two weeks ago—waiting times below what they were at the time of the last election; the number of people waiting beyond 18 weeks cut by 50,000; the number waiting beyond a year reduced by nearly two thirds; infection rates in hospitals at their lowest ever level; cancer waiting times met; ambulance trusts all meeting the category A8 standard; 95.8% of patients seen, treated and discharged from A and E within four hours; 92% of in-patients and 95% of out-patients saying that their care was good, very good or excellent; and patients across the NHS saying that they support the NHS and believe the care they received to have been excellent. On

16 July 2012 : Column 749

that basis, the House should reject the motion as unfair in its characterisation of the NHS and wrong in its denigration of the NHS.

Question put.

The House divided:

Ayes 228, Noes 303.

Division No. 54]

[7.30 pm


Abbott, Ms Diane

Abrahams, Debbie

Ainsworth, rh Mr Bob

Alexander, rh Mr Douglas

Alexander, Heidi

Ali, Rushanara

Anderson, Mr David

Ashworth, Jonathan

Bailey, Mr Adrian

Bain, Mr William

Balls, rh Ed

Barron, rh Mr Kevin

Bayley, Hugh

Beckett, rh Margaret

Bell, Sir Stuart

Benn, rh Hilary

Benton, Mr Joe

Betts, Mr Clive

Blackman-Woods, Roberta

Blears, rh Hazel

Blomfield, Paul

Blunkett, rh Mr David

Bradshaw, rh Mr Ben

Brennan, Kevin

Brown, rh Mr Nicholas

Brown, Mr Russell

Bryant, Chris

Buck, Ms Karen

Burden, Richard

Burnham, rh Andy

Byrne, rh Mr Liam

Campbell, Mr Alan

Campbell, Mr Ronnie

Caton, Martin

Chapman, Jenny

Clark, Katy

Clarke, rh Mr Tom

Clwyd, rh Ann

Coaker, Vernon

Coffey, Ann

Connarty, Michael

Cooper, Rosie

Cooper, rh Yvette

Corbyn, Jeremy

Crausby, Mr David

Creagh, Mary

Creasy, Stella

Cruddas, Jon

Cryer, John

Cunningham, Alex

Cunningham, Mr Jim

Cunningham, Sir Tony

Curran, Margaret

Danczuk, Simon

Darling, rh Mr Alistair

David, Wayne

Davidson, Mr Ian

Davies, Geraint

Denham, rh Mr John

Dobbin, Jim

Dobson, rh Frank

Docherty, Thomas

Donohoe, Mr Brian H.

Doran, Mr Frank

Dowd, Jim

Doyle, Gemma

Dromey, Jack

Durkan, Mark

Eagle, Maria

Edwards, Jonathan

Efford, Clive

Elliott, Julie

Ellman, Mrs Louise

Esterson, Bill

Evans, Chris

Farrelly, Paul

Fitzpatrick, Jim

Flello, Robert

Flint, rh Caroline

Flynn, Paul

Fovargue, Yvonne

Gapes, Mike

Gardiner, Barry

Gilmore, Sheila

Glass, Pat

Glindon, Mrs Mary

Godsiff, Mr Roger

Goggins, rh Paul

Goodman, Helen

Greatrex, Tom

Green, Kate

Greenwood, Lilian

Griffith, Nia

Gwynne, Andrew

Hamilton, Mr David

Hamilton, Fabian

Harman, rh Ms Harriet

Harris, Mr Tom

Healey, rh John

Hendrick, Mark

Hepburn, Mr Stephen

Heyes, David

Hillier, Meg

Hilling, Julie

Hodge, rh Margaret

Hodgson, Mrs Sharon

Hoey, Kate

Hopkins, Kelvin

Howarth, rh Mr George

Hunt, Tristram

Irranca-Davies, Huw

Jackson, Glenda

Jamieson, Cathy

Jarvis, Dan

Johnson, rh Alan

Johnson, Diana

Jones, Graham

Jones, Helen

Jones, Mr Kevan

Jones, Susan Elan

Joyce, Eric

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Lammy, rh Mr David

Lavery, Ian

Leslie, Chris

Lewis, Mr Ivan

Lloyd, Tony

Llwyd, rh Mr Elfyn

Love, Mr Andrew

MacShane, rh Mr Denis

Mactaggart, Fiona

Mahmood, Mr Khalid

Mahmood, Shabana

Malhotra, Seema

Mann, John

Marsden, Mr Gordon

McCann, Mr Michael

McCarthy, Kerry

McClymont, Gregg

McCrea, Dr William

McDonagh, Siobhain

McDonnell, John

McFadden, rh Mr Pat

McGovern, Alison

McGovern, Jim

McGuire, rh Mrs Anne

McKechin, Ann

McKenzie, Mr Iain

McKinnell, Catherine

Meacher, rh Mr Michael

Meale, Sir Alan

Mearns, Ian

Michael, rh Alun

Miliband, rh David

Miller, Andrew

Moon, Mrs Madeleine

Morden, Jessica

Morrice, Graeme


Morris, Grahame M.


Mudie, Mr George

Munn, Meg

Murphy, rh Paul

Murray, Ian

Nandy, Lisa

Nash, Pamela

O'Donnell, Fiona

Onwurah, Chi

Osborne, Sandra

Owen, Albert

Pearce, Teresa

Perkins, Toby

Phillipson, Bridget

Pound, Stephen

Qureshi, Yasmin

Raynsford, rh Mr Nick

Reed, Mr Jamie

Reeves, Rachel

Reynolds, Emma

Reynolds, Jonathan

Riordan, Mrs Linda

Ritchie, Ms Margaret

Robertson, John

Robinson, Mr Geoffrey

Rotheram, Steve

Roy, Mr Frank

Roy, Lindsay

Ruane, Chris

Ruddock, rh Dame Joan

Sarwar, Anas

Seabeck, Alison

Shannon, Jim

Sharma, Mr Virendra

Sheerman, Mr Barry

Sheridan, Jim

Shuker, Gavin

Skinner, Mr Dennis

Slaughter, Mr Andy

Smith, Angela

Smith, Nick

Smith, Owen

Spellar, rh Mr John

Stringer, Graham

Sutcliffe, Mr Gerry

Tami, Mark

Thomas, Mr Gareth

Thornberry, Emily

Timms, rh Stephen

Trickett, Jon

Turner, Karl

Twigg, Derek

Umunna, Mr Chuka

Vaz, rh Keith

Vaz, Valerie

Walley, Joan

Watson, Mr Tom

Watts, Mr Dave

Whitehead, Dr Alan

Williams, Hywel

Williamson, Chris

Wilson, Phil

Wilson, Sammy

Winnick, Mr David

Winterton, rh Ms Rosie

Woodcock, John

Wright, David

Wright, Mr Iain

Tellers for the Ayes:

Tom Blenkinsop and

Nic Dakin


Adams, Nigel

Afriyie, Adam

Aldous, Peter

Alexander, rh Danny

Andrew, Stuart

Bacon, Mr Richard

Baker, Norman

Baker, Steve

Baldry, Sir Tony

Baldwin, Harriett

Barclay, Stephen

Barker, Gregory

Barwell, Gavin

Bebb, Guto

Beith, rh Sir Alan

Beresford, Sir Paul

Bingham, Andrew

Binley, Mr Brian

Birtwistle, Gordon

Blackman, Bob

Blackwood, Nicola

Boles, Nick

Bone, Mr Peter

Bottomley, Sir Peter

Bradley, Karen

Brady, Mr Graham

Bray, Angie

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Browne, Mr Jeremy

Bruce, Fiona

Bruce, rh Sir Malcolm

Buckland, Mr Robert

Burley, Mr Aidan

Burns, Conor

Burns, rh Mr Simon

Burrowes, Mr David

Burstow, Paul

Burt, Alistair

Burt, Lorely

Byles, Dan

Cable, rh Vince

Cairns, Alun

Campbell, rh Sir Menzies

Carmichael, rh Mr Alistair

Carmichael, Neil

Carswell, Mr Douglas

Cash, Mr William

Clappison, Mr James

Clark, rh Greg

Clarke, rh Mr Kenneth

Clifton-Brown, Geoffrey

Coffey, Dr Thérèse

Collins, Damian

Colvile, Oliver

Cox, Mr Geoffrey

Crockart, Mike

Crouch, Tracey

Davies, David T. C.


