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House of Commons

Monday 13 May 2013

The House met at half-past Two o’clock


[Mr Speaker in the Chair]

Bill Presented

High Speed Rail (preparation) Bill

Presentation and First Reading (Standing Order No. 57)

Patrick McLoughlin, supported by the Prime Minister, the Deputy Prime Minister, Mr Chancellor of the Exchequer, Secretary Vince Cable, Secretary Iain Duncan Smith, Secretary Eric Pickles, Secretary Owen Paterson, Secretary Edward Davey and Mr Simon Burns, presented a Bill to make provision authorising expenditure in preparation for a high speed railway transport network.

Bill read the First time; to be read a Second time tomorrow, and to be printed (Bill 10) with explanatory notes (Bill 10-EN).

Points of Order

2.35 pm

Chris Bryant (Rhondda) (Lab): On a point of order, Mr Speaker. You will know that the parliamentary website states officially:

“If the Queen’s Speech is amended, the Prime Minister must resign.”

The Fixed-term Parliaments Act 2011 has obviously changed what constitutes a no confidence motion but, historically, any amendment to the Queen’s Speech has been termed a no confidence motion.

I raise that question because the ministerial code of conduct, which is embodied in a motion of this House, states:

“Parliamentary Private Secretaries are expected to support the Government in important divisions in the House. No Parliamentary Private Secretary who votes against the Government can retain his or her position.”

I understand that the Prime Minister is letting his PPSs know that they are free to vote as they wish. Does that not suggest to you, Mr Speaker, that the Prime Minister has no confidence in his own Government?

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Mr Speaker: What I would say to the hon. Gentleman is twofold. If he is quoting accurately, the website is wrong and can speedily be put right. On the second point, I simply say for his benefit and that of the House that the selection of amendments has not yet taken place. He is therefore in the realm of the hypothetical. Whether he wishes to be there I cannot say, but I do not and, I trust, neither does the House.

George Galloway (Bradford West) (Respect): On a point of order, Mr Speaker. At 3 o’clock in the morning on 6 May in Shapla square in Dhaka, the capital of a Commonwealth country, Bangladesh, thousands of sleeping demonstrators were set upon by commandos. The reports are that significant numbers of people have been killed. Have you had any indication that the Foreign Secretary wishes to come to the House and make a statement about those extraordinary events?

Mr Speaker: I have received no such indication. However, when I think of the hon. Gentleman and an issue of concern to him, I almost invariably think of dogs and bones. Therefore, I imagine that this is a matter to which he will take other parliamentary opportunities to return. We look forward with interest and anticipation.

Debbie Abrahams (Oldham East and Saddleworth) (Lab): On a point of order, Mr Speaker. You may be aware that last Thursday, Andrew Dilnot, the chair of the UK Statistics Authority, wrote to the Secretary of State for Work and Pensions regarding his misuse of official statistics on the benefit cap. It was found that, once again, the Department was making claims that were unsupported by official statistics. That follows similar issues regarding the Child Support Agency statistics in February, and also extends to the Secretary of State for Health and his health funding claims last December, and even to the Prime Minister’s use of official statistics last October. The Work and Pensions Committee has also—

Mr Speaker: Order. I allowed the hon. Lady to pursue—[Interruption.] Order. No assistance from anybody is required. I let the hon. Lady raise her point of order, but it was in danger of becoming an abuse. From what I heard, the matter that she raised is obviously of concern to her and to others, but is not a point of order or a matter for the Chair. There are opportunities, which I am sure she will use, to draw attention to the issue. We will leave it there.

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Debate on the Address

[4th Day]

Debate resumed (Order, 10 May).

Question again proposed,

That an Humble Address be presented to Her Majesty, as follows:

Most Gracious Sovereign,

We, Your Majesty’s most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled, beg leave to offer our humble thanks to Your Majesty for the Gracious Speech which Your Majesty has addressed to both Houses of Parliament.

Health and Social Care

2.38 pm

The Secretary of State for Health (Mr Jeremy Hunt): In challenging circumstances, the NHS is performing extremely well. Front-line staff are making heroic efforts to control costs as they cope with the pressures of an ageing population and when 1 million more people are using A and E every year than at the time of the last election.

The Opposition run down NHS performance, but the reality is a service delivering more than it ever did on their watch: 400,000 more operations every year than under Labour; the number of people waiting more than a year for an operation down from over 18,000 in May 2010, to just 665 at the end of February; MRSA infections halved; mixed-sex accommodation nearly abolished; dementia diagnosis rates going up; and more than 28,000 people receiving life-saving drugs from the cancer drugs fund that Labour refused to set up. As we debate health, care and support today, I take the opportunity to commend and thank all the dedicated professionals who work extraordinary hours, day in, day out, for their part in making this happen.

If we are to prepare for the future, however, we need to do more. In our generation, the number of over-85s will double, the number of people with dementia will pass the 1 million mark, and 3 million people will have not one, not two, but three chronic conditions to cope with, on top of the other pressures of old age. We must be there for each and every one of them—the founding values of the NHS would accept nothing less—and to do so we must be able to answer three big questions: how can we be certain that people receive compassionate care even when they are not able to speak for themselves; how can we deliver joined-up care to people who use the NHS and social care system on a regular basis; and how can we ensure that sustainable funding is in place for care and support?

David Tredinnick (Bosworth) (Con): The Secretary of State will be aware of widespread concern among the herbal medical community that there is no statutory regulation on that area in the Care Bill. Does he agree that if polymorbidity is to be dealt with we must have firm regulation, and that just licensing herbs, as the European Union wants, would destroy the industry?

Mr Hunt: My hon. Friend follows such matters extremely closely and I reassure him that the Government will update the House on that issue very soon.

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The Care Bill will take a critical step forward in addressing each of the big questions that I raised, so let us consider how. First is compassionate care. Labour’s target culture led to warped priorities in our NHS and appalling human tragedy. No one disputes the value of targets, and the four-hour target played an important role in improving A and E departments. We do not, however, need targets at any cost, as we saw at Stoke Mandeville, Maidstone and Mid Staffs.

Stephen Timms (East Ham) (Lab): I agree with the Secretary of State about the value of the four-hour target. Is he disappointed, as I am, that that target has so often been missed in major A and E units over the past few months?

Mr Hunt: I am pleased that we hit our A and E target in the NHS last year, but disappointed that in Wales, which is controlled by the Labour party, the A and E target has been missed since 2009. Those on the Opposition Front Bench still refuse to condemn that.

Toby Perkins (Chesterfield) (Lab): Will the right hon. Gentleman give way?

Mr Hunt: I will make some progress.

Even worse, when signs of how the targets policy was going wrong became clear, Labour’s response was to ignore or cover up the findings.

Andy Burnham (Leigh) (Lab): Rubbish!

Mr Hunt: The right hon. Gentleman says “rubbish” from a sedentary position, but the Francis report—if he read it—mentioned 50 warning signs that were missed by his Government about Mid Staffs. He himself rejected 81 separate requests for a public inquiry into what happened. The Labour party created a lame duck Care Quality Commission, unable to speak out or force change, and an NHS where too often the system was more important than the individual.

