The other area that I wish to discuss briefly is the absence of legislation to bring in standardised packaging of cigarettes. That has also been talked up, not only by the Prime Minister but by others. The consultation on standardised packaging started on 16 April last year and ended on 20 August; now, nine months later, nothing is going to happen. I am deeply concerned, and I will tell Members why, although there can be no surprises about me and tobacco, because I have been on an
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anti-tobacco crusade in the House for nearly two decades. In my borough—I represent a third of it—there are still some 48,000 smokers, and although the number is declining, it is likely that more than 950 young people between the ages of 11 and 15 will take up smoking this year, and half of them will die a premature death. This year, more than 100,000 of our fellow citizens will die a premature death from using tobacco as instructed to by the tobacco companies. If half that many people were dying of anything else in this country, this House would be up in arms about such a massive number of deaths. In the past few months, what we have had is Ministers talking up the idea of legislation further to protect young children from starting smoking, but none of that has come about.
Paul Burstow: When the right hon. Gentleman chaired the Health Committee, it published the report that led to the banning of smoking in enclosed public places. That ban was only secured by a free vote in this House. Does he agree that, if we cannot get the Government to act, we need a free vote so that we can make the change in that way?
Mr Barron: I shall be putting my name in the ballot for a private Member’s Bill in a few days. If I am successful as I was in 1993, the right hon. Gentleman will have a Bill on standardised packaging on which to vote.
The Government have ducked the issue. There has been some influence—many people say that Lynton Crosby, who has come along to advise the Government, has had that influence, but I will not make that accusation. I wrote to the Prime Minister last week to ask several questions about whether Lynton Crosby has been involved in giving any advice in political circles in this country. Lynton Crosby is advising the Conservative party about re-election, but I want to know whether he has been involved in this area, given his record both politically with the party that he ran, and with his company’s work with and the money it has taken from tobacco companies.
The right hon. Member for Sutton and Cheam (Paul Burstow) is quite right to say that in 2006, when this House took a decision on smoking in public places, Members of this House had a free vote. I was effectively the architect of that free vote, because I tabled an amendment signed by 10 members of the Health Committee and I negotiated a free vote with my own party, as one was being offered by the then Opposition. On that major public health measure, this House was trusted to take the decision itself. Yes, we were lobbied by our constituents. There is nothing wrong with that—after all, it is what we are here for, although we cannot represent them all, as some people seem to think we can. The House was trusted to make that decision and the then Government, to their credit—they should have been awarded that credit—allowed it to do so. Many people were against that, including the Prime Minister, who has said since that he thinks it is the best piece of legislation that ever went through this House.
I say to Ministers that, whether it is because of strings being pulled by people close to the tobacco lobby or because of anything else, we cannot tolerate their not taking further action against tobacco when it is killing 100,000 of our fellow citizens each year. It is about time that someone showed some courage, stood
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up for ordinary people and for good public health measures—not nonsense measures—and did something to stop the dreadful premature deaths in this country.
4.57 pm
Sir Gerald Howarth (Aldershot) (Con): I must say at the outset that I am disappointed that no day has been set aside for us specifically to discuss defence and foreign affairs, because we face some pretty severe challenges around the world and, of course, our armed forces are undergoing major change. Such a debate would have provided me with a further opportunity to argue that we should not spend another £2.5 billion on overseas aid this year and that we should divert that money to our armed forces, which are very hard-pressed.
James Duddridge: I understand my hon. Friend’s argument, but I disagree with it. I respectfully ask him: what is the right amount to spend on international aid?
Sir Gerald Howarth: It is a question of priorities. Our level of aid is such that the Prime Minister can say, with great justification, that Britain has given a lead in the world, but the figure of 0.7% is entirely arbitrary. I would submit that there is no natural level for the amount of aid to be given. I am not an opponent of overseas aid; I just believe that there should be other priorities at the moment.
I do not wish my speech to be a negative one, and it was written not by Mr Lynton Crosby but by myself. I welcome some aspects of the Gracious Speech. The first is the continuing priority to cut the budget deficit. It was pretty nauseating to listen to the shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), and to hear him demand more money here, there and everywhere. He was part of a Government who destroyed the public finances of this country. That is why we have to make cuts. These cuts are Labour’s cuts across the country, because Labour destroyed the public finances by running up an impossible debt.
Secondly, I welcome the confirmation that we are going to pursue further reforms of the benefits system. It has been most encouraging to see how warmly the country has received our changes, particularly the £26,000 limit on families receiving benefits. The Philpott case was an eye-opener to many, highlighting that far too many people in this country are living a wholly immoral lifestyle on public finance, and we need to crack down on that.
Mr Barron: Will the hon. Gentleman give way?
Sir Gerald Howarth: As the right hon. Gentleman would not give way to me, I am rather disinclined to give way to him.
Mr Barron: Will the hon. Gentleman give way?
Sir Gerald Howarth: I will come back to the right hon. Gentleman in a minute.
Thirdly, I welcome the further attempts to bear down on regulation. We need to do much more to liberate businesses from regulation, but we are, of course, inhibited by Europe, on which I wish to say a few words later.
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Fourthly, the reform of long-term care arrangements has not come before time. I recommend to my Front-Bench colleagues an excellent publication from March 1997 called “A New Partnership for Care in Old Age.” We had a tremendous scheme then, which unfortunately we were not able to implement because power passed to Labour, whose Government did nothing in the 13 years when they had stewardship of these matters. I also welcome the measures to tackle immigration, although I suspect they will have limited effect.
Finally on the good news front, I think the Prime Minister has done a fantastic job of promoting Britain’s interests overseas, particularly in developing overseas trade. We have seen some reflection of that in increased trade with non-EU countries, as against trade with the EU, which, as we all know, is in meltdown.
Two issues were not mentioned: gay marriage and Europe. My hon. Friend the Member for Gainsborough (Mr Leigh) set out why the same-sex marriages proposal is a complete diversion. We should not be doing this: the Government have no mandate for it, it is deeply divisive, particularly among many Conservative supporters, and I think we should drop it here and now.
Immigration is a big issue and it is relevant to this debate, as the Government are seeking to put in place changes to prevent people from benefiting from our taxpayers’ money by coming to this county simply to tap into our health care system. There have been encouraging signs. The observations made by the right hon. Member for Rother Valley (Mr Barron) show precisely what has been wrong in this country, in that anybody wishing to speak up on immigration has been told that their tone is wrong, or this is not the right time, or they are insensitive. His Front-Bench colleagues have now recognised that the kinds of policy he supports have been deeply damaging to his party. Labour supporters are as concerned about immigration as Conservative supporters and, I suspect, Liberal Democrat supporters.
Mr Stewart Jackson (Peterborough) (Con): My hon. Friend is making a powerful case. Does he agree that we should take the blandishments of the right hon. Member for Rother Valley (Mr Barron) in respect of Romania and Bulgaria with a pinch of salt, given that the Labour Government predicted that between 13,000 and 15,000 eastern European citizens would come to the UK, yet over 1.2 million have come here since 2004? Labour got the figures catastrophically wrong.
Sir Gerald Howarth: My hon. Friend is absolutely right. I was going to tell the right hon. Gentleman that some 1% of the Romanian population of working age, which is 150,000 people, have indicated that they wish to come to this country, as have 4% of the 4.9 million Bulgarians of working age, which is another 200,000 people. That is another 350,000 people. We cannot go on building houses and cities. As MigrationWatch has said, we will need eight cities the size of Birmingham if we are going to accommodate all the people who wish to come to this country.
I welcome the fact that the Opposition have at long last recognised that this is a serious issue. They have not a snowball’s chance in hell of being re-elected unless they are prepared to recognise the concerns of the
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British people. Under Labour’s stewardship, there was a deliberate act of policy: Andrew Neather, a speech writer at No. 10, said immigration was being positively encouraged by the Labour Government in order to
“rub the Right’s nose in diversity.”
They knowingly inflicted this on the country—it was not done by accident—and they left this Government with the most awful backlog of cases to deal with, which is unfair to those who ought to be allowed to stay in the UK and to those in our country whose lives are affected by the presence here of people who should have been deported.
Mrs Main: The Select Committee report “Community Cohesion and Migration”, which Labour Members seem to have forgotten about, stressed that second and third-generation immigrants were as resentful as the native British population, because the necessary resources were never provided by the Government, who encouraged so much immigration so fast and without preparation.
Sir Gerald Howarth: My hon. Friend is absolutely right. Immigration is imposing burdens on our services, such as the health service and social services. I am seeing that in my own constituency. We now have some 10,000 Nepalese, mostly elderly, who have come to the United Kingdom as a result of the politicians’ caving in to the campaign run by an actress called Joanna Lumley. That has resulted in a fundamental change to the nature of Aldershot that has deeply upset my constituents, who are entitled to express a view without being told that they are racist. They do not like seeing their locality changed—[Interruption] I wish the right hon. Member for Rother Valley would shut up—because of something on which they were not asked for their opinion. When they do express an opinion, they are dismissed as being racist.
The projection that the United Kingdom’s population is likely to reach 70 million in the next 15 years means, as I said, that we will need to build eight large cities outside the capital during that time—in other words, one home every seven minutes, day and night, just to house new immigrants unless the Government are able to continue their progress in tackling immigration. The 2011 census revealed a mass exodus of white British from the city of London—a fall of 600,000 between 2001 and 2011. Almost half the population of Ealing and Hammersmith were born outside the United Kingdom. These are fundamental changes to the nature of our country. The people of Britain are entitled to express a view on the composition of their country. Last week there was a story in the Evening Standard about Harris Primary Academy Philip Lane in Haringey, where 59% of the 463 children are on free school meals, 79% have English as a second language, and Somali and Turkish are the most prevalent languages. What are we doing to our country? We have to take sterner action, and I recommend that to the Government.
Let me turn briefly to Europe, which the right hon. Member for Leigh dismissed as irrelevant and not a great issue that should be addressed, although he had no answer to the challenge by my hon. Friend the Member for Gainsborough. This issue is not going to go away, and it is of great concern to people in this country. Our European partners are determined to create a united states of Europe, which is not what the people
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of Britain want. The Prime Minister is entirely right to seek to renegotiate. He is also right to have a referendum. Like my right hon. Friend the Member for Mid Sussex (Nicholas Soames), I profoundly believe that he will deliver that referendum after the next election. The trouble is that people are uncertain about whether we are committed to that. The way to deliver it is a new Act of Parliament during this Parliament to determine that there will be a referendum during the next Parliament.
5.8 pm
Mrs Anne McGuire (Stirling) (Lab): It is a pleasure to speak in this debate and to follow the hon. Member for Aldershot (Sir Gerald Howarth), although obviously I would not necessarily agree with all his comments.
I was not going to say anything about immigration, but sometimes we need to look to ourselves when we talk about that subject. I suspect that there is not one individual here who has not had at one point in their background an immigrant who came to the United Kingdom. Those who talk about the “native British” need to reflect on the fact that Britain has always had immigrants—from the Vikings to the Huguenots and from the Dutch to the Irish. My father told me that our family were descended from members of the Spanish armada who were shipwrecked off the north coast of Ireland when they were trying to avoid the English fleet. We need to reflect and have a rational debate about immigration, not the hysteria that there sometimes is in this House.
Mrs Moon: Will my right hon. Friend give way?
Mrs McGuire: Very quickly, because I want to get on to the main substance of my speech.
Mrs Moon: Should we not get some of the figures clear in our heads? According to the Department of Health website, the actual cost to the NHS budget of the amount spent on foreign nationals is a mere 0.06%. This is not something that we cannot afford.
Mrs McGuire: As I have said, I do not want to go down that track but, having been nursed in a UK hospital by non-indigenous British staff, I think we ought to be more balanced in our comments on immigration.
The main focus of this debate—health and social care—is a vital issue for many people; even if they do not think so at present, it certainly will be in the future. As we are all aware, the changing demography and advances in modern medicine and technology have thrown up challenges to our society in how to develop the capacity for social care and, indeed, how to pay for it. The issue is not unique to the United Kingdom; it is a challenge in many countries across the world. As has already been said, the Administrations in Wales and Scotland are developing their own policies in the realm of social care.
Although the legislation under discussion relates to England specifically, I want to discuss some general issues that cut across the debate in the whole of the UK. Like my colleagues on the Opposition Front Bench, I welcome some aspects of the Care Bill, which builds on the work undertaken by my right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, when he was in government. I hope that the Bill will
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simplify the existing regulations, provide some confidence that lifetime assets will not be swept away by care costs, and—I stress that I hope that this will happen—eradicate the postcode lottery of care, introducing an element of consistency to the system. The Bill should also give stronger legal rights to carers—I echo the words of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley)—who are often the forgotten players when we debate social care.
