7.30 pm

Kate Green (Stretford and Urmston) (Lab): It is a pleasure to follow the hon. Member for Worcester (Mr Walker). I, too, want to talk about social care. First, however, let me reinforce the comments made by my right hon. and hon. Friends about the announcement on compensation for sufferers of mesothelioma. That devastating illness affects a number of families in my constituency, as well as many workers in Trafford Park over many decades. Work was begun by Labour on a system of compensation for asbestos-related illness where employers and insurers cannot be traced, and we now at last have a proposal from the Government although it is disappointingly limited in its reach.

The proposed scheme will apply only to diagnoses made after 2012, and it completely misses half the victims of asbestos-related cancers because it is limited to mesothelioma sufferers and a cap is imposed on the level of payments. The deal favours insurance companies; it is not good enough for victims or for the public purse because many sufferers will continue to rely on payments from the Department for Work and Pensions as they will not be eligible for the compensation scheme. Although the proposals in the Queen’s Speech for a system of compensation are welcome, I hope we will be able to improve the legislation as the Mesothelioma Bill passes through the House.

On social care, everyone agrees that people would prefer to be cared for in their own home for as long as possible, but community-based provision must be in place for that to happen. As many right hon. and hon. Members have said, a lack of community provision is placing excessive strain on the NHS with regard to A and E and bed blocking, and my local authority in Trafford has received repeated reports that a lack of access to rehabilitation, physiotherapy, speech and language therapies—for example, after a stroke—and to support and care packages means that it is often impossible to

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discharge someone, even when they are medically fit to go home. That backdrop is of particular concern at a time when a significant reconfiguration of our national health service is being proposed in Trafford. There must be real concern about a squeeze on NHS services when community provision is not in place.

I am pleased that the Secretary of State has recognised the need for a single named professional to have oversight of an individual’s health and social care needs, but the fragmentation and contracting of NHS services does not help. Competition works against the integration of primary, secondary, tertiary and social care and, as many colleagues have said, cuts to local authority budgets are having a massive effect. Trafford is cutting nearly £3 million this year from social care budgets, which means cuts to day services, for example, or increased costs for meals. Curiously, the local authority intends to achieve a large part of those savings through the introduction of personalised budgets, which we understood were not intended as a savings measure.

Families want to help and keep loved ones at home, but they are under great pressure and rely particularly on day services and respite care. They tell me that assembling a personal package is complex. One constituent —a highly resourceful and articulate businessman—told me of his struggle to use a personalised budget to assemble a care package for his partner. He called seven potential providers, but most could not cope with assembling the package she needed to meet her complex needs. If my constituent could not put together that package, how—as he rightly asked me—will the more marginalised and excluded manage? He pointed to the importance of decent brokerage services, yet at the same time we are seeing cuts to advocacy services. There is already evidence that personalised budgets do not work so well for elderly people or those without family and friends to help.

It is not clear what the long-term effects of spreading personal budgets will be, but they could lead to further fragmentation of services or exacerbate inequalities. For example, there is evidence of a lack of cultural awareness among brokers and providers, and the complexity of putting together a personal care package may leave the most excluded even further behind. I invite Ministers to tell the House what steps they will take to monitor the impact of personal budgets on inequality and outcomes for the elderly and most vulnerable.

Norman Lamb rose—

Kate Green: I am pleased the Minister is seeking to intervene.

Norman Lamb: Does the hon. Lady accept that there has sometimes also been a lack of cultural awareness in the traditional way of delivering services when people make assumptions about someone’s care needs and the right way to deliver them? Putting the individual in charge and letting them determine their priorities gives us a better chance of getting it right and meeting the cultural choices that are so important to people.

Kate Green: I accept what the Minister is saying but evidence suggests that for certain more disadvantaged and vulnerable individuals, articulating those needs is very difficult and so culturally appropriate advocacy, representation and brokerage services will be of huge

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significance. Evidence from research carried out so far suggests that the effects of personal budgets are patchy. I am sure the Minister will wish to raise standards across the board, and I look forward to the further work that we—collectively and with local authority colleagues—can do to ensure that that is the case.

Work force issues relating to social care are also a concern. As others have pointed out, many of those working in social care earn the national minimum wage and contract pressures mean that they have little time to do more than rush in and out of appointments and provide the basic physical care that clients need. There is little time to stop for a chat or a cup of tea, or for some of the social interaction that is so valued by those in receipt of social care. Many providers have told me they are anxious and that they are being screwed down on pricing as a result of local authority spending pressures, which could lead to their contracts becoming unviable. Poor levels of pay— as my hon. Friend the Member for Bridgend (Mrs Moon) said, staff are often not paid as they move from one appointment to the next—mean that they will not be motivated to provide the best care in those circumstances, and some will be forced to give up their jobs.

Finally, I welcome the development of extra care for those in need of residential care, and some good projects are under development in Trafford. I hope the proposed development in Old Trafford will receive approval. As colleagues have pointed out, the Dilnot recommendations, as taken forward in a more limited form by the Government, will leave many families in my constituency with substantial costs but without liquid savings with which to meet them, meaning they are still likely to be forced to consider the sale of the family home.

Overall, the Queen’s Speech needed a much bolder approach to prepare us for an ageing society, including policies for maximising saving in working age—difficult when the Government are putting family budgets under such pressure—and a bolder approach that looks at combining health and social care budgets, investment in primary and community health provision to keep people out of hospital longer, integration over competition, personalisation accompanied by a service investment programme, and serious attention to work force development. I regret the many missed opportunities in those areas in the Queen’s Speech.

7.38 pm

Stephen Mosley (City of Chester) (Con): We are now three years into the coalition Government and there is much that we can be proud of—health, welfare, police and education reforms; this has been one of the most radical Governments in a generation, but there is still much to do. It is not only about ensuring that our country is on the right economic track; the British people must know that the Government are on their side.

Recent local elections have shown that a sizeable minority are disaffected, disillusioned and dismayed by politicians and political parties, and the Prime Minister, Deputy Prime Minister and Leader of the Opposition have been bombarded with advice, often from their own Back Benchers. Often—surprise, surprise—the advice from those Back Benchers seems to be that the only way we can re-engage the trust of the electorate is by taking over their pet project. My advice to my party leader is

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that there is no magic bullet to winning over the electorate. Voters are cynical and fed up of political spin. They will spot a phoney a mile off. My right hon. Friend should be himself, be natural and not pretend to be something he is not. He should be proud of what we have achieved.

Things can sometimes be difficult in a coalition. Compromises need to be made. Sometimes our friends in the Liberal Democrats have had to make compromises; sometimes Conservatives have had to do so. However, at long last, Britain is moving in the right direction again. I urge the Government to hold their nerve, do what they believe to be right and ignore the siren voices calling for a change of direction. Some in the Chamber shout loudly, but that does not mean they are right, or that they have the support of the majority of their colleagues.

The Government should stay calm, because the foundations of future prosperity have been laid in the past three years, but we must not be complacent. The measures announced in the Queen’s Speech are another step on the journey to national recovery. I am particularly pleased that the Queen’s Speech tackles head-on two tricky problems that were classified as too difficult to touch by the previous Government. Both problems—reform of social care and reform of pensions—involve helping people in their old age.

Twenty years ago, Britain had the best pensions provision in Europe. Our pensions savings were the envy of the world. Millions of workers were signed up to excellent final salary pension schemes. Schemes were in surplus, and workers could look forward to retirement with a good, inflation-proof income. All that changed in 1997. The scrapping of advance corporation tax relief blew a massive hole in the value of pension schemes. That measure cost more than £5 billion a year—it has now cost pension schemes more than £100 billion, and the average worker has lost around £100,000.

Labour’s raid on pensions was just one nail in the coffin of final salary pension schemes. People are living much longer, and the global recession, the turmoil in the eurozone and our massive deficit have not helped matters—they have resulted in historically low interest rates, meaning that pensioners get less income from their savings.

Reform is urgently needed, which is why I warmly welcome the inclusion of the pensions Bill in the Queen’s Speech and the introduction of the single-tier pension. To ensure that future pensions remain affordable, people will have to work a year or two longer, so the Bill will bring forward the increase in the state retirement age and introduce a five-yearly independent review to ensure that the state pension remains sustainable. The current pension system is complex and confusing. It is almost impossible for people to work out how much they will receive. Under the new single-tier pension, people will qualify for the full pension of £144 a week provided they have made 35 years of national insurance contributions. Millions of future pensioners will be removed from poverty, and people who have saved for retirement will be able to enjoy the full benefit of their savings.

The proposals will address the inequalities in the current pension system. The Bill will support women who have taken time out to raise a family, and support low earners. The national insurance contributions of the self-employed will count towards a pension for the first time. Future generations will also benefit from the option of a workplace pension, with a contribution

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from both their employer and the Government. The pensions Bill will provide a clear, straightforward and fair pension for all—one that is secure as we face the problem of an ageing population.

Another big worry for people as they get older is who will look after them in their old age. The cost of care can be astronomical. For many, the fear of running out of money or being forced to sell their home to pay care charges causes huge concern. It is only natural for people to want to leave something behind for their children and grandchildren, and only natural that, after a lifetime of working hard and paying taxes, people want and expect the Government to be there to help. I therefore warmly welcome the announcement of the social care Bill and the reforms to long-term care funding. A cap on social care costs will help to ensure that the elderly do not have to sell their homes to meet their care bills, and that old people do not feel that they are a burden on others as their lives draw to a close.

The Bill will make a great many other improvements to the social care system, such as standardised thresholds for determining whether individuals are eligible to support from a local authority. It will include a duty on councils to inform residents about care provision, and a new right for carers to receive more support. For too long, Governments have found the problems of social care too difficult to tackle, and consequently tried to ignore them. I am proud that this Government are tackling the problem head-on and proposing a long-term solution that will benefit millions.

I warmly welcome the Government’s programme outlined in the Queen’s Speech. We have begun the long and hard process of restoring our nation’s finances to order. We must now turn to strengthening our society. We have achieved a massive amount in the past two Sessions of this Parliament, but a great deal more needs to be done. This year’s Queen’s Speech is an excellent step in the right direction.

7.46 pm

Dan Jarvis (Barnsley Central) (Lab): I am grateful for the opportunity to contribute to the Queen’s Speech debate on health and social care. Protecting the health of young people, reducing preventable deaths and safeguarding the health of Britain’s population are three important goals, but the absence of a Bill to introduce plain packaging for cigarettes undermines the Government’s commitment to those goals.

Cancer is an illness that touches many people’s lives. Although research is key to finding new ways to treat cancer, the Government can take simple and practical measures to avoid preventable deaths. Last week, the Government failed to introduce one such measure that could help to reduce cancer and other forms of smoking-related disease.

The introduction of standardised, plain packaging had been heralded as a good idea by a number of members of the Government. The Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), a member of the medical profession, had previously shown his support for plain packaging. He said that plain packaging

“could certainly help to reduce the brand marketing appeal of cigarettes to teenagers, and most importantly, help to stop young people from developing a smoking habit that can only shorten their lives.”

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I agree with him. The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), has stated that the evidence she has

“seen suggests that it is the attractiveness of the packets that leads young people to decide to take up smoking.”—[Official Report, 16 April 2013; Vol. 156, c. 561.]

I agree with her, too, and yet, three years into this Parliament, no action has been taken by the Government.

According to Cancer Research UK, more than 100,000 deaths are caused by tobacco each year in the UK. That could be much reduced if the Government took meaningful action. Between 2006 and 2007, the Labour Government took action to curb the harmful effects of smoking by banning smoking in public places. As the shadow Secretary of State for Health has said, the introduction of plain packaging for cigarettes is a natural progression, and as the Leader of the Opposition said in his response to the Queen’s Speech, plain packaging is the right thing for public health and the right thing for the country. I agree with him.

Since the Government consultation on plain packaging closed some nine months ago in August 2012, more than 150,000 children will have started an addiction to a substance that results in the death of half its long-term users. I accept that the introduction of plain packaging is not a silver bullet, but neither is it the nanny state, as some have described it. Plain packaging is a means of preventing young people from taking up a habit that, in the long run, could cost them their lives. Some 257,000 11 to 15-year-olds become smokers each year, and that number is unacceptable. We already have legislation to prevent children below the age of 18 from buying cigarettes. We banned smoking in public places, but more needs to be done.

Mrs Moon: The allegation is that it would be a nanny state if we introduced plain packaging. Is that not a contradiction, given that we know that state intervention often saves lives? If we had been worried about the nanny state, we would never have introduced seat belts or drink-driving laws, yet we would never move back from those. Is it not time we moved forward on plain packaging as well?