Andy Burnham: At the outset, will the Secretary of State correct the record and remind the House that it was my decision, two months after being appointed Secretary of State in June 2009, to appoint Robert Francis to conduct an independent inquiry?

Mr Hunt: The right hon. Gentleman’s decision not to have a public inquiry that revealed extremely important information has meant that we are finally addressing the issue that his Government failed to address.

The Care Bill will include a vital element of our response to the Francis report, including regulatory clarity on who is responsible for identifying problems, driving up standards, and operating a single failure regime when urgent changes are not made.

Miss Anne McIntosh (Thirsk and Malton) (Con): My right hon. Friend will be aware that there have been teething problems with the 111 telephone service, which could be an essential tool to treat people in their own homes, certainly for palliative care. Will he provide stringent new guidelines to all providers to ensure that such teething problems are addressed and to enable the 111 service to operate as it should?

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Mr Hunt: My hon. Friend makes an important point. Teething problems have led to unacceptable levels of service in some parts of the country, which we are in the process of sorting out. As we sort them out, we also need to look at the long-term causes of the problems of out-of-hours provision and the fact that the general practitioner contract of 2004 has led to a removal of GP responsibility for out-of-hours care, which means that there is much less public confidence than there needs to be in the whole picture. We need to sort that out, too.

Dame Joan Ruddock (Lewisham, Deptford) (Lab): Will the Secretary of State give way?

Mr Hunt: I will make some progress, then take more interventions.

The Care Bill will allow for comprehensive Ofsted-style ratings for hospitals and care homes, so that no one can pull the wool over the public’s eyes as to how well or badly institutions are performing. The Bill will make it a criminal offence for any provider to supply or publish deliberately false or misleading information. We cannot legislate for compassion, but in a busy NHS, we can ensure that no institution is recognised as successful unless it places the needs of patients at the heart of what it does. The Care Bill will be a vital step forward in making that happen. That compassion should extend not just to patients, but to carers. The Bill will put carers’ rights on a par with the people for whom they care. They will have a right to a care assessment of their own and new rights to support from their local authority.

Barbara Keeley (Worsley and Eccles South) (Lab): Is the Secretary of State as disturbed as I am that the Bill puts young carers backwards a step? Adult carers’ rights might be taking a step forward, but young carers’ rights are not. We must address that during the passage of the Bill.

Mr Hunt: We are not putting young carers backwards. We very much recognise their needs—and a children’s Bill will address their concerns in a way that I hope will put the hon. Lady’s mind at rest.

The second issue that we need to address for the NHS going forward is joined-up care. It is shocking that, in today’s NHS, out-of-hours GP services are unable to access people’s medical records; that paramedics and ambulances answer a 999 call without knowing the medical history of the person whom they are attending; and that A and Es are forced to treat patients with advanced dementia, who are often unable to speak, without knowing a thing about their medical history.

Dame Joan Ruddock: I am grateful to the Secretary of State—out-of-hours is relevant to my point. He will be familiar with Newark. He closed the A and E department and the rate of deaths among local residents went up from 3.5% to 4.9%. Why does he therefore persist in saying that, if he downgrades Lewisham A and E, 100 lives will be saved across the south-east of London?

Mr Hunt: Because that is what the independent medical advice I have received has told me. The right hon. Lady should be very careful about the Newark statistics, because the increase in mortality rates, which is worrying

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and should not happen, happened before the A and E was downgraded. It is very important that we do not get the figures wrong.

Jim Dowd (Lewisham West and Penge) (Lab): Will the Secretary of State give way?

Mr Hunt: I am going to make some progress.

Before I took the right hon. Lady’s intervention, I was talking about joined-up care. The truth is that Labour’s disastrous IT contract wasted billions and failed to deliver the single digital medical record that would transform the treatment received by so many vulnerable older people. Yes, it was a financial scandal, but it was also a care scandal. Last year, 42 people died because they received the wrong medicines. There were more than 20,000 medication errors that caused harm to patients, and 127,000 near misses. On top of that, structures such as payment by results were left unreformed for more than 13 years, making hospitals focus on the volume of treatment over and above the needs of individual patients. The Care Bill will help to address those issues by promoting integrated care. It creates a duty on local authorities and their partners to co-operate on the planning and delivery of care; it emphasises the importance of prevention and the reduction of people’s care needs; and, by making personal budgets the default and not the exception, it will significantly increase the control people feel over their care.

Andy Burnham: I am grateful to the Secretary of State for giving way, but the trouble with him is that, often, there is a huge gap between the rhetoric he comes out with at the Dispatch Box and the reality on the ground. He says he is promoting integrated care, but what does he say about the pioneers of integrated care in Torbay, who are threatening to take legal action because of the requirement for compulsory competitive tendering of services? Under this Government, are not the beacons of integration being demolished by his free market?

Mr Hunt: It is the right hon. Gentleman who has a problem with the difference between rhetoric and reality. Let me tell him about the reality of what happened to integrated care under Labour. Between 2001—[Interruption.] The right hon. Gentleman intervened, so perhaps he would like to hear the reply. We are talking about integrated care. On his watch, between 2001 and 2009—eight years during which Labour was in power—hospital admissions went up by 36%. In Sweden, where people started thinking about integrated care, such admissions went up by 1%. That is how badly Labour failed to do anything about integrated care when it had the chance. We are doing something about it. If the Opposition listen, I shall explain what.

Jim Dowd: Will the Secretary of State give way?

Mr Hunt: I am going to make some progress.

The third question that the Care Bill addresses is about sustainable funding for care. We are all going to have to pay more for social care costs, either for ourselves or our families. Tragically, every year, up to 40,000 people have to sell the homes that they have worked so hard for all their lives to fund their care.

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Our system does not just fail to help those who need it; it actively discourages people from saving to ensure that they have the funds. In 1997, Labour promised a royal commission on long-term care. The commission reported in 1999, and its recommendations were ignored. We then waited 10 whole years for a Green Paper, which arrived in 2009 and, again, was able to deliver nothing.

In stark contrast, in just three years, the coalition Government commissioned a report from Andrew Dilnot, have accepted it and are now legislating for it. The Care Bill will introduce a cap on the costs that people have to pay for care in their lifetimes. With a finite maximum cost, people will now be able to plan through their pension plan or an insurance policy. With a much higher asset threshold for state support, many more people will get help in paying for their care.

Sheila Gilmore (Edinburgh East) (Lab): I respectfully suggest that the Secretary of State should look at the situation north of the border, where reform to change who pays has worsened the situation because no extra funding was put into care; all that happened was that we shuffled around who actually paid. Will he look carefully at that situation so that it is not repeated? How much extra funding is he going to put into the system?

Mr Hunt: I agree with the hon. Lady that the amount of financial support is important. I gently say to her that her party wants to cut the NHS budget, which would make the situation vastly worse.

The Bill is a vital element of our plans to improve the lives of the frail and elderly and of people with long-term conditions and disabilities, but it is only one element. Other areas that do not require legislation will come together in a plan for vulnerable older people. The plan will consider all aspects of how we look after older people most in need of support from the NHS and social care system. It will look at how our hospitals are set up to support frail and elderly patients, particularly those with dementia, in emergencies. Of course, we must continue to give people with serious needs immediate access to highly specialised skill, but in many cases we could offer better alternatives outside hospital. That would improve clinical outcomes and reduce pressure on A and E departments.