Having said that, there are still some major areas of concern and I want to concentrate on them. Frankly, they throw up challenges for everyone in this House, regardless of which political party we belong to. I am not convinced that the Government have thought through where young carers fit into the big picture painted by the new Bill. It is, of course, a welcome development that, for the first time, councils will have to meet the eligible needs of carers for support. I also welcome the aim for a family assessment, which in some areas should pick up the pressures on young carers.
Many organisations representing young carers, however, feel that many concerns have not been covered adequately. The well-being of young carers very much depends on the level of support that the person they care for—more often than not their parent—receives. If that support is not adequate, an unacceptable pressure remains on young people who should, to be frank, be doing other things. Council budgets are being stretched and care and support is being restricted in many instances to those who have critical or severe needs, so an unacceptable burden is still being placed on young carers who support family needs but who will not meet the new exacting standards.
I do not want to reiterate some of the points that other hon. Members have made about the need to move from the current random method of identifying young carers to a more systematic approach. I want to spend a few moments on the issue of working-age people who need support from our social services. Too often the debate on social care concentrates on older people, but it should not focus on them alone, because the reality is that about a third of people who rely on support are of working age and they are often forgotten. I am sure we will all agree that a younger person’s need for support from the care system is not necessarily the same as that of an older person. To that end, the all-party parliamentary groups on local government and on disability launched a joint inquiry to investigate how social care policy, funding and practice can better meet the needs of disabled adults. The hon. Member for South Derbyshire (Heather Wheeler), as chair of the local government all-party parliamentary group, and Baroness Campbell of Surbiton and myself, as joint chairs of the disability all-pary paliamentary group, were delighted that 10 parliamentarians of all parties and from the Cross Benches in the Lords agreed to undertake an independent inquiry.
The report will be launched officially on Wednesday, so I will not pre-empt its findings. I hope that colleagues will take time out of their schedules to come along and hear what the disabled people, organisations and experts that appeared before the inquiry committee said. The evidence is powerful and I hope that people will read it. When we debate health and social care over the next few weeks, I hope that we will listen to the voices of the people who matter: the people on the receiving end of the system. What they say gives us food for thought and food for action.
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It is well documented that more than a third of the people who receive social care are of working age. We must also recognise that most of the pressure and innovation will be at a local level. It is important that we encourage local organisations and local government to ensure that there is innovation in the system. As my right hon. Friend the Member for Leigh said in his opening remarks, there is a funding crisis in local government that no amount of innovation can mitigate. There is only so much innovation that any system can support without the recognition of financial instability. It is not just Labour councils that are saying that to the Government; councils of all political persuasions are trying to persuade the Government that they cannot continue to support the pressure that is being placed on their social services.
Finally, we have spoken a lot about the cap and the protection of assets. The Government have not been clear about what will happen to people who do not have the capacity to build up assets, and I am talking about working-age adults who are disabled who have not had that opportunity. The overwhelming majority of people with learning disabilities will not be affected by a cap because they do not have an asset base to protect.
I hope that there will be a robust, challenging and honest debate about the future of social care.
5.17 pm
Pauline Latham (Mid Derbyshire) (Con): It is a pleasure to speak in the health and social care debate on the Queen’s Speech, which seems to have been rather wide-ranging.
I pay tribute to the Government for introducing the Care Bill. It shows that they have listened to the concerns of many people. I support the proposals for three main reasons. First, the Bill will put people in control of their care and give them greater choice. Secondly, it will simplify the system and processes to provide the freedom and flexibility that local authorities and social workers need to innovate and achieve better results. Thirdly, it will provide people with a better understanding of what is on offer, help them to plan for the future, and ensure that they know where to go for help when they need it.
The Care Bill is essential to the modernisation of adult care and support in England. One purpose of the Bill is to set out clearly what support people can expect from the Government and what action the Government will take to help them to plan, prepare and make informed choices about their care. I support the well-being principle as an underlying principle for care and the support for carers. However, I urge colleagues in the Department of Health to monitor the implementation of the Bill carefully to ensure that local authorities are completely clear about their responsibilities.
I have a constituent who suffers from an acquired brain injury. His parents sought assistance from the adult care services department of their local authority, Derby city council, and from the primary care trust. Both organisations say that it is the other’s responsibility. That is causing great distress and frustration to my constituent’s elderly parents who are caring for him and his six-year-old child. I have written to both parties, as well as to Ministers in the Department of Health, and so far both have repeatedly refused to take responsibility.
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I have also written to Health Ministers about another constituency case. A constituent of mine is suffering from severe chronic pancreatitis and has been told he needs to undergo a pancreatectomy and an islet cell transplant. However, as the national specialised commissioning group has not issued confirmation of funding for an islet cell laboratory in my region, my constituent is left suffering in extreme pain unnecessarily. I would like to see movement on the two cases that I have raised with the Department of Health.
Over the past three years, I have also raised constituency casework concerning the cancer drugs fund, and I pay tribute to my right hon. Friend the Prime Minister who set up that initiative. Some 23,000 cancer patients in England have benefited from the additional £650 million provided by the Government to fund cancer drugs.
Mel Stride (Central Devon) (Con): Like my hon. Friend, I welcome the cancer drugs fund, which I think is important. About 150 of my constituents will die from cancer this year—about 100,000 people a year. Currently, 15% of 15-year-olds are regular smokers. Does my hon. Friend feel, as I do, that we should have standardised plain packaging of cigarettes to discourage the take-up of smoking and the cancer that results from it?
Pauline Latham: I certainly do, and having watched my mother die from lung cancer, I passionately believe in anything that will stop people smoking. It is not a pretty sight, and I would do anything to stop young people in particular taking up the drug of smoking. That is important.
Sir Gerald Howarth: I am grateful to my hon. Friend for giving way. Our hon. Friend the Member for Thurrock (Jackie Doyle-Price) mentioned the risk from counterfeit tobacco, which is very serious indeed. There are two risks: first that the substance will be less pure than commercial tobacco; and secondly that the Treasury will lose a tremendous amount of money as the result of trafficking.
Pauline Latham: There is already counterfeit tobacco, so I do not see that it would make much difference. Those who are drawn to smoking do not go over and buy counterfeit goods; they start off in this country—often under age—by buying cigarettes over the counter. If we can stop that, I passionately believe we should do so, and I am disappointed that that measure was not in the Queen’s Speech.
The cancer drugs fund is a force for good, but in my constituency of Mid Derbyshire, which was covered by the east midlands cancer drugs fund, I have had constituents who were unable to access cancer drug treatment that was available from other CDFs. In one case, if my constituent had lived just 40 minutes down the road in Burton upon Trent in the west midlands, that CDF would have paid for her treatment. She paid more than £60,000 of her own money, but since I first raised the issue she has sadly died. The reforms introduced by the Government from 1 April this year and the establishment of the national CDF will end the unfair system of the postcode lottery. Under treatments now offered by the new NHS Commissioning Board, if my constituent were alive today, she would have access to that treatment.
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Hugh Bayley: Will the hon. Lady give way?
Pauline Latham: I am running short of time; I am sorry but I must make progress.
I urge my right hon. and hon. Friends on the Front Benches to look again at this matter because the Government have set up the CDF to ensure that people get access to the life-saving cancer treatment they need. I have constituents who need access to a form of radiotherapy called “SIR-Spheres”, which is used where bowel cancer has spread to the liver. That treatment is not now available anywhere in the NHS—people can pay for it, of course—although it was previously available in most CDF areas, although not the east midlands. Will the Minister look again at the issue and meet me and my constituents’ hospital consultant, Dr Jamie Mills, to see whether we can make progress?
I recently started working with the British Heart Foundation on sudden adult death syndrome after I was contacted by two constituents whose son, Sam, died suddenly as a result of cardiac arrest. He was 19 years old. SADS claims the lives of at least 12 young people such as Sam every week, but many of those fatalities are completely preventable. I knew a young man in his 20s who died in the middle of his round in a dressage competition. Like Sam, he was a very fit young man. All such young deaths are devastating for everyone concerned, family and friends alike.
The seconds and minutes after someone has a cardiac arrest are vital to ensuring their survival. Cardiopulmonary resuscitation should be used immediately until a defibrillator can be located. If those activities are used together, the potential for survival is immediately increased. In fact, here in the UK, we currently have only a 20% survival rate—that figure is for all cardiac arrests, not just cardiac arrests among young people—but in Seattle, where there is mandatory CPR education in secondary schools, the survival rate has increased to 54%. I am sorry that my hon. Friend the Under-Secretary of State for Skills in the Department for Education is no longer in the Chamber—he was here a few minutes ago. My suggestion is that, if we roll out a schools programme, we could increase survival rates, as more children are trained to undertake CPR and to follow-up with defibrillators.
I am deeply concerned about those figures. I should like to highlight the pressing need for the availability of life-saving equipment and skills in our schools. In the first instance, will the Department of Health work with local authorities through health and wellbeing boards to urge them to consider providing funding to install automated external defibrillators in all schools and other local authority facilities? AEDs are very simple to use, even for the untrained layperson. Detailed instructions on how they are to be deployed are delivered through a set of simple audio and visual commands. The machines are programmed to administer an electrical shock only if the patient’s condition requires it. In order to prevent mortality as a result of SADS, it is essential that those easy-to-use and relatively inexpensive devices are made available in schools.
Further to the availability of AEDs, it is also extremely important that, through citizenship lessons, children of school age are aware of, and able to administer, life-saving treatment such as CPR. Such a scheme would cost local authorities very little, and ultimately has the potential to save many lives every year. Organisations such as
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St John Ambulance would be able to go to schools to train students and teachers so that they are able to undertake such treatment.
In addition, I should like to point out to hon. Members that the British Heart Foundation provides grants to schools for defibrillators. Many schools are not aware of that. Perhaps MPs on both sides of the House could make schools in our constituencies aware of the grant. I look forward to working with the Department of Health on the issues that I have raised about the cancer drugs fund and on defibrillators.
5.28 pm
Steve McCabe (Birmingham, Selly Oak) (Lab): It is a pleasure to follow the thoughtful speech of the hon. Member for Mid Derbyshire (Pauline Latham).
I congratulate the Government on their fine display of unity on the Queen’s Speech. In all my years in the Whips Office, I cannot recall seeing anything quite like it. In the early days of the Government, the ambition was simple: wipe out the deficit in a single Parliament, set debt on a downward path and restore health to the economy. Hon. Members were to judge success by how the credit ratings agencies maintained the triple A rating. Simple! The Government now claim that their ambition is to cut the deficit by a third, but almost everyone else believes it is more likely to be cut by only a quarter. That is our lot for the rest of the Parliament. Debt is rising, not falling, and triple A credit ratings are but a distant memory.
After the costs in administrative chaos caused by the top-down reorganisation of the health service, which the Prime Minister promised would not happen, the Government are turning their hand to social care. They are right to do so, at least in the sense that social care is a time bomb that desperately needs tackling. My most recent survey of constituents in Selly Oak shows that 73% of them consider care to be an issue of extreme importance, and only 42% think that the quality of care received by someone close to them is satisfactory.
People are struggling—people such as Mrs Hanslow, who cares for her 96-year-old father. She asks only for the odd break, and in the past she has arranged that by phoning a social worker. When she tried that this February, she discovered that the social worker had left. The office said that somebody would phone her back, but nobody did. She phoned again and was told that she needed to make a fresh application; apparently, files and arrangements leave with the social workers these days.
After several abortive attempts, Mrs Hanslow spoke to a nice lady called Wendy, who said that she would sort the situation out. Then a Mrs Collins rang saying that she was arranging for a social worker to come. But guess what? Mrs Hanslow waited in all day and no one came. Frustrated, she rang again and spoke to a Jackie, who could find no record of her application or complaint but said that someone would ring her back. No one rang, so Mrs Hanslow phoned again. This time, people at the office were not so nice. Mrs Hanslow was told that nothing had been reported because the social worker was out of the office.
Pauline Latham: What the hon. Gentleman is describing is the fault of the local authority, not the Government. The local authority is responsible for social workers, not the Government.
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Steve McCabe: Bad practice is a problem everywhere, and everyone has to take responsibility for it—that is my point.