Dan Jarvis: I completely agree. The term “nanny state” has been used, but we want to prevent young people from taking up a habit that in the long term could cost them their lives. In 2013, Labour Members are on the correct side of the debate, which is also where the public are.

We should pause to consider the financial costs of smoking, which can be seen in its impact in towns such as the one I am proud to represent. The financial costs encompass much more than heightened NHS expenses; lost output and lost productivity both increase the price associated with smoking. For Barnsley alone, smoking creates a bill amounting to £75.3 million each year.

Yet the financial cost is small compared with the human cost. In Barnsley, there are 485 adult deaths from smoking each year. Despite that, nearly 1,000 children in Barnsley aged between 11 and 15 take up smoking each year and approximately 1,100 10 to 14-year-olds there are regular smokers. Like the rest of the UK, Barnsley has paid too high a price. It is time that action was taken to prevent the costs of smoking from stretching further and further into the future.

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Let us be clear: advertising works. If it did not, the tobacco industry would not spend such vast amounts of time, money and effort on packaging presentation and it would not be opposing plain packaging with such vigour. For the tobacco industry, packaging is a form of advertising that helps to keep existing customers loyal and attracts new ones. On that point, the World Health Organisation is clear:

“Marketing of tobacco products encourages current smokers to smoke more, decreases their motivation to quit, and urges”

young people to start.

Of course children will be attracted to sophisticated and glamorous packaging. When he was Health Secretary, the Leader of the House echoed that view, stating:

“It’s wrong that children are being attracted to smoke by glitzy designs on packets…children should be protected from the start.”

Unusually, I agree with him.

A lack of evidence cannot be used as an excuse for delaying the essential legislation. Advertising does impact on young people’s decisions, and in the context of smoking that means that children’s health is put at risk. The trade-off between the tobacco industry and children’s health has been in favour of the industry for too long. It is time that something was done to redress the balance.

There is also clear support for plain packaging from the public. Last year, 63% of the UK public supported standardised, plain packaging and only 16% of people opposed it. A lack of public support is not holding the Government back from introducing the legislation; in fact, 85% of people back Government action to reduce the number of young people who start smoking.

By delaying the next step in smoking prevention, the Government are not only putting a future generation’s health at risk, but ignoring a key issue that British people want and need Parliament to address. There is the evidence, the public support and the moral imperative to act, yet the Government have so far failed to take the definitive action needed to save lives, reduce health care costs and prevent children’s health from being put at risk.

Madam Deputy Speaker, please accept my apologies for not being able to attend the winding-up speeches. Let me conclude by saying that I am in no doubt that plain packaging is the right thing for public health and the right thing for the country. I am in no doubt we will have plain packaging. When we get there, we will wonder why it took so long to protect children against the harmful impacts of smoking and about the lives that could have been saved if we had acted sooner. We can stop that wondering if we act sooner rather than later. We know that advertising works and that smoking kills. It is time to do something about it.

7.55 pm

Jeremy Lefroy (Stafford) (Con): It is an honour to follow the hon. Member for Barnsley Central (Dan Jarvis), with whom I entirely agree about standardised packaging for cigarettes. I also agree with those who have spoken in favour of a minimum price for alcohol on public health grounds.

The Gracious Speech contains many important measures that are likely to assist the economy in my constituency—not least the employment allowance, the reduction of the burden of excessive regulation and measures to make it

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easier to protect intellectual property. Unemployment has fallen in my constituency since the election, but there is still a great deal to do. The number of apprenticeships has risen, so I welcome the Government’s plans to ensure that it becomes

“typical for those leaving school to start a traineeship or an apprenticeship, or to go to university.”

As previous speakers have said, the Government are taking important long-term decisions on the financing of pensions and certain parts of social care. Those decisions, including the change in the state pension age, the introduction of a flat-rate pension and the capping of care home costs, aim to give more certainty in an increasingly uncertain world, and I shall return to that.

I shall be opposing one measure, I am afraid—the plan for High Speed 2. It is my belief and that of my constituents that both the concept and the business case are deeply flawed. My constituents cannot understand why a route is announced 13 years before work starts without a proper plan to compensate immediately those whose property has been rendered unsellable. I have visited and heard from constituents who must, for pressing personal reasons, move house now, but who simply cannot. I urge the Government to put in place a full, fair and speedy system of compensation or purchase of property to enable those constituents to carry on with their lives.

I now wish to concentrate on health and social care. First, I ask the Government to provide time for a full debate on the Francis report into the Mid Staffs NHS Foundation Trust. Important lessons have already been learned. The appointment of a dedicated inspectorate of hospitals is a major step—unusually, I must disagree with the hon. Member for Walsall South (Valerie Vaz)— as is the introduction of more practical teaching into nursing training.

However, there is much more in the Francis report that needs to be debated. The vital and important work that Julie Bailey and Cure the NHS did to highlight problems in care deserves a thorough hearing. Earlier, we were all moved by the speech made by the right hon. Member for Cynon Valley (Ann Clwyd), who is looking into the matter and takes it so seriously. We also need to look at how mortality statistics are compiled and used, as they are becoming important and controversial.

Secondly, I spoke about the importance of trying to give some certainty on basic needs in an uncertain world. That applies to health as much as to pensions and social care. The provision of a national health service free at the point of need probably provides more peace of mind to the people of this country than any other single thing that a Government could do, apart from ensuring security, law and order.

Health care affects each of us and does so, in different ways, throughout our lives. It is a common bond between us and contributes to social cohesion. Yet its long-term financing is on difficult ground. The Government have rightly protected NHS spending at a time when other budgets have had to be cut, but with a growing and ageing population, it is likely that we will need a real-terms increase in spending in the coming years.

There is little room to cut costs from other Departments. We have to find another way to allow controlled, efficient and effective increases in health and social care spending, to deal with the challenges posed by an ageing population while not cutting other essential public services. I encourage

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the Government, over a period of years, to look at turning national insurance into a national health insurance that, as now, is based progressively on personal income, and which will provide the funding for health and, eventually, social care. That would enable us to have a sensible discussion on the national insurance rate required to fund health and social care properly, separate from the wider debate on tax rates and tax policy.

Thirdly, I wish to raise again the question of emergency and acute tariffs, on which my hon. Friend the Member for South West Devon (Mr Streeter) spoke so eloquently. The continuing squeeze on them, coupled with the fact that activity greater than 2009 levels is paid at only 30% of the full tariff, is leading inexorably to financial difficulties for acute hospitals, particularly district general hospitals such as mine at Stafford. However, it is not only the smallest that are affected. Major trusts also face deficits. Even if they are not, they will have to pick up the work load if acute services are removed from their smaller neighbours. That situation cannot continue. The drift towards centralising all emergency and acute services in the largest hospitals has to be stopped—even reversed. It will mean much closer working between hospitals, as hon. Members have said, and perhaps the end of many smaller trusts, though not smaller hospitals. It will also mean that royal colleges will have to get a grip and stop the fragmentation of health care into more and more specialties that cover less and less. We need, as the head of a medical school said to me recently, to rediscover the importance of high-quality generalists. A publicly funded national health service can only survive on that basis. That does not mean that specialisms have no place in the NHS—of course they do—but they must not drive out good general medicine.

Fourthly, the Government need urgently to look at health allocations across the country, as my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) said. The welcome increase in public health funding where there are particular inequalities was meant to enable per head allocations to become fairer, but that has not happened. Currently, South Staffordshire receives at least £40 million per year below its recognised fair shares allocation, and that is making the work of local clinical commissioning groups even harder. The Government have committed themselves to addressing this, but it needs to be done this year or CCGs will find themselves in a very difficult position right from the outset.

Finally, it is vital that the Government listen to the public. On 20 April, it is estimated that 50,000 local people went on a local march and rally, which I had the honour of addressing, in support of Stafford hospital. They were speaking out against the idea that emergency, acute and maternity services could be removed, and were making the point that alternative services were too far away and, in any case, themselves under great pressure, and that the proposals did not take proper account of the increasing population and demography. All of that is common sense, and I hope that the administrators currently running Stafford and Cannock hospitals listen to that common sense, and that it is heard across the country.

Monitor has a chance, together with the trust development authority, to establish a sensible and long-lasting configuration for emergency and acute hospital services across the country that recognises the important role of our smaller, acute district general hospitals. That

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can be done and it must be done. The Government are tackling the long-term problems on pensions that we need to take on, and it is vital that we do the same for health and social care.

8.3 pm

John Woodcock (Barrow and Furness) (Lab/Co-op): It is a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy), who made a thoughtful and considered speech on an issue of great importance nationally, as well as to his constituents.

It was a pleasure to be in the Chamber to hear such a powerful speech on plain packaging for cigarettes from my hon. Friend the Member for Barnsley Central (Dan Jarvis). Frankly, if Ministers are not convinced after hearing his arguments, they should probably not be in their place. I think that they are convinced and I hope to see them make progress.

I want to start on a note of consensus. I welcome the inclusion in the Gracious Speech of the Bill on mesothelioma compensation. This dreadful disease is a time bomb that, once detonated, often goes on to kill within months. With its shipbuilding heritage, more individuals in Barrow and Furness suffer from mesothelioma than in any other constituency in England. We owe a duty of care to all those who are suffering: they made an honest living and what is happening to them is not right. We should applaud all those who have pushed for further progress, including former Labour Ministers and the hon. Member for Chatham and Aylesford (Tracey Crouch), who I understand wanted to be here but is on her sick bed.

There are early concerns about the Government’s paucity of ambition. It is vital that the Government mandate a scheme that will build fittingly on the work of my predecessor, Lord Hutton, who expanded and speeded up compensation in the previous Parliament. However, many will see the thin programme last week as a missed opportunity to address increasing alarm about the Government’s poor stewardship of the NHS. It would be too optimistic to hope that Ministers have had an early change of heart on the costly and ill-conceived reforms they have just bulldozed through Parliament. In addition to the lamentable absence of plain packaging legislation, they could have introduced measures that sought to bridge the yawning gap between their rhetoric on listening to local people and the reality that is seeing the clear wishes of residents on NHS services ignored up and down the country.

In Barrow and Furness, we hope that health professionals in charge of provision across Morecambe bay will heed the passion and powerful arguments from local people on oncology, maternity, and accident and emergency provision. While residents understand that it can make sense to travel to get the best that 21st century health care can offer, like so many across the country they love their local hospital, they think it should have its fair share of the very best, and they think local provision, that is accessible to them and visiting loved ones, is a basic part of a quality service, not something to be dismissed as an unnecessary luxury.

I have some hope that the new management team at Morecambe Bay NHS Foundation Trust will listen to local concerns. An early test will be the publication of revised plans for Furness General hospital’s oncology unit this month. However, we see what is happening in

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other areas where the Government’s local engagement test is proving to mean little more than holding a meeting and nodding in an understanding manner, and ignoring everything people say and downgrading services anyway. When my constituents see the scale of the upheaval and cuts to front-line nursing staff involved in reducing the budget of Morecambe Bay Trust by £25 million within two years, they are, understandably, very wary of trusting Government promises that no efficiency savings will be allowed to affect the quality of patient care. I hope the Minister will tell me whether the Government will heed calls, including from the trust itself, for a rethink on the speed and scale of the cuts they are imposing.

Will the Government not take heed of the dismay felt about recent NHS reorganisations and enact measures to strengthen the power of local opinion in determining the future of our hospitals? We live in times of strained resources, but faith in the future of the NHS may continue to be eroded until we learn genuinely to trust local communities. When we come to look back at the history of the NHS over the current decade, I think we will see this as the time when we were bound overly tightly to the idea that the clinician always knows best. We will come to see the Government’s blind faith in the clinical stamp for taking services away as an early 21st century equivalent of the “Whitehall knows best” mentality that gripped reforming Governments after the second world war. Just like the “Whitehall knows best” ethos of the 1940s and 1950s, the clinician knows best mantra has the best of intentions but is insufficiently responsive to challenge from the patients who rely on the services that are being shaped by those at the centre.

Let me be clear. It is essential that health professionals make their case when decisions are made. Their expertise is immense and people should not deviate lightly from their plans. However, it is by no means certain that any one group, even one bursting with medical experience, will always call it right first time. Their views must be subject to scrutiny. Often the clinical push to concentrate a specialism at a single site takes less account of local geography and community links to health facilities than is demanded by local people, who ultimately pay the clinicians’ wages.