Secondly, the plan will look at primary care—in particular, the role of GPs in supporting vulnerable older people. Active case management of vulnerable people is making a huge difference in some parts of the country and we will look at whether the primary care sector as a whole has the incentives, investment and skills to deliver that. We will also consider the provision of out-of-hours services and how to restore public confidence in them following the disastrous changes to the GP contract in 2004.

Thirdly, the plan will look at the barriers and incentives that prevent joint commissioning and stop people from getting joined-up care. In particular, it will consider the operation of financial incentives in the system, which can act as an unnecessary and counter-productive barrier. The Minister responsible for care, my hon. Friend the Member for North Norfolk (Norman Lamb), who is leading on integration, will announce further practical steps forward later this week.

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I intend to announce the plan in the autumn, with implementation from April 2014. It will require a great deal of careful work, ask difficult questions and make tough decisions, but if it leads to more personal, more integrated and more compassionate care, it will stand alongside the Care Bill as an important step forward in reforming the care received by millions of people.

Mr Dave Watts (St Helens North) (Lab): Does the Secretary of State agree that that can work only if social services budgets are increased? Where will the resources come from to deal with the problems we face, and will there be an increase in social services budgets to pay for the services we need?

Mr Hunt: There is currently a difficult environment for public finance, for which the hon. Gentleman’s party bears considerable responsibility. The Labour party has given up on the budget; it says it wants to cut the NHS budget. We say that these changes are possible without cutting the NHS budget and in dealing with the inefficiencies caused when care is not joined up. Taken together, the measures represent more progress in three years than the Labour party made in 13 years. They represent our determination to prepare the country for the consequences of an ageing population.

Huw Irranca-Davies (Ogmore) (Lab): The right hon. Gentleman knows that the cap on costs of care is a little way off the Dilnot proposals. How many weeks—surely his Department has made some calculations—would that involve for a typical older person before they reach the £72,000 cap?

Mr Hunt: The point of a cap is not that we expect everyone to have to pay £72,000 towards their care. First, through pension plans and insurance policies people can make provision so that they never have to pay that £72,000. Secondly, as part of the package, we are increasing the threshold, below which the Government help, to £118,000—much higher than it is currently—so that it will be available to help, I think, around 40,000 more people than are currently helped because of the level of the means-testing threshold.

Chris Bryant (Rhondda) (Lab): Will the right hon. Gentleman give way?

Mr Hunt: No, I am going to make some progress.

Finally, the values of the NHS—compassionate care and free at the point of need—are its greatest asset, but they open it up to risk of abuse from health tourists coming to this country to exploit that generosity.

Chris Bryant: Will the right hon. Gentleman give way?

Mr Hunt: I am going to make some progress.

Over the summer, we will consult on proposals to make the system fairer and ensure that people who should pay for NHS services do in fact do so. That will also help to ensure that our NHS remains sustainable at a time of tight public finance.

These proposals represent our commitment to ensuring a compassionate, fully integrated and sustainable system of health and social care built entirely around the needs

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of the patient. They represent a commitment to the NHS and social care system, which lies at the heart of our determination to make Britain the best country in the world to grow old in.


Mr Speaker: Order. It is not altogether obvious whether the Secretary of State is giving way or has concluded his speech. [Interruption.] He has concluded his speech. It is usually helpful to have some indication of that.

2.57 pm

Andy Burnham (Leigh) (Lab): Like you, Mr Speaker, I am tempted to say, “Is that it?” I suggest to the Secretary of State that he starts reading the weekend newspapers. He began with complacent statements about how everything is marvellous and it is all going so well, but it will not feel like that to staff working in A and E. The Secretary of State’s statement will just confirm to them that he is completely out of touch.

Every day brings new signs of an NHS in distress: more ambulance queues outside A and E; more patients left waiting for a call-back by a 111 service ill-equipped to deal with their needs; more older people seeing social care support withdrawn, or struggling to pay spiralling care charges and ending up in A and E; more patients waiting hours in A and E on trolleys in corridors; and more hospitals running way beyond safe occupancy levels. This is the fragile state of the NHS today: battered and bruised by a reorganisation that nobody wanted and nobody voted for; an entire health and care system on the brink, facing huge challenges that require urgent answers. However, we will not find them in this Queen’s Speech. There is no answer to the collapse of social care, and no answer to the understaffing of hospitals or the growing chaos in A and E. On the preventable deaths and health harm caused by smoking and alcohol, there is silence.

This Queen’s Speech is the product of a dysfunctional Government who have lost any ability they once had to face up to the big challenges the country faces. It cements the impression of a failed coalition project now preparing the ground for the next election rather than governing in the national interest. What else could explain the pathetic spectacle this weekend of Government Members, spooked by UKIP, falling over themselves to say that they will be voting against their own legislative programme? Has this place ever seen something so ridiculous?

James Duddridge (Rochford and Southend East) (Con) Will Labour give us a referendum?

Andy Burnham: I thought the new compassionate Conservative party was meant to have stopped “banging on about Europe”—that was the phrase, was it not?—but now its Members are all dancing to UKIP’s tune and reading out what Mr Crosby gives them. It will not wash. The country can see that this is a shambles of a Government who look ridiculous to the country they purport to govern. When Britain needed leadership, it got the farce of this coalition. There is no need to send in the clowns; they are already here.

Toby Perkins: Does my right hon. Friend think, like me, that perhaps the Government feel more comfortable exposing their divisions on Europe than facing up to

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their record on the NHS, which, as many people across the health service recognise, is an absolute disgrace?

Andy Burnham: I shall come to that point directly, because the Queen’s Speech is a diversion from the real issues, an attempt to say, “Look over here at this other issue” and divert people’s attention from the chaos the Government have visited on the NHS.

On health and care, our objection is not to the modest measures the Government are proposing. We will of course wait to see the detail, but it sounds as though we will be able to give our support to many of them. Our objection to the Gracious Speech is not to what is in it, but to what is not in it and to the unpleasant political strategy that lies behind it. As a response to the developing crisis in our health and care system, it is inadequate. Worse, however, it tries to disguise that fact by pointing the finger at others. Forget compassionate Conservatism; this is straight back to the dog-whistle tactics—failed tactics, I might add—of the 2005 general election. This is the coded message the Government want the Queen’s Speech to send: “You see all those problems with accident and emergency departments? Well it’s all down to immigration. It’s nothing to do with us.” It is a Crosby-fied Queen’s Speech that is more about positioning and politics than a serious programme for government.

Mr Edward Leigh (Gainsborough) (Con): On a real issue that concerns people, there have been 1.1 million immigrants from eastern Europe since 2004, so I repeat the question very courteously put by my hon. Friend the Member for Rochford and Southend East (James Duddridge). The right hon. Gentleman talks about leadership, so will he show some and tell us whether the Labour party would grant the British people a referendum on Europe? Yes or no?