When Mrs Hanslow got upset and said she would have to cancel her break and lose her deposit, she was told, “That’s up to you.” She did not get her respite care. She is now under the care of the GP, and if she cannot carry on, we will need to find a bed for her dad. Perhaps he will become another bed blocker; there are so many in Birmingham that the brand new Queen Elizabeth hospital cannot cope and emergency wards in the old hospital, scheduled for closure, are reopening.
What about my constituent Margaret McGarry? She has cared for her elderly mother, who now has 9% kidney function and has had a dementia score of six, for about 10 years; if it was not for Ms McGarry’s love and care, her mum would probably be dead. In 2004, her mum received direct payments from Birmingham, which enabled Ms McGarry to hold down her job as well as look after her. The family then moved to Redbridge, but Redbridge decided that Ms McGarry’s mum was Birmingham’s responsibility. Ms McGarry pointed out that she was the carer and that her mum lived with her, but that was not the case as far as Redbridge was concerned. Eventually, the council offered the equivalent of six hours of support, as opposed to the 34 that Birmingham had provided.
Last year, after a hospital experience that almost killed her mum, the family moved back to Birmingham. Ms McGarry’s mum now needs almost constant care. That means another assessment, which takes weeks and weeks. As soon as they moved, Redbridge council terminated the payments. Birmingham’s assessment commenced in August. In November, it recommended fewer care hours than Redbridge and by December still had not paid a penny. As the old lady’s health deteriorates, so does the level of support.
I have had a letter from the man in charge assuring me that the case is complex. One of the complexities seems to be that Ms McGarry has exercised her rights and engaged a solicitor. Apparently, that is a very naughty thing to do if a person is caring for an elderly relative because Ms McGarry has now been advised that all direct payments are being stopped. That is the reality of social care in this country today, and it is against such nonsense that we are asked to have faith that the Government are going to give people more rights. We are asked to accept that £150 million and promises from the Secretary of State will fix the problem. It may have escaped the Government’s notice, but the most recent round of cuts took a further £800 million out of services for the elderly and disabled, on top of last year’s cuts. When will it dawn on the public relations boys in No. 10 that it is pointless pretending they are giving people more rights when they are cutting services to the bone?
Let us examine what the Government are actually doing. They say they are setting a cap at £75,000—£72,000 in the first instance—raising the savings limit to £123,000 and giving a guarantee that no one will have to sell their home. Of course, £75,000 covers only the costs of care, not what is called hotel costs, such as food and accommodation. The cap is not, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) pointed out, the amount the individual spends, but the amount a local authority can buy for £75,000. When we add the real costs of residential care, rather than the
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local authority rate, to the hotel charges, it is much more likely that an individual will spend at least double that amount before the cap kicks in.
The £123,000 savings threshold means that anyone who has capital, including an empty home, will have to pay all their care costs until the cap is reached. That only leaves the guarantee that no one will be forced to sell their home—except that since October 2001 no one has been forced to sell their home. The previous Government introduced the deferred payments scheme and, in 2009, advised local authorities that if they failed to recognise the scheme, the courts would almost certainly rule their actions illegal. No interest is charged on deferred payment arrangements while a person is in receipt of care, or for 56 days after their death. The Government intend to make the existing arrangements compulsory, but also apply interest charges from the moment the scheme is activated. While questions remain about who will qualify, it is estimated that most of the additional subsidy will go to the richest 40% of people in the care system. That is what is wrong with the Government. The Government are built on falsehoods: falsehoods about the unity and purpose of the coalition; denial about the real state of the economy; and policies that are more about UKIP than the UK. We need genuine reform. That is what a decent Government would put in the Queen’s Speech.
5.37 pm
Mr Robert Walter (North Dorset) (Con): I would like to talk on two issues that, although not included in the Queen’s Speech, will come before the House in this Session, one of which needs to be addressed with some urgency.
In 2005, the European Court of Human Rights ruled that Britain’s automatic blanket ban on the right of prisoners to exercise their vote was incompatible with the convention on human rights, of which we are a signatory. Almost eight years on, the United Kingdom has still not acted on that ruling and time is running short. The Government must submit their response to the Council of Europe’s Committee of Ministers by 30 September. We have less than five months to prepare and present a formula that will be not only satisfactory to the Committee, but acceptable to Parliament and credible in the eyes of the British public.
I would like to state from the outset that I disagree with the ECHR ruling. I believe that the current ban on prisoner voting, which was ruled on and reinforced by successive Parliaments, is a proper and proportionate response following conviction and imprisonment, and I spoke and voted accordingly when the House last debated this matter. I repeat that to my mind the right to vote is not an intrinsic right, but a civic duty reserved for responsible citizens. However, we cannot talk of individual duty and responsibility in the eyes of the law while shirking our national obligations to uphold the international rule of law, one of the basic tenets of British foreign policy. Here is the troubling paradox: if, as the old maxim goes, no man is above the law, surely no country is either. I welcome the fact that this Government, unlike their predecessors, have recognised this responsibility, and I am pleased that the draft Bill on prisoner voting has been presented and that a Joint Committee will consider its options, but I am concerned that matters are progressing slowly against a swiftly approaching deadline and that we are not making a strong enough case for a pragmatic solution.
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If the Government choose to maintain the status quo, we will stand in breach of the convention. If we ignore the judgment, we send the message that dissent is an acceptable state of play, and we would damage our reputation and lose the moral authority to demand compliance from those countries that persistently violate international law. Do we want our record on observing the rule of law compared with that of Russia, Ukraine, Turkey, Azerbaijan and Armenia? It would be neither right nor desirable, but a solution might be closer to home than we think.
Before the blanket ban came into force under the Representation of the People Act 1969, limited forms of prisoner voting were permissible and even practised. The Forfeiture Act 1870 disqualified convicted felons from voting, but only those serving a sentence exceeding 12 months. Felons serving less than 12 months could legally vote, and where it was practically and logistically possible, some indeed did. In the 1950 general election, for example, postal ballots were returned from prisoners in jails across the country.
There is more. When the Criminal Law Act 1967 abolished the distinction between felonies and misdemeanours, the concomitant disqualification on prisoner voting came temporarily to an end. In fact, all prisoners could vote. In effect, these prisoners had the right to vote, and it might surprise people that this was not an unintended consequence of the legislation, but a conscious decision based on a recommendation by a law review committee that the practice of prisoner disfranchisement should not continue.
That policy continued until a ban was introduced in 1969 under the Representation of the People Act, but the point is that the issue was not historically set in stone—not under the Forfeiture Act and not when the United Kingdom signed the convention in 1950—so past precedents should lead the way. To this end, the Government’s proposals on minimum thresholds are worthy of consideration, as they reflect an approach that was deemed compatible with UK law, public opinion and the convention, but we need to step up the dialogue.
How, then, do we move forward? I believe that the distinction between felonies and misdemeanours is obsolete, but the classification of crimes into indictable and summary offences, which distinguishes between grades of crime, mode of trial and punishment available, continues to apply. Like the old felonies, the most serious indictable crimes are tried before a Crown court, and I believe that this distinction could be used as a building block for a sentence-based solution that recognises the gravity of an offence committed. This is a route that we should consider, and the United Kingdom now has an advantage: the European Court recently reaffirmed its commitment to allowing the UK greater flexibility in how we apply the ruling, providing an opportunity to develop a policy that reconciles both principle with pragmatism and which allows our past to pave the way forward.
Mr Christopher Chope (Christchurch) (Con): I think my hon. Friend has made a constructive contribution, but would he accept that what he is saying is totally at odds with what the people of this country believe? They do not want prisoners to have the vote and they do not see why European judges should be bossing them around and telling them otherwise.
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Mr Walter: I do not see why European judges should be bossing us around either, but if we stick to the principle that we should do nothing that we did not already do when we signed the convention back in 1950, then we have a pragmatic way forward to deal with the problem.
I said I wanted to deal with two issues. I want to say a few words to those of my colleagues who are often banging on about Europe. Let me remind them that divided parties do not give the electorate confidence and are generally not re-elected. If those colleagues genuinely want a referendum, they should rally behind the Prime Minister, who has a clear commitment to address the European Union’s institutional deficiencies and to get a better deal in Europe and then put that to the people of this country in a referendum. Carrying on in this mode is a sure-fire way to give Nigel Farage job security, for we will keep UKIP in business for ever if we undermine the Prime Minister and lose the next election. Perhaps some of my colleagues enjoy banging on about Europe and are not interested in the Prime Minister’s endeavours to find a solution, but they will have plenty to bang on about if we have another Labour Government. If they sincerely believe that what we want is a referendum on Europe, let me tell them that the only way we will achieve that is to return a Conservative Government. Therefore, I shall not support the amendment that has been tabled, although not yet selected; I shall definitely be supporting the Prime Minister.
5.46 pm
Stephen Timms (East Ham) (Lab): I am pleased to follow the hon. Member for North Dorset (Mr Walter). He is right: we have heard a wide variety of views about Europe from the Government Benches in this afternoon’s debate. The most compelling case was the one set out in the first Back-Bench contribution, by the right hon. Member for Mid Sussex (Nicholas Soames). He made a compelling case for the UK to remain in the European Union. He was also right to make the point that what his constituents are really concerned about is the state of the economy.
That is the background to the Queen’s Speech. There is wide anxiety across the country because of our economic difficulties—rising unemployment and falling living standards. Their root is in the global financial crisis that has engulfed us and others, but they have been compounded by the failure of the Government’s economic policy to deliver what we were promised it would. We were told—I remember the Prime Minister telling us this three years ago—that the policy would deliver steady growth and falling unemployment. Instead, we have had no significant growth since, and unemployment has stayed high. It is rising at the moment and is forecast to become higher still later this year. We will get an update on Wednesday, but the key backdrop to the rather thin Queen’s Speech that we are debating over these few days is rising unemployment, falling living standards and the inability of the Government’s economic policy to deliver what we were told it would.
There is also a lot of anxiety about what is happening in the health service. That was clear from a survey of 1,700 nurses, the findings from which were published in the Sunday Mirror yesterday. Fifty-five per cent of them said things had got worse in the NHS since the election, compared with 6.5% who said they had got better.
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More than half the nurses surveyed said that morale in the national health service was either poor or at rock bottom. Rather startlingly, more than 40% said that there had not been enough staff to provide safe cover on their most recent shift. It is quite difficult to reconcile that description of what is happening in the health service—which tallies with some of the things we have heard in this debate about what is happening in hospitals—with the rather rosy picture that the Secretary of State presented to us at the beginning of the debate.
When this Government were elected, they criticised the health service targets that had been set under Labour, but there is no doubt that some of the targets delivered massive and very welcome improvements. In particular, the target for 98% of accident and emergency patients to be seen within four hours was very valuable. I was pleased to hear the Secretary of State affirm its value this afternoon. Before it was introduced, I regularly saw constituents who had experienced terribly long delays in accident and emergency. It was not unusual to hear from people who had been kept waiting all night, for example, but when the target was introduced the problem was resolved completely, and remarkably quickly.
After the election, this Government weakened the target from 98% to 95%. I am glad that there is still a target in place, but, as I said to the Secretary of State in an intervention earlier, there are growing signs that it is not being hit. The NHS in England has now missed the new, reduced target for major accident and emergency units for 32 weeks running. I hope, as he has reaffirmed the importance of the target today, the right hon. Gentleman will take steps to ensure that it can be delivered rather than be missed.
I want to mention two other parts of the Queen’s Speech. My first point is not a matter for the Ministers on the Front Bench today, although it is likely to be of some interest to them. The Mesothelioma Bill, announced last week, is the culmination of a process begun by the last Government, in which my noble Friend Lord Mackenzie played an important role. The plan was for the insurance industry collectively to compensate the victims of diseases caused by exposure to asbestos during their employment, often many years previously. Problems have arisen when the original employer’s insurance policy cannot be found.
The Bill is starting in the other place. I was struck by a report in The Independent on Sunday—not yesterday, but the week before—that the proposal had been so
“watered down after extensive lobbying from the insurance industry”
that it would help only a fraction of the victims, and that payments would be 30% lower than was standard. The report went on to say:
“Department for Work and Pensions minister Lord Freud met insurers 14 times about asbestos between October 2010 and September 2012. Over the same period, he met victims’ groups twice.”
It also stated that the scheme would apply only to people with mesothelioma and not to the similar number of people affected by other conditions caused by exposure to asbestos, and that one of the victims’ groups had described the Bill as an “insult”. As the Bill goes through the other place and then through this House, I hope that the Government will accept that many of us want to see a fair settlement for asbestos victims, rather
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than a scheme that simply minimises the costs to insurers. We know what a terrible disease mesothelioma is, but the other asbestos-related conditions are also very troubling.