This is not an argument for sentimentality. The views of local people will sometimes be irreconcilably different in a single area, but if, for example, Barrow families suddenly face the prospect of a 100-mile round trip to visit a relative—because a unit at Furness General hospital has moved to Lancaster—their views on the move will be important. Many communities across England are fighting for their local health services. Some are threatened by cuts, but others are at risk from this clinically led decision-making model.

James Duddridge: The hon. Gentleman is making some valid points, several of which I am deeply sympathetic to, but on clinicians, is he referring to GPs or specialists? Does he think that the clinical commissioning groups of GPs who are more fixed in the community could have an impact on, for example, oncology and other specialisms in local hospitals?

John Woodcock: That is a good point, and it remains to be seen. We hope so, but the system has yet to be put to the test.

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I am disappointed that no move towards genuine localism was outlined in the Gracious Speech. It is time for a people’s NHS Bill to end the toothless sham that too often passes for local consultation. When local people say no, the default should be that they have exercised a veto that ought to be heeded. That would require a step change in our NHS away from a model that, yes, might have helped deliver improvements in health outcomes of which the country should be proud, but which has done so—

Norman Lamb: Will the hon. Gentleman give way?

John Woodcock: I will give way, if the Minister is quick, because I do not have much time left.

Norman Lamb: I am interested in what the hon. Gentleman is saying, and I accept the point about the importance of accountability. [Interruption.] He has just realised that he has got an extra minute of time, so I have done him a favour. Does he accept, however, that the old NHS, which we reformed, had no local accountability at all and that we have introduced some accountability through the health and wellbeing boards, bringing together local authorities and the NHS?

John Woodcock: It is an interesting point. I am not claiming that the system operating now is fundamentally different from that of three years ago, but around the country people who were promised a say in local decisions have been devastated to find out that they have none. Unquestionably, what has been put in place is not adequate. It is a sop to localism that does not do what it says. It would be a step change to move away from the current model.

Following the current model has meant alienating many local people who understood the trade-offs, but nevertheless fervently desired to keep services local. Whatever happens, surely the current tension between national planning and local unrest is unsustainable in the long term. In opposition, the Conservative party told the public that it understood that and pledged to end local hospital service closures, but of course its promises turned out to be a cheap election con trick. Instead, Ministers have forced through an expensive, chaotic and divisive health reform package that ultimately has pushed NHS decision making still further from the people it serves. We need a change of direction. Local communities pay for the health service they receive, and they deserve to be treated with greater respect.

8.13 pm

Paul Maynard (Blackpool North and Cleveleys) (Con): It is a pleasure to speak in this section of the debate on the Queen’s Speech.

It is three years, almost to the day, since I made my maiden speech, in the very same section of the debate on the Queen’s Speech—health and social care—and a lot has changed in those three years, especially on the Government Benches, in terms of policy. Listening to the Opposition speeches, however, and indeed to some from the Government Benches, it seemed to me that a lot had not changed. I think back to 1997, when the Conservative party experienced an appalling and traumatic defeat. How did it react? For a short while, we thought that the voters had got it wrong, that we could keep

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thrashing away at the same old themes and that very soon the voters would repent of their folly and everything would be all right, we would be carried back, shoulder high, into power. Of course, it did not happen; it took us 13 years and three election defeats to realise that singing the same old tune, time and time again, did not deliver the promised nirvana.

When I listen to Opposition Members, I feel as if I am listening to the Conservative party of 1997, only now it is the Labour party of 2013: unwilling to change, going back to what makes it feel comfortable, bashing the tobacco companies—perhaps quite rightly, but there needs to be a much stronger evidence base than disliking global capital, for heaven’s sake! Time and again, I listen to Labour Members and think, “Theirs is not a party that is ready for power”, because I am not hearing a new analysis or new arguments; I am just hearing the same old grudges, although I might except the hon. Member for Barrow and Furness (John Woodcock), who is one of Labour’s more thoughtful Members—that is quite rare on the Labour Benches.

I was delighted to have the Leader of the Opposition in Cleveleys for the local election campaign. On this occasion, he kindly wrote to tell me in advance—the first time he had done that, despite having made several visits—so I thank him for that small courtesy, if for nothing else. He gathered in the shopping centre in the centre of Cleveleys, with his little pallet, which he stepped on to. Labour bussed in all the councillors it could from Blackpool, because there are hardly any Labour activists in Cleveleys, and he just stood around, and my spy, who was there, tells me that no one paid him the slightest attention—he was looked upon as rather a curiosity, while people walked by eager to get on with their shopping and get their bargains. What happened? The political compass needle in Cleveleys barely shifted compared with 2009. If Labour cannot win back Lancashire—a county it controlled from 1981 to 2009—it is not in a position to gain power, in my view. That is why it is doubly important that Conservative Members do not get overly seduced by what UKIP is doing, but focus on what matters and what we were elected to do.

In my maiden speech three years ago, I stressed the importance of the dignity of patients in our health care system, and I have stressed it ever since. We are now starting to see progress on that, not least thanks to the activism of the right hon. Member for Cynon Valley (Ann Clwyd) and the role she now plays, but more importantly thanks to the rhetoric around what we recognise as being important. On my way here today from Euston, I was standing on an underground train behind a young trainee nurse. In her arms was a thick folder bearing one title: “dignity”. That message is starting to get through to NHS staff, in particular.

Although we can all recite cases from constituents of cases of care that they felt were below standards, we must balance that with the recognition that nurses are the glue that holds the NHS together and that we talk them down at our peril. For every nurse who might not have ensured that somebody was adequately fed or had their fingernails clipped or their conversation in the morning, there is another for whom nursing is a vocation. We have to recognise that. Nursing is a vocation. Occasionally, it is a very difficult vocation. The system can be testing, trying and infuriating for many, but nurses are there because they want to care for their patients.

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Perhaps the secret to health policy lies in allowing our health care professionals to express that vocation, not to smother it beneath a system that does not allow that feeling of good will and desire to do good for our fellow patients to express itself.

The other thematic issue I want to come to is perhaps a little more controversial. We are all politicians, are we not, whether we like it or not? I am sure I would rather not be a politician, but I am a Member of Parliament and it comes with the territory. The moment anything is scheduled to close in our constituencies, there is an immense temptation to man the proverbial barricades. We issue a press release and set up a photo op outside the threatened location, but do we always pause to think what is in the best interests of our constituents, or do we think, “What will get me more votes?”

I am fortunate, as I have an excellent hospital in Blackpool, the Victoria. It has one of the premier stroke rehabilitation units in the north-west. When it opened, it started taking in-patients from as far away as the south lakes. I am not quite sure, but the area it covers might even stretch as far as Barrow—I know it goes as far as Kendal. That was quite controversial at the time, because it meant that a patient having a stroke would have to drive past about four hospitals to get to Blackpool. Some people thought, “Why can’t we go to our local hospital? It’s got wonderful facilities.” However, since the stroke unit at Blackpool opened, survival rates have increased for all patients in all groups, because of the excellence of its specialist care. That is a challenge for every Member of this House, no matter what our political parties. The easy answer—the easy campaign, the scare story, or what I call “campaigning in the conditional”—is not always in our long-term interests.

I ask myself how I would have reacted if the stroke unit had been in Lancaster rather than Blackpool. Would I have manned a barricade, gone on a march or set up a petition? I do not know; I hope I would not. I hope I would have trusted in the idea of outcomes. Although I recognise what the hon. Member for Barrow and Furness (John Woodcock) said about localism needing to mean something, I also recognise that clinicians, too, have a role. Where outcomes are unacceptably poor, something has to be done. However, we need to do a much better job of communicating to our electorate why the clinical evidence that suggests that a particular thing has to change is powerful evidence, because evidence is power and we need to convince those who are most concerned.

8.21 pm

Mrs Madeleine Moon (Bridgend) (Lab): There are approximately 6 million carers in the UK, 2.2 million of whom provide more than 20 hours of care a week. Between them, they provide more than £119 billion- worth of care each year. They are listening to this evening’s debate. They want to know whether what is in the Queen’s Speech are empty words and further promises, or whether their lives will improve and changes will be made.

A lot of people have spoken of the work undertaken by my right hon. Friend the Member for Cynon Valley (Ann Clwyd) in the complaints review. I have sent copies of the letters I wrote when I made a complaint about the absolutely appalling treatment of my mother in an English hospital over a number of visits. I worked

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hard to make the complaint stick and ensure that my voice as her carer was heard, but even I, as a Member of Parliament, was worn down in the end.

I have sat in this debate and listened to Government Members criticise the Welsh health service. I have a very sick husband. He uses the Welsh health service, and I am grateful for the quality of care that he receives from it every day of the week. I know that my GP service is excellent and I know that if I need care from my local hospital for him, it is there, so I want to hear no more nonsense about the Welsh health service.

John Glen: Will the hon. Lady give way?

Mrs Moon: No, I will not; I am in the midst of my speech.

In Bridgend, there are 18,000 people providing care for relatives or friends. Some 5,500 of them provide unpaid care for more than 50 hours a week—care that is compassionate and dedicated; care of a quality that we would love to hear is being provided in our hospitals. I asked a group of carers recently what it meant to be a carer. One of them said, “It’s like trying to live two people’s lives and cramming them into one person’s life.” The other said, “You’re an expert in bodily fluids. Urine, faeces, blood and vomit are the daily recipe.” Is it any wonder that the Royal College of General Practitioners recommended last week that all carers should be screened for depression? It recognises that carers are particularly susceptible to depression and that there is a need for greater support.

Carers UK has reported that almost a third of those caring for 35 hours a week or more receive no practical support, while 84% of carers surveyed said that caring had a negative impact on health. That is up from 74% in 2011-12, so the problem is getting worse. Four in 10 —42%—of those caring for someone discharged from hospital in the last year felt that the person they were caring for was not ready to come out of hospital and that they did not have the right support at home. I worked in discharge care in a number of hospitals in Wales. Safe discharge was a major platform on which we worked. The things that are a problem remain the same. There is a lack of specialist equipment readily available for carers to assist with discharge—I am talking about beds that prevent bed sores, hoists, commodes, adapted bathrooms, swallowing assessments, speech and language therapy, occupational therapists and physios. It is not just nursing we need to focus on; it is all those important services.

We also need to look at the availability of treatment and medication that make a difference to people’s lives. I want to talk briefly about a condition that really shocks me and the carers of those who have it: aHUS, or atypical hemolytic uremic syndrome. I am the co-chair of the all-party kidney group. A few weeks ago I chaired a meeting of people with aHUS. There is a drug available for the condition that is called—excuse me, Madam Deputy Speaker, but it is a dreadful drug to pronounce—eculizumab. It sounds like some sort of African tribe, but that is what it is called. Taking eculizumab can virtually cure someone with aHUS. They get their life back. We are talking about a very small number of people who have the condition—less than 170. The typical form is triggered by a bacterial infection such as E. coli; the

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atypical form is genetic. We heard tragic evidence from families in which perhaps three or four generations of children and adults carried the genetic trigger. More importantly, the only treatment other than taking eculizumab is to have dialysis on a virtually daily basis. We heard from carers who have to place the extremely painful and long needles needed for dialysis into their children’s arms. Those children cannot have a kidney transplant because the transplant would almost certainly have the same condition. Even if they had a transplant, they would continue to need dialysis.

I am appalled to learn that the Government have agreed that those who are taking the drug on a trial basis may continue to take it, while those who have already been diagnosed but refused access to the drug on a trial basis will not be allowed access to it. Newly diagnosed patients will, however, have access to it. That is nonsense. We could save a large amount of money, and we could save those patients the trauma of daily dialysis. The drug was recommended for use by the Advisory Group for National Specialised Services and it has now been submitted to the National Institute for Health and Clinical Excellence for further appraisal. Sufferers of the condition might therefore have to wait until 2014 to get access to it, which is totally unacceptable.

Madam Deputy Speaker, I am sorry that I shall not be able to stay for the winding-up speeches, but I hope that the Minister will consider whether it might be possible for access to this drug to be extended to all sufferers of aHUS, so that they and their carers can once more have a decent quality of life, and so that the NHS can save money.

8.29 pm

James Duddridge (Rochford and Southend East) (Con): It is a privilege to be called to speak in the debate, and it is good to follow the hon. Member for Bridgend (Mrs Moon). Some of her comments about rare kidney diseases resonated with me, as I have recently visited the very good renal centre in Southend. I have also looked into the issue of rare diseases. Individually, they might be rare, but collectively they are quite common as a group, and the funding for the relevant drugs and for more general treatment can be tricky.