Andy Burnham: It is interesting, isn’t it? Here we are, in the middle of this Parliament, discussing the Queen’s Speech and health and social care, and what is the only issue Conservative Members can raise? Europe! We are talking about people waiting hours on end in A and E, about ambulances queuing outside, about a 111 service that does not ring anybody back, and about social care close to collapse, but they have nothing to say about those issues. Instead, they bang on about Europe. That is because they are preparing the ground for the 2015 election. The nasty party is back, scapegoating vulnerable people and stoking social division as a means of diverting attention from its own record, so get ready to hear how problems in the NHS are caused by health tourism and are nothing to do with the coalition’s toxic medicine of fragmentation, privatisation and budget cuts.

Chris Bryant: Is there not another side to the argument about immigration in relation to the NHS, which is that many of the people who keep the NHS functioning are from outside this country? One of the biggest problems facing accident and emergency departments around the country is that they cannot recruit enough consultants, yet the system that the Government have introduced on migration for those people is making it more difficult to recruit overseas. Would not a more enlightened attitude give us a more effective NHS?

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Andy Burnham: As ever, my hon. Friend says it more eloquently than I can. The Government are playing politics rather than addressing the national interest. People will see that, but at least the Government have revealed their hand. We will work hard over the next two years to show who is really to blame and expose this Government’s failures on social care, the NHS and public health. Let me take each in turn.

At face value, the social care measures that the coalition is proposing sound like progress towards a fairer and simpler system. Indeed, the Care Bill builds on many of the recommendations of the Law Commission’s review of adult social care legislation, which was initiated by the last Government and included in the White Paper I published before the last election. National standards for eligibility could help to bring consistency to the care system, and stronger legal rights for carers are long overdue, as is improved access to information and advice. However, the question in the minds of many today, particularly councillors watching this debate, will be: how on earth will we be expected to pay for all that? That is when we realise again that there is a huge gap between the rhetoric we hear from the Dispatch Box and the reality on the ground across England. More than £1.3 billion has been cut from local council budgets for older people’s social care since this Government came to power.

Just last week, the Association of Directors of Adult Social Services said that Government cuts to care and councils would mean a further raid of £800 million from care budgets in the next year. The Care and Support Alliance has said that the system is in deep crisis and that without

“appropriate funding for the social care system…the aspirations set out in the Care Bill will not be reached.”

The Care Bill does nothing for people who face a desperate daily struggle to get the support they need right now, with many paying spiralling charges for their care. That is the effect of this Government’s drive to cut councils to the bone. They are foisting huge care charges on the most vulnerable people in our society. These are the coalition’s dementia taxes.

John Glen (Salisbury) (Con): Does the right hon. Gentleman not understand that the people of this country would have more confidence in what he says at the Dispatch Box had he not said in the last general election campaign that it would be irresponsible to safeguard the NHS budget, which is what this Government undertook to do?

Andy Burnham: I will come directly to that quotation in a moment, because the hon. Gentleman will remember that at the last election he stood on a manifesto promising real-terms increases for the NHS. I hope that when he speaks later—or if he wants to get up right now—he will tell me whether they have been delivered.

John Glen: I am grateful for the opportunity to acknowledge the great difference between England and Wales, where Labour is in power and where we are seeing real cuts in NHS spending.

Andy Burnham: Government Members are just embarrassing themselves. When they cannot answer a question, they try to raise another one or go on about

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Europe. It is just not good enough. The answer is—though the hon. Gentleman cannot admit it—that Andrew Dilnot said this Government had cut the NHS. It is there in black and white. That is what they have done, and they stood on a manifesto promising the opposite. I secured a budget to protect the NHS at the last election. I said that I could not give real-terms increases because that would be irresponsible; and as it turns out, nor can the hon. Gentleman. His party was writing cheques that it simply could not cash, and that is a fact.

The Care Bill does nothing for those hit by the coalition’s dementia taxes right now. Since this Government came to power, the average care user has paid £655 a year more for home care than when they came into office. Overall, that is around £6,800 a year. Dial-a-ride transport services have doubled in price over the same period, from an average of £1.92 to £4.12. Meals on wheels now cost an extra £235 a year, while people in Conservative areas pay more for each service on average than friends and family in Labour-controlled areas—on average, £15 a week or £780 a year more for home care. That is the record of this Government.

Stephen Mosley (City of Chester) (Con) rose

Andy Burnham: I will give way one last time.

Stephen Mosley: The right hon. Gentleman has been speaking for more than 10 minutes and he has not once said what Labour would do. Will he come to what the Opposition propose we should do?

Andy Burnham: I assure the hon. Gentleman that I will come on to that, but I have a job to do in holding this shambles to account and that is exactly what I am doing.

Under this Government, people are paying more out of mum or dad’s bank account for care, which often does not come up to the standards that they want, because their council has been cut to the bone. What are they meant to make of a promised, far-off cap of £72,000, or £144,000 for a couple? The Government are giving a little with one hand, while with the other they are grabbing a fortune from people’s bank accounts.

Barbara Keeley: Does my right hon. Friend acknowledge that this is not even a question of £72,000 or £144,000, because those caps will be metered at the level that the council would pay, and will take no account of top-ups or accommodation costs? I have seen examples that show that people might have to pay £250,000 before they get anywhere near the cap and any help from the state.

Andy Burnham: My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.

How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a

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question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—

Mr Jeremy Hunt indicated dissent.

Andy Burnham: That is what this Government are doing. A cap is ineffective without long-term funding for the future of social care, and the failure to face up to the crisis in adult social care budgets that Conservative councillors are talking about will leave people with the impression that this Health Secretary is fiddling while Rome burns. The social care system in England is close to collapse, and the reality behind the Government spin is that, under this Government, people’s savings are being washed away more quickly than ever before.

I want to turn now to our accident and emergency services. The crisis in social care is the predominant driver of what we are now seeing in our accident and emergency departments. If people’s services are withdrawn, or if they cannot afford to pay for them, they are more likely to struggle and fall ill at home and to end up in hospital. That is bad for them, and it costs the NHS more. Also, NHS staff are finding that people who are ready to leave hospital cannot be discharged because the necessary support cannot be put in place. Beds are not being freed up on the wards, and A and E therefore cannot admit people to the wards because there is no space. A and E then becomes full, which results in ambulances queuing up outside because they cannot hand over patients. The system is now backing up right through A and E.

Mr Hunt indicated assent.

Andy Burnham: The Secretary of State is nodding; he should do something about it. This is happening on his watch. Across the country, hospitals are operating at levels way beyond safe bed occupancy—[Interruption.] He nods, but I am saying, “Do something. Don’t just nod!” We need action from the Secretary of State.

Let me return to the quote that I mentioned earlier. People love to say that I would have cut the NHS. For the record, I have never said that I would cut the NHS. At the last election, I promised real-terms protection for the NHS. The Conservatives promised real-terms increases, which have never been delivered. Let me read that quote in full:

“It is irresponsible to increase NHS spending if the effect is that it is damaging, in a serious way, the ability of other services to cope…that are intimately linked to the NHS. The health service needs functioning day care, and housing”

and meals on wheels.

That warning has now come true.