I also want to comment on the commitment in the Queen’s Speech to ensure that
“it becomes typical for those leaving school to start a traineeship or an apprenticeship, or to go to university.”—[Official Report, 8 May 2013; Vol. 563, c. 3.]
I do not know what that means. I searched through the speech made by the Secretary of State for Business, Innovation and Skills on Friday without finding any illumination of that commitment. Indeed, when my hon. Friend the Member for Streatham (Mr Umunna) responded, he accurately described the proposal as “vague”. It is not at all clear what “typical” means in this context, for example.
I was in Germany with the shadow Secretary of State for Work and Pensions, my right hon. Friend the Member for Birmingham, Hodge Hill (Mr Byrne), last month. In the jobcentre in the town we were visiting, we were struck by the fact that young people were expected either to be on their way to university or to have an apprenticeship place arranged by the age of 15. For the 20% of youngsters who are not in that position, the jobcentre sorts it out for them. I hope that we can do something similar here.
Sir Gerald Kaufman (Manchester, Gorton) (Lab): On a point of order, Madam Deputy Speaker. I am sorry to interrupt the debate, but I need to raise a matter of extreme urgency. At the weekend, a constituent of mine, Augustine Umukoro, came to my surgery to consult me about his immigration situation. He handed me a letter and told me that he had had a meeting with representatives of the UK Border Agency, who said that in two weeks they might have to start removal proceedings, for which they would visit him and his family—his wife and their two children—in their home. I therefore dictated a letter to the Home Secretary today, asking her to look into the matter. Within the past hour, I have had a telephone call from Mr Umukoro to say that when he reported to the UK Border Agency office at Dallas Court in Salford, as he does every week, he and his children were taken into custody. His wife was not, as her whereabouts appeared to be unknown. He was taken down to Heathrow, and he is due to be removed from this country at 10 o’clock tonight without any warning and without the Border Agency having fulfilled any of its conditions.
I took the matter up with the office of the Minister for Immigration, the hon. Member for Forest of Dean (Mr Harper), half an hour ago. His principal private secretary told me that, as far as he knew, the Minister was content for the removal to go ahead. This is not a removal; it is a kidnapping. It is against every aspect of the rule of law in this country, and I am making it public because it is about time that acts such as these were stopped and because, in this particular case, Mr Umukoro should be allowed, through his Member of Parliament, to make representations.
Madam Deputy Speaker (Dawn Primarolo):
As the right hon. Gentleman will know, that is not a point of order for the Chair. He is an experienced Member of Parliament, and he has placed this important issue on the record today, which I suspect was his intention. I am sure that he will continue to hold discussions with
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the relevant Minister right up to 10 o’clock tonight. This is not a matter for the Chamber or for the Chair but, as I have said, I know that he will wish to pursue it elsewhere.
5.57 pm
Sarah Newton (Truro and Falmouth) (Con): The inclusion in the Queen’s Speech last week of a Care Bill in this new Session of Parliament is nothing short of a landmark occasion. Those of us who have been concerned with the reform of our social care system for decades know that those desperately needed reforms, which are well summarised in the Bill, have repeatedly been kicked into the long grass or filed under “Too difficult to do”. Finally, however, we are making progress.
I have been disappointed by the response to the Bill from Labour Members, who know as well as I do how welcome the proposals are, and what a step forward they will represent for the quality of life of many thousands of people in this country. It was a courageous decision by the Government to introduce the Bill at this time, given that public finances are under enormous pressure as we try to clear up the mess of the financial legacy bequeathed to us by the Labour Government, because the reforms will require additional public finances.
In the last Session of Parliament, excellent work was done by the group of Members of both Houses in undertaking pre-legislative scrutiny of the draft Bill. That was a good example of how people can bring the experience they have gained outside Parliament into their work as legislators. I am grateful for their consideration of my contribution and the subsequent inclusion in their report of my recommendations. The recommendations resulted from work undertaken with a number of Members across the political parties who worked with the charity Macmillan, looking at what could be done to improve the quality of care of people who want to stay at home at the end of their lives. Ensuring people have a genuine choice over where they die is of particular importance to me.
Last year, I chaired a round table event in Parliament, organised by Macmillan Cancer Support, which brought together carers, health and social care professionals and policy makers to discuss how to enable more people to be cared for at home until they die, if that is what they choose. The expert attendees were clear that access to basic social care support can make the difference between somebody dying at home surrounded by their families or dying in an expensive hospital ward. All too often, however, patients and families cannot access the support because of a lack of integration of health and social care systems or because they cannot afford to pay for it.
I believe that removing the social care means test for people on the end-of-life care register would lift a significant barrier to the integration of care, allowing many more people to access the support they need and to exercise choice, which could also save the considerable costs of people being in hospital. The Government’s commitment, made in the care and support White Paper, to assess free social care at the end of life through the palliative care funding review pilots represents very good progress. However, with the Care Bill likely to become an Act before the pilots finish in 2014-15, it is also crucial that the Bill allows for the delivery of free social care at the end of life. This would enable the Government to implement the policy without delay, once the pilots report.
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I understand from the responses I have received to written questions that the Minister is undertaking a review of the pilots this year. I very much hope that clauses will be added to the Bill to enable free social care for those at the end of life. Such a step forward would be welcomed by professionals and families alike. It would make such a difference to families at such a difficult time of their lives.
Another specific aspect of the Bill I would like the Minister to consider—together with the Under-Secretary of State for Work and Pensions, the hon. Member for Wirral West (Esther McVey), who has responsibility for disabilities—is social care for working-aged adults with disabilities. The debate about the future of our adult care system has very much focused on the elderly and their family and carers. I am as guilty as anyone else of focusing on the injustices in the current system for elderly people and the need for a fairer and better system, but the care system has another group of people who need support: adults who acquire a disability through an accident or an illness. They might not have been working long enough to have savings that they can spend on their care needs and they might have a degenerative condition that has prevented them from working full time. For them, reform of the current system is less to do with how they can protect their assets or how they can pay for care without selling their homes than with how they can get the help they so desperately need.
The definition of eligibility for care within the Bill is of greater importance than the means-tested threshold and the caps on personal expenditure. We must have a realistic threshold of eligibility, so that people can participate in society as a whole—in education, as volunteers or as employees.
As the Minister will be aware, some local authorities have, sadly, chosen not to spend the money provided by central Government on the adult social care budgets and have been increasing the eligibility criteria. The Dilnot commission highlighted this concerning trend, and I know that Ministers listened. I understand that the Department of Health is working on amendments to the fair access to care criteria currently used by local authorities. The amendments are reflected in the Bill, which includes new interim eligibility criteria. Concerns have been raised, however, that the interim criteria will not address the continuing shift of social care provision away from those with moderate needs. Research undertaken by the London School of Economics indicates that 105,000 people could lose eligibility if the Government move ahead as proposed.
Mr Ward: Is the hon. Lady aware that in 2005, 50% of local authorities were setting the level at a substantial 84% for the move from “moderate” to “substantial” needs?
Sarah Newton: The hon. Gentleman makes a very good point, which illustrates the findings of the Dilnot commission.
I urge the Minister to consider this further and to ensure that the final interim criteria agreed upon, which will be in the Bill, recognise the very real care needs of those who fall into the moderate care category within the current fair access to care system. We found from the report we received on Friday on the Government’s consideration of what improvements might be put into the Bill that they have agreed to look at the eligibility
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criteria and to fund the proposals under the June comprehensive spending review. All that is very welcome. I hope that, once the criteria and the funding to support it have been agreed, the money passed over to local authorities will be ring-fenced for a period, perhaps up to three years. The Government have done that for public health, and doing it in this instance would enable the estimated 105,000 people who have moderate care needs to receive the funding and to continue with their working and volunteering lives, playing their full part in society.
I am sure that the Minister of State has been listening closely to the organisations that represent people with disabilities. I am also sure he supports the excellent vision and work of the Minister with responsibility for disabilities that aims to enable people living with disabilities to play as full a part in society as possible. I very much hope that, as this Bill passes through the House and is further scrutinised and consulted on, we will address the concerns of these groups of people who all too often fail to have their voices heard.
The Government have listened hard to the needs of elderly people and have produced a good way forward. These straightforward and common-sense improvements will make a hugely positive contribution to the lives of people at the end of life and those of working age who are living with disabilities. Those people are often living out of sight; we must show them that they are not living out of our minds.
6.6 pm
Chris Ruane (Vale of Clwyd) (Lab): I wish to speak on four matters in today’s debate on the Queen’s Speech. The first—heart-related issues—has already been mentioned by my right hon. Friend the Member for Rother Valley (Mr Barron) and by the hon. Member for Mid Derbyshire (Pauline Latham), who is no longer in her place. I am the chairman of the all-party parliamentary group on heart disease, which was set up 12 years ago. I give credit to the Government for consulting on minimum pricing of alcohol and on plain packaging for cigarettes and tobacco. Both those consultations have been good, engaging MPs from all parties and, indeed, the wider community, but the Government have lost a golden opportunity to put these measures in this year’s Queen’s Speech.
Over the past 10 or 12 years, we have had a fantastic record on heart disease, with deaths going down by 46%. We have taken some big and bold decisions: for example, the Labour Government passed a measure to ban smoking in public places; we also introduced statins, which are largely responsible for the 46% drop in heart-related deaths. We must keep up the momentum, however, and minimum pricing of alcohol and plain packaging of cigarettes could have helped us to do so.
Each year, about 11,000 10 to 15-year-old children in Wales take up smoking. The industry wants to catch those smokers young and keep them smoking until they are 55, 65 or until they die, in order to keep up profits. Those young people have been deliberately targeted. The hon. Member for Mid Derbyshire mentioned the use of defibrillators and the teaching of resuscitation skills in schools. If the Government made progress on those, it would help to keep up our excellent momentum on tackling heart disease in the UK.
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Many Members have touched on immigration and some have connected it with the health service. There will not be one of us in this Chamber whose life has not been touched by an immigrant worker in the NHS. My doctor for 25 years, Dr Rao—sadly, now passed away—came from the Indian subcontinent, while the man who delivered my first-born child was an Egyptian consultant, and I am really grateful to both of them. If all the immigrants working in the national health service left tomorrow, our national health service would collapse. I pay tribute, too, to the Filipino workers in the care sector—lovely, family-orientated people, who have great respect and great compassion for the elderly. Immigration is an issue throughout the country and we need to reflect concern about it in Parliament. What we do not need to do is add to it. We certainly do not need to whip it up, as I feel some Members have done today.
I praise the hon. Member for Mid Derbyshire for what she said about cancer treatments. I pay tribute to the work of my constituent Mike Peters, a friend of mine, who has had cancer twice in his life and currently has a chronic leukaemia condition. Mike is spearheading an international campaign to increase the number of donors of matching blood cells for leukaemia treatment. He has set up two organisations, the Love Hope Strength Foundation and Delete Blood Cancer UK. He is a rock star who is a lead singer in The Alarm and Big Country, and he tries to recruit people when he sings in countries around the world. He has personally recruited 35,000 donors, mainly in America, through his concerts, and 500 people’s lives have been saved as a result.
Mike is holding an event in Room R in Portcullis House on Tuesday 4 June. Anyone—any Member of Parliament!—aged between 17 and 55 will be welcome to become a donor. All it takes is a mouth swab. The DNA is then kept on file, so that anyone in this or any other country who needs stem cells will be able to gain access to them. Let me again pay tribute to the work that Mike Peters has done.
I now want to say something about how mindfulness can help with problems related to health and social care. Members may ask “What is mindfulness?” Mindfulness is an integrative mind-body-based approach which helps people to change the way they think and feel about their experiences, especially stressful experiences. It involves paying attention to our thoughts and feelings so that we become more aware of them, less enmeshed in them, and better able to manage them. It uses breath as an anchor to slow down the mind and body and to help us to live in the present moment, rather than being chased by our past or worried by our future. It is the perfect way to combat stress—and the impact of stress on heart problems, cancer and mental health conditions is massive.
Members may think that that sounds a bit airy-fairy, but the National Institute for Health and Clinical Excellence has backed mindfulness as a better way of treating repeat-episode depression than drug therapy. It puts the individual in control. It is as cheap as drug therapy in the short term, and cheaper in the long term. It has no known side-effects, and, if taught early enough, it is preventive. Let me give the House some statistics. A total of 32.3% of people aged between 15 and 25 suffer from one or more psychological conditions. Every Member in the Chamber will know someone with such a condition, perhaps even a family member. In 1991,
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9 million prescriptions for anti-depressants were issued; in 2011, 46 million were issued. That is a 500% increase in 20 years.