I have a quite carefully drafted speech here, but I was blown away by my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), who spoke without notes and whose speech was a fantastic tour de force. I am tempted, perhaps unwisely, to pick up on a number of issues that have been mentioned in the debate, some of which have been quite controversial. I did not listen to every single speech today; I missed half an hour. While I nipped out for a cup of tea, I heard colleagues on this side of the House speaking out against equal marriage—perhaps some Opposition Members did so as well—but I for one am glad that that legislation will be dealt with in this Session. The carry-over motion will ensure that we have ample time to debate it and to work through some of the issues. In 20 or 30 years, we will look back in confusion as to what the problem was. We are perhaps introducing the legislation faster than the public has an appetite for, but politicians sometimes need to lead rather than follow.

At lunchtime today, I had the privilege of having lunch with my mum and dad, who were in very good form. They said that they had been looking for me

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during the Queen’s Speech but had been unable to see me, and I told them that the debate was carrying on today. I asked them what they had thought of the speech, and they told me they thought it was very funny. I am not sure that either Her Majesty or the Prime Minister wanted to create that impression. I asked my mum why she found it funny, and she described how Black Rod had got stuck halfway down and been held up by the Speaker.

There has been a debate today about whether the Queen’s Speech was too narrow. The right hon. Member for Rother Valley (Mr Barron) criticised Conservative Members for talking more about what was not in the speech, but the general public do not think in terms of Bills and Acts; they think in themes, as my hon. Friend the Member for Blackpool North and Cleveleys said. One theme of today’s debate has been immigration seen through the prism of the NHS, although the general public probably also look at it through other prisms, including housing and Europe. Looking at the Queen’s Speech in a thematic way is perhaps slightly more useful.

I am tempted to make some comments on Europe. It is constructive that we should vote on the matter. If the coalition is to survive, it will need to be more comfortable about having open debates rather than simply private ones. We will need to have more open debates, rather than fewer, if the coalition is to be healthy all the way through to 2015. It is a strength of democracy to have open debate rather than narrowly commit ourselves to certain lines.

On immigration, the right hon. Member for Rother Valley talked about the use of extremist language. Actually, far from its use being negative in this context, the use of immoderate language can sometimes be essential if we are to have an open discussion. Otherwise, the debate gets overtaken by the Daily Mail and the Daily Express. We should have a full and frank debate on immigration, and on other issues.

When we consider health—the main focus of today’s debate—I think politicians are sometimes too scared to ask questions about a merger or a closure, for example, and to query whether those are the right things to do. We should be more open minded. The hon. Member for Barrow and Furness (John Woodcock) said that more local people should be involved in the process. I am sure he is right, but I am not sure that that is a totally new thing, as the Minister intervened to say in the latter part of his speech. I was certainly very close to the position the hon. Gentleman stated. I am not sure which of us should worry more about that, but it is a statement of fact about how I felt.

The commitment to spending 0.7% of gross national income on international aid was not in the Queen’s Speech. That is a totally arbitrary figure, but it is a promise that all the main political parties made and one that I fully support. To be frank, I cannot get het up about whether or not the commitment is built into a piece of legislation. If my family was starving in Ethiopia, or in the northern badlands as Bob Geldof would describe them, I would not care whether the money was coming because it had been mandated or because it had been promised. It makes little difference. I certainly congratulate the Government on actually spending that money, which is far and away the most important thing.

Let me deal with the deregulation Bill—legislation announced in the Queen’s Speech to reduce the body of existing legislation. I feel that an awful lot more can be

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done. The Bill has not been published, but I think that the Government have been too modest in their ambitions when it comes to deregulation. The Better Regulation Task Force is producing some really strong ideas.

John Woodcock: I am fascinated by what the hon. Gentleman is saying. Perhaps he was about to mention this, but what does he want to deregulate?

James Duddridge: At the moment, we have piecemeal deregulation, whereby we look at specific issues and then deregulate. I was elected as chair of the Regulatory Reform Committee, which as a body deals with pieces of legislative reform that the Government think can be fast-tracked for regulation or deregulation in order to avoid burdensome regulation. That is very much a piecemeal process—we looked, for example, at veterinary legislation—but it would be much better to have a big thematic review of issues surrounding care homes, for example. Rather than look at health and safety, the medical issues or equipment separately, it would be better to have a thematic review, cutting across Departments in the same way this debate cuts across the division between the health service and social services, local councils and different funding streams. I think it is our responsibility to do that here in the House of Commons.

The deregulation Bill will be good and tidy up bits of the statute book, but I would like to see a lot more detail about how that is going to happen. A Joint Committee will be set up between the Lords and the Commons, and I would very much like to serve on it, but as much as possible we should open out the number of Bills that we are looking at. Setting aside the issue of whether we should be in or out of Europe, the increase in European legislation demands that we face up to a two-for-one deregulatory challenge, just to stay standing. We need to go further.

The economy is another key theme in the Queen’s Speech. Given our current economic position, if we had had a Conservative Government from the outset, I believe such a Government would have tested every single Bill by asking, “Will this Bill help the economy? If not, it is marginal, and we should push it to one side—certainly when it comes to parliamentary time and impact.” I think that the Budget is much more important. When we highlight the themes in the Queen’s Speech, we should not judge ourselves by the amount of paperwork we sign off. The Budget is, in many ways, more important. Corporation tax, the national insurance deal and so forth will get Britain booming. I have seen it in my local area, where, for example, Southend airport has boomed, generating over 500 jobs in the few years that it has been motoring in a serious way, as opposed to when it was a rather hobbyist airport. There is much still to be done, but we should not judge ourselves by the volume of legislation. In fact, through the deregulation Bill, we should be able to reduce that volume.

8.39 pm

Grahame M. Morris (Easington) (Lab): I thought that, rather than speaking about Europe or votes for prisoners, I might make a couple of points about health and social care.

There are many provisions that I should have liked the Government to include in their legislative programme. For instance, I should have liked to see a commitment

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to extending freedom of information requests to private health care companies. I should also have liked to see a commitment to excluding health care from the scope of trade agreements as part of a broader exclusion of public services. I understand that the Prime Minister is involved in negotiations at this moment, and I hope that the trade agreement issue is on his agenda, because there is an increasing fear among Opposition Members that—in that context, and also as a result of the Health and Social Care Act 2012—our health care system is being prepared for privatisation, and the way is being cleared for the mass entry of United States health care multinationals to the UK market.

I am pleased that the Care Bill is to be introduced in the current Session. It will go some way towards helping those who are most in need of social care, as well as their carers, providing as it does the first ever legislative framework for social care. It is a much-needed first step in the right direction, which has been a long time coming. However, it raises a great many issues. As usual with this Government, we need to look beneath the veneer and establish whether an opportunity is being taken or missed, and whether we are taking one step forward and several steps back. It would certainly be a retrograde step to raise expectations only for them to be dashed as people discover that the proposals are really quite limited. We need to be honest about what is on offer.

Members often receive some shocking and surprising statistics in their mailbags, but some of the most surprising pieces of information that I have seen relate to social care. I must thank a range of organisations—including Scope, Age UK, the Alzheimer’s Society, the TUC, the British Medical Association, Barnardo’s and the European Federation of Public Service Unions—for supplying briefings to me and to other Members. It shames me, and I am sure it shames Members in all parts of the House, that in Britain in the 21st century four out of 10 disabled people who receive social care support say that it does not meet their needs. That was established recently by research on social care conducted by the disability charity Scope following the publication of a report by the Joint Committee on the draft Care and Support Bill, on which I served. It is feared that the current provisions, and some of those that are proposed, will not be sufficient.

Other Members have welcomed the Bill. However, it is hugely worrying that local government finance has been hollowed out. That will have major consequences. It has been said that local government allocations for social care are protected, but they are certainly not protected when it comes to provision for transport and other supplementary services that are of value to members of the group involved. Many organisations have pointed out that setting eligibility criteria for care at “moderate” is essential if this framework is to be effective. As the hon. Member for Bradford East (Mr Ward) pointed out, according to the findings of a survey by Scope, by 2012 84% of councils had set their eligibility criteria at the “substantial” threshold. That represents an increase of nearly a third since 2005. As a result, only 14% of people with “moderate” needs are now receiving care, and the findings of recent surveys suggest that the position will only get worse.

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According to Marc Bush, head of research and public policy at Scope,

“if we take moderate level needs, there are 36,000 people within the system of working age who, if the reforms go through as they are currently set, would fall out of the care system…if you do not meet need early, people's needs escalate and the costs escalate.”

Mr Bush’s evidence is in paragraph 186 of the Joint Committee’s report. Indeed, the Local Government Association has estimated that by 2019-20, 45% of council budgets will be spent on social care. Unless we increase substantially the amount of resources available—

Mrs Moon: There is pressure on people with illnesses and with disabilities if they do not get access to that social care, but should we not acknowledge the wider pressures on their families, who have to fill that gap all too often? That means taking time off from work and reducing the time spent on their leisure pursuits, thereby adding to family tensions.

Grahame M. Morris: That is an excellent point. The role of carers and families is absolutely critical; they are an army of unsung heroes.

We cannot build a quality care service based on driving down the terms and conditions of the people who deliver it. I am very concerned about the increase in the number of zero-hour contracts, through which staff are paid the bare minimum. Such contracts are increasingly being used by private care companies seeking flexibility when meeting short-term staffing needs, and they often lead to job insecurity and a lack of appreciation of workers. We are seeing the fragmentation of social care, driven by the pressure to cut costs, which only places obstacles in the way of quality and of integrating services. Contracting out and privatisation also make it more difficult to have joined-up services, and there is a real risk that local authorities will find it impossible to comply with their new duties.

We should be honest about what the Bill can achieve. It is a framework. It is paving legislation. It will not stop people having to sell their homes to pay for care. Under the existing deferred payment scheme, councils can loan money to people to cover their care costs, which has to be paid back by selling the family home after the elderly person has died. The Government propose something similar, but unlike the current system, interest is charged on the loan. The care Bill will not necessarily cap at £72,000 the costs elderly people actually pay for residential care. As has been said, hotel and other accommodation charges are not covered. Many elderly people in care homes will die long before they reach the cap that is being trumpeted as such a success. It certainly will not mean that pensioners get their care for free if they have income or assets worth up to £123,000. Elderly people will get free care only if they have income or assets under the lower means-tested threshold, which is not being increased and will be £17,000 in 2016.

More widely, the care Bill does nothing to address the funding crisis in social care or to help those who face a daily struggle to get the support they need right now. Elderly and disabled people are facing huge increases in home care charges, which are a stealth tax on the most vulnerable people in society. Few older people are getting their care for free, and more older and disabled people are being forced to pay for more vital services that help them to get up in the morning and get washed, dressed and fed.

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We need a far bigger and bolder response to meet the needs of our ageing population: a genuinely integrated NHS and social care system which helps older people to stay healthy and live independently in their own homes for as long as possible. That would truly reinstate the idea of people being looked after from cradle to grave—a worthy extension of Aneurin Bevan’s legacy. Labour’s alternative is integrated, whole-person care, incorporating health, mental health and social care in a truly national health and social care service.

8.49 pm

John Glen (Salisbury) (Con): I welcome the Queen’s Speech, particularly where it promotes the interests of people in our society who work hard, want to get on and recognise that in the long term their well-being is likely to be sustained when they rely more on themselves than on the state.

I want to focus most of my remarks on the Care Bill and on the absence of the plain packaging legislation. Before I do so, I make the observation that the integrity of the Government and their ultimate success will be reliant not so much on what they say on Europe, but on what they deliver on welfare reform and the state of the economy. Thankfully, there was no significant new legislation on welfare reform in the Queen’s Speech, because it is now about the delivery of what we have already brought before Parliament. I am delighted that the Government are listening carefully and working deliberately and carefully through the process of pilots before bringing in fully the welfare reform.

One aspect of that reform, referred to in the Queen’s Speech, is access to benefits for immigrants. It is right that the Government are considering limiting access to housing benefit and health care for people who have not earned the right to it. It is not enough to keep ignoring that uncomfortable truth because we are frightened of being too right wing, too nasty or too unpleasant. The routine experience of people up and down this country is that on the front line, at the point of delivery and at the point of receiving public services, they are too often displaced by people who, apparently, should not have the right to access those services. I am pleased that the Government will address that in legislation.