Davies, Glyn

Davies, Philip

Davis, rh Mr David

Dinenage, Caroline

Dorrell, rh Mr Stephen

Dorries, Nadine

Doyle-Price, Jackie

Drax, Richard

Duddridge, James

Duncan, rh Mr Alan

Duncan Smith, rh Mr Iain

Ellis, Michael

Ellison, Jane

Ellwood, Mr Tobias

Elphicke, Charlie

Eustice, George

Evans, Graham

Evans, Jonathan

Evennett, Mr David

Fabricant, Michael

Fallon, Michael

Farron, Tim

Featherstone, Lynne

Field, Mark

Foster, rh Mr Don

Francois, rh Mr Mark

Fullbrook, Lorraine

Fuller, Richard

Gale, Sir Roger

Garnier, Mr Edward

Garnier, Mark

Gauke, Mr David

George, Andrew

Gibb, Mr Nick

Glen, John

Goldsmith, Zac

Goodwill, Mr Robert

Gove, rh Michael

Graham, Richard

Grant, Mrs Helen

Gray, Mr James

Grayling, rh Chris

Greening, rh Justine

Grieve, rh Mr Dominic

Griffiths, Andrew

Gummer, Ben

Gyimah, Mr Sam

Halfon, Robert

Hames, Duncan

Hammond, rh Mr Philip

Hammond, Stephen

Hancock, Matthew

Harper, Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Hayes, Mr John

Heald, Oliver

Heath, Mr David

Heaton-Harris, Chris

Hemming, John

Henderson, Gordon

Hendry, Charles

Hinds, Damian

Hoban, Mr Mark

Hollingbery, George

Hollobone, Mr Philip

Holloway, Mr Adam

Hopkins, Kris

Howell, John

Hughes, rh Simon

Huhne, rh Chris

Hunt, rh Mr Jeremy

Huppert, Dr Julian

Hurd, Mr Nick

Jackson, Mr Stewart

James, Margot

Javid, Sajid

Jenkin, Mr Bernard

Johnson, Gareth

Johnson, Joseph

Jones, Andrew

Jones, Mr Marcus

Kawczynski, Daniel

Kelly, Chris

Knight, rh Mr Greg

Kwarteng, Kwasi

Laing, Mrs Eleanor

Lancaster, Mark

Lansley, rh Mr Andrew

Laws, rh Mr David

Leadsom, Andrea

Lee, Jessica

Lee, Dr Phillip

Leech, Mr John

Leigh, Mr Edward

Leslie, Charlotte

Letwin, rh Mr Oliver

Lewis, Brandon

Lewis, Dr Julian

Liddell-Grainger, Mr Ian

Lord, Jonathan

Luff, Peter

Lumley, Karen

Macleod, Mary

Main, Mrs Anne

Maude, rh Mr Francis

Maynard, Paul

McCartney, Jason

McCartney, Karl

McIntosh, Miss Anne

McLoughlin, rh Mr Patrick

McPartland, Stephen

McVey, Esther

Mensch, Louise

Menzies, Mark

Mercer, Patrick

Metcalfe, Stephen

Miller, Maria

Mills, Nigel

Milton, Anne

Moore, rh Michael

Mordaunt, Penny

Morgan, Nicky

Morris, Anne Marie

Morris, James

Mosley, Stephen

Mowat, David

Mulholland, Greg

Mundell, rh David

Munt, Tessa

Murray, Sheryll

Murrison, Dr Andrew

Neill, Robert

Newton, Sarah

Nokes, Caroline

Norman, Jesse

Nuttall, Mr David

O'Brien, Mr Stephen

Offord, Dr Matthew

Ollerenshaw, Eric

Osborne, rh Mr George

Ottaway, Richard

Parish, Neil

Patel, Priti

Paterson, rh Mr Owen

Penning, Mike

Penrose, John

Percy, Andrew

Perry, Claire

Phillips, Stephen

Pickles, rh Mr Eric

Pincher, Christopher

Poulter, Dr Daniel

Prisk, Mr Mark

Pritchard, Mark

Pugh, John

Raab, Mr Dominic

Randall, rh Mr John

Reckless, Mark

Redwood, rh Mr John

Rees-Mogg, Jacob

Reevell, Simon

Reid, Mr Alan

Robathan, rh Mr Andrew

Robertson, Hugh

Robertson, Mr Laurence

Rogerson, Dan

Rosindell, Andrew

Rudd, Amber

Ruffley, Mr David

Russell, Sir Bob

Rutley, David

Sanders, Mr Adrian

Sandys, Laura

Scott, Mr Lee

Selous, Andrew

Shapps, rh Grant

Sharma, Alok

Shepherd, Mr Richard

Simmonds, Mark

Simpson, Mr Keith

Smith, Miss Chloe

Smith, Henry

Smith, Julian

Smith, Sir Robert

Soames, rh Nicholas

Soubry, Anna

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stanley, rh Sir John

Stephenson, Andrew

Stevenson, John

Stewart, Bob

Stewart, Iain

Stewart, Rory

Streeter, Mr Gary

Stride, Mel

Stuart, Mr Graham

Stunell, Andrew

Sturdy, Julian

Swales, Ian

Swayne, rh Mr Desmond

Swinson, Jo

Syms, Mr Robert

Tapsell, rh Sir Peter

Thurso, John

Timpson, Mr Edward

Tomlinson, Justin

Tredinnick, David

Truss, Elizabeth

Turner, Mr Andrew

Tyrie, Mr Andrew

Vaizey, Mr Edward

Vara, Mr Shailesh

Vickers, Martin

Villiers, rh Mrs Theresa

Walker, Mr Charles

Walker, Mr Robin

Wallace, Mr Ben

Walter, Mr Robert

Ward, Mr David

Watkinson, Angela

Webb, Steve

Wharton, James

Wheeler, Heather

White, Chris

Whittaker, Craig

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Mr Mark

Williams, Roger

Williams, Stephen

Williamson, Gavin

Willott, Jenny

Wilson, Mr Rob

Wollaston, Dr Sarah

Wright, Jeremy

Wright, Simon

Yeo, Mr Tim

Young, rh Sir George

Zahawi, Nadhim

Tellers for the Noes:

Greg Hands and

Mr Philip Dunne

Question accordingly negatived.

16 July 2012 : Column 750

16 July 2012 : Column 751

16 July 2012 : Column 752

16 July 2012 : Column 753

Adult Social Care

7.45 pm

Liz Kendall (Leicester West) (Lab): I beg to move,

That this House notes the growing crisis in adult social care; welcomes many of the proposals in the Care and Support White Paper including national minimum standards on eligibility, stronger legal rights for family carers, portability of care packages and improvements to end-of-life care; notes that many of these ideas were proposed by the previous administration, but believes they are now in danger of appearing meaningless without the ability to properly fund them; is concerned that the Government is considering a cap on individual costs as high as £100,000; is committed to the important Dilnot Commission principle that protection against the risks of high care costs should be provided for everyone; and calls on the Government to honour the commitment in its 2010 NHS White Paper to introduce legislation in the second session of this Parliament to establish a legal and financial framework for adult social care.

The issue of how we provide decent care for older and disabled people and their families is one of the biggest challenges facing Britain today. Ten million people in the United Kingdom are now over 65, and that figure will rise to more than 15 million by 2030. The number of over-80s is growing even faster, and is set to double to nearly 6 million in 20 years’ time. Medical advances also mean that people with disabilities are living longer than ever before.

The fact that we as a nation are living longer is something that we should celebrate. There have been many improvements in adult social care over the past 10 years, and I shall say more about that in a moment. However, too many people still face a daily struggle to get the care and support that they need if they are disabled or become frail and vulnerable in their old age. The ways in which we provide and fund care need major reform if we are to deliver a better, fairer and more sustainable system. That reform is vital for older and disabled people and their families who want and deserve a decent system of care and support, but it is also vital for our economy. The Office for Budget Responsibility’s fiscal sustainability report states that the primary pressure on the public finances is our ageing population. Without major changes to pensions and, crucially, to health and social care, the long-term growth of our economy and the sustainability of our public finances could be put at risk.