Mr Hunt rose

Andy Burnham: I will give way to the Secretary of State, but I ask him to address this point. He has paid for the so-called ring fence on the NHS by ransacking local government funding, and that makes no sense whatever.

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Mr Hunt: If the right hon. Gentleman looks at the figures, he will see that real-terms spending on the NHS has gone up since Labour was in power. Given that he thinks it irresponsible to increase the NHS budget, does he agree that if he were to follow his own policy, he would now need to cut that budget from its current level? That is Labour policy.

Andy Burnham: I do not think the right hon. Gentleman is listening. I said that if there were to be any increase, it should go into supporting social care. I now hear that Government Members are proposing emergency transfers from the NHS budget to social care because of the crisis that the Secretary of State has created.

Hugh Bayley (York Central) (Lab): Surely the Secretary of State has forgotten that he received a letter in December from Andrew Dilnot, the chair of the UK Statistics Authority, which said that

“we…conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10…In light of this, I should be grateful if the Department of Health could clarify the statements made.”

Andy Burnham: I am very grateful to my hon. Friend. He has now embarrassed the Secretary of State who, just a moment ago from the Dispatch Box, claimed the opposite. Similarly, the Work and Pensions Secretary was pulled up last week for doing exactly the same thing. They think they can stand there and say whatever they like, and they think they can get away with it, but they cannot, because people have seen through them. They have cut the NHS; they have broken the central promise on which this Government came to office. Now they are saying that the pressure on A and E has nothing to do with social care funding or NHS funding, but is all to do with the GP contract in 2004. That is what they have been saying on the radio for the last three weeks.

Let the Government answer this. In 2009—five years after the GP contract came into force—98% of people were seen within four hours at A and E departments across England. What we have seen recently is that, week after week, major A and E units are missing their lowered target. That is the reality right now, and the Secretary of State had better start facing up to it.

Dame Joan Ruddock: My right hon. Friend will have heard me refer to the situation in Newark, when intervening on the Secretary of State. Does my right hon. Friend agree that when a promise is made that closing or downgrading an A and E will save lives, that is what one logically expects to happen? The fact that the death rate subsequently went up is an indictment of what the Secretary of State has done. Does my right hon. Friend agree that when we cannot meet the four-hour target for A and E throughout the country, it is ludicrous to close existing, well-functioning A and E units?

Andy Burnham: I could not agree more with my right hon. Friend. All over the country, we hear that A and E is under intense pressure. Such is the importance of these services to every community that changes should be made only if there is a compelling clinical case to support them. If clinicians can demonstrate that more lives will be saved and disability will be reduced by changing A and E services, I think every Member

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should have a moral obligation to support them, but when the changes are financially driven—my right hon. Friend knows this better than anybody, as the Secretary of State has downgraded a successful A and E in Lewisham to deal with problems in another trust—that simply will not do. A and E units in west London, for example, are being closed one after another. That is not good enough, and neither is it good enough in Greater Manchester, where huge changes are planned. These changes must be clinically driven, not driven by finance, which is what we are seeing under this Government.

Mr Watts rose

Andy Burnham: I will give way one last time, before making some progress.

Mr Watts: I am grateful to my right hon. Friend, who is rightly concentrating on A and E units and social care. Does he agree with me that many hospitals around the country are facing a financial crisis, too, where the Government are refusing to fund anything other than consultancies? In my area, that has meant spending hundreds of thousands of pounds to tell us what we already knew—namely, that my hospital is underfunded.

Andy Burnham: That is what happens when a market is set up in the NHS, pitting one hospital against another in open competition. That is what is beginning to take hold in the NHS, where the Government waste money on consultants and all the other things that come from bidding for contracts. That is a direct effect of the legislation they pushed through. This reorganisation and the budget cuts I mentioned a few moments ago are providing a toxic mix. This is why for 32 weeks running, the NHS in England has missed the Government’s own lowered A and E target for major units. It really is time that the Health Secretary got a grip on the issue. We hear that last week he was trying to hatch a panic plan to deal with the A and E crisis. That is the reality of what was going on behind this threadbare Queen’s Speech: the Health Secretary was trying to cobble together a plan to deal with the A and E problems, weeks after we had first raised the issue in the House.

We hear of an e-mail leaked by an NHS finance officer which said:

“The SoS would like to announce tomorrow that £300m-400m is being invested to solve the A&E problem. We have spent most of the day trying to hold him off doing this.”

The Health Secretary seems to have forgotten that his powers to intervene were given away by his predecessor. He no longer has the power to mandate the NHS to do what he wants; the NHS can now “hold him off”. I am afraid that he looks weak. He has no response to what is happening to A and E departments. And where is the “£300 to £400 million” plan? It has not materialised. That is proof that when the Government surrendered their powers of control over the NHS, the Health Secretary surrendered his ability to do anything about the problems that we now face.

It is just as bad when it comes to staffing. We hear that nurses’ posts continue to be lost. Nearly 5,000 have been lost since the Government came to power, and according to the findings of a survey published yesterday, nurses fear that further tragedies could happen as a

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result of staff losses. That should set alarm bells ringing throughout the Department of Health. The Care Quality Commission has said that one in 10 hospitals in England does not have adequate staffing levels. The Health Secretary nods. I am glad that he accepts that, but, again, what is he going to do about it?

I welcome the fact that the Care Bill will contain measures relating to the Francis report, and I will work with the Health Secretary on that, but let us get to the crux of the issue of safe staffing levels, because that is the most urgent problem facing the NHS. The Health Secretary nods again. Let me make him an offer. If he introduces a benchmark—if he specifies minimum staff to patient ratios—we will support him, and the measure will go straight through the House. I shall wait for him to respond to that offer, and to ensure that the recommendations of the Francis report are properly implemented.

I give a cautious welcome to some of the Health Secretary’s measures to deal with health tourism, but let me issue two caveats. First, it is important not to overstate the nature of the problem, and secondly, it is essential for health practitioners not to be turned into immigration officers. In March, when asked how much health tourism was costing the NHS, the Health Secretary said:

“I don’t want to speculate… but… we have heard… it’s £200 million.”

On the same day, the Prime Minister’s spokesman said he believed that the figure was more like £20 million. Perhaps the Health Secretary could account for the difference—or did he just add a zero?

Steve McCabe (Birmingham, Selly Oak) (Lab): Would it not be helpful if the Health Secretary could tell us exactly how much he thinks is being lost and what it will cost to try to recover the money? At present the only figure that he has is the one on the invoices, rather than one relating to the money that is actually recovered.

Andy Burnham: We must wait to see what the Government produce, but we need to be sure that they are attacking the real problem rather than playing politics with an issue and creating the impression that all the A and E problems are caused by immigration. If that is their real intention, they will have no support from the Opposition.

Chris Bryant: Did my right hon. Friend have an opportunity to hear what the Conservative right hon. Member for Haltemprice and Howden (Mr Davis) said during the debate on the Queen’s Speech last week? It was very intelligent and nuanced. He said that it was necessary to ensure that not just life-threatening diseases but notifiable diseases and mental health conditions would not be covered by the proposed measures. The position is not quite as straightforward as some newspapers might like to suggest.