On the health aspects that are the focus of today’s debate, it is right that the Government have finally introduced the Care Bill, as every constituency MP has been concerned about this issue for many years. In some of our earlier exchanges today, we have, as usual, debated who cut what when. I know that before 2010—or before 2007—there were prolonged periods when this country had significant surpluses of moneys and, despite considerable evidence indicating that reform of the care system was required, nothing was done. I am therefore pleased that the coalition Government have found a way forward.

Some specific details on how the arrangements will work—the interaction with the local authorities, and the timing and practicalities of the cap roll-out—need to be delivered. That requires a spirit of collaboration and constructive engagement, and an examination of the complexity of multiple agencies of government working together to deliver care in circumstances that cannot always be defined by legislation. Too often in these debates we use examples from our constituency case load, which are often emotive and provoke an emotional response, but our responsibility as Members

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of Parliament is surely to absorb and take on those challenging individual cases, and to work through the different processes of government to see that better outcomes accrue and occur. We must also reflect honestly on the systems that led to those failures, and distinguish between the systems that may have failed and cases where—sadly, unfortunately—human error and individual failures led to dissatisfied constituents.

We must be honest about issues with the NHS, because we need behavioural change and a different appetite among the electorate for public health measures. We also need to take a constructive view about what is affordable with pensions. Therefore, I welcome the single-tier pension, which simplifies a lot of the complexity that has developed in our system.

I am deeply disappointed that the Government have failed to include legislation on plain packaging of cigarettes explicitly in the Queen’s Speech. I completely agree with the speech made by the hon. Member for Barnsley Central (Dan Jarvis). When we have 10 million smokers, when two thirds of those who start smoking do so before the age of 18 and when 200,000 young people start to smoke every year, it is not enough to rely on arguments about the complexity of illegal trafficking.

Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): The hon. Gentleman is making an important and valid point and we have heard a number of his colleagues making similar points; I suggest that they table an amendment on the issue. If they do so, they might find that a lot of Labour Members support them, and who knows what might happen?

John Glen: I am grateful to the hon. Gentleman for that intervention, but I think we have had quite enough amendments this week.

Nevertheless, the point remains that we cannot rely on a debate about the issues of the illegal production of illicit cigarettes or in the packaging industry; those issues need to be tackled head-on. The core point is this: why does the tobacco industry spend so much money on elaborate packaging? It does so because such packaging works and because it encourages young people to take up the habit of smoking.

In this Chamber, the hon. Member for Shipley (Philip Davies) would usually sit next to me. Fortunately he is not here today, because if he were I am sure he would have intervened. He would have said it should be about freedom to choose. I am sorry, but I do not believe that 16-year-olds faced with massive peer pressure in certain communities genuinely have freedom to choose. It is not enough to say that the Government gain lots of tax revenues. For those individuals and their families, the health implications of smoking are dire. The situation is disappointing and I hope that a private Member’s Bill or another mechanism will be found to address the issue before the end of this Parliament.

James Duddridge: I am persuaded to a degree by my hon. Friend’s argument, and if plain packaging were the solution to eliminate the problem, I would be inclined to vote for it. However, I cannot help but think that there will be something else around the corner, such as a ban on smoking in films or a ban on role models being seen to smoke, and ultimately an absolute ban on smoking. That might well be the right answer, but I am not quite sure where the debate is going.

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John Glen: The reality is that smoking is almost unique in its proven health implications: the fact that it is so addictive and the fact that, particularly for young people, the implications for their future health are dire. We cannot just use the “freedom” arguments or ask “Where will the debate go?” to hide from that reality. We have a responsibility to do something about it.

I want to use my remaining speaking time to focus on the issue of rhetoric versus reality and the gap between the two, because I recognise that the election results a couple of weeks ago threw up big issues for my party about how we handle that. That takes me back to what I said at the outset. Most people want a Government who are concerned about the economic well-being of this country, about generating growth, about delivering fairly provided quality public services that not only look after the most vulnerable properly but give incentives to those people who can create wealth and jobs to do so, and about allowing the economy to prosper.

I think it would be wrong to get into a trade-off of rhetoric on the Europe issue, because all the proposed solutions are a long way off. The reality for this Government is that it will be a slow, hard and difficult process, but it is one that is well set out in this Queen’s Speech, with practical, sensible measures that are likely to win support over the course of the remainder of this Parliament.

9 pm

Mark Lazarowicz (Edinburgh North and Leith) (Lab/Co-op): It is appropriate that I should follow the hon. Member for Salisbury (John Glen), as he made an important point about the economic aspects of the Queen’s Speech, and that serves to remind us that health is not just a matter of hospitals, doctors, nurses and medicine—important though all that is—but it is also affected by Government policies in other areas. I disagree with the hon. Gentleman in this respect, as I am very concerned that many of this Government’s policies are, directly or indirectly, having a damaging effect on the health of many millions of people in this country.

The first of those effects is illustrated by the growth in real poverty, which has led to the mushrooming number of food banks throughout the UK. I now have two food banks operating in my constituency, along with other sources of free food for those in need, and that situation is replicated in every constituency across the land. The food provided through the food banks is healthy food that is beneficial to the diets of those who receive it. In most cases food is provided only for a limited period, however, which suggests that at other times those who depend on food banks do not get decent meals and a decent diet, and often go hungry. Evidence from the Trussell Trust suggests that about one third of the people who are dependent on food banks are children, and we all know that those who have a bad diet at the beginning of their life can face serious lifelong consequences.

I acknowledge that the reasons why people go to food banks are complex. There is a world economic crisis and increases in food prices at a worldwide level, so I do not pin all the blame on this Government’s policies. No doubt in the current global circumstances we would have seen an increase in food banks under any Government. I would, however, have liked to have heard some mention in the Queen’s Speech about policies that would serve to tackle child poverty and the scandal of so many in our society being dependent on food banks.

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We might have reversed policies such as the 1% cut in many benefits that passed through Parliament not long ago. Another broader area that has a direct impact on health is poor-quality housing and lack of housing provision. The situation has been exacerbated by the bedroom tax. There cannot be a single MP on either side of the House who has not been contacted by constituents who are suffering directly as a result of the introduction of the bedroom tax. I shall not comment on the tragic case recently reported in the media and which was mentioned earlier, but I know of plenty of cases in my constituency where people’s lives have been turned upside down by the bedroom tax. It often has a serious effect on their mental health and sometimes takes away their ability to work, which in turn affects their ability to feed themselves and their family and to meet their energy bills. So, too, does the fact that the bedroom tax leads to people losing benefits, but there was not a word in the Queen’s Speech to amend a policy that has increasingly been shown to be indefensible.

The housing problem is not just about homes being under-occupied. Many of us know from our own constituencies about the problems of poor-quality housing, overcrowded housing and lack of affordable housing. The Queen’s Speech did not give sufficient priority to addressing that. Yes, there were policies designed to support the housing market, some of which will have benefits as regards affordable housing, and I welcome that. However, the Government still seem desperately keen to promote a housing boom at the higher end of the market, because houses worth up to £600,000 will be eligible for their programme. Again, that is an example of the wrong priorities when the real priority should have been to tackle poor-quality housing, and not to force people into the terrible situation in which many find themselves because of the bedroom tax.

Another area where wider policies have a direct impact on health is employment. We all know that health and being in a job go together. In many cases, being unable to work or being in insecure employment is likely to be extremely damaging to health. I was taken by the comments of my hon. Friend the Member for Easington (Grahame M. Morris) about workers on zero-hours contracts in the health service. That is bad not only for the health service but for the workers whose health may be directly affected by the insecurity of being in such a situation.

No matter what the official employment figures say, and they are bad enough, the reality of unemployment, low employment and under-employment is underestimated. In all our constituencies, people are working part-time when they do not want to and being forced to take large wage cuts. We have the spectre of people working on zero-hours contracts, returning to a day-labourer system where people do not know from day to day whether they will be in employment. If anyone thinks that that does not have direct effects on people’s health and well-being, they are deluding themselves. If we do not tackle these issues, there will be increasing health problems for many people in our society. That is why Labour’s job-creation programmes, which we will discuss in later debates on the Queen’s Speech, are so important. We also need international action, with a change in direction to get away from the austerity programmes that are causing so many problems and so much unhappiness not only in our country but throughout the rest of Europe.

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Toby Perkins: The link between health and unemployment was addressed very well, under the previous model of the NHS, by Derbyshire primary care trust, which supported and funded programmes to get the long-term unemployed into work. This does not seem to be happening as much in the restructured NHS. Will my hon. Friend expand on the importance of getting the long-term unemployed into work and the impact that joblessness has on their health?

Mark Lazarowicz: My hon. Friend makes an important point. Measures to address long-term unemployment and child poverty, to tackle housing inequality and poor housing provision, and to provide more security in jobs and housing and in other ways are some of the biggest things that could have been done to promote health throughout our country.

I wish that Conservative Members who have spoken in the debate on the Queen’s Speech and the debates leading up to it had shown as much concern and passion about these issues as they have with the in-fighting on European issues that has taken up so much of the internal debate within their party. I accept that in the past few hours we have heard mainly constructive and thoughtful speeches on health issues by Conservative Members, but I suspect that that is simply because the ones who are doing the plotting and the in-fighting are doing it elsewhere. It is a pity that more Conservative Members have not paid attention to the issues that the people in our country want addressed—health, employment and housing. In those areas we need a significant change in direction from the Government which the Queen’s Speech did not give us.

9.8 pm

Sarah Champion (Rotherham) (Lab): I would like focus on two groups of people who are not adequately covered in the Care Bill: young carers and the disabled.

I recently had the pleasure of spending time with a remarkable group of Rotherham young carers who are supported by Barnardo’s. Because of funding limitations, Barnardo’s is able only to work with young people between the ages of eight and 18, and only 100 in a year. Sadly and shockingly, Barnardo’s estimates that 3,000 young people are carers in Rotherham alone. It has on its waiting list children as young as six who are counting down the days until their eighth birthday when they can get some support.

The young carers asked me to make colleagues aware of their plight. Hannah told me that the main thing she wanted was recognition for the work she did. She understands her mum, who suffers from severe depression, better than anyone. Hannah wants her experience to be fed into her mum’s assessments. As she said,

“they trust me to look after her but they don’t trust my opinions.”

When Hannah calls the medics to say that her mum is deteriorating, she should be taken seriously. Instead, young carers have to contact their Barnardo’s worker to lobby on their behalf, because they are not recognised by the authorities.

I welcomed many of the measures in the draft Care and Support Bill, but they are limited to adults caring for adults. The Care Bill represents a missed opportunity to improve the rights of all carers, including adults caring for children and young carers. The young carers I met know that, because of them, their parents do not

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have to stay in hospital, a mental institution or a care home. They know how much their help saves the Government. On their behalf, I urge the Minister to make sure that the Care Bill gives young carers a little support in exchange.

Consolidating provisions relating to adult carers in previous Bills will create neat, codified legislation, with

“clear legal entitlements to care and support”

for adults, while young people will be left with piecemeal, leftover legislation that practitioners will struggle to navigate. This is highly problematic. As I have said, workers often need to act as advocates for young carers and protect their rights. This area has long faced the challenge of a confusing legal framework, and the Bill has the potential to make matters worse. It appears to provide a clear picture of carers’ rights, while in effect excluding some of the most vulnerable carers.

I recognise that the bulk of the changes needed to protect young carers need to be made in the Children and Families Bill, but changes could also be made in the Care Bill. In order to prevent inappropriate caring, it is important that measures are put in place to ensure that adults’ needs are met and that young people with potential caring roles are identified as part of an adult’s assessment. Not only would that recognise the important role that young carers play, but it would allow their needs to be acknowledged formally, forcing existing services to be more accommodating. For example, all of the young carers I met faced challenges at school, with inflexibility on late homework, missing school and the need to call home during the day. If young carers are formally recognised as part of the assessment process, that could be fed through to the school and teachers could be notified of the young person’s needs, allowing them to be better supported.

On the Bill’s implications for those with disabilities, my office has seen a marked increase in the number of cases of disabled people struggling to make ends meet. The introduction of the employment and support allowance has been confused and poorly administered. I have dealt with numerous cases of vulnerable people being placed in unnecessarily stressful situations and left financially worse off by this Government’s reforms. Such cases already make up 10% of my overall case load. The abolition of incapacity benefit will soon be followed by the abolition of the disability living allowance and the introduction of personal independence payments, meaning that disabled people are being squeezed at an unsustainable level.

John Woodcock: My hon. Friend is making an important speech. Does she share the concern of my local disability association that the problems with the ESA benefit and how it has been reassessed have led to grave worries about the introduction of personal independence payments?