Last week, the Government had the chance to show that they were prepared to meet the challenge of fundamentally reforming care and support, and many of the promises in their White Paper and draft Bill on social care are welcome. They build on Labour’s achievements when we were in government. Indeed, many of the Government’s announcements were put forward by Labour in our White Paper, “Building the National Care Service”, more than two years ago. They included a shift in the focus of local council and NHS services towards prevention and early intervention to help more older and disabled people to stay living independently in their own homes, and more joined-up NHS and council care to stop families having to struggle with the different services to get the support that they need.

Mr Graham Stuart (Beverley and Holderness) (Con): I am experiencing a sense of déjà vu. Those of us who take an interest in these matters pleaded with the previous

16 July 2012 : Column 754

Government in debate after debate to take action and to make some tough decisions to ensure that we looked after our ageing population, but, time and again, they failed to take any real action. We are not building on what they did; we are having to go into the space where they failed to act.

Liz Kendall: I always respect the hon. Gentleman’s interventions, but he seems to forget that we faced up to those difficult decisions and choices on adult social care in “Building the National Care Service”. We tried to get cross-party agreement on those proposals, but they became a political football at the last general election. The hon. Gentleman should be encouraging those in his Front-Bench team to engage seriously in cross-party talks and to take the difficult decisions that need to be taken.

Margot James (Stourbridge) (Con): Will the hon. Lady give way?

Liz Kendall: I want to make some progress, then I will give way.

Labour proposed better information and national minimum standards to tackle the postcode lottery in care. We also proposed that everyone should have the right to have a personal budget—which we introduced—that people should be able to take their care package with them if they moved to a different area, and that carers should have the right to have their own needs assessed and met independently of the person for whom they cared.

The difference between the Labour Government and the present Government is that we set out the difficult decisions about how those changes would be paid for. The absence of that information is the gaping hole at the heart of this Government’s plans. There is a risk that their promises of new rights and services will be meaningless without the ability to fund them properly. Indeed,

“this White Paper is not worth the paper it's written on.”

Those are not my words, but those of the Alzheimer’s Society, which has damned the White Paper as a massive failure. Similarly,

“the key test for this White Paper was to deliver an urgent timetable to reform social care funding. The Government has failed this test.”

Again, those are not my words. They are the words of the Care and Support Alliance, which consists of more than 65 organisations that represent and support older and disabled people.

Kelvin Hopkins (Luton North) (Lab): I entirely support the principle of a national care service, but will my hon. Friend go slightly further and be as bold as Nye Bevan in suggesting that it should be free for all at the point of need?

Liz Kendall: I know that my hon. Friend is passionately committed to this issue, and he will know that we remain determined to ensure that there is a fair, affordable and sustainable system for care and support in future.

The Government have failed to take proper action to tackle the immediate care crisis, and they have failed to confront the difficult funding decisions that we need for the future. Last week we heard nothing but complacency

16 July 2012 : Column 755

from the Government about the desperate care crisis that faces people throughout the country. Ministers repeatedly claim that there is enough money in the system, but the truth is that the Government’s savage cuts in council budgets have pushed an already pressurised care system to breaking point.

Adult social care accounts for about 40% of council budgets—it is up to 60% in some areas—and for the largest elements of councils’ discretionary spending. When council budgets are slashed by a third, it is inevitable that care services will be cut. Figures from the Government’s own Department for Communities and Local Government show that more than £1.3 billion has been cut from older people’s social care provision since the coalition came to power. Fewer people are receiving the support that they desperately need as councils raise eligibility thresholds. Charges for vital services such as home help are soaring, with huge variations across the country. That is a stealth tax on the most vulnerable members of society. At the same time, the quality of care is being put at risk as councils are forced to pass on cuts in their budgets to care providers. [Interruption.] From a sedentary position, the hon. Member for Truro and Falmouth (Sarah Newton) asks what we did in 13 years. We increased spending on adult social care by 53%, we invested £1.2 billion in the carers’ grant, we provided new rights for carers to have their needs assessed and to request flexible working, we introduced the Supporting People programme, and we spent £227 million on extra care housing. I rest my case.

According to the United Kingdom Homecare Association, one in 10 home care visits now lasts for only 15 minutes. That is a completely inadequate amount of time if frail, vulnerable people are to be helped to get up and to be washed, dressed and fed. Residential care is under huge pressure too. Nine out of 10 home care providers say that low council fees are creating a two-tier system, with new investment being directed only towards wealthier parts of the country. Unpaid family carers are suffering as well as they are forced to give up work, and their own health suffers because they cannot obtain the help that they need to look after their loved ones. Yet the Government repeatedly deny the scale and urgency of the care crisis.

Several hon. Members rose

Liz Kendall: Last week, local councils throughout the country will have listened in disbelief as Ministers repeatedly insisted that there was enough money in the system and no need for councils to cut care provision. Sir Merrick Cockell, the Conservative chairman of the Local Government Association, has said that the current system does not have enough money to provide care for

“anyone other than the most needy, or those who can afford to pay for all of their own care.”

Without more funds, he says, we will

“see some of the most popular services councils provide, such as parks, leisure centres…winding down by the end of the decade.”

The Government are astonishingly complacent about the impact that cuts in social care are having on the NHS. Last week the Secretary of State for Health brushed aside concerns about delayed discharges from hospitals, saying that they were

“broadly the same as… last year”.—[Official Report, 11 July 2012; Vol. 548, c. 322.]

16 July 2012 : Column 756

Several hon. Members rose

Liz Kendall: In reality, the number of days on which a hospital bed is occupied by someone who could have been discharged has risen by 18% since this time last year, and by a staggering 29% in the last 18 months. These delays now cost the NHS £18.5 million every single month, and more than a third are due to cuts in social care. The number of delayed discharges from social care has risen by 11% in the last month alone.

Instead of burying their heads in the sand, Ministers should be taking action. Labour has called for £700 million from last year’s NHS underspend to be ring-fenced for social care immediately, and I was delighted to learn that the all-party group on local government today called for those funds to be used for that purpose, rather than being absorbed back into the Treasury coffers. I hope that, when the Minister responds, he will tell us whether he agrees.

Paul Maynard (Blackpool North and Cleveleys) (Con): I congratulate the hon. Lady on giving way at long last. It is nice of her to do so, and we are most grateful. Given that she began by saying that she wanted to see a consensual, non-partisan approach to the issue, can she explain why we have just heard a party political diatribe? I find that very disappointing.

Liz Kendall: I was stating the facts about the care crisis, which have been made clear not by me but by organisations representing older and disabled people, by local councils and by the NHS. It is the Government’s denial of the existence of the care crisis and their insistence that there is enough money in the system that I am seeking to correct.

As I have said, the Government have failed to recognise, let alone tackle, the care crisis, and they have failed to face up to the difficult decisions that we need for the future. Their progress report on funding merely says that the Government support the principles of Andrew Dilnot’s commission on the funding of long-term care and support. They now claim that it is only right for Dilnot’s proposals to be considered as part of the spending review. That was not their view two years ago, when they made a clear promise in their NHS White Paper to legislate on a new legal and financial framework in the current parliamentary Session. Now we have only a draft Bill to reform social care law alone. At best that means that there will be no change in funding before the next general election, and at worst it means no change at all if the Government return to power.

Richard Fuller (Bedford) (Con): Will the hon. Lady give way?

Liz Kendall: I want to make a little more progress.

According to yesterday’s edition of The Sunday Telegraph, Andrew Dilnot has said that the delay has left older and disabled people in fear and misery. He expressed serious concern about the possibility that the Government will set the cap at a far higher level than that proposed by his commission—at £75,000 or even £100,000 rather than £35,000. He also said:

“if you go beyond £50,000 it is less effective in giving reassurance to the population and ceases to be a way of helping people with lower levels of assets.”

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Instead of making real progress on funding reform, the Government trumpeted proposals for a national deferred payment scheme, providing loans to cover the costs of residential care.

Sarah Newton (Truro and Falmouth) (Con): Does the hon. Lady recall what the Secretary of State actually said when he announced his proposals last week? He made it very plain that, if the hon. Lady’s party sat down seriously with Ministers and reached the consensus that the whole country is clearly crying out for, the necessary mechanisms could be introduced in the Bill and the funding could be found in the comprehensive spending review. We need less party politics and more consensual conversations.

Liz Kendall: It was Labour Members who proposed cross-party talks, and it was Government Members who decided unilaterally to publish the progress report on which we had been trying hard to agree. The hon. Lady accuses Opposition Members of not being serious about funding reform. We are, and I will set out what we would like to happen so that those talks can proceed.