Mrs Moon: As my hon. Friend says, one of the problems on which we need to focus is depression among young people. Young people oppose the idea of taking anti-depressants. Will my hon. Friend say something about the importance of mindfulness in enabling them to build up their self-awareness, their self-confidence and their ability throughout their lives to handle possible recurring depression?
Chris Ruane: I know that the incidence of suicides among young people is a particular issue in my hon. Friend’s constituency, and mindfulness has a role to play in that context.
Many Members have mentioned compassion today. Mindfulness can help to give compassion to the individual and also to the health care worker. If compassion is lacking, mindfulness can enhance it. It can be used within the health care system, and has been taken up by doctors who are then in a better position to relate to their patients. Earlier this year there was a mindfulness session in the House of Commons for Members of this House and the House of Lords, and another will begin on 4 June.
Mindfulness can help in a personal capacity, but it can also assist the development of policy in prisons—85% of prisoners have mental health conditions—in education, in the armed forces, in the police and fire services, and in any area where there is trauma. It can play a big role throughout society and in all departments. I urge the Department of Health to recognise that, to act on NICE’s 2004 recommendations, and to ensure that the use of mindfulness for the treatment of repeat-episode depression is fully implemented. I also urge the Department to consider carefully its possible use in other parts of the national health service.
6.16 pm
David Tredinnick (Bosworth) (Con): It is a pleasure to follow the hon. Member for Vale of Clwyd (Chris Ruane). I entirely agree with what he said about mindfulness and the need for NICE to ensure that it is available for the treatment of stress in particular. That is all the more important now that we have a Government who have put patient choice at the heart of the health service, a fact that will become more and more evident as health and wellbeing boards and Healthwatch start to make an impression through the Health and Social Care Act 2012.
Like the hon. Gentleman, I intend to focus exclusively on health issues. I shall concentrate not on what is in the Queen’s Speech but on what is missing from it, particularly the expected statutory regulation of herbal therapies. If we are to ensure that the range of treatments that people demand, including mindfulness, are safely regulated in the health service, we must tackle the issue of herbal medicine, which is a crucial tool in our cupboard.
At this point, I must declare an interest. I was involved in the legislation applying to the last two groups that were made subject to statutory regulation, the Osteopaths Act 1993 and the Chiropractors Act 1994, as a member of the Standing Committees that considered those Bills. Let me emphasise to Ministers how important it is to take that route. It makes practitioners focus on a disciplined
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structure and operate a robust complaints procedure, it makes it easier for doctors to refer, and it makes treatments more widely available.
When it comes to herbs, we need an interface with European legislation. We must deal with regulation 3(6) of the Human Medicines Regulations 2012, which grants “a person”, not a therapist, the right to practise. What worries me is that Ministers may regulate not therapists but specific herbs. There are thousands of them out there, and that cannot be satisfactory. We must give therapists the right to prescribe. In the case of traditional Chinese medicine, for example, most practitioners will prescribe three herbs to work in conjunction. As I have said in the House before, it works like the Whips Office: there is a chief, a deputy and a messenger. The messenger takes the chief and the deputy to cure the problem. My hon. Friend the Member for Rochford and Southend East (James Duddridge) laughs; of course, that does not always apply to Whips.
My greatest worry is this: I believe that the statutory regulation has been blocked by vested interests in the orthodox medical community who have said to the Secretary of State “We do not want this, because it will enhance the status of herbal therapists.” If that is true, it is selfish and stupid.
A sub-set of the problems lies in the fact that there are two types of herbal therapies. There is the phyto therapy provided by Hydes Herbal Clinic in Leicester, which I believe is in the constituency of the hon. Member for Leicester West (Liz Kendall), and there is traditional Chinese medicine, which involves the use of different types of herb. We need separate registers to make sure that these therapies are prescribed safely.
It is interesting to see the headlines that are appearing now. The hon. Member for Vale of Clwyd talked about doctors using mindfulness. One headline states, “GPs prefer herbal remedies to Prozac, says survey”, and one such cited remedy is St John’s wort, which in fact has side-effects if used with other, conventional, medicines. One reason why I want statutory legislation is to make sure that people who are taking herbal medicines can go to their doctors and say, “Yes, I am taking it, and doing so under the prescription of a statutorily regulated practitioner.”
I should say in passing that the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), who has been dealing with this issue, has graciously offered me a meeting to discuss it further, and I look forward to taking him up on that.
Provision was made in the Health and Social Care Act 2012 for the Professional Standards Authority, which should regulate all complementary therapies other than those provided by individual practitioners, who are regulated under individual legislation. The Society of Homeopaths, which I have supported for years, should be regulated too. Here, we are completely out of line not just with Europe but with Asia and America. We have not used enough of such resources. It is patently absurd to say it is all placebo, given that in Europe 40,000 physicians practise homeopathy, in Asia, 250,000 physicians practise it, and it is practised in Brazil, Nigeria and America. It is not a placebo, because people are using it. One can fool some of the people all of the time and vice versa, but not all the people all of the time.
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The other reason why those who oppose such therapies make some headway is they refer only to homeopaphy randomised control trials. Sixty-four of 156 have been positive, and only 11 negative. We should also consider meta-analyses and patient-reported outcomes. Where double-blind placebo-controlled trials are conducted, they are ignored.
Just a few centuries ago, scientists were saying that the sun went round the earth; now, we know that the earth goes round the sun. Science changes. Here, we should bear in mind what is known as the Semmelweis reflex. When a doctor in Germany discovered that child mortality rates could be reduced if doctors washed their hands, conventional practitioners pooh-poohed the idea, but eventually it became the norm. We have to be progressive, and so it is with some homeopathic remedies, which are so dilute that they cannot be seen through conventional analysis. However, the fact is that those very dilute substances work effectively. The future lies in a wider range of health provision across the health service.
I want to finish with an e-mail I received today:
“Dear David,
From browsing the web I hear you are cynically referred to as the honourable member for Holland and Barrett.”
Yes, a Labour Minister many years ago called me that. The e-mail continues:
“If those who jeer had survived a life debilitating illness like Parkinson’s for twenty years, I would have more time for them.
I have done this while trying to escape the unsolicited attentions of a family populated with several consultants and even more GPs… Alternative therapies like homeopathy, acupuncture, herbs and now helminths are the reason I am alive today.”
6.24 pm
Alison Seabeck (Plymouth, Moor View) (Lab): It is a pleasure to follow my hon. Friend the Member for Vale of Clwyd (Chris Ruane) and the hon. Member for Bosworth (David Tredinnick), who care passionately about health care in its widest and broadest sense.
This Gracious Speech is unprecedented. I cannot recall in all my years of working in this place, dating back to 1977, another instance of a Prime Minister saying it is okay for their party to vote against the Government’s programme. I cannot see the late Baroness Thatcher condoning such a move. This coalition Government are in meltdown, and the public must be wondering whether any of the proposals in the Queen’s Speech have the wholehearted support of their Members.
That said, there are measures in the health Bill that could and should be shaped and improved on a cross-party basis. It is therefore important that adequate time be allotted for the various debates and the Committee stage. The proposed programme is hardly onerous, so the guillotining of Bills should not be required—unless the Government decide that they dare not encourage full debate, and chicken out. We shall see.
Before moving on to the health-related elements of the Gracious Speech, I would like to mention the draft consumer rights Bill because it revisits the private Member’s Bill introduced by my father—Michael Ward, who was a Member of Parliament—which became the Unfair Contract Terms Act 1977. He was supported by the
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late David Tench in enacting what was groundbreaking consumer legislation. Lord Denning, the then Master of the Rolls, described it as
“the most important change in civil law”.
My father would, if he were alive, be very keen to ensure that the streamlining and simplification process in bringing together so much consumer legislation does not water down consumer rights.
There are a number of health-related proposals in the Queen’s Speech. In Plymouth—a mesothelioma hot spot because of the nature of its industrial base—people will welcome the further progress that has been made on speeding up the process through which insurance companies accept liability and pay compensation. However, for too many of my constituents progress has been tragically slow: they have not survived this awful disease long enough to benefit from the legislation. We have a moral duty to do everything we can to support the victims, and we need to ensure that the Bill, which has had a very slow gestation—it was discussed under the last Labour Government—does what it says on the tin and guarantees faster pay-outs. The failure to address other asbestos-related diseases is also giving rise to concern.
Those who are more fortunate are now, with support, living into grand old age, and we have to resolve the issue, which has dogged successive Governments, of providing care for our older citizens, as well as younger people with illness or disability. The care and support Bill should be welcomed as a step in the right direction, but I fear it will not be enough and, rather than having a full-blown national care service, we will end up with a piecemeal one. The level of the cap has been set too high—higher than Andrew Dilnot recommended—and without investment in local services the Bill will have serious consequences, as clearly set out in the opening speech by my right hon. Friend the Member for Leigh (Andy Burnham).
To deliver much of what will need to be delivered, local authorities will therefore be required to step up to the plate—the joined-up care that the Secretary of State talked about. Yet we know that many are having to dismantle the architecture upon which good care and support is offered—as we are seeing in Torbay, an exemplar—because of the deep cuts being made to their budgets. Can the Government please be clear about who will be running these care and support networks? If it is the private sector, how will they ensure that there is not a postcode lottery?
Oddly, earlier the Secretary of State was behaving like one of those nodding dogs we see in the backs of cars when it was pointed out that hospitals are under pressure and staffing levels are not all they should be. However, he has provided no real answers in this Queen’s Speech.
At long last, after almost four years, we have a Bill paving the way for a potentially dramatic change to the way defence procurement is carried out. There is consensus across the political divide that successive Administrations did not sufficiently reform defence procurement. Equipment programmes were overheated in respect of funding, and the Ministry of Defence was underpowered in the skills required to deliver increasingly complex programmes. There are too many questions that need to be asked for the time available, and today is not about defence, but we will need to come back to those questions. The themes, however, are the accountability of the proposed GoCo
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—Government-owned, contractor-operated organisation —and where the risk lies. For example, does it lie with the taxpayer or with the private company? Warning bells are already ringing around Westminster about the management of risk. We know from successive Public Accounts Committee and National Audit Office reports that the MOD struggles when it comes to assessing risk. We need to know whether the Ministry of Defence, like the Department of Health, is producing legislation that removes the Secretary of State’s power to intervene and take responsibility.
Finally, I come to the Bills that were not mentioned. My right hon. Friend the Leader of the Opposition emphasised the missing legislation in his response to the Loyal Address. The cold hand of the Prime Minister’s henchman, whose links to the tobacco industry as a lobbyist are well documented and who has accepted major donations to his campaign in Australia from British American Tobacco, is writ large on this Gracious Speech.
Mr John Leech (Manchester, Withington) (LD): I agree that not having legislation to introduce standardised packaging for tobacco products is the wrong decision, but does the hon. Lady agree that it is appalling how the unions, too, have tried to stop this legislation?
Alison Seabeck: People work in those industries, and, understandably, the unions representing them have to consider the membership’s point of view. Among the unions as a whole, there is a broad range of views, very much reflecting those in this place today.
Returning to my point, perhaps that is why No. 10 has U-turned, from a position where it was wrong for children to be attracted to smoking by glitzy designs on packets and there were statements that children should be protected from the start, to the obverse position, where we are not being allowed to have legislation that would have a beneficial impact on the future health of our population and on the NHS budget. As my right hon. Friend the Member for Rother Valley (Mr Barron) said, we need to know who is pulling the strings in setting Government policy. The Government have bottled it; they are in thrall to their right wing. Young people in Plymouth, particular our Youth Parliament members and those in our youth cabinet, who wanted very much to see this change brought forward, will feel that they have been sold down the river. Many young people are asking what is in the Queen’s Speech for them; there is nothing to protect their future health and nothing to help them into work.
If the Government were serious about improving the health of the nation, we would have given these measures a fair wind. They would have had broad support from the Opposition, as would investment in other areas, such as housing that is affordable to rent, because good housing equates to good physical and mental health. Nothing has been said on those issues. The Queen’s Speech is a huge missed opportunity, and it is simply not good enough.
6.32 pm
Mr Gary Streeter (South West Devon) (Con):
It is a real joy to follow the hon. Member for Plymouth, Moor View (Alison Seabeck), my next-door neighbour—you are being extremely skilful in your selection of speakers
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today, Mr Deputy Speaker. I very much enjoyed her contribution; she spoke in her usual trenchant and passionate style. I also enjoyed hearing about the work that her late father was involved in, and I can say with some confidence that he would be extremely proud of her and all that she has done in her time as a Member of Parliament.