Sarah Champion: I thank my hon. Friend for yet another example of the extreme stress that people are being put under and the mismanagement of this entire process. The pressure of the burden being placed on them is intolerable.

I am extremely concerned that the Government’s Care Bill will put further pressure on that vulnerable group. The key issue for social care reform is eligibility. A third of social care users are working-age disabled people. The Bill will not improve the social care system

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for them, and 105,000 disabled will be shut out from receiving the social care that enables them to live their lives.

My hon. Friend the Member for Easington (Grahame M. Morris) mentioned statistics from Scope that make depressing reading. Four in 10 disabled people who receive social care support say that it does not meet their basic needs, including eating, washing, dressing and just getting out of the house. A third of working-age disabled people say that cuts to their social care have prevented them from working or volunteering.

The Bill appears to focus on the elderly and does not address the care crisis facing disabled people. For those working-age disabled people who do not meet the eligibility threshold, the £72,000 cap on care costs will not apply. They will continue to need to meet the cost of their social care. If an individual’s care needs increase later in their working life to the point that they become eligible for social care, the cap will not take into account the contributions they have already made to meet their care needs.

I agree that the introduction of a national eligibility threshold is a step in the right direction. Alongside a new assessment system, I hope that it will end the postcode lottery in care provision. However, it is vital that the threshold is set at a level that ensures that working-age disabled people receive support to meet their basic needs.

The Government spend £14.5 billion a year, or 2% of public expenditure, on adult social care, which includes older people’s services. However, it was estimated by the Dilnot commission that social care services are under-resourced by £2 billion. Those services are being further squeezed by the pressure of an ageing population and a 33% reduction in local council budgets. Local authorities are therefore dramatically under-resourced for the demands that are placed on them. As a consequence, they have been raising the threshold at which disabled people become eligible for support. Recent surveys suggest that almost half of local authorities plan to reduce spending on care services for adults, which will hit those with learning difficulties and those with disabilities.

Unless there is sustainable funding for adult social care, the situation is likely to get worse. The upcoming spending review must be used to secure more long-term funding for social care services to underpin the Care Bill. The Government must not lose sight of disabled people and young people as the Bill progresses.

9.16 pm

Jim Shannon (Strangford) (DUP): Will you confirm, Mr Deputy Speaker, that I may speak until 9.40?

Mr Deputy Speaker (Mr Lindsay Hoyle): The hon. Gentleman has eight minutes, and if two interventions come along that will give him 10 minutes.

Jim Shannon: I am sure that my colleagues will intervene.

I thoroughly enjoyed the opening of Parliament. It always fills me with a sense of optimism to look forward to another Session and what we can do. As the DUP Health spokesman, that optimism was dulled when I noted, with some dismay, that the Government had not

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included standardised cigarette packs in the Queen’s Speech. It would have been great to see essential measures on that.

I am reminded of the dance, the hokey-cokey: they are in for packaging, they are out for packaging, they are in for packaging, they are out for packaging, and they swing it all about. I cannot do the hokey-cokey, but I know who can. The Government can do the hokey-cokey and nobody can do it better. Bruce Forsyth often says, “Didn’t they do well?” If he ever retires, there are two hon. Members who will be vying for his position.

I am encouraged that some hon. Members have had the courage of their convictions. The hon. Member for Salisbury (John Glen) has taken a clear stance on plain packaging, as have other Members. I appreciate that.

I have received many e-mails from constituents on this issue. One stated:

“Since tobacco advertising became illegal in the UK, the tobacco companies have been investing a fortune on packaging design to attract new consumers. Most of these new consumers are children with 80% of smokers starting by the age of 19.”

Other Members have made it clear that we must stop smoking being an attraction for young people. About 200,000 children as young as 11 years old are smoking already and the addiction kills one in two long-term users. A recent YouGov poll showed that 63% of the public back plain packaging and that only 16% are against it.

Last week, I asked the Prime Minister whether he would introduce plain packaging. He said:

“On the issue of plain packaging for cigarettes, the consultation is still under way”.—[Official Report, 8 May 2013; Vol. 563, c. 24.]

That is not exactly accurate because the standardised packaging consultation started on 16 April last year and ended nine months ago on 10 August 2012. I am keen to hear from the Government just what is happening.

Chris Ruane: I am just doing Mr Deputy Speaker’s bidding by intervening to give the hon. Gentleman an extra minute. When plain packaging was introduced in Australia, the tobacco industry fought the longest, dirtiest battle it had ever fought against any Government proposal to curb smoking. Why does the hon. Gentleman think that was? It threatened that triads would come over from China and take over Australia, but that never occurred. Why did it threaten so much and fight so hard? Is he pleased that it lost?

Jim Shannon: I thank the hon. Gentleman for his intervention. I perceive and am of the opinion that companies saw such measures as a loss to their profit margin, and we would like to see what happened in Australia happen here.

The former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley),was quoted in the media saying that the Government did not work with tobacco companies as they wanted them to have “no business” in the UK. Has that changed? The current Health Secretary stated that one of his key priorities is to reduce premature mortality. His call to action on premature mortality commits to a decision on whether to proceed with standard packaging. He also stated:

“Just because something is not in the Queen’s Speech doesn’t mean that the Government cannot bring it forward in law.”

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Even at this late stage, may we hear a commitment to bringing forth such a measure in law? If we do, that will be good news and we will welcome it.

Some 10 million adults smoke in the UK and more than 200,000 children start smoking at a very early age. More than 100,000 people die from cancer-related smoking diseases across the UK, which is more than from the next six causes of preventable death put together. The immensity of the number of deaths from smoking cannot be underestimated. Many Members have spoken about that, and I believe the fact we are all saying the same thing is something we should underline.

We cannot remove people’s choice to smoke—that is a decision to be made by any adult—but we can, and must, ensure that everyone knows they are doing harm to themselves and those around them. Evidence that standardised packaging helps smokers quit and prevents young people from taking up the habit and facing a lifetime of addiction is clear, and we should encourage more people to stop smoking and not to become addicted.

Frank Dobson: Does the hon. Gentleman agree that the argument sometimes put by defenders of the tobacco industry—usually paid defenders—is that people are exercising free choice? In fact, they are not exercising free choice because they are addicts who took up the addiction when tobacco companies persuaded them to smoke when they were teenagers.

Jim Shannon: I thank the right hon. Gentleman for that intervention and for clearly underlining the stand we are all taking on this issue. We hope that Ministers will respond positively. I believe that plain packaging is a major step in this informational and educational journey to end smoking, and I ask the Minister to commit today to begin that journey that has been planned for so long.

Another disappointment in last week’s speech was the lack of reference to the minimum pricing of alcohol, although there has been some indication that there may be a change of heart, which we hope will be the case. Last week I was sent a copy of a study containing numerous sources, and there are certainly some shocking statistics. Its findings, among other pertinent points, demonstrate that alcohol is 45% more affordable today than it was in 1980. Men and women can currently exceed the recommended low-risk daily drinking guidelines for £1. That is hard to believe in this day and age, but it is the truth. Data from Canadian provinces suggest that a 10% increase in the average minimum price would result in about an 8% reduction in consumption, a 9% reduction in hospital admissions, and—this is the big one, Mr Deputy Speaker—a 32% reduction in deaths caused wholly by alcohol, which is even higher than the figure suggested in the Government’s impact assessment.

Alcohol Health Alliance UK stated:

“The case for introducing minimum unit pricing is clearer than ever, yet despite committing to the principle of minimum unit pricing, it appears that the Government are going to drop the measure from their alcohol strategy.”

Perhaps Ministers will comment on that, but I sincerely hope it is not the case. Minimum pricing of alcohol is not to ensure that those on low incomes cannot have a drink, but to ensure that people of all incomes are aware how much they are drinking and conscious of the

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health implications of excessive or binge drinking. When it comes to minimum pricing for alcohol, we can all take note and take advantage of it.

Every year there are 1.5 million victims of alcohol-fuelled violence in the United Kingdom, and it is clear that community safety is threatened by the misuse of alcohol. Police superintendents have advised that alcohol is present in half of all crimes committed, and a 1990 study for the Home Office found that growth in beer consumption was the single most important factor in explaining the growth in crimes of violence against the person. The figures are clear. Statistics show that 37% of offenders had a current problem with alcohol; 37% had a problem with binge drinking; 47% have misused alcohol in the past; and 32% had violent behaviour related to their alcohol use. When we mix young people, who have not had time to develop their moral standards and ideals, with alcohol, we have a generation who are fuelled by the desire to live in the moment, with no thought of the consequences. Alcohol changes personalities, and young people are only learning who they are. Adding alcohol to the mix means that they will never have a good understanding of who they are. A minimum price for alcohol will lessen the number of young people who drink copious amounts of it. Hopefully, it will also mean a lessening of crimes that are aggravated or exacerbated by alcohol.

My third point is on diabetes, which is a ticking bomb in our society. We had a debate on it in Westminster Hall, when the right hon. Member for Leicester East (Keith Vaz) made the point about diabetes and obesity among children. The figures are overwhelming. The United Kingdom of Great Britain and Northern Ireland diabetes strategy ended in April, but perhaps the Minister can tonight commit to its continuation. I believe the strategy was working. Had it not had an effect, the figures would be much worse. Even given the strategy, the number of people living with types 1 and 2 diabetes has increased by 33% in Northern Ireland, 25% in England, 20% in Wales, and 18% in Scotland. The numbers are rising. A commitment to the continuation of the strategy would be helpful. The statistics are scary—3.7 million people in the UK are diagnosed with type 2 diabetes. However, we are talking not only about statistics, but about people’s lives. We need to prevent and control as well as we can.

I am aware that the health portfolio is not an easy one. Everybody needs something urgently. I understand the restrictions that apply, but does the Minister understand that the three issues that I and others have raised affect every corner of the United Kingdom of Great Britain and Northern Ireland? I believe we could have reform on those issues if the Government put their hand to the plough and disregard all but the health and safety of our population.

9.26 pm

Liz Kendall (Leicester West) (Lab): It is a great pleasure to speak at the close of the debate after so many passionate and thoughtful speeches from hon. Members on both sides of the House.

My right hon. Friend the Member for Stirling (Mrs McGuire) and the hon. Member for Truro and Falmouth (Sarah Newton), who is not in her seat, rightly stressed that, although many debates on the future of health and care services focus on the needs of older

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people, social care is critical to adults of working age. My hon. Friends the Members for Bridgend (Mrs Moon), for Worsley and Eccles South (Barbara Keeley), and for Rotherham (Sarah Champion), spoke of the vital role of unpaid family carers, who are the bedrock on which the care system rests. They spoke particularly of the needs of young carers, who often feel that their childhood is being taken away from them by their caring responsibilities.

My hon. Friends the Members for Birmingham, Selly Oak (Steve McCabe), for Easington (Grahame M. Morris) and for City of Durham (Roberta Blackman-Woods) spoke of the growing crisis in social care funding, the increase in care charges that family members must pay, and the pressures on services and support. The hon. Member for Stafford (Jeremy Lefroy) gave, as ever, a thoughtful speech on how we might pay for NHS and social care in future. There will be different views on his proposals, but he made, as ever, a thoughtful contribution.

My hon. Friends the Members for Stretford and Urmston (Kate Green) and for Barrow and Furness (John Woodcock) rightly said that we have a duty to provide decent compensation and care for mesothelioma sufferers. My right hon. Friend the Member for Rother Valley (Mr Barron), my hon. Friends the Members for Vale of Clwyd (Chris Ruane), for Sheffield Central (Paul Blomfield), for Gateshead (Ian Mearns) and for Barnsley Central (Dan Jarvis), and the hon. Members for Salisbury (John Glen), for Mid Derbyshire (Pauline Latham) and for Strangford (Jim Shannon), spoke with passion about the Government’s failure to introduce standardised packaging for cigarettes to reduce premature deaths from smoking in this country. I hope the Government think again on that. Finally, my right hon. Friend the Member for Cynon Valley (Ann Clwyd) once again gave a direct voice to people who have suffered from unacceptably poor standards of care in the NHS. My right hon. Friend and all of us here are absolutely determined to stamp those out.

I want to focus on the measures in the Queen’s Speech on social care. The current legislation on adult social care is complex and confusing, and it needs reform. That is why the previous Labour Government set up the Law Commission review, which has led to many of the measures in the Care Bill. We support the new rights that the Bill contains; they build on the rights that Labour introduced in government, such as the right for family carers to request flexible working.