The deferred payment schemes that were announced last week already exist in some parts of the country and are currently interest-free, but according to the Government’s plans interest will be charged, which will make loans more expensive than they are now. Many councils remain utterly unclear about how they will find the money to pay for those schemes. As the Local Government Association says,

“Councils are not banks and the implication of this level of debt in an already overstretched system needs urgent attention.”

The truth is that the Government have so far ducked the care challenge, and the reasons for that are clear. First, owing to their disastrous economic policy, they are now borrowing £150 billion more than they originally planned to borrow. The Treasury has pulled the plug, and has kicked long-term care funding into the long grass.

Richard Fuller: I thank the hon. Lady for giving way. As she recognises, cross-party consensus is required if we are to solve the social care problem. Care workers—the people who actually provide the care to people—do not get sufficient attention, however. One of the problems they have suffered from over many years is per-minute billing. Does she recognise that our changes to get rid of per-minute billing are worth while, and what impact does she envisage that will have on the provision of care over the long term?

Liz Kendall: The hon. Gentleman raises a serious point. I know from shadowing care home assistants in my constituency that commissioning by the minute can cause considerable problems. For instance, it does not allow the staff to meet the individual needs of those who are most desperate for help and support. As I have said, we welcome many of the proposals in the White Paper, but they need to be properly funded, and that is why I am so concerned that the issue of long-term care funding has been kicked into the long grass.

The second reason why the Government have failed on this issue is that the Health Secretary’s obsession with reorganising the NHS has been a disastrous distraction.

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Two years have been wasted on an unwanted and unnecessary reorganisation, when everyone should have been relentlessly focused on the key challenge of our ageing population: meeting rising demand for care at a time of unprecedented financial pressure.

The third reason is the most fundamental of all. Many Conservative Members have still not grasped the basic principle that we must collectively and universally pool the risks of facing catastrophic care costs, as we do in the NHS, in order to make things better and fairer for us all. A voluntary system that leaves it up to individuals and their families alone will not work. The only way forward is through an effective partnership between individuals and the state.

Kelvin Hopkins: I agree with what my hon. Friend is saying. The Government keep on talking about consensus, but the problem is that we say yes to Dilnot, but they do not. If they were to say yes to Dilnot, we might have a basis for consensus.

Liz Kendall: We remain serious about trying to achieve cross-party consensus. If one party comes forward on its own and proposes a controversial and difficult decision, that always leads to a political fight; we saw that only too clearly before the last general election. However, we need cross-party consensus because this is a long-term challenge. We have to try to get agreement so that, whichever party is in power, people know there is a system that they can understand and pay for in future.

Government Members have criticised Labour’s record in government, but we are proud of our achievements on social care. We increased spending by 53% when we were in government. We helped drive up quality through national performance assessment of local councils and independent inspection of care services. We championed integration, with new legal powers for the NHS and local councils to pool budgets, and new care trusts jointly to commission care. Those care trusts will be swept away under the Health and Social Care Act 2012. We supported carers through the carers grant and new rights for carers. We introduced the first ever national dementia strategy, and we backed improvements in housing through the Supporting People programme and extra care housing. [Interruption.] The hon. Member for Reading East (Mr Wilson) mutters from a sedentary position that that is not real action. He should try telling that to the carers we supported through breaks that are now under threat, and the people who have benefited from extra care housing and the Supporting People programme, which his Government have cut by 12%.

We understood that we had much further to go, however. That is why before the last general election we published plans for fundamental reform, including difficult decisions on how care should be funded. We tried to get cross-party agreement. We did not succeed, but we are determined to try again now.

A year ago, my right hon. Friend the Leader of the Opposition made an open and sincere offer of cross-party talks, and it is a matter of genuine regret that the Government unilaterally decided to publish their own progress report on funding, rather than the joint report we had wanted to agree. Labour remains committed to serious and meaningful cross-party talks.

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I hope that the Minister will tell the House whether the Government will commit to addressing the current funding gap as well as future reform. Andrew Dilnot says that that is vital. Will they also set a clear timetable for reform, with legislation on funding reform in this Parliament, as Labour has called for? Will they agree to include their Treasury team in the talks, which Labour has offered from the start?

Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con): One of the authors of the Dilnot report was Lord Warner, who was a member of the previous Labour Government. He made the point that one of the reasons for the funding crisis is that the previous Government failed to invest adequately in social care; it received only 70% of the funding compared with the NHS. That was one of the major failings of the previous Government. They should have invested more in social care when the sun was shining and the country had the finances to do that.

Liz Kendall: I politely say to the hon. Gentleman that we did not cut local council budgets by a third. I have always said that social care budgets have been under increasing pressure for many years, which is why we desperately need funding reform. I know that he supports that reform and will work with us in the years ahead.

The Government’s decision to kick the issue of long-term care funding into the long grass is a bitter blow for older and disabled people and their families. It is a huge disappointment for local councils, which are desperate for a new social care settlement, and it is a disaster for our NHS, which will face intolerable pressure as our care system crumbles further still. This issue will not go away, because our population is ageing. Our care system needs fundamental reform—reform this Government have so far failed to deliver. I commend the motion to the House.

8.6 pm

The Minister of State, Department of Health (Paul Burstow): Let me begin by striking a note of agreement between Government and Opposition, before moving on to the areas where we disagree. I agree with the hon. Member for Leicester West (Liz Kendall) that our debates about our ageing society are too often couched in terms of burdens and impacts on public expenditure, when they should be a cause for celebration as we have more people living longer and living healthier for longer. That stands as a tribute to our national health service, our local authorities and many others besides.

I sat in the House for 13 years in opposition to a Labour Government, and it became very clear to me that, despite the wealth of the nation being much greater at that time than it is now, the Labour party was not willing to tackle the pressing need for serious systemic reform of social care. I shall talk in a moment about the Labour Government’s last-minute moves to address that agenda.

Social care is Bevan’s orphan. It was left over after the NHS was established in the 1940s, and it has suffered ever since. It has been hidden behind its favoured sibling, the national health service, out of sight until life takes a turn and tips people into crisis. Social care’s founding principles date back to the Poor Law; it was a poor relation to the NHS, ripe for reform, but neglected for decades.

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Much of last week’s reporting about the Secretary of State’s statement in the House and the publication of the White Paper and draft Bill gave the impression that the only subject that was talked about was who pays for care—where the line is drawn between what an individual personally is responsible for in meeting their care costs and what costs the state would pick up. The Government do not dispute that that is an important issue, and we have made significant progress on that agenda, but it is not enough simply to redraw the boundary between personal responsibility and state support, because the system of social care in England is undoubtedly broken.

Given that there were 13 years of Labour inaction, the hon. Member for Leicester West must face up to some of the challenges in respect of social care. A White Paper finally emerged in the dying days of the last Labour Government; it was published on 30 March, just seven days before a general election was called. That is not good enough; it is too little too late. What did that White Paper say? It talked about national eligibility, but when? It was by 2015, so it was going to take Labour five years to introduce that change. On portability, it did not commit to ensuring that support would be provided immediately in the area to which the person was moving. In other words, there was still a risk of interruptions. In addition, that Labour White Paper said nothing about the rights of carers. The hon. Member for Leicester West was absolutely wrong when she told the House that Labour was responsible for introducing carers legislation. Back-Bench Members in this House, tirelessly arguing the case, were responsible—[Interruption.] Labour, Conservative and Liberal Democrat Members supported those many measures over a number of years, but none came from the Front-Bench and none came from the Labour Government.

Hugh Bayley (York Central) (Lab): I would like to get back to the issue in hand and call a spade a spade. The only substantial asset that most families have to pass on to their children and grandchildren is the home they live in. If the Government want a new inheritance tax, would it not be fairer to levy it at the same percentage rate on rich and poor alike, and not simply target those people who have the misfortune to fall ill at the end of their life?

Paul Burstow: I will come in a moment to our response to the Dilnot commission recommendations, so I will deal with the hon. Gentleman’s point at the right time.

Hugh Bayley: Now would not be bad.

Paul Burstow: No, I am talking about the time at which in the sequence of my speech I will make the point about the Dilnot commission recommendations.

I wish to make one other observation on the national care service White Paper that the Labour Government published seven days before the last general election was called. Our White Paper addresses the end-of-life care issues, but Labour’s failed to address them.