I liked the Queen’s Speech, but it was a little long for my liking. I was looking forward to the Queen sitting on the throne and saying, “My Government have decided to introduce no new laws this year, but to concentrate on implementing and overseeing well the policies that we have already passed and the laws that we have already put in place.” As we all know, coming to the House and taking legislation through involves a huge time commitment for Ministers, and there is a huge case to be made for Ministers to focus on implementing well the things that we have already decided. We have been radical in the past three years in this Parliament, so let us make sure that the policies now work in practice on the ground—let us set our Ministers free to do that. Interestingly, the key areas our constituents are most concerned about—getting the deficit down, getting the economy moving and cracking down on immigration—do not require any legislation at all. They simply require us to do well the things we have already decided.
I welcome the Queen’s Speech and, despite having said what I just said, the increased attention on immigration, which is what our constituents want. The reaction of my constituents to some of the tough measures we have introduced so far on immigration and on welfare changes is, “It’s about time. We have been waiting for this for many years.” So I support the broad direction of travel of the Government, and I have full confidence in the Health Secretary.
I want to make two points in a brief contribution about health issues, the first of which is about the challenge of urgent care. Our parliamentary system has many strengths, but one weakness is that every Government Member is inclined to say that everything we are doing is wonderful, while the Opposition are inclined to say that everything we are doing is rubbish. We all know that the truth lies somewhere in between. I support and pay tribute to the fact that we continue to pump fresh money into the health system year after year. The shadow Health Secretary is convinced that we are not meeting our commitment to increase health spending above inflation every year—I think we are, but of course there is a debate to be had. I do know that there are pressure points in the health system that need to be tackled, and urgent care is one of them.
Andy Burnham: The hon. Gentleman’s association with the detail seemed to be loose there; Andrew Dilnot wrote to the Government to say that health spending was lower in real terms in 2010-11 than it was when Labour left government. It is important to point out that the promise the hon. Gentleman stood on was for real-terms increases in every year of this Parliament and that that has not been honoured.
Mr Streeter:
That is Andrew Dilnot’s opinion, but it is not mine—that is the point I am seeking to make. [Interruption.] The right hon. Gentleman’s speech was riddled with references to spending—more spending on health and on local councils—but is he not aware that
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this year the deficit in this country will still be, even after three years of austerity, £110 billion? If he comes to the Dispatch Box to make speeches about extra spending for health and local councils, he is obliged to tell us where that money will come from. At the moment, I can see no signs of it whatever.
Mr Streeter: I will not take any further interventions, but let us not hear any further speeches calling for extra spending unless we know where the money is coming from.
As I was saying, before I was so rudely interrupted, there are pressure points in the health system, and urgent care is one of them. This is about not only accident and emergency departments, but GP and out-of-hours services, community nursing, social care, ambulance services and hospital beds—there is pressure on all those points.
The hon. Member for Plymouth, Moor View and I are fortunate to go to Derriford hospital in Plymouth for briefings. I have been going slightly longer than she has—21 years—and I can tell the House that in good times and in bad times Derriford hospital is under pressure. It has a running capacity of about 95%, which means that when there are spikes, as there have been this winter, it can be running at 103% capacity, which puts the hard-working staff under enormous pressure. Even when the Labour Government were spending money as though it were going out of fashion, I have never gone to Derriford hospital and had the staff tell me, “It’s fine. There are no pressure points. Everything is working in our health service. It’s all working well and waiting lists are coming down.” That has not happened once in 21 years.
Stephen Phillips (Sleaford and North Hykeham) (Con): Does my hon. Friend agree that perhaps one problem with the Queen’s Speech, and one of the issues with which neither Ministers nor shadow Ministers tend to grapple, is that there is a real problem in this country with demand? Unless and until we grapple with that, the national health service will always be under pressure.
Mr Streeter: I completely agree with my hon. and learned Friend, and I might come on to deal with that point in a moment.
The point I wanted to raise with Ministers is that the funding formula for emergency work needs to be reviewed. As I understand the system, the formula is based on the 2008-09 baseline, and any extra patients who come into an acute hospital over and above that baseline are paid at 30% of the tariff. It costs hospitals 100% to meet the needs of those people coming in, yet they are paid at 30%; the extra 70% is supposed to be spent by other health care agencies in providing alternative centres of treatment, which are intended to divert people away from acute hospitals. I am pretty well plugged into what is going on in my constituency, and I have not seen anything since 2008 that looks vaguely capable of diverting pressure away from Derriford hospital. The system of allocating 30% to the hospital and 70% elsewhere is simply not working. I ask our Ministers to look urgently
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at that formula and to find out why, if it is not working, we are still using it and to address that. I am not calling for extra money; I am calling for money to be diverted to the acute hospitals, because they are where the pressure points are. In my constituency, there have been no realistic options for treatment other than to go to Derriford hospital. So, such hospitals should be receiving not 30% but 100% of the tariff.
My hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) is absolutely right about demand growing exponentially. In 1979, if a man reached the age of 65, they could expect to live until they were 77. If a man reaches the age of 65 now, they can expect to live until they are 88, and of course that age is rising year on year, so the demand is going up.
One thing that we are noticing is that although the number of people admitted to the emergency department at Derriford hospital in the last 12 months has been stable, there is much higher acuteness—in other words, people are much sicker and therefore it requires a lot more effort to treat them. Please, nice Ministers on the Front Bench, may we have a look at that formula for the funding for people accessing acute hospitals on an emergency basis?
My final point, in the one minute of my time that remains, is that 20 years ago or so I made a speech in this House saying that the health service had lots of challenges, issues and problems, but that one of the things we did not need to touch was primary care as it was working fine. I cannot make that speech today. I will not hammer the Opposition again about the GP contract, but in the past few years constituents have been complaining to me in a way that they never did in the previous 15 years to say that accessing their GP is becoming extremely difficult. For someone—whether they are a mum with a young baby, or a senior citizen—to get a surgery appointment when they want it has become a serious issue in the past few years. Addressing that issue does not necessarily require legislation, but may I ask Ministers whether we can please put in place a system whereby GPs give the seven o’clock in the morning to seven o’clock at night, seven days a week service that this country so desperately deserves?
6.41 pm
Paul Blomfield (Sheffield Central) (Lab): It is a delight to follow the hon. Member for South West Devon (Mr Streeter). I might not have agreed with everything he said, but he was right to point out that away from this place people’s concern is about economic growth. Sadly, the Queen’s Speech does not adequately address that concern.
Some of the less thoughtful contributions have demonstrated just how deeply divided this Government are—not between parties, but within the main party of government. The Prime Minister is unable to command the support of his own party. When he makes a decision, it is often the wrong one, putting party squabbles before national interest.
Just for one moment, let us imagine the scene in Washington today. The Prime Minister is there to seek the ear of the President on the EU-US trade deal, which is hugely important to this country and worth £10 billion a year. As the President received his pre-meeting briefing, I wonder what his advisers would have been saying:
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“Don’t waste time on this Prime Minister, Mr President. He has only two years left. He can’t even command the support of his own party. His Cabinet members are speaking out against him as they jostle for succession, and he has even told members of his own Government that they can vote against him on the Government’s programme. We will have to talk to the people who count in Government—ignore this one.” As Barack Obama raises his eyebrows in incredulity, British influence disappears out of the window because of the weakness of this Prime Minister.
That situation is also demonstrated in the Queen’s Speech, and as much by what is not included in it as by what is. When the Prime Minister makes a decision, too often he buckles under pressure from the wrong people, backing powerful vested interests against those of ordinary people. As a number of my colleagues and a number of Government Members have done, I want to highlight the absence of the promised legislation for standardised cigarette packaging, which sacrifices the health of our children in favour of the profits of the big tobacco companies.
Back in February, the Prime Minister talked clearly about introducing legislation for standardised packaging. The papers reported that
“Ministers are convinced that the ban is necessary to take the next step to reduce smoking in the UK.”
Those reports were confirmed by a senior Whitehall source, who said:
“We are going to follow what they have done in Australia.”
The source correctly went on to say:
“The evidence suggests it is going to deter young smokers. There is going to be legislation”.
That was what we were all expecting, although perhaps some of us were surprised that the Government had actually got it right on this issue and were putting people first—that was, until just a few days ago. I do not know whether they were under the influence of Lynton Crosby—bear it in mind that he earned considerable sums of money from the tobacco lobby, and that he failed to win the argument against standardised packaging in Australia before bringing his toxic approach to politics here—or perhaps they were just running frightened from the UK Independence party’s opposition to public health measures against smoking.
Mr Leech: I note that the hon. Gentleman does not mention the intervention of the unions and their support for retaining the existing system of packaging. Would he like to condemn the position that the unions have taken on standardised packaging?
Paul Blomfield: My understanding is that the majority of unions would support standardised packaging. I deeply regret the fact that the tobacco giants use some individual trade unionists as de facto lobbyists.
The Government surrendered to the tobacco giants. What message does that send to the country? This Government are prepared to see people die and, as the hon. Member for Mid Derbyshire (Pauline Latham) said, die horribly, and in their hundreds of thousands, to prop up the profits of the tobacco industry. There are no industries like the tobacco industry—the more cigarettes it sells, the more money it makes and the more people die.
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Since science confirmed the link between smoking and lung cancer, the tobacco industry has opposed every single measure to reduce smoking. We all know that smoking is the largest preventable cause of cancer; it is responsible for four out of every 10 cancer deaths. According to Cancer Research UK, tobacco is responsible for 100,000 deaths in the UK every year. We have made huge strides with the measures that have already been taken against smoking, but as we have encouraged people to stop smoking, the tobacco giants have been building their market among young people. A report from Cancer Research UK in March showed that the number of children smoking had risen by 50,000 in just one year.
Frank Dobson: Let me demonstrate the absolutely vile morality—if I can combine those two words—of the tobacco industry. When it was discovered that nicotine was addictive, the industry increased the proportion of nicotine in cigarettes to make them more addictive. People like that should not be listened to; they should be shown the door.
Paul Blomfield: I agree with my right hon. Friend: the tobacco industry should not be listened to. However, it finds no end of ways to seek to defeat the arguments of public health lobbies against smoking, and indeed to encourage the wider use of cigarettes.
Shockingly, in the last year for which figures are available about 207,000 children aged between 11 and 15 started smoking. The vile way—to use my right hon. Friend’s word—in which the tobacco giants operate means that that is a direct result of the industry’s marketing strategies, which are as sophisticated as they are cynical. Flavoured cigarettes have been introduced, and not only menthol, but chocolate and fruit flavours. Some cigarettes are targeted at young women. Even the Daily Mail pointed out, in condemning that move, that those cigarettes seek to
“make smoking look elegant, sexy and classy”.
Alternatively, as British American Tobacco’s Hinesh Patel said, almost acknowledging the company’s strategy:
“We’ve taken a creative approach to respond to the female under-30 demand for a smaller, slimmer, less masculine cigarette…a contemporary product in a new accessible size.”
In that context, packaging is crucial. A Saatchi & Saatchi marketeer said this of British American Tobacco’s Vogue package:
“The cigarettes look like something found behind a glitzy counter at Selfridges....trying to capitalise on a woman’s desire to feel beautiful to sell their cigarettes.”
The Government public health Minister, the hon. Member for Broxtowe (Anna Soubry), is not present, but she has made her views on this subject clear. In April, she said before a House of Lords Select Committee:
“We know that the package itself plays an important part in the process of young people and their decision to buy a packet and to smoke cigarettes.”
All the experts back standardised packaging, and until a few days ago we thought the Government did, too. The public back that as well, with 63% in favour and only 16% against, according to recent polling. This Government are getting it wrong again. They are showing again that they are out of touch with people and they are on the wrong side of the argument, and I urge them to think again.
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6.50 pm
Mr David Ward (Bradford East) (LD): I want to congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on her contribution, and I hope to add to her comments.
A quiet revolution is taking place. Slowly—although probably not very slowly—but surely, the life chances of thousands of vulnerable people are being changed. We in Bradford did a huge amount of survey work following the publication of the health and social care White Paper, the Bill and the progress report on funding reform, and we received a huge response with more than 500 direct responses from within the constituency. I want to pay tribute to Bradford council, which was very much involved, as well as the Bradford and District Age UK, the Bradford Alzheimer’s Society, Ideal Care Homes, Bradford disabled people’s forum, the Consortia of Ethnic Minority Organisations and also the area manager of Specialist Autism Services, who submitted a response last week.