During the Bill’s passage, we will work to ensure that older and disabled people and their family carers get the best possible deal. We will seek to make amendments where there are serious omissions, such as the needs of young carers, or where improvements should be made, such as introducing free social care at the end of life. Organisations such as Sue Ryder and Macmillan Cancer Support have shown that such care can give people more choice about the place of their deaths and save taxpayers money by reducing the need for more expensive hospital care.

Those new rights, however welcome, risk being meaningless if people cannot get the services and support they need on the ground. That is the reality that hundreds of thousands of people now face. The 70 organisations that make up the Care and Support Alliance are clear

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that the Bill will not solve the crisis now engulfing social care. They warn that there is now a real danger that most people—not some, but most—will not get the help they need just to get up, dressed and out of the house as councils struggle to cope with swingeing budget cuts and growing demand.

Ever tighter eligibility criteria for council support mean that fewer older and disabled people get the help that they desperately need. Let us be clear. People talk about providing care and support only for people with substantial needs but not for those with moderate needs, but those latter needs are serious. I have seen in my constituency that “substantial needs” involve only people with terminal illnesses or who are incontinent or blind. There are many other very high levels of need. We are missing out support for those who desperately need it.

Even when people do qualify, they routinely face 15-minute home visits—barely enough time to get an elderly, frail, vulnerable person with dementia up, washed, dressed and fed. People wait a long time to get basic help such as grab rails and stairlifts so they are without the support for basic preventive care that helps people to live independently at home, which is what they and their families desperately want. Family carers are left struggling without the breaks that they need just to keep going or even a bit of emotional support and advice on the phone, as local voluntary organisations cut back and close.

The tragedy is not just that older and disabled people and their family carers suffer; it is that taxpayers end up paying more for the price of failure. Elderly people have to go into more expensive hospitals or residential care when they do not need to, because they cannot get the support they need in the community or at home. One in three family carers have to give up work or reduce their hours because they cannot get the help they need to care for their loved ones. Their own health suffers, which puts more pressure on the NHS, and their income suffers. The Treasury loses more than £5 billion a year in lost tax revenues and benefit bills because those family carers have to give up work.

The Government remain in complete denial about the scale of the care crisis we now face. They have been repeatedly warned by local councils about what the cuts in budgets and pressures on services mean. Councils are warning that in 15 years’ time they will not be able to provide the services that members of the community want and like—the libraries, leisure services and swimming —because of the pressures on local council adult social care budgets. The Government refuse to listen.

The Government are not being straight with people about their future plans either. The Prime Minister, Deputy Prime Minister and Health Secretary have repeatedly said that no one will have to sell their home to pay for their care. That simply is not the case. In future, all local authorities will have a duty to offer deferred payment schemes, lending people money to pay for their residential care. However, the loans will have to be paid back, after the elderly person has died, by selling the family home. The Government’s new scheme will charge interest on the loans, unlike under the current system, so people will lose even more of their family home than they do now. However, they have not told the public that they will be paying more, with that interest, under their new scheme. Will the Minister now come clean and tell families how much interest they will be charged? Will the Minister tell us

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how much interest families will be charged? Will he give a straight answer? He is not going to now. I hope he will when he responds to the debate.

Ministers also repeatedly claim that the Bill will cap the amount people are charged for their care at £72,000. The Health Secretary was at it again when he was at the Dispatch Box today, claiming that the Bill sets “a finite maximum cost” that individuals will have to pay. Again, that simply is not the case. The so-called cap on care costs is based on the standard rate local councils would pay for their residential care in their area—approximately £480 a week nationally—and not what people actually pay for their care. The 125,000 people who fund their own care fully, and many more who pay top-ups, will face far higher bills, particularly in the south and east of England. Government Members should take heed of that point, because if they tell their constituents that there will be a finite cap on their care costs, they will be sorely disappointed. The extra costs, above and beyond the standard rate that councils pay, will not count towards the cap. That means that older people will think they have reached it when they have not. In reality, it will take four years to hit the cap, yet the average length of stay in a care home is just over two years, and a quarter of people in care homes die after just a year. In other words, most people will be dead years before they reach the cap. Even if they are still alive, the state will pay only the standard council rate, leaving self-funders no choice other than to either leave the care home and move somewhere cheaper, or to pick up the extra costs.

The Government have failed to explain that people will not get their care for free if they have income or assets worth up to £123,000, the new increased upper means-tested limit. They will get care for free only under the lower means-tested limit, which is not being increased, and will be £17,500 in 2017. In between, there is a sliding scale of support. However, the way the means test works will mean that pensioners on average incomes—those who have worked hard and saved for a modest second pension of, say, £80 a week—will not get any council support, even with the increased upper means-tested limit, because councils calculate it by determining a notional income based on the capital in people’s homes. That, combined with the average pensioner income, takes them above the level at which they would receive council-funded support.

Government Members look surprised. That is unsurprising, as their Ministers have not spelled out the reality of the Government’s plans. Ministers should be straight about what their plans really mean, so that older and disabled people and their families can plan for the future properly. Instead, they tour the TV studios and make statements to this House giving false reassurances that are simply not borne out by the facts. We all know that people are fed up with politicians who say one thing and do another: claiming that people’s care costs will be capped when they will not, and claiming that raising the means test will help pensioners on average incomes with modest second pensions when it will not. I warn Government Members that that will not help to restore faith in politics or politicians, or help us to plan properly for the future.

Things could and should have been so different. Rather than forcing through their damaging and distracting backroom NHS reorganisation, the Government should

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have spent the last three years laser-focused on the service reforms people desperately need, shifting care out of hospitals and into the community and more towards prevention. Instead of diluting Dilnot’s proposals and then misrepresenting them to the public, they should have engaged in meaningful cross-party talks to agree a system that helps those on low and modest incomes, not just those predominantly at the top. And instead of driving greater fragmentation of NHS care services, jeopardising some of the best examples of integrated care, such as in Torbay, they should have adopted Labour’s plans for whole-person care, a single service with a single budget, funded through a year of care, that would shift the emphasis out of hospitals and into the community and result in better care for people and better value for money for taxpayers too.

Meeting the challenges of our ageing population is one of the biggest issues facing our country and society. We need a far bigger, bolder, straighter, clearer response, which this worn-out, divisive and divided coalition will never provide.

9.41 pm

The Minister of State, Department of Health (Norman Lamb): I thank hon. Members for their contributions to the debate.

Despite all the knocks that Opposition Members like to give it, the NHS is performing remarkably well, with 3.3 million more out-patient appointments, more than 500,000 operations, 1.5 million more diagnostic tests, the number MRSA infections halved and record low numbers of people waiting more than a year for their operations—just 665 people, down from 18,000 in 2010. These are real achievements for the NHS, and we should applaud and pay tribute to a really remarkable work force who have achieved these things despite tough economic times. The last Government rightly set in train £20 billion of efficiency savings, and those savings are being achieved despite the tough challenges.

Despite the doom and gloom heard during the debate, some brilliant things are happening in social care, including in some Labour authorities. In Leeds and Barnsley, for example, great things are happening, with people looking at new ways of doing things and redesigning services, recognising that times are tough and that, even under a Labour Government, they would face the same challenges. I recognise, however, that the system is facing real pressures, so it is disappointing that the Opposition, including the shadow Secretary of State and shadow Minister, the hon. Member for Leicester West (Liz Kendall), sought to polarise the debate by making exaggerated claims about the state of the NHS, when we all know the truth, which is that pressures are growing and have been for a long time. We have people living with long-term conditions, often for many years, and with a mix of mental and physical health problems. Those are the difficult cases sometimes clogging up our A and E departments, so let us have a mature debate about how we deal with the challenges.

We have a completely fragmented system and we are not spending money effectively to achieve the best possible care. Mental health is institutionally entirely separate from physical health, health care is separate from social care, and primary care is separated from hospital care. The whole urgent care system is under significant pressure. [Interruption.] I tell the shadow Secretary of State that

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on some of these issues we in fact agree more than he would sometimes like us to believe. The system is dysfunctional and we have to change it. We have had 4 million more people visiting A and E since the disastrous renegotiation of the GP contract by the last Labour Government. The hon. Member for South West Devon (Mr Streeter) talked about the significant pressures on A and E. Let me reassure him that Monitor and NHS England have issued a call for evidence on how the tariff system is working, with a view potentially to reforming it.

Liz Kendall: Does the Minister agree that in 2009, five years after the GP contract was agreed, 98% of patients were seen in A and E within four hours?

Norman Lamb: What I would say to the shadow Minister is that since 2010, 1 million extra people have visited A and E. These are real pressures and we all have to think about how we manage them. Surely the way to do that is to try to improve people’s care so that they avoid ending up there in the first place. Tomorrow I will announce a decisive shift towards integrated care, which will be part of a major strategy for vulnerable older people, whom the Secretary of State talked about earlier. We have to focus on preventing people’s health from deteriorating, stopping the crises that end up with people in A and E despite the system’s best efforts.

Several hon. Members referred to pressures in social care, including the hon. Member for City of Durham (Roberta Blackman-Woods) and my hon. Friend the Member for Bradford East (Mr Ward). The Government have done what they can. We have put £7.2 billion extra into social care and local government to support the system through these difficult times because of the local government settlement, but we all know that things have to be done differently. The Care Bill is totally consistent with that approach: it focuses on prevention, co-operation, integration of care and spending money more effectively to improve care for patients. I was pleased that the hon. Member for Easington (Grahame M. Morris) welcomed the Bill, as did the hon. Member for Salisbury (John Glen) and many others. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his work as Minister and subsequently as Chair of the pre-legislative scrutiny Committee. He has done a lot of brilliant work to highlight the issues that the Bill deals with.

It is hard to exaggerate just how badly the Care Bill is needed. Previous legislation is now hopelessly outdated and almost irrelevant to the needs of today’s society. Tinkering around the edges was keeping the system afloat, but no more than that. The shadow Secretary of State was dismissive of the value of the Bill, but it will be a big social reform—one of which this coalition Government should be proud. The new Care Bill will reform an antiquated, paternalistic system, improve people’s experience of care and establish both health education England and the health research authority as non-departmental, stable, independent public bodies. The Bill will pool together threads from more than a dozen Acts into a single, modern framework for care and support, but it is far more than a mere compilation. The Bill will fundamentally reform how the system

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works, prioritising people’s well-being, needs and goals, so that they no longer feel they are battling against the system to get good care.

Barbara Keeley: The Minister is back on his point about the Bill creating a single statute, but it will not do that for young carers, who will be left with the protection only of the private Member’s Bills I mentioned earlier. It is not good enough for young carers to face a higher threshold than other carers before their needs are assessed. That has to be looked at. The children’s Minister has let the House down on this issue; I hope that this Minister will not do that.

Norman Lamb: I was coming on to pay tribute to the hon. Lady for the work she has done. I absolutely agree with her that we need to get this right. We have the juxtaposition of two Bills, dealing with children on the one hand and adult social care on the other. Earlier I made a commitment to meet the children’s Minister; I had an opportunity to speak to him briefly when he was in the Chamber earlier. I am also meeting the hon. Lady later this week. I am committed to doing everything I can to get this right, and to ensure that young carers are not let down.

The Care Bill also highlights the importance of preventing and reducing ill health and of putting people in control of their care and support. This will involve the right to personal budgets, taken as a direct payment if the individual wants it, and putting people in charge of their care and of how the money is spent. This will put carers on a par with those for whom they care for the first time. The hon. Lady has consistently argued her case, and I am determined that we should get this provision right. The hon. Member for Rotherham (Sarah Champion) also made some powerful points on the subject.

The Bill will also end the postcode lottery in eligibility for care support. My hon. Friend the Member for Totnes (Dr Wollaston), the hon. Member for Easington and others raised concerns about the level of the eligibility. That question will obviously have to wait until the spending review, but I point out that if we were to set it at moderate need, the cost attached would be about £1.2 billion. All hon. Members need to recognise that this is difficult, given the tough situation with public finances. We also need to do longer-term work on developing a more sophisticated way of assessing need and providing support before people reach crisis point.

The Bill will refocus attention on people rather than on services. It will bring in new measures based on the Francis inquiry, ushering in a new ratings system for hospitals and care homes, so that people will be able to judge standards for themselves. The hon. Member for Walsall South (Valerie Vaz) criticised the idea of appointing a chief inspector of hospitals, but I disagree with her. It will be really important to identify where poor care exists and to expose it so that improvements can be demanded without fear or favour. The chief inspector will be able to do just that. It will also be really important to celebrate great care, so that those people in the health and care system who are doing everything right can be applauded and recognised for the work they are doing.