Mr David Anderson (Blaydon) (Lab): The Minister is rightly critical of the failure of the previous Government to bring in care for the people of England. Does he support what was done in Scotland by the previous Government?

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Paul Burstow: I am not certain which thing the hon. Gentleman is inviting me to support. Many measures were introduced by the coalition Government in Scotland over a number of years to reform the social services system in Scotland, not least some relating to adult safeguarding which this Government are now making progress on.

Andy Burnham (Leigh) (Lab): I think that the Minister has unfairly misrepresented the process we went through in the last Parliament. We did not just have a White Paper before the general election. We had a Green Paper in the summer of 2009, and the whole process was kicked off in the 2007 spending review. Upon a request from the then shadow Health Secretary, I agreed to cross-party talks. So the Minister is unfair in saying that nothing was done and then a rabbit was produced from the hat. May I say to him that the White Paper that I produced before the election addressed both service reform and funding? I am afraid that the same could not be said of the White Paper that emerged last week.

Paul Burstow: That is interesting, because the White Paper that was published seven days before the general election was called carried no details on who should pay, what they should pay or when they should pay. It contained no details of that sort, and I urge people to read it and compare it with the White Paper, draft Bill and other details that we published just last week. In 13 years, when the money was available, the Labour Government did not do anything; they left it until the last seven days and even then did not come up with the details.

In the space of two years, this coalition Government have advanced further and faster than any in the previous 20 years on addressing a wide range of issues and challenges and backing that with tangible action. Unlike what happened with Labour’s royal commission, so firmly kicked into the long grass, this Government have accepted all the recommendations of the Dilnot commission as the basis for a reformed system. Many of those recommendations are translated into the legislation that we published last week. Crucially, the Government accept the principles of a capped cost system as the basis for protecting people from catastrophic costs. Labour’s motion seems to suggest that Labour does, too. I want to make it clear that we are keen, still, to engage with the official Opposition and other stakeholders in reaching a final settlement on this question of the boundary between the state’s responsibility and the individual family’s responsibilities for meeting care costs.

Mark Field (Cities of London and Westminster) (Con): Does the Minister not recognise that any cap, be it at £35,000 or £60,000, as was initially proposed by Dilnot, is likely within a very short time to be wholly inadequate, given the funding constraints that we are under? The harsh reality is that people who wish to preserve an inheritance for their children—that is an understandable desire—must recognise, as must their children, that those children will have to take on the burden of looking after aged parents, in both time and financial terms. It sounds like a hard truth, but it needs to be put on the record, because otherwise we are not going to get any further forward in dealing with this matter.

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Paul Burstow: The hon. Gentleman expresses an opinion that is held by many people, but the Government’s position is not to take that view. We take the view that a cap on care costs is an important component in a redesigned system for funding in this country. What we have said clearly is that we have to address how that is paid for as part of a spending review. That is why we believe that both a cap and an increase in the means-test threshold provides the necessary assurance for a family to plan and prepare for care, and provides the mechanisms by which the financial services industry can grow and develop to offer appropriate products.

Mark Field: Is there not a problem with what the Minister has said? I understand that this is an incredibly difficult issue, which we all have to deal with. I have lost both my parents. One died at the age of 70, only 18 months ago, at a time when we were on the cusp of putting her into full-time care, which would have been ruinously expensive. Is not the problem with all this that if we put in place today any system with a fixed cap, it will almost certainly be superseded by events and will then be seen as unjust for future generations?

Paul Burstow: The hon. Gentleman identifies one of the issues associated with the design of the introduction of a cap. It is worth pointing out that the interaction between the cap and the means-test threshold means that every family would have a different level for which they would be liable to meet their care costs. The issues relating to design are real, as are those about how to meter the system from the point someone enters it, and they require detailed work as part of the design of an effective implementation alongside the costings of it.

Hugh Bayley: The hon. Member for Cities of London and Westminster (Mark Field) is right to identify that there is a link between inheritance and the high cost of end-of-life care for people. May I put it to the Minister that if there is a cap of £100,000, the entire inheritance could be wiped out for a family who have a modest home in the north of England, whereas somebody living in a home worth 10 times as much in southern England would still maintain a large proportion to pass on?

Paul Burstow: That is why we have to explain this clearly. By lifting the means-test threshold to £100,000, the interaction between the absolute cap and the means test means that the amount the individual will ultimately pay as their lifetime contribution towards their care costs is related to their wealth. I urge the hon. Gentleman again to look at both the tables and the graphs in the progress report, as he will see exactly how it protects the assets of a family, even in the scenario he has described.

It is also important to understand that redrawing the boundary between what the individual pays and what the state pays does not—things all too often were conflated in this way last week—add any new spending power to the system. That leads me to the question of getting funding into the system. Before the 2010 spending review, the Dilnot commission urged the Government to protect baseline funding for social care, and we did just that. In October 2010, we confirmed an extra £7.2 billion of support for adult social care, which, together with a programme of efficiency, was sufficient to protect access to support. That included an unprecedented £4.2 billion

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of NHS resources to support social care, to promote integration and innovation, and to support the expansion of reablement services. The Labour party wants to paint a picture of doom and gloom up and down England on these services, tarring every council with the same brush of being crude cutters of services, when that is not the case.

Kate Green (Stretford and Urmston) (Lab): Perhaps I could describe to the Minister what is happening in Trafford, which has a Conservative council and is where my constituency is located. We are seeing a twin squeeze, despite the Minister’s apparent sanguinity about the funding. On the one hand, we are seeing thresholds for access to care being raised as a means of rationing the way in which the money is spent. On the other hand, as care providers are telling me, commissioners are reducing and reducing the price they are prepared to pay providers to the point where they can hardly sustain their business at all or meet minimum wage legislation.

Paul Burstow: We know from the surveys that although last year there was a cash freeze in the increases that local authorities paid to provider organisations, this year across the country the average was a 1.4% increase. Again, that does not quite tally with the picture that some hon. Members want to paint.

It is also worth saying that the picture of local authorities grappling with tough budget settlements is complex. Different councils are responding to the pressures on budgets in different ways. Some are acting in a very smart way, as the Demos report, “Coping with the Cuts”, revealed. Such councils are protecting access by focusing on reablement services, helping more people to get back on their feet without the need for long-term support, which is better for the individual and more cost-effective. Indeed, the latest figures from the Association of Directors of Adult Social Services reveal that councils are protecting front-line care.

Roberta Blackman-Woods (City of Durham) (Lab): Would the Minister agree to look closely at the report of the all-party local government group on social care, published today? It makes it very clear that a funding gap still exists and recommends that NHS money should be used to plug that gap. Will the Minister commit to continuing to do that and to considering the other recommendations in the report?

Paul Burstow: Obviously, I will happily look at the report and I look forward to meeting the all-party group to discuss its findings and recommendations later.

I want to report to the House the findings of the ADASS survey, which was published recently. Last year’s survey found that for every pound saved by local authorities in social care, 69p came through greater efficiency. This year, it found that that had risen to 77p in every pound. Yes, some councils are cutting services, and last year 23p in every pound that councils saved came from service reductions, but this year that figure is just 13p in every pound. Local authorities are getting smarter in organising their services, so I want to pay tribute to those councils and councillors who have worked hard with service users, carers and providers to protect services to make the best possible use of the extra money the

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Government have provided. As a result, between last year and this year, council budget spend on social services has gone down by just 1%.

Sheila Gilmore (Edinburgh East) (Lab): On the question of efficiencies, would the Minister include councils that tendered a service and made a saving, but to the detriment of the end user of the service? That is how we got to the 15-minute, short-term care options. Is that an efficiency or a cut in service?

Paul Burstow: When there is a crude race to the bottom and contracting is by the minute simply to ration access to the service, resulting in a care home provider or home care provider delivering care on a very time-and-task oriented basis, that is totally unacceptable. We know that in places such as Wiltshire, where home care services are organised on an outcomes basis, that is delivering better results for the service users and releasing resources to reinvest in services.

Richard Fuller: When I intervened earlier, Mr Deputy Speaker, I forgot to refer hon. Members to my entry in the Register of Members’ Financial Interests as the director of two care companies.