Andy Burnham: Nuance, care and caution are precisely what we need in this debate; we do not need press statements written by Lynton Crosby which then turn up in the House as Bills. We want responsible government, ensuring that the NHS is not abused. We will support the Government as long as that is their intention, but if they are doing something more sinister and playing politics with these issues, they will not have our support.

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We have had no answers on the NHS. Let me finally turn to public health. There was not much on which I agreed with the last Health Secretary, but he had my strong support when he spoke about tackling smoking. He said that he wanted tobacco companies to have “no business” in this country, and that introducing standardised packaging was an essential next step to ensure that young smokers were not recruited by the tobacco industry. [Interruption.] The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), looks confused, but I think she advanced the same argument on the radio a couple of weeks ago, saying she was an advocate of standardised packaging. Then, we read in advance in our newspapers that the measure had been dropped—one of the “barnacles” on “the boat”, we were told, by the said Mr Crosby. This is the same Mr Crosby who has represented “big tobacco” since the 1980s, who masterminded the campaign against standardised packaging in Australia, and who was federal director of the Liberal party of Australia when it accepted millions of pounds in donations from the tobacco industry.

The Secretary of State said last week that a decision has not been made yet because the consultation has only just finished. It ended nine months ago. He can make a decision. I say to him again today, here is another positive offer from the Opposition: if he brings forward these proposals, they will have our full support and we will get them on the statute book.

Ian Mearns (Gateshead) (Lab): My right hon. Friend may be interested to learn that the Prime Minister wrote to me about plain packaging before the Queen’s Speech was delivered to both Houses. He said in that letter that there were currently no proposals to introduce plain packaging.

Andy Burnham: The former Secretary of State said that it was full steam ahead and that is what they would do. This Secretary of State comes in and says nothing about the issue. Then, a right-wing Australian lobbyist arrives, and all of a sudden no one mentions it at all. Has the Secretary of State ever met Lynton Crosby and discussed this issue with him? I think we have a right to know. [Interruption.] He nods; I should be interested to know the substance—[Interruption.] He has not met him to discuss the issue. He looks very uncomfortable all of a sudden.

Mr Jeremy Hunt: Just to put the right hon. Gentleman out of his misery, I have not discussed this matter on any occasion with Lynton Crosby.

Andy Burnham: We are going to have to get to the bottom of this—not just the Secretary of State, but all his Ministers and advisers and all the No. 10 advisers—because it looks to us as though this Government have raised the white flag on having any semblance of a progressive public health policy. I cannot believe that the Liberal Democrats put their name to such reactionary stuff. Where is minimum alcohol pricing? Where is public health in this Queen’s Speech? They are totally absent.

Jackie Doyle-Price (Thurrock) (Con): I appreciate that the right hon. Gentleman has very clear convictions and a desire to tackle smoking as a public health issue.

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However, a third of cigarettes smoked in London are contraband. How would standardised packaging deal with that problem?

Andy Burnham: I agree that we need to do something about that, and we did bring forward measures in government, but standardised packaging is not plain packaging: it is about having designs on the pack that could be used to ensure there is no counterfeit tobacco. Surely some things are more important—the young smokers in the hon. Lady’s constituency and mine who are targeted by the tobacco industry. Surely we in this House can unite on issues such as this and take steps to improve the long-term health of the country. It seems to us that the Government have given up on the health of the nation.

I said I would set clearly out for the House what I would do had I been standing at the Government Dispatch Box today. For a start, I would have introduced a Bill to repeal the disastrous Health and Social Care Act 2012, which has placed our NHS on a fast track to fragmentation and privatisation. That Bill would have restored the powers and responsibilities that the Secretary of State’s predecessor gave away, and which he found out last week he no longer has. I would legislate for the full integration of health and social care as the only realistic answer to the challenges brought by the century of the ageing society.

People can see that increasingly it is the Opposition who have the courage and the answers to deal with the big challenges the country faces, not a failed coalition that is now playing out time. Its toxic medicine of cuts and reorganisation has laid the NHS low, and now it has no answers to the chaos it created. That is because the Secretary of State only discovered last week that his own reorganisation had stripped him of his powers to intervene, leaving him looking weak—in office, but not in power. Having done that, the Government’s answer is to try to scapegoat others for problems of their making. It will not work—we will remind people that it was a right-wing reorganisation that has left the NHS destabilised and demoralised. We will never tire of reminding the Prime Minister that the British people never gave him their permission to put the NHS up for sale, and we will restore the right values to the heart of our NHS—compassion before competition, integration over fragmentation, people before profits. The NHS and the country deserve better than a Government who are out of touch and out of ideas.

3.30 pm

Nicholas Soames (Mid Sussex) (Con): I am grateful for the opportunity to speak in the debate on the Address.

In nearly 30 years in the House, it has been my experience that Governments are always accused of having either too much or too little in their Queen’s Speeches. As my hon. Friend the Member for Banbury (Sir Tony Baldry) rightly said in his excellent contribution, however, they are works in progress. I congratulate the Government on bringing forward a measured and carefully thought-out programme, which has been welcomed by my constituents and which will make a positive contribution to the lives of many of our fellow citizens. The immigration measures, the national insurance contributions Bill and the deregulation Bill are particularly important to the

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work that the Government are doing—in my view far more successfully than they are being given credit for—in fixing the British economy, which is showing clear signs of real improvement.

I would like to report to the House that at the Burgess Hill Business Parks Association business exhibition on Friday there was a solid mood of determination to grow our local economy, as well as considerable satisfaction at the progress being made. The message that I take back from that admirable gathering is one that all our colleagues will find when they go to gatherings of that type: people want the Government to press on with getting rid of regulation and bringing in lower taxes—above all, they want to get on with growth. This Queen’s Speech presses on with a number of key reforms on welfare, on education and by the Home Secretary in her excellent work on immigration.

We were fortunate to have exceptionally good local election results in Mid Sussex, where the combination of a prudent and well-run West Sussex county council and an extraordinarily efficient and well-led district council have delivered with confidence the Government’s agenda, which is welcomed and well understood. What is clearly most important locally, however, is the state of the economy. For all of us, that must be at the very top of all our constituents’ concerns about the future of the country. Our constituents want the Chancellor and the Prime Minister to press on. If they do and the economy grows, much of the country’s serious anxieties will begin to disappear like the winter snow.

I am delighted that my right hon. Friend the Prime Minister is in Washington today with President Obama in our pursuit of the European Union-United States free trade agreement, which is clearly extremely important to our future, not only for our national trade and commerce in Europe and elsewhere, but as a mark of stability in world trade, which is vital to the ordinary conduct of economic and world trade growth. All of us here know that the opportunities in that regard are enormous.

Mr Robert Walter (North Dorset) (Con): Does my right hon. Friend agree that if we were to vote to leave the European Union, we would no longer benefit from that free trade agreement?

Nicholas Soames: I do agree, but I will come to that point in a moment, if I may.