The report was published after a Westminster Hall debate on this subject, and many of the Government’s proposals were generally welcomed. Some areas caused concern, however, including on hospital discharges, specialist housing, and waiting times for adaptations. Much of the concern is less about legislation and more about local delivery—about what is actually in place in the locality.
The backdrop to everything we are doing in all policy areas is the austerity programme and the deficit, and many local authorities are facing severe funding cuts as a consequence of the measures being taken. Their effects are being exacerbated by the increasing demand for social care. In my area, there will be an additional 5,000 over-65s in the next 10 years and a 38% increase in the number of over-85s. There will also be a large increase in those with learning disabilities. This will add an extra £10 million to local costs. A lot of complex cases are arising, and all of this must be seen against the backdrop of the cuts and changes.
The Government say that local authorities must decide on priorities. That is true, but it is also a bit dishonest. The national health service budget, for which the Government are seen as responsible, is protected, but the social care budget, which is predominantly picked up by local authorities, is under attack and being cut. If many of the preventive measures we are seeking to introduce enable people to go home sooner and have a better experience on their return from hospital, that will reduce the pressures on the NHS budget but increase the costs facing local authorities, as they will have to pick up the costs arising from those successful preventive measures. Things will be difficult for many local authorities, therefore.
The report we in Bradford produced following the publication of the Bill focused on residential care, and since then we have done a lot more work on another crucial, and topical, area: Bradford council has, through a consultation process, been addressing the fair access to care services—FACS—criteria, and I will focus on the criteria for the provision of social care. I mentioned discharge from hospital and adaptations, but the level at which the FACS criteria are set is crucial in determining the services many people will receive in their homes and the life chances and experience they will have.
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The “critical” criteria include when “vital social support systems” and
“vital involvement in work, education or learning cannot or will not be sustained”.
A person’s care and support needs are deemed as “substantial” when
“many aspects of work, education or learning cannot or will not be sustained.”
We understand all that, but the bit I am not comfortable with is the description of anything lower than that as being “moderate.” That is a terminological inexactitude or misnomer. Listed under “moderate” are
“an inability to carry out several personal care or domestic routines and/or...several aspects of work, education or learning”.
I do not regard that as being “moderate.” The ability to do such things is often essential if people are to live a satisfactory life in their own homes and as part of their local community.
In plain and simple terms, and without trying to be funny, if someone cannot get their knickers or underpants on in the morning, they will not go to the day centre, however good it is, and if someone does not get the help to get the right tablets in the morning, they will not be going to the day centre in a minibus; they will go to hospital in an ambulance. We must not call this level of need “moderate.” For many people, it is essential if they are to have a full life in their community and in their home.
We must look less at what can be funded and more at what levels of need we need to fund. My right hon. Friend the Member for Sutton and Cheam (Paul Burstow) pointed out that much of the proposed legislation is about intervention and prevention, on the basis that prevention is better than cure, but the danger is that today’s moderate needs will become tomorrow’s substantial or critical needs if they are not met at the correct time. This is not about cutting our cloth or making do in times of austerity. It is about, foolishly, making short-term savings to the detriment of future taxpayers who will have to bear the costs of what should, and could, be regarded as avoidable needs.
6.58 pm
Roberta Blackman-Woods (City of Durham) (Lab): My hon. Friend the Member for Sheffield Central (Paul Blomfield) made a powerful case against the influence of the tobacco companies and their lobbying of this Government, and the utter ineffectiveness of the Prime Minister in standing up to them. I am also pleased to follow the hon. Member for Bradford East (Mr Ward), who made an impassioned plea on behalf of his constituents and others. He demonstrated the need for proper local authority funding to support care services, and I will address that later in my speech.
I think it is true to say that all independent commentators are noting that the Gracious Speech was very thin and did not rise to the many challenges facing this country, particularly the need for economic growth. I was therefore concerned to hear speech after speech in which Conservative Members talked only about Europe in a very obsessive way, without any recognition of the fact that constituencies such as mine that are desperately in need of economic growth rely on our relationship with Europe. Our region exports the most from this country, and a huge proportion of our exports are to European countries. We need
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those exports to grow, not to be damaged by the rhetoric on Europe that we hear day after day from the Government and Conservative Members.
I was also concerned when I listened to the Secretary of State for Health and heard how complacent he is about the state of the NHS. He showed no recognition at all of the anxiety of many of my constituents about what sort of health service we are going to end up with in a couple of months’ time and whether it will be able to meet their most basic needs. He showed no awareness at all of the challenges facing A and E departments right across the country, including my own in Durham. I am not criticising the staff, who struggle against the odds to provide the best care. This is happening because the Government are not looking at how to use the resources effectively and how to channel them towards under pressure A and E departments.
It would be extraordinary if we did not have a Bill on care in this Queen’s Speech given the clamour for it from carers, carers’ organisations, other agencies, cross-party commissions, and cross-party groups, and some of the work that Labour did when in government. The question remains, however: is the Bill up to the job of dealing with the problems facing our care system, which need to be addressed urgently because, as we all know, it is in danger of falling into crisis? The House of Commons Library has produced research showing that 10 million people in the UK are over 65 and that by 2030 the number is projected to rise to 15.5 million. Many of these additional older people will have care needs, putting increasing pressure on our care system. At the same time, more funds are being stripped from social care. The £500 million funding gap in our social care provision is still growing and, as Age UK has made clear, this is having a hugely detrimental impact on the care received by our elderly people. Age UK states that
“the widening funding gap has led to a reduction in service provision, increasing charges levied by councils for their services and less older people receiving the support they need.”
“Every older person using local authority care services is now being charged £150 per year more in real terms in 2010-11 than in 2009-10, and £360 more than 2008-09”.
The situation is expected to get worse still. Due to the massive cuts faced by local government, by 2013-14 local authorities will have reduced their expenditure on adult social care by £2.7 billion—a massive 18% reduction when demand is increasing all the time. Clearly, this is not sustainable.
The Bill will do nothing to close the growing funding gap or to help the thousands of people who are already suffering with spiralling living costs and increases to home care costs. These people find themselves passed between care providers, often without any continuity of service. We will all have heard about such experiences in our constituency surgeries. Many people are ending up in hospital unnecessarily because they are not getting the care they need at home. Similarly, the Government’s earlier decision to ignore Dilnot and the experts who recommended a maximum cap of £35,000 and set it at £72,000 plus accommodation costs will not help many of my constituents, particularly those on lower or middle incomes.
Where the Bill might make some meaningful progress is with regard to improved rights and support for carers, but, as several hon. Members have said, there are huge
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gaps, particularly in identification of and support for young carers. That will need to be addressed as the Bill makes its way through the House. More needs to be done to support the various organisations that help carers. I work with a number of voluntary sector bodies in my local communities, and they are very worried that they will go out of business because they are not able to get enough resources to keep going.
Carers UK has set out some tests of this Bill. It says that it needs to be underpinned by appropriate funding, that it must promote the well-being and dignity of all our elderly residents, that it must ensure that independent advice is available to people and that there are appropriate advocacy services, that it should make sure that the criteria for people to get support are clear and transparent —it is no good just having assessments; they have to produce something in the form of appropriate levels of care—and that it must guarantee continuity of service and portability in whatever care support is given. I hope that as the Bill goes through the House it will be tested on those criteria.
7.6 pm
Eric Ollerenshaw (Lancaster and Fleetwood) (Con): I am pleased to follow the hon. Member for City of Durham (Roberta Blackman-Woods), who picked up the theme of the hon. Member for Bradford East (Mr Ward) in talking about social care, which I too should like to remark on.
Unlike others, I will not be tempted into the subjects of tobacco, Europe or gay marriage but will stick fundamentally to the title of this debate on health and social care. I have a few specific points to make about the impact on my constituency. In general, though, I am proud to be part of a Government who, despite the need to eliminate the huge budget deficit left to us, have protected spending on the NHS. That has been necessary, in large part, because of the demographic changes that are happening in the UK with a rapidly ageing population. We need to do more than just target health spending on the older population; we need to change the way we think about providing care for the elderly and what this means for our society. I think that that is what other hon. Members are working towards as regards the cross-over between social care and health care.
I warmly welcome the inclusion of the Care Bill in the Queen’s Speech and the Secretary of State’s comments about personal health care and social care plans for the elderly. We can all make criticisms in saying that more should have been done, but the fact is that this Government have actually done it. The previous Government kept promising to do something about the tragedy of people having to sell their homes to pay for care; this Government have set about doing it by introducing a Bill that will end that tragedy by introducing a cap on care costs. That is remarkable given the background of the deficit we face. The implications of that will be borne out when the electorate understand that finally a Government have committed to go this far.
I firmly believe that this is the right way forward. It has been clear for some time that we needed to create a long-term solution to allow people to plan with confidence for their future. Now other generations, too, can plan how they want to look after themselves in old age because they know that the cap is there and that there will be a higher means-testing threshold allowing them
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to put some money aside to address these issues. We have already heard in this debate arguments about the threshold, the cap, and the way forward. However, I hope that Labour Members will recognise that, as the right hon. Member for Leigh (Andy Burnham) and the hon. Member for Worsley and Eccles South (Barbara Keeley) indicated, we need to find a bipartisan way to deal with this fundamental demographic issue facing the population of this country and try to shift it out of the political arena.
Having talked about social care, I now want to address NHS funding more broadly. As I have said, I am proud that NHS spending has risen in real terms over the life of this Parliament, but the historic formula used to distribute NHS money around the country needs to be reassessed. Although it is correct to factor in depravation when deciding where funds are allocated, a bigger weighting needs to be given to the age of the local population. A recent Age UK briefing note stated that at any one time about 65% of hospital patients will be over the age of 65, while, according to national statistics, areas with the highest depravation are also likely to be those with the youngest population. At present, therefore, those parts of the country with the highest numbers of older people have to deliver highly specialised services and care without a funding formula to assist them in their work. Moreover, as a Member representing a semi-rural part of the country, I see at first hand the effect that geography also has on the delivery of services and the extra costs involved in delivering quality health care over a wide area.
Lancaster is part of the Morecambe Bay NHS Foundation Trust. It is a pleasant and wonderful geographical area, but it is enormous. It has three hospitals—in Lancaster, Barrow and Kendal. The distance between the hospital in Barrow, which offers some specialist services, and that in Lancaster, which offers others, is 50 miles by car, but the hills and dales mean that it sometimes takes one and a half to two hours to travel between the two. Nothing in the national formula acknowledges the problems faced by the trust. Specialist services need to be retained in as many of those hospitals as possible if journey times are to be kept to acceptable levels, which means that they will require proper funding to allow them to operate. I look forward to working with my hon. Friends the Members for Suffolk Coastal (Dr Coffey) and for Beverley and Holderness (Mr Stuart), as well as others, to try to tackle this unfair disparity with regard to some geographical areas.
I want to pinpoint how the problem affects us locally. The Royal Lancaster Infirmary has a vascular service unit and, despite the excellent clinical outcomes it has delivered for years, it has been suggested that it should close. That would leave a service gap between Carlisle in the north and Preston in the south of nearly 90 miles. It would leave patients from the more rural parts of my constituency, especially those from Barrow or south Cumbria, with lengthy journeys if they needed specialist treatment. Some areas are well outside the 90-minute transport target time, which is already an extension of the national target of 60 minutes.
That delay in journey time is a genuine issue for consideration when establishing where specialist services should be located, as has already been proven by the decision to retain a vascular service in Carlisle, where
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an exception was made to most of the scoring criteria because of the local geography and the time it would take to transport patients elsewhere. If exceptions are rightly being made in one part of the north-west, they should apply to other areas where substantial delay is likely to occur. As I have already said, under the current plans there is a huge geographical gap in service provision between Carlisle and Preston.
The closure proposal has been referred to the Secretary of State for a final decision and I sincerely hope that he and his Ministers will decide in favour of retaining the specialist provision at the RLI. That, however, is just one example. A more wide-ranging review is being undertaken of service provision across north Lancashire and there are concerns that our local A and E unit may be under threat as a result of geography not being taken into account.
The funding formula needs to change to take greater account of those parts of the country with an elderly population. It also needs better to reflect the difficulties of providing services in large geographical, sparsely populated areas. Without that and the accompanying reallocation of resources, hospitals in rural and semi-rural areas will struggle even more to provide the necessary services to their residents. I urge the Secretary of State to look into this as a matter of urgency.
7.14 pm
Ian Mearns (Gateshead) (Lab): I am pleased to follow my hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and in particular my hon. Friend the Member for Sheffield Central (Paul Blomfield), who made a very strong speech about the Government bottling the proposal for plain packaging for cigarettes.