The Minister is absolutely right to say that there is a patchwork of responses from local authorities. I absolutely welcome the end of per minute billing, which is a tremendous step forward, but I draw the Minister’s attention to the comments made by the hon. Member for Stretford and Urmston (Kate Green). She talked about the pressures of meeting the minimum wage and the pressures that local councils are putting providers through. The Government must consider that issue, because there is exploitation in some areas. As businesses and charities try to meet the requirements local councils are putting on them, workers are finding it difficult to achieve a sustainable wage in providing care services.

Paul Burstow: My hon. Friend is absolutely right to highlight that issue, which the Low Pay Commission has commented on over a number of years, including before this Government came into office. In our White Paper, we make it very clear that local authorities, as the commissioners of such services, must be mindful of their responsibilities in ensuring that the resources they provide to providers are sufficient to allow them to fulfil their legal obligations.

Heidi Alexander (Lewisham East) (Lab): The Minister talks about the financial pressures faced by local authorities in providing care to elderly and disabled residents, but is he aware that the cost to local authorities of self-funders who have to fall back on the state is in the region of £1 billion a year? Does he agree that that is a very unpredictable thing for local authorities to deal with? What proposals does he have to help local authorities in that regard?

Paul Burstow: I am grateful to the hon. Lady for her question, because it allows me to talk about some of the points I think will directly address it. Reform of our care and support system is about more than just who pays for care; it is also about some other very important issues. A central proposition in the White Paper we published last week concerns the move from a service focused on managing crisis, and often not doing so very

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well, to one focused on supporting people’s well-being by concentrating on early intervention and prevention. That is why, alongside the White Paper, we published a draft Bill that will underpin the reforms we intend to make, consolidating, simplifying and modernising the legislation. The Bill sets out for the first time in statute some very clear governing principles about how decisions are made in social care, focusing on people’s well-being and living by the idea set out by our first White Paper in government of “No decision about me, without me”.

The Bill sets out a number of important changes that go to the heart of people being able to plan, prepare and have proper choice about the care available to them. First, it makes it a requirement for local authorities to ensure that there is a universal offer of information and advice so that people can plan and prepare. Secondly, it requires for the first time local authorities to focus on prevention. Thirdly, it requires a sufficiency of quality care so that choice is available to people locally. Fourthly, it requires integration and co-operation not just between the NHS and social care but between those agencies and housing.

The Bill will not only do that; it will simplify the point of entry into the state system. It will ensure consistent national eligibility and, for the first time in Government legislation, will ensure that there are rights for carers not just to an assessment of their needs but to support for those needs. It will also deal with the often mentioned issue of protection from disruption when people move from one part of the country to another or when a child moves from children’s services to adult services. It will guarantee continuity of services, which is not currently provided for.

Personal budgets, which were started by the Opposition but have not stuck well because of the legal framework, will for the first time be given a clear legal basis. I am delighted to say that whereas when this Government came to office in 2010 we inherited 168,000 people receiving personal budgets, by March of this year 432,000 people were benefiting from them. There will also be clear legal duties on the NHS, police and councils to safeguard people.

At the heart of our White Paper reforms is the notion that we need less variability on quality, to ensure that providers are responsible for driving up quality and accountable for doing just that, and to have more and open information about the quality of provision. That is why our provider quality profiles will provide that information in a way that will allow people to compare and rate providers for the first time and why we are putting an extra £32.5 million in to support those services.

Andy Burnham: The Minister is mentioning the things in the White Paper that he will ask councils to do. Can he give us a figure tonight for how much the Government have estimated that the cost to councils will be of providing all those things and tell us how councils will pay for it?

Paul Burstow: I will come on to give a specific figure in a moment, so the right hon. Gentleman will have to be patient.

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I wanted to pick up again on the point about the White Paper ruling out crude contracting by the minute—a culture of clock-watching which has been allowed to grow up for years in too many places and which is not good for dignity, respect or quality. Under the Labour Government there were years and years of delay and dither when it came to addressing the quality of care workers and health care assistants. This Government are putting in place a code of conduct and national minimum training standards, and will double the number of people able to access apprenticeships in the care sector to 100,000.

Andrew George (St Ives) (LD): I am grateful to my hon. Friend for his remarks. I hope I am not taking him back too far, but given that he is talking about the integration of services, particularly among authorities, and implying the portability of assessments for those with care packages, will he comment on the extent to which the Local Government Association has approved and supported the proposals in the Government’s White Paper?

Paul Burstow: On the proposals for portability of assessment and guaranteed continuity of care, the LGA is certainly aware and has been engaged in the consultations that we undertook last year as part of our preparations for the White Paper. It did not, of course, negotiate line by line the text of the White Paper, but it has the opportunity, as does everyone else, to participate now in the scrutiny of the draft Bill that we introduced. I hope the LGA will do so. We wish to engage with the LGA on these issues.

Integration is an important part of these reforms. Too often, people feel bounced around the system. What we do for the first time in the White Paper is set out a number of important steps towards more integration of the two existing systems.

Jim Shannon (Strangford) (DUP): The Minister has used the term “integration” several times. In Northern Ireland we have an integrated health and social care system, which is working extremely well. I am conscious that that is very different from the position on the mainland. Are there lessons from the integrated system in Northern Ireland that could be applied here? We have done it well in Northern Ireland. Perhaps the example could be used here.

Paul Burstow: From my own limited study of the system and from visits that I have made over the years, one of the conclusions that I would draw, which is at the heart of our reforms as well, relates to culture and collaborative behaviour across the various parts of the system. That has been essential to delivering genuinely integrated care in some parts of Northern Ireland. I believe it is essential to delivering genuinely integrated care in England as well.

I mentioned earlier that end-of-life care was an omission from the Labour Government’s last White Paper. It has not been omitted from ours. We are doubling the budget of the pilots that we have instituted to test the patient funding mechanisms and to make sure that we have the necessary data to understand the benefits of a free social care system at end of life. We want to make it

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clear that we see the merits of such a change, and it is why we want to make sure that we have the information on which we can base the final decision.

Our goal is to shift the focus of the system to prevention and early intervention, not to wait for the system to stutter into life when a crisis strikes. We want to make it easier for people to plan and prepare, both to avoid and reduce the need for care and to meet the need for care in the first place. Last week we laid out a reform agenda of universal information and advice, national eligibility, deferred payments, integration of health, housing and social care, better transition for children to adult services, and support for carers. Together those constitute the most comprehensive overhaul of adult social care in 60 years, and they are a contrast to the motion before us, which adds nothing, says nothing about how change will be paid for, and says all that it can to scare people about the current system.

Rather like 13 years of a Labour Government, today’s motion gets us nowhere. That is why we are investing an extra £300 million in the system to support change, and why I urge my right hon. and hon. Friends to vote against the motion.

Several hon. Members rose

Mr Deputy Speaker (Mr Nigel Evans): Order. To accommodate as many Members as we can, a five-minute limit will be introduced, with the usual overtime for two interventions.

8.32 pm

Mr Michael Meacher (Oldham West and Royton) (Lab): The Minister, as always, sought to present a positive picture of his proposals, but I continue to be struck by the internal conflicts of the White Paper.

The whole thrust of this Government has been to shrink the state, but Dilnot will clearly expand it. The Chancellor, who torpedoed Labour’s social care proposals just before the last election by claiming that they represented a death tax, is now supporting his own death tax, only this time it will be £35,000 to £50,000, as opposed to Labour’s £20,000. Now the Chancellor has once again sabotaged a fair and reasonable inter-party settlement, which is plainly needed, by abruptly breaking off the talks and introducing a pretty vacuous White Paper with no costs in it—or, to use the words of Sir Alec Douglas-Home in 1964, a menu without the prices.

Furthermore, the Chancellor clearly wants the adult social scheme to be voluntary—I think this is what lies behind many of the difficulties—but the sums add up only if there is compulsory risk pooling. Yet the Chancellor—it is he, rather than the Secretary of State, whom we must deal with—still will not face up to the ineluctable logic of a mandatory adult social care system, and he is still trying to dodge it in two rather unscrupulous ways: first, he is kicking it into the long grass by postponing it to the uncertainties of the next spending review in 2014, even though gross neglect is endemic and reform is needed urgently; and secondly, he is evading today’s realities by ignoring any need for upgrading standards. The Minister referred to upgrading standards, and clearly he wants to, but the means with which to do so are incompatible with the White Paper. The Treasury’s £1.7 billion is purely a dead-weight cost to protect

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family inheritances. It takes no account of rising care costs or the imperative need to lift care standards, which in many cases shame a civilised society.