As co-chairman with the right hon. Member for Birkenhead (Mr Field) of the cross-party group on balanced migration, I warmly welcome the considerable progress that the Government have made on the difficult and sensitive matter of immigration. They have succeeded in driving down numbers and there is real progress, but there are no easy solutions. I welcome the carefully thought-out work of my right hon. Friend the Secretary of State for Health on those services. The cross-party group, and I think most of the House, knows that the most careful attention must now be paid to the question of access to benefits and the health service. Thus, the immigration Bill is an important step forward.

I know the Government do not underestimate the anger and frustration that many people feel about too many people arriving in Britain and accessing public

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services before they truly should. To that end, I will conclude by saying a few words about the European issue.

The House knows that I am a staunch but not uncritical pro-European. I acknowledge the profound frustration of dealing with Europe, and there are certainly the most serious problems with the European Union that we must fix. The Conservatives are committed to doing that. In many of these matters, we will find solid support across the continent from our European partners, and my right hon. Friend the Prime Minister will do that.

People need to understand that the Prime Minister has committed to the negotiation of a new settlement between Britain and the European Union. People questioned whether he would veto an EU treaty, but he has vetoed an EU treaty; people questioned his ability to get the EU budget cut, but he has succeeded in getting it cut; and people questioned his ability to get powers back from the EU, but the fact is that he got us out of the EU bail-out mechanism and saved this country hundreds of millions of pounds.

The Prime Minister has said that he is committed to negotiating a new settlement for Britain within the EU and I have every confidence that that is precisely what he will achieve. It will be then for the British people to judge that settlement in a referendum. There will be a referendum on our membership of the EU; the commitment on that is absolute. Some of my hon. Friends and indeed some of my right hon. Friends need to be a little cautious about trivialising what is involved. The decision on a referendum is hugely important for this country; it is probably the most important decision that it will have to take for generations. It is not to be lightly taken, or on the basis of prejudice or pub rhetoric.

Sir Gerald Howarth (Aldershot) (Con): Will my right hon. Friend give way?

Nicholas Soames: No, I will not. No good is done to the public governance of this country by a constant chipping away at trust and at the Government’s integrity. If the Prime Minister says that something will happen, such is the momentous nature and importance of this decision that it will happen with orderly process and proper debate, and not with some hysterical, knee-jerk, publicity-seeking action.

I beg this House to remember that, with all the EU’s imperfections and all its problems, it gives our country free and fair access to the single largest integrated economic area in the world; a single market of 27 countries and 500 million people with a gross domestic product of $16 trillion. I could not possibly look my constituents in the eye and tell them I was prepared to risk that. I urge the House to support the Prime Minister and the Government in the orderly process that has already been announced, which will result in a referendum. I am confident that it will be a positive referendum for the United Kingdom.

3.38 pm

Frank Dobson (Holborn and St Pancras) (Lab): I will not follow the right hon. Member for Mid Sussex (Nicholas Soames) in referring to Europe, other than to say I regret the possibility that European competition

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law will in future apply to the national health service, which will no doubt be exploited by major American health corporations.

I will talk exclusively about the current destruction of NHS Direct, a successful, safe and popular service, and its replacement by 111—I hesitate to call it a service— that has proved to be a shambles in many parts of the country. I must declare an interest—a sort of proprietorial one—because I was Health Secretary when we decided to set up NHS Direct in 1998. We set it up in a sensible way, and it worked from the start. We established three pilot schemes. The service was gradually rolled out across the country, learning all the time from the experiences of the earlier services that were already working. It worked well from the start, and there is no excuse for Ministers in this Government who have introduced the 111 service as a mess. They have been calling summits and announcing reviews ever since it started going wrong. That is pathetic, because they are not in the Department of summits and reviews; they are in the Department of Health.

Those Ministers were not even doing anything new. They had the opportunity to build on NHS Direct, which was a successful example. In 2002, it was described as a remarkably successful service by the Public Accounts Committee, then chaired by the hon. Member for Gainsborough (Mr Leigh), and of which the current Chancellor of the Exchequer was a very active member. Reports by the Comptroller and Auditor General and the PAC commended the service, saying it had met all its deadlines and properly addressed all the risks, and that it had a practical approach and had learned lessons as it went along. It was also commended for the fact that its computer procurement had been well managed and had been delivered to cost, and that there had been satisfactory consultation and it was clinically safe.

It was praised, too, for reducing demand on other parts of the NHS. The main reason it was reducing demand was because it was predominantly staffed by nurses, who had the professional confidence and judgment simply to offer reassurance to some who got in touch. In the current service, however, there are many call handlers, who do not have that professional knowledge and confidence, and are therefore referring people to GP services or A and E and are arranging ambulances.

I commend the views of the PAC back in 2002. It was far sighted, because it said:

“Departments should consider what wider lessons they could learn from the successful introduction of this significant and innovative service on time.”

The Chancellor’s Government have clearly decided to ignore that recommendation. The PAC also noted:

“Short lines of communication between the Project Team and those implementing the service at local level enabled lessons to be learnt quickly as the projects progressed.”

Clearly the current Government did not learn that lesson either.

The current Chancellor himself said in one of his contributions to the Committee:

“My concern is that the Permanent Secretary…is going to start saying, we are great, we have this giant switchboard for the NHS, and your service is going to lose the focus of its original function”.

That perfectly describes what has happened with the abolition of NHS Direct and its replacement by the 111 service.

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The 111 service does not have short lines of communication—indeed, I doubt whether it has any at all. It has also taken on innumerable new functions, and has been expected to carry them out at less cost than NHS Direct was operating at. The only way it could reduce costs was by getting rid of nurses, because they are more expensive than call handlers. Indeed, GP representatives have told me the current service has reversed the situation: whereas there used to be more nurses than call handlers, there are now more call handlers than nurses, and in one area there are 15 call handlers and one nurse.

The computers keep going down, there are massive delays, and a lot of the call handlers are giving the wrong advice, much of which is expensive for the NHS. The Government cannot say that they were not warned about this because they were warned by Members, even Government Members, as long ago as March, not this year but last year.

In bidding to get one of these contracts, people assumed, in good faith or bad faith, that they could provide as good a service as NHS Direct at half the cost. It is now clear that they cannot. Other parts of the NHS are bailing them out to try to keep the 111 service going. As my right hon. Friend the Member for Leigh (Andy Burnham) said, the question that arises is what the Secretary of State can do about it. The people running these services have bid for fixed-price contracts. If they now need to spend more, how is the money going to get to them so that they can do so? They are left with three alternatives: they can struggle on providing this very poor, unreliable service, they can go bust and there is no service, or the money is found from somewhere else in the NHS. However, under the crackpot system that the Government introduced when they changed the law, there is no machinery for putting extra money into these services so that they can do their job properly.

3.46 pm

Paul Burstow (Sutton and Cheam) (LD): I want to concentrate my remarks on social care, because all too often in debates entitled “Health and Social Care” we tend to spend most of our time debating health, and yet our social care system is absolutely vital in regulating health care costs and delivering a better-quality health service. The Bill announced in the Queen’s Speech—it was indeed published on Friday—goes a long way towards laying some important foundations for a better social care system.