Frank Dobson: Does the Minister accept that a generalised rating for a hospital is not going to be valuable because, within one hospital, some departments

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might be doing a brilliant job while others are not? It would be stupid if an overall rating persuaded people not to go to a particular hospital for treatment if the specialty they required was being practised brilliantly.

Norman Lamb: I disagree. We brought in Jennifer Dixon of the Nuffield Trust to advise on this matter. There will be ratings for specific services within hospitals to identify areas of great care, but the single rating will give the hospital the incentive to bring up to a proper standard those areas that are falling short, and that will be a good thing.

Alison Seabeck: Will the Minister give way?

Norman Lamb: I want to make some progress; I am conscious of the time.

The Bill will introduce a single failure regime, so that, for the first time, a trust can be put into administration because of quality failure as well as financial failure. Until now, it has been only the finances that can put a trust into administration. This Government recognise that quality failure is just as important, if not more so, and that such failure must carry consequences.

The stories recounted by the right hon. Member for Cynon Valley (Ann Clwyd) and the hon. Member for Bridgend (Mrs Moon) reinforce our determination to make improvements and to ensure that people get the best possible care. I again pay tribute to the impressive work carried out by the right hon. Lady, and I thank her for her work on complaints procedures. The hon. Member for Mid Bedfordshire (Nadine Dorries) also talked about the importance of compassion in good nursing care.

The Bill will make it a criminal offence for providers to provide false and misleading information. My hon. Friend the Member for Stafford (Jeremy Lefroy), who has done great work representing his constituents in the most honourable and responsible way, drew our attention to the importance of mortality statistics being accurate so that we can rely on them. Alongside this Bill, we will introduce the statutory duty of candour—something of which I am personally proud. It does not require primary legislation, but the Government will introduce it.

The funding of care is to be reformed so that there will be a cap on the care costs that people will pay in their lifetime. This is long overdue. Reform has been in

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the long grass for too long. Several hon. Members, including the hon. Members for Worcester (Mr Walker), for City of Chester (Stephen Mosley) and for Lancaster and Fleetwood (Eric Ollerenshaw), made the point that people will no longer have to sell their homes during their lifetime to pay for care. So often people have had to sell their homes in distress at the moment they go into a care home. When they cannot organise their affairs properly, they have to sell up to pay for care. No longer will that be the case. They can delay all those issues because of the right to deferred payments.

It is this coalition Government who have bitten the bullet on a very important reform. I am very proud of the fact that we are doing this, introducing a long overdue reform. Andrew Dilnot himself has strongly supported the Government’s action. That is happening together with a very significant extension of support—I take on board what the hon. Member for Leicester West said—to help people of modest means with their care costs. Each one of those measures would be significant by themselves. Together, they provide real optimism that we can shake off the shackles of the past and look towards the future, not with fear, but with optimism. The Opposition are wrong to dismiss the importance of this Bill. They should recognise just how much it could improve the lives of some of the most vulnerable people in society.

Liz Kendall rose

Norman Lamb: I am going to conclude.

We are two thirds of the way through this Parliament and we have already addressed big challenges that were ignored during Labour’s three terms in office. We have been and will always be 100% committed to an NHS that is not satisfied with mediocrity, but is always searching to be better, more focused, more helpful than ever before. Society is changing, drug costs are increasing and expectations are higher. The NHS and the social care system must change to meet those challenges and we are helping to make that happen, safeguarding the NHS now and in the future.

Ordered, That the debate be now adjourned.— (Mr Swayne.)

Debate to be resumed tomorrow.

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Cleveland Fire Authority

Motion made, and Question proposed, That this House do now adjourn.—(Mr Swayne.)

9.57 pm

Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab): First, I thank you, Mr Speaker, for giving me the opportunity to have this important Adjournment debate.

I am sure that hon. and right hon. Members—at least those on the Opposition Benches—are acutely aware of the financial squeeze being applied to their fire and rescue authorities by central Government. Indeed, two years ago, my hon. Friend the Member for Hartlepool (Mr Wright) raised the point that Cleveland’s government settlement was the second worst in the country. However, I fear that many Members and the public might not be aware of this Government’s support, both financial and political, for proposals to take front-line fire and rescue services out of the public sector.

The Minister may say that this is not the case and that these services would remain under local authority control. However, the community interest company in the case of Cleveland fire authority, is already registered at Companies House as a separate entity, and managers are stating that an expansion of the existing CIC is the vehicle they intend to use for the formation of a “public service mutual”.

Recently, fellow Cleveland MPs and I met the Cleveland fire authority. Let me make it clear now that the categorical statement from the chair and other members was that they would do nothing that would lead to the privatisation of the service. However, the chief fire officer said that any contract would be subject to competition after the initial contract awarded to any mutual expired. He said at that meeting that the initial contract could be for anything from three to nine years. My hon. Friend the Member for Stockton North (Alex Cunningham) and I have been greatly concerned about what the chief fire officer—along with, if I may add, firm Government encouragement—had proposed.

Alex Cunningham (Stockton North) (Lab): I congratulate my hon. Friend on securing this important debate. I am sure he agrees that the Cleveland fire chief responsible for the area that probably has the highest fire risk in Europe is ploughing a lone furrow with his proposals, given that other fire chiefs throughout the country are dismissing the mutual model, and firefighters themselves are convinced that competition law would soon open the way for private companies to take them over and put profits—

10 pm

Motion lapsed (Standing Order No. 9(3).

Motion made, and Question proposed, That this House do now adjourn. (Mr Swayne.)

Alex Cunningham: That took me a little by surprise, Mr. Speaker.

I am expecting my hon. Friend to agree with me that the Cleveland fire chief responsible for the area that probably has the highest fire risk in Europe is ploughing a lone furrow with his proposals, given that other fire

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chiefs throughout the country are dismissing the mutual model, and firefighters themselves are convinced that competition law would soon open the way for private companies to take them over and put profits before people—for the second time of asking.

Mr Speaker: We probably got it the first time, and certainly the second.

Tom Blenkinsop: I think you will agree, Mr. Speaker, that it was such an important point that it had to be made a second time. I shall develop my response to it during my speech, if my hon. Friend will allow me to do so.

In Cleveland, the chief fire officer is exploring the possibility of spinning out the fire brigade. The whole range of fire and rescue services activity, including emergency response, is being examined for the purposes of being “spun out”—to coin a Government phrase. The proposal is being supported by Ministers in the Department for Communities and Local Government and by the Cabinet Office, which is spending over £100,000 on the legal advice that will be necessary for the pursuing of such a restructuring.

James Wharton (Stockton South) (Con): Will the hon. Gentleman give way?

Tom Blenkinsop: I will, although Members normally inform the Member who has secured the debate that they wish to intervene.

James Wharton: I thank the hon. Gentleman for his generosity. He was at the same meeting with the fire authority and the chief fire officer that I attended with the hon. Member for Stockton North (Alex Cunningham). We discussed these matters then, and I think that the main concern among all the MPs who were present was to ensure that the employment rights of the people who work for the fire service were protected.

The hon. Gentleman has mentioned the organisations that he thinks are backing this proposal. Will he acknowledge that it is the Labour-run fire authority that is pushing it, and the Labour chairman of the authority who thinks that it is such a good idea?

Tom Blenkinsop: We understand that, under the recent regulations introduced under the Government’s own Health and Social Care Act 2012, the TUPE regulations are worth about 90 days in practice. As for the hon. Gentleman’s claim that the Labour authority is pushing the proposal, the Labour chair actually said “If we were properly funded, we would not even consider going down this route.” As I shall make clear, this is a devolved blame game initiated by Ministers to thrust a mutilation of the concept of mutualisation on the people in Cleveland.

Mr Iain Wright (Hartlepool) (Lab): That is very good. Very clever, at 10 o’clock at night.

Tom Blenkinsop: Thank you very much.

Many operational issues arise from the proposals, relating to, for instance, local, regional and national resilience. I understand that the Fire Officers Association, the Chief Fire Officers Association and the Fire Brigades Union have raised them with officials in the Department

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for Communities and Local Government. I shall focus on four specific concerns. The first is the apparent lack of employee support for the proposals, and the uneasy lack of public awareness. The second is the sheer lack of transparency on the part of both the Government and the fire authority's senior officers. The third is the question of whether a spun-out brigade would raise additional revenue. If so—as a caveat—would such a spin-out have an adverse impact on existing local economy arrangements? Finally, and most importantly, I want to discuss the real risk that these proposals could lead to the privatisation of front-line fire services on Teesside.

I am a member of the Co-operative party, and a supporter of co-operatives and mutuals. I believe that if a mutual is to function effectively, it will require the support of its members, and that measures should not be forced on a work force. I am not at all convinced that that would be the case in Cleveland, given that the proposals appear to be very much management-driven. The only letters I have received from firefighters in my constituency about this matter strongly oppose the proposals. Indeed, at a single meeting attended by more than 250 firefighters, approximately half the uniformed service in Cleveland, there was unanimous opposition to them. The FBU, which represents some 85% of uniformed fire service workers, has identified a total lack of demand from staff for employee ownership in the fire sector. Instead, there has been “overt hostility”, except from a “smattering of principal managers”. Indeed, I doubt whether there is support even among principal managers, with 40 English chief fire officers and fire chief executives adding their names to the CFOA’s pre-consultation response, which highlighted major concerns with these proposals.

Even the language used by those promoting the model seems to have been redefined to address the level of employee support. According to the FBU, the model was originally promoted as a John Lewis-style, employee-owned mutual. However, that was only until it became apparent that employees did not want ownership, and nor would they be afforded shares as per that model. The title changed to an “employee-led” mutual, until the vast majority of employees indicated that they did not support the model, and that the only employees who did were a select group of senior managers. The latest title employed is a “locally led” mutual, which in effect acknowledges employee opposition and in doing so employs the term “mutual” as a misnomer.

Interestingly, one senior local manager has indicated that 51% work force support is the threshold required, although FBU legal advice suggests the fire authority has the ultimate say. It is difficult even to assess the extent to which any spun-out fire brigade would in fact be a mutual, with the authority’s senior officers showing a total disregard for transparency in these proposals. In the authority’s meetings, just about everything related to the proposals has been transacted under “confidential business”, making it impossible for me, my hon. Friends, the media or the public to scrutinise them. Although I believe that the authority will be putting out a business plan to public consultation in due course, I fear it may be presented as a fait accompli. It is indeed remarkable that the authority’s officers, prior to spending tens of thousands of pounds of taxpayers’ money, did not consult stakeholders to ascertain the appetite for these proposals or involve them in setting the terms of reference for the creation of any business plan.

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The Minister may want to say that the authority’s integrated risk management planning has previously stated that it would explore alternative business models, which it did, but only in the most generic terms. What it has not done so far is consult in detail the people of Cleveland. It has not even indicated whether this would be subject to detailed consultation as part of the ongoing IRMP process.

The Government are doing all they can do to prevent us from analysing these proposals. The fire authority’s senior officers are also providing the bare minimum they can under freedom of information legislation. When my office requested copies of these briefings and their assessment of procurement options for spinning out the brigade, they declined to provide a copy. Amazingly, they argued that it was not in the public interest to do so.

Andy McDonald (Middlesbrough) (Lab): I note my hon. Friend’s comments about the failure to publish the pre-consultation responses. Does he share my concern that the proposal fundamentally to change the basis upon which our fire and rescue service is delivered is being progressed beneath a veil of secrecy? If the scheme is such a good idea, should it not be subject to open and transparent scrutiny, with comprehensive information being shared among all interested parties?

Tom Blenkinsop: I absolutely agree with my hon. Friend, who himself has had to get FOIs and put those letters of information into the House of Commons Library, due to the lack of transparency.

One of the main genuine reasons why some members of the fire authority are even considering going down this route is their belief that it would mitigate some of the cuts, due to the spun-out body’s ability to bid for private contracts. Also, one of the chief fire officer’s stated aims is job creation. The areas the CFB is exploring are not related to core FRS activity; indeed, these are services currently provided by other sectors. The CFB proposals seek to replace these “others” by providing the same service with their existing work force, thus removing other workers from employment. That in no way can be described as job creation; in fact, it is the very opposite. However, nor do I believe that this would raise any further revenue.

Mr Iain Wright: I congratulate my hon. Friend on securing what is a vital debate for our area. Can he confirm that there is nothing to prevent the community interest company from bidding for existing work? Can he think of anything that, in an effort to secure additional revenue streams, would prevent the current situation from continuing, compared with what a mutual or private model can do?