This is where we come to the crux of the matter. At present, many local authorities pay only for 15-minute or 30-minute visits, and many do not pay for the journey time, even though that is part of the contract, or the petrol costs, which care providers are obliged to provide themselves. Frankly, it is impossible in 15 or 30 minutes to get an elderly and often infirm person out of bed, to clean the sheets, which may well be soiled, to get him or her dressed, washed and fed, to clean and tidy up and, of course, to engage in some kind of conversation to generate some decent human relationship. Equally, it is impossible, as my hon. Friend the Member for Leicester West (Liz Kendall) pointed out, with the minimum wage rates paid by local authorities because of their squeezed budgets—a funding shortfall of at least £1 billion this year—for care providers to offer the higher standards the Minister talked about and which they want to provide and which the service users deserve.

How is the big black hole in the White Paper to be dealt with? The Local Government Association says that the gap between the money available this year and the predicted cost is about £1.4 billion, stretching to £16.5 billion by 2020, when spending on social care will exceed 45% of council budgets. Against that shortfall, the £300 million of extra funding announced by the Secretary of State in his statement last Wednesday looks derisory.

This dilemma is by no means insoluble. The long-term costs of Dilnot are estimated at about £3 billion a year. In his Budget four months ago, the Chancellor had a choice in the allocation of precisely such a sum, but he decided to spend it on the top 1% earning more than £3,000 a week by cutting the 50p rate of tax. For the same amount of money he could have funded Dilnot in full, but for this Chancellor the priority are the super-rich, not the elderly, infirm or disabled people in need of social care. The long-term answer to this problem is the introduction of a new social insurance scheme.

8.38 pm

Fiona Bruce (Congleton) (Con): I welcome the Government’s White Paper “Caring for our future: reforming care and support” and its priority of putting the well-being of the cared for and their carers at the heart of its approach. As the Member who represents the constituency with the highest proportion of elderly people in the north-west of England—there are 72,000 carers in Cheshire—I particularly welcome the proposals.

For the first time there will be a clear legal basis for the cared for and their carers having their own individual care and support plans, a tangible recognition of the utterly invaluable contribution that some 6 million carers make, many of whom often work more than 50 hours a week, at great personal cost. With 2 million people moving in and out of caring roles each year, the Government are right to recognise that giving carers a right to personal assessments and plans is a priority so that their own health and well-being are supported and recognition is given to the fact that they, too, have lives to live.

I am also pleased that the Government have already allocated £400 million for carers’ breaks over the current five-year period, but it is important that that is reviewed

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to ensure that the effectiveness of such payments is maximised. I welcome the new duties placed on local authorities, which will substantially help the cared for and their carers to access appropriate support, as the fragmented health, housing and care support services that have existed until now have caused at best frustration, and at worst despair.

Clearer dissemination, and the duty on local councils to provide advice and preventive services, should go a long way towards alleviating the problem described by one volunteer in the care sector, when she said that social workers just do not have time to help signpost carers to information, advice and support.

The Government are to be commended for their commitment to working towards the assurance of quality care standards through improved training provision for care workers, the introduction of a new code of conduct and of minimum standards for care workers and the appointment of a chief social worker, and for their aim of doubling the number of care apprenticeships to 100,000 by 2017. In that respect, I commend the excellent work of the apprentices on Cheshire East council’s A-Team, who are already blazing a trail through their apprenticeships as carers for the elderly in our community —soundly rebutting the myth that younger people do not care for our elderly or give them the dignity and respect they deserve.

I also welcome the Government’s proposals to fund adaptations to keep the homes of the elderly safe, because the NHS is estimated to spend £600 million a year treating injuries caused by hazards in inappropriate housing—the majority of cases associated with falls. The Government’s new care and support housing fund of £200 million over five years, to support the development of specialised housing and adaptations of homes, is particularly welcome.

I welcome also the Government’s commitment to abolish per-minute billing for care visits. That will be music to the ears of a distressed care worker who came to my surgery and said that she was seriously considering leaving the profession, because not only was she unable to provide within the time frame allocated the care needed for those she visited, but there was nothing like the necessary allocation of travel time between the homes that she needed to visit. In some cases, they were even in different towns. She showed me her timetable, and I can only say that I entirely agreed with her.

I welcome in particular in the White Paper the Government’s recognition that if we are to address this massive challenge and make a reality of good quality, comprehensive care provision for all, which I am sure is everyone’s aspiration across the House, we will do so only if we harness the energy, resource and skills of the whole community, including community groups, many of which are highly professional and which work very hard to support carers and the cared-for.

I am very pleased that the Government have committed to working closely with Age Action Alliance jointly to find practical approaches to improving the lives of older people; that they have decided to invest funds through Big Society Capital, so that social enterprises, charities and voluntary groups can access greater resources in order to make a difference in communities; and that they have decided to involve those communities in strategic decisions on health and care services through

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local health and wellbeing boards. That will be particularly welcomed by Crossroads Care Cheshire East, whose director told me, shortly after I was elected in 2010, that

“we could do so much more and add so much value if we were more involved in strategic discussions about care provision.”

The Government’s proposals in the White Paper are to be welcomed.

8.43 pm

Mr David Anderson (Blaydon) (Lab): In 1989 I became a care worker after losing my job as a coal miner. I did so almost by mistake, but it was one of the best decisions I ever made, and over the next 16 years, as a care worker and as a representative of people working in care, I came to realise that we can look at care in three ways: we can provide none, provide it on the cheap or provide quality. We cannot do a combination of the three, and I hope that in the Chamber tonight we all agree that, if we are going to do quality care, we need to look after the work force properly, train them properly, treat them like professionals, have them in numbers, respect them, treat them with dignity, have the resources in place and give them some responsibility. They respond to that if allowed to, and the best way they respond is by showing respect for, and treating with dignity, the people they are taking care of, building the trust and confidence not just of those they are caring for but of their carers—their family and their friends who look after them.

I believe that my Government did some good things over their 13 years in office, regardless of what the Minister says, but in truth we did not do enough. In 1999 we set up the Sutherland commission, but we backed down on it—we chickened out. We did the right thing in Scotland, and, yes, it was done under coalition government, but the commission was set up by a Labour Government.

We should have done more, and we have a chance today to do more. My view is clear: why is someone needing care because they cannot take care of themselves different from someone who needs care because they are ill? We never say to anyone who needs physical or mental care on the NHS that they cannot have it, but we do say that to people who cannot take themselves to the toilet, bath themselves or take their medication. We would never do that with children, so why should we do it with the elderly and disabled?

I am clear that there is a cost; of course there is. I want to ask the Minister about some of the things he was saying earlier, and I hope that I get a response. What resources are we going to put in? If there are to be 100,000 apprentices, what will that cost? If there is to be a new code of conduct, what is the implication of that? If there is to be extra training, what will that cost? All those things are welcome, but if we are just going to talk about them and not resource them, we might as well not bother to talk about them.

I would like to have clear in my mind the issue raised by my right hon. Friend the Member for Oldham West and Royton (Mr Meacher). What is the difference between what is now proposed and the death tax that the current Secretary of State so cleverly used during the last election to undermine the stuff that my Government were trying to do? He talked then about £8,000 a year and a saving of £40,000 for everyone. That has all disappeared—it is all under the carpet. Did he mean what he was saying back then and does he mean what he is saying now?

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Yes, if we are going to do this properly, there will be a cost—but we always find the cost of going to war and of extending the nuclear deterrent. In the past week, we have found the cost of taking 3,500 troops off duty to save the embarrassment of the Home Secretary. If we can do all that for those reasons, why can we not do it to take care of the elderly, vulnerable and frail in this country?

We were attacked by the Minister, who said that Labour MPs were moaning and whining on. That is part of the game that we play in this place, but what about what other people are saying? The Care and Support Alliance says that

“the social care system faces collapse”,

while the Alzheimer’s Society says:

“Millions of vulnerable people had been promised vital reform but today they are being massively let down.”

Mencap says:

“this promising blue print will never get off the ground if it fails to address the chronic underfunding in social care.”

Finally, the UK Home Care Association says:

“The Coalition Government’s White Paper has failed the frail and disabled”.

Those are those organisations’ words—not mine, and not my party’s.