The response to the Queen’s Speech from my constituency of Gateshead, the north-east and the whole country is: what a missed opportunity. Research by Sheffield Hallam university highlighted recently in The Times illuminated the impact of welfare reforms on local areas across the whole of Britain. The impact varies from place to place: the worst affected areas face financial losses that are twice the national average and four times those in the least affected areas, and—surprise, surprise—it is Britain’s regions and older industrial areas that are hit the hardest, whereas much of the south and south-east of England outside London escapes comparatively lightly. As a general rule, the more deprived the local authority, the greater the financial hit. Professor Steve Fothergill, who undertook the study, said that
“the Coalition government is presiding over national welfare reforms that will impact principally on individuals and communities outside its own political heartlands.”
So that is what they mean by, “We’re all in this together.”
What are the Government’s priorities? A local audit Bill, a water Bill, a deregulation Bill and, in terms of health, a chronic outbreak of Europhobia. Those are hardly the country’s priorities. Meanwhile the country and its people in regions such as mine continue to suffer.
New research in a book published this month, “The Body Economic: Why Austerity Kills” by the respected political economist David Stuckler and the physician and epidemiologist Sanjay Basu, shows conclusively that austerity policies are
“seriously bad for our health”.
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They argue that in Greece, HIV infections have risen by more than 200% since 2011, as prevention budgets have been cut and intravenous drug use has grown amid 50% youth unemployment. Greece has also experienced its first malaria outbreak in decades, after budget cuts to mosquito spraying. David Stuckler has said:
“Austerity is having a devastating effect on health in Europe and North America. The harms we have found include HIV and malaria outbreaks, shortages of essential medicines, lost healthcare access, and an avoidable epidemic of alcohol abuse, depression and suicide, among others. Our politicians need to take into account the serious, and in some cases profound, health consequences of economic choices. But so far, Europe’s leaders have been in denial of the evidence that austerity is costing lives.”
Despite the clear evidence, the coalition is taking no action on minimum pricing of alcohol or on plain packaging of tobacco products. It has capitulated to manufacturers, lobbyists and self-interested advisers. In the face of the clear and unequivocal damage that this coalition’s policies are doing to the health of our nation, it has no appropriate response, despite the fact that we all know that prevention is better than cure. My hon. Friend the Member for Sheffield Central highlighted the number of people who annually die prematurely as a result of cigarette smoking. Over the weekend Wembley stadium was almost full for the FA cup final; imagine that number of people dying annually as a result of preventable disease induced by smoking.
A health warning should be printed on this Government: “Warning: this Government’s policies will seriously harm you and others around you, and will detrimentally impact your mental health and that of your family and friends.” We have heard example after example. It was reported this week that, sadly, Stephanie Bottrill killed herself on 4 May. Already struggling financially, Stephanie faced the devastating prospect of the bedroom tax. In a suicide note left for her son, she said that
“the only people to blame are the government”.
Stephanie’s case is, of course, only the tip of the iceberg. Since this Government came to power the website Calum’s List has listed 33 cases where a coroner has recorded that an individual has been driven to suicide by welfare cuts.
On the evidence of this Queen’s Speech, the Government clearly do not understand or care about the human cost of what is happening. It is equally clear that they do not understand or care about the economic devastation that their policies have brought to significant sectors of our economy. Do they read the IMF reports on our economy? Do they even know how to contact the IMF to talk about them?
Having read the Queen’s Speech, it appears that the Government have no idea what to do. They seem like rabbits stuck in the headlights of their own rhetoric. The plans are more and more and more of the same: cuts followed by cuts followed by more cuts. With sectors and regions of our economy stuck in a spiral of decline, the country needs leadership, yet we have a vacuum of a Queen’s Speech. We need leadership to get us out of the problem, not dig us further into it, but instead we have a coalition strangled by indecision and political inertia. Where are the plans for growth? Where is the growth Bill, the national recovery Bill, or even the “We understand what the problem is” Bill? The Government seem to have no idea how to move things forward. There is not one substantial proposal in the speech.
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It is not just me, my hon. Friends and the IMF who are saying that. Even the Chancellor’s new Governor of the Bank of England, Mark Carney, said only last month that Britain is an economy in crisis. He compared the UK with basket case countries in the eurozone. Speaking on the fringes of the IMF’s spring meeting in Washington, he said:
“The US is breaking out of the pack of crisis countries that includes the euro area, the UK and Japan.”
That pales into insignificance compared with the words of the IMF’s chief economist, Olivier Blanchard, who said last month that Britain was “playing with fire” by pressing ahead with austerity. We need change and we need action. The Queen’s Speech delivered neither.
7.21 pm
Mr Robin Walker (Worcester) (Con): It is a pleasure to speak in the debate on the Humble Address that was proposed so elegantly by my neighbour and hon. Friend the Member for Mid Worcestershire (Peter Luff), in whose speech I was named and suitably embarrassed. I was grateful for the kind tributes that were paid to my late father by my hon. Friend and the right hon. Member for Doncaster North (Edward Miliband), the Leader of the Opposition. I was keen to speak in today’s debate because what the Leader of the Opposition referred to as “that voice of moderation” and what my hon. Friend rightly identified as the middle way, the spirit of one nation conservatism, is not, as the right hon. Gentleman tried to suggest, unfashionable, but is at the heart of this Government’s programme and embedded in the Queen’s Speech.
“Efficiency with compassion” were the watchwords of my late father. He believed that a balance of the two was essential to meet the challenges of the hour and the needs of our country. I believe that the same is true today. Compassion has been shown by the coalition Government in introducing the Care Bill and by being the first to introduce legislation to cap social care costs. I spoke in the debate on last year’s Gracious Speech to express my disappointment that there was no such legislation and to support Opposition Members who were calling for it. It would be churlish of those who spoke out then not to recognise the enormous significance of the move in this Gracious Speech.
By setting a cap, albeit a higher one than many of us would have liked, the Bill will start the process of ensuring that nobody has to lose their home to pay for care. Setting a cap at any level should help the insurance industry to create products that protect thousands more people from that risk. The threshold, as the right hon. Member for Sutton and Cheam (Paul Burstow) pointed out, is key and will ensure that thousands more people are helped by the Government than would have been the case without the legislation.
This is not a theoretical far-off issue that we can put off tackling, but a real and painful issue that has affected our constituents for too many years. Hard-working people who have laboured and saved for years to afford the roof over their heads should not find that when they need care, their families are deprived of that asset. We all have constituents to whom that has happened. This is not, as some would like to pretend, a problem only for the rich. It affects everyone who owns a home and stands to lose it if the costs of their care are too great.
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Many of them are people who can afford to own a home only in retirement and many of them live in former council houses.
It was right of the Government to commission the Dilnot review and it is right to strike the balance that Dilnot acknowledged was needed between the cost of the policy to the public purse and the desperate need for a cap. Too many homes have been sold to pay for care. It is a tragedy that Governments of all colours have failed to act sooner to address the problem. It is greatly to the credit of the coalition that it is proposing the first part of a solution. I also draw the Minister’s attention to Macmillan’s ongoing campaign for further progress on free social care at the end of life, which was mentioned by my hon. Friend the Member for Truro and Falmouth (Sarah Newton).
Compassion is also being shown in the determination to improve the pensions of those who have spent years bringing up children, in the focus on preventing sexual violence across the world, and through tackling the impact of climate change, which will affect millions of the poorest people in the world. Compassion continues to be served by other ongoing policies of the coalition Government, such as the pupil premium, which directs funding to the most deprived pupils and helps schools to raise their attainment; the greater increase in the basic pension; and the increased investment in our NHS.
We have heard much from Labour Members about the pressures on our NHS and Ministers are right to have acknowledged the challenges faced in A and E and urgent care, but it is absurd for the Labour party to rail against pressures that have been building for years, including under its rule, and then to implement cash cuts in NHS spending in Wales, where that party runs the Government. The South Worcestershire clinical commissioning group will receive a £7 million increase in funding this year as a result of the coalition’s policy of increasing NHS spending. By coincidence, that is the amount by which the funding of Welsh health boards is being cut this year by the Labour Administration. On a recent visit to my local hospital, I saw some of the pressures on A and E, but I also saw how the coalition’s investment had enabled the retention of more nurses and how it will soon deliver a new clinical decisions unit that will help to alleviate some of the pressures.
We have heard much from the Labour party about the supposed privatisation of the NHS. I recently asked my local clinical commissioning group what amount of its budget goes to the private sector. Knowing that it has for some years, including under Labour, contracted certain operations, such as hip replacements, to private sector providers, I had presumed that the amount would be quite significant. I was surprised to find that the spending of the South Worcestershire clinical commissioning group in the private sector amounted to just 1.8% of its budget. That is less than its increase in spending this year. This Government are committed to efficiency and compassion in the NHS.
Compassion and efficiency are served by the emphasis on education in the Queen’s Speech. I would like to expand on that in more detail, but fear that I do not have time. We have heard excellent speeches from my hon. Friends the Members for Lancaster and Fleetwood
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(Eric Ollerenshaw) and for South West Devon (Mr Streeter) about the funding formula in health. I merely point out to the Government that addressing the funding formula in education is equally urgent.
Jeremy Lefroy (Stafford) (Con): Will my hon. Friend acknowledge that that is an issue across many parts of England, including in my county of Staffordshire?
Mr Walker: I wholly agree with my hon. Friend. I will be in Staffordshire to meet the F40 group and its executive, who are campaigning for fairer funding and a more efficient system.
That brings me to the efficiency side of the equation. As a member of the Business, Innovation and Skills Committee, I would have liked to speak on the day of the debate that was themed on that portfolio. I regret that the Opposition chose to assign that theme to a Friday when I, like most other MPs, have many commitments in my constituency, including speaking to local businesses and schools.
There is a great deal in the Queen’s Speech to support business and increase efficiency in Government. The employment allowance is something that I have campaigned for and it will be extremely welcome to smaller businesses and entrepreneurs as it will reduce the cost of taking people on. I would like to have seen a Bill to reform business rates and will continue to push for further such reforms. The Bill to reduce regulation on business has been called for by almost every business organisation that I have met and will be universally welcomed, as long as it works.
The investments in infrastructure are sensible and necessary to support growth in our economy and to get Britain moving. Reducing the deficit is essential. For all the noises off that we have heard from the Opposition in this debate, they still have not got the point that the answer to a debt crisis cannot be to borrow more. When one invests, it is essential to invest well. The story of Worcester’s colleges is just one example. The previous Labour Government promised huge rebuilds costing tens of millions of pounds, but delivered nothing. This Government have delivered measured investments that have made a difference.
It would be remiss of me, having spoken in the Back-Bench debate on an EU referendum some years ago, not to mention the amendment that has been tabled by many Back-Bench Members, which I hope will be selected for debate by the Chair. I was proud to support a motion that called for a European referendum two years ago. I welcome the fact that our Prime Minister has set out clearly that he will fight for a referendum at the next election and that he is pressing for a renegotiation of our relationship with the EU in the meantime. He was right to wield his veto, he was right to press for a reduction in the European budget, which many thought was impossible, and he is right to say that the people of this country need to be given a real choice. Like my right hon. Friend the Member for Mid Sussex (Nicholas Soames), I have every confidence that he will continue to succeed on this issue.
I regret that some in the media have sought to build the amendment up as a criticism of the Prime Minister. It is for that reason that I did not sign it. However, I do regret that we could not include an EU referendum Bill in the Queen’s Speech, not because I believe it could
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have succeeded against the arithmetic of this House and its current composition, but because the debate would have shown how out of touch the main Opposition party is on this issue. I shall therefore support the amendment if the chance arises, and I welcome the fact that in my party at least, it will be a matter of conscience and a free vote. Although the current media frenzy is trying to paint a picture of division, I am pleased that my party is united in its determination to change our relationship with Europe for the better.
In conclusion, it is a challenge for all Governments to balance efficiency with compassion, but for all the strains of coalition—and there are many—the coalition Government continue to govern in the national interest. Perhaps that is why, despite being mid term and despite visits in the weeks before the recent local elections from the leaders of UKIP and the Green party and the Leader of the Opposition, the party that won the greatest share of the popular vote across Worcester was none of those but the true one-nation party—the Conservative party.
I particularly welcome the historic and long overdue decision announced in the Gracious Speech to place a cap on the cost of social care. I am honoured to have spoken in this debate and I look forward to supporting the Government as they continue to press for a fairer and more prosperous Britain.