Like other Opposition Members, I believe that the only real answer is a care system funded from general taxation. We have a generational chance to make this a crusade, just as 60 years ago people in this House made a crusade for the NHS. I know that some Government Members will say that that has been anathema, because ultimately the NHS—when we get down to the bare bones—is socialism in action. It is socialism delivering for the people of this country. What I want would be exactly that—the strong providing for the weak, not the weak being let down by the strong. We have the chance to do that. It is a challenge for this generation. The question for all of us on both sides of the House is: are we up for it?

8.47 pm

John Pugh (Southport) (LD): I want to be constructive. I fear that this debate may take a different route from that taken in the recent consensual Back-Bench debate. We all recognise that the cost of adult social care is a problem not just for this country, but for every advanced society that we can think of. The outline is fairly familiar: funders, private and public, feel stretched and frightened by demographic change and the elderly are scared and anxious about mounting costs. Treasuries throughout the world are nervous whenever the issue crops up, and normally they vacillate. Last week, the Government were, in part, accused of that—of dragging their feet.

That is nothing new. Back in 2009, following the publication of the Green Paper, there was very much the same thing. The current Secretary of State, who was then the shadow Secretary of State, said:

“One debate always seems to roll into another with this Government. We need a decision, and we need serious, costed proposals to be the basis for that decision.”

The current shadow Secretary of State, then the Secretary of State, said:

“we are putting forward three broad options for the country to debate, and it would be wrong to force the pace of that debate.”

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For the Liberal Democrats, my hon. Friend the Member for North Norfolk (Norman Lamb) said that the Green Paper

“comes 12 years too late. It is this Government’s shameful legacy that they will leave office having failed to reform a system that the Secretary of State”—

now the shadow Secretary of State—

“himself has described as a cruel lottery.”—[Official Report, 14 July 2009; Vol. 496, c. 160-62.]

When social care is viewed as a sustainable enterprise, Governments always see it as involving a big—and, worse still, an uncertain—sum, and that is why Treasuries usually baulk at it and we make very little progress. Governments are far happier in clarifying people’s rights and then passing the buck to local authorities. What paralyses Governments is the potential, not the identifiable, cost—what it is and how we are going to share it out —and that amounts to a huge political headache.

In order to resolve this, we need to do two things. First, obviously, we need to get a handle on the costs; but secondly, we need to work out a way of trying to defray them. Elderly people to whom I have spoken following our recent debates and last week’s statement have spoken in slightly different terms from how we speak here. They are sceptical about some of the Armageddon scenarios. They are resentful about their perceived lack of contribution to society—not in the past but currently. They do not see themselves, en bloc, as a drag on society.

We know that some people incur massive costs because they are frail, disabled, suffer with dementia and so on, and the social, personal and family costs are appreciable, but we also know of many pensioners who make a huge family and social commitment, and some who are even in employment. My predecessor, Lord Fearn, still has a delivery round of 500 copies of “Focus”, as does his wife, and they are both in their 80s. That shows the benefits of delivering “Focus”. We do not know enough, and need to know more, about how we get people into the category of the fit and keep them out of the category of the frail. We need to know why people end up in one category or the other and what the relative costs are of maintaining them there in terms of drugs, treatment and so on. We do not know whether by advocating an active, healthy old age we are deferring costs or eradicating them. The science of gerontology has an appreciable way to go. It is not clear to me, and probably not to many Members, how public health can move people into the better category of the fit and away from the category of the long-term frail.

My main point—to some extent it is not mine, as it was suggested to me by what the hon. Member for South Thanet (Laura Sandys) said in a previous debate—is that even if we accept that there is no way of avoiding the cost of the last years of life and the fact that as people get older their maintenance gets more expensive in terms of calls on the NHS, there is a case for considering whether we should do some serious number-crunching to re-engineer social care in order to sharpen up and prioritise interventions, as we have seen with dementia and arthritis. We do not know at this stage what the true benefits of that could be. I am not quite sure what I mean by re-engineering social care even as I say it, but we need to find out what it means and try to implement it in order to defray the costs.

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8.52 pm

Mr Virendra Sharma (Ealing, Southall) (Lab): Thank you, Mr Deputy Speaker, for calling me to speak in this important debate.

I am often contacted by my elderly constituents and their families about social care and its funding, and I can tell the House that it is a massive worry to many of them. While I welcome many of the “in principle” recommendations in the Government’s White Paper, their lack of commitment to reforming the long-term funding of social care means, in effect, that they are kicking this urgent reform into the long grass. Dilnot recommended capping social care contributions at £35,000 and increasing the means-tested savings figure to £100,000. Supporting that in principle is all well and good, but the fact that the Government are not proposing anything specific until the 2013 comprehensive spending review and not implementing anything this side of the general election means that thousands of my constituents will continue to face anxiety about the potential cost of their social care and a substantial loss of their lifetime savings. One in 10 of them will face catastrophic social care costs of over £100,000. That is not acceptable and shows that the Government are out of touch and ducking the issue.

Social care funding is in crisis. Councils across the country have been forced to cut £1 billion from social care. In Ealing, the Labour council has had its overall budget cut by 30%. With a substantial proportion of its budget being spent on adult social care, it is struggling to protect the most vulnerable, who depend day in, day out on the social care that it provides. It has found 70% of the £85 million that it must cut over four years from efficiencies and has cut a smaller percentage from adult social care to try to protect the vulnerable.

The spend on social care is decreasing while the number of elderly people in need of social care is increasing. The Local Government Association recently released a report on local government financing that made it clear that with the elderly population and the cost of social care both increasing, unless the Government reform social care funding urgently, by the end of the decade, councils will be able to pay only for social care and all other council services, such as refuse collections, will have to stop. That is not a sustainable situation for social care or for other council services. The Government cannot afford to do what they have done in this White Paper. They have not grasped the financial nettle, but have kicked social care funding into the long grass.

One action that the Government could take immediately would be to use some of the £1.7 billion underspend from the NHS—£1.4 billion of which has been returned to the Treasury—to tackle the funding crisis in social care. Labour is sensibly calling for £700 million of that underspend to be given to councils immediately to tackle the crisis in social care funding. That would be a significant step that would help my constituents who have social care needs. The need for a long-term funding solution is critical. I hope that the Government will engage urgently in all-party talks so that a solution can be found without further delay. I therefore support the motion.

8.59 pm

Margot James (Stourbridge) (Con): I will start my contribution with some points that I wanted to make earlier in the debate about the origin of the problems.

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I accept that there are severe problems with adult social care. I do not know where the hon. Member for Leicester West (Liz Kendall) got her figures about the last Government’s record on adult social care spending, but according to local government figures, between 2004 and 2010, spending increased by 0.1%. Meanwhile, the population of over-65s grew by 7.7% and the number of over-80s by 11.6%.

Liz Kendall: I am grateful to the hon. Lady for being more generous with her time than perhaps I was. I got my figures from an independent assessment of Labour’s record in Government that was produced by the King’s Fund before the last general election.

Margot James: I am grateful to the hon. Lady for clarifying that. According to local government statistics, in the six years up to 2010, the spend was flat, and I have mentioned the demographic pressures. Interestingly, the same analysis states that over the same time, NHS expenditure rose by 27%, expenditure on the police rose by 20%, and even expenditure on schools rose by 12%.

A picture is emerging of the deprioritising of adult social care under the last Government. That is the origin of the problem that we are debating. That is what gave rise to the restrictions of the eligibility criteria for care. Long before this Government came to office, many local authorities started to restrict eligibility to those in moderate need of care and then to those in critical need of care.

Mr Anderson: Will the hon. Lady give way?

Margot James: I will give way one more time.

Mr Anderson: I appreciate it.

May I suggest that in criticising the last Government, the hon. Lady needs also to look at the record of the Government before that? Throughout the 1980s and 1990s, the social care and health service budgets were drastically reduced to a degree that was an embarrassment to this country.

Margot James: I welcome the hon. Gentleman’s intervention, but I will move on to the present day, relevant though the NHS and social care budgets of 20 or 30 years ago no doubt are.

We are beset by problems, although I was pleased to hear the Minister confirm that according to ADASS, social care spending has gone down by just 1% in the past year. Given the incredibly difficult economic situation that we are in, much of which we inherited from the previous Government, that is an achievement. However, we do have problems.