The Care Bill attempts to address a number of long-standing flaws in the system that have developed over the past 60 years through a series of piecemeal measures enacted by successive Governments. It is essential that in considering this over the next few months we make sure that we get it right, because legislation in the social care sphere comes to the House very infrequently. Our care and support system is of key importance because the rapid age shift that is taking place in our population is profoundly changing the nature of the demands on the system. It is important to note that this is not just about ageing; it is about the complex co-morbidities of long-term health conditions, both physical and mental, that are at the heart of the serious pressures on our whole system.

Our social care system has a number of features that need to change. It is too oriented around crisis and stutters into life when things have already gone wrong.

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It does not enable people to plan successfully for future care needs or, indeed, to prevent and postpone them. It does not provide adequate signposting, information, advice and advocacy for people to secure what they need from it, making it feel too much like a fight to get what is necessary. There is a lack of recognition of, and support for, family carers. Quality is variable around the country. We have heard announcements today about co-ordination of care and continuity, which is clearly a problem too. The costs of care are a lottery, and that needs to be addressed.

The Bill is taking all this forward. It focuses on early intervention and prevention, with a new responsibility for that to be up front in the way that local authorities plan their services. There are new duties on information and advice. I welcome the fact that the Government have agreed that the Bill should specifically refer to financial advice as being part of the legal obligations. There are new rights for adult carers—I will talk about young carers in a moment—with a lower threshold of eligibility for services. That is very welcome. A new rating system is being established to assist with quality of care and to help providers themselves to benchmark their performance.

Andy Burnham: I know that the right hon. Gentleman is very knowledgeable on this subject, but does he believe that councils have sufficient resources to consider new rights, given that we hear that care is collapsing all over the country and the Local Government Association says that if nothing else happens councils will be overwhelmed by the costs of care in less than 10 years?

Paul Burstow: I am grateful to the right hon. Gentleman for intervening. If he looks at last year’s Government impact assessment of the draft Bill, he will see that it gave a commitment to directing an additional £150 million specifically towards the rights of carers. The White Paper also gave a commitment to an additional £300 million over this and next year to support the system during this spending review period. I will address the funding questions for the future in a moment.

The right hon. Gentleman was a little harsh in his comments on the Bill laying the foundations for the implementation of the Dilnot cap on care costs. To understand this properly, we need to consider the relationship between the Government’s generous change to the means test—the threshold is being raised to £118,000—and the cap itself. Of course, we do not want people to reach the cap. We want steps to be taken to enable them to avoid having to pay catastrophic lifetime costs in the first place. The biggest gain of implementing the Dilnot proposals is a public health gain. It is about having conversations about care needs earlier, so that steps can be taken to minimise the risks of heavy-end care costs later in life. The Bill also commits the Government to national eligibility for the first time, which is hugely welcome.

I want to touch on three issues in the time remaining. First, some serious questions remain about how the Bill, which we will scrutinise over the coming months, will deal with the issue of young carers, which has already been raised. It is possible that young carers will fall into a gap between the Children and Families Bill,

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which is currently before the House, and the Care Bill, which will soon be before us. The Care Bill needs to address situations in which an adult does not qualify for local authority support and their children end up taking on caring responsibilities that become overly burdensome and inappropriate. In such circumstances the adult should be entitled to some sort of service so that their child does not lose their childhood to caring responsibilities. That requires action in the adult-related Care Bill; it should not be pushed away to be dealt with in the Children and Families Bill.

The second issue is poor commissioning practice, which was highlighted by an Equality and Human Rights Commission report on home care more than 18 months ago. It identified that contracting by the minute, or time-and-task contracting of home care, denigrated people and that they were being dealt with in an undignified way as a consequence of how services were being commissioned. Just a few weeks ago the Low Pay Commission’s most recent report highlighted, yet again, too many circumstances in which home care is being delivered by people who are paid below the national minimum wage. That is unacceptable and the Government need to deal with it.

Mrs Madeleine Moon (Bridgend) (Lab): In a previous life I was a contracting officer for a local authority, and I contracted and commissioned care from the private sector. We always faced the same problem: the local authority tried to get more care for less money. That meant that contractors were paid less for their care workers, who were constantly not paid for travel time. How do we break this vicious cycle if we do not accept that we have to fund local authorities properly to make possible the provision of quality care?

Paul Burstow: I thank the hon. Lady for here intervention and will come to the issue of funding in a moment. The Joint Committee on the draft Care and Support Bill, which I chaired, was unanimous in its report’s recommendation that Government legislation must address the need for actual costs to be a relevant factor in determining fees for care. That is not covered adequately in the Care Bill at present and I am sure that hon. Members will take that into consideration. The Association of Directors of Adult Social Services said in its most recent survey that it was already concerned that some providers were suffering financially and that the situation would get considerably worse over the next two years. Will the Minister consider allowing the Care Quality Commission to inspect councils again when its inspections of local providers reveal that poor commissioning practices are at the heart of its concerns about those providers? The CQC has created a space for local authorities to self-improve and collaborate with one another. However, when its inspections reveal provider stress because of that, it should be able to inspect the council.

The Minister of State, Department of Health (Norman Lamb): I agree that the quality of commissioning needs to be addressed as well as the quality of provision if we are to get better care for the people who need it.

Paul Burstow: I welcome that comment from the Minister and look forward to seeing more detail.

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My final set of concerns relates to money. I and other hon. Members have referred to the report by the Association of Directors of Adult Social Services that came out last week. That report can be portrayed in very different ways. I took heart from the finding that despite undoubtedly being confronted with serious budgetary constraints, there is a lot of incredibly good practice by local authorities to protect front-line services. Only 13p in every pound of cuts has come from services being taken away directly.

Mr David Ward (Bradford East) (LD): Can I tempt my right hon. Friend to comment on his proposals on the use of universal benefits for wealthy pensioners? I know that he has produced a pamphlet.

Paul Burstow: I will try to do that in the one minute and 14 seconds left to me.

The ADASS survey paints a quite disturbing picture of the next two years. More providers will face financial difficulties and there will be increasing pressures on the NHS as social services shunt people into health care services.

The spending review that is under way is for just 12 months. It needs to fund the successful implementation of this legislation, and not least the introduction of the Dilnot proposals. More than 450,000 people will need assessments to get into the new system. The spending review also needs to sustain the transfers of money from the NHS to social care. Beyond that, the spade work needs to be done now to make the case for the critical interdependencies between social care and health that will sustain our social care system and make our health system deliverable and affordable.

The Queen’s Speech, with its specific commitment to this legislation, contains a landmark reform that will do a great deal to improve the quality of life of our constituents.

3.57 pm

Ann Clwyd (Cynon Valley) (Lab): I am grateful to the 2,500 people from England, Scotland, Wales and Ireland who have written to me since last December, when I first raised the issue of compassion in nursing. The e-mails keep coming and I want to quote from some of them.

A man whose elderly mother was in hospital asked how many staff it takes to cut a fingernail:

“The hospital staff won’t cut my mother’s fingernails. They won’t clean them properly either. The excuse given to me is that this amounts to an ‘assault on patients.’”

My mother…has for the past several weeks been positive for a new superbug which is carried in faeces and would cause havoc if it got into the bloodstream…she’s in an isolation ward now. Barrier nursing, rubber gloves and pinnies for all staff and visitors. And still the nurses won’t do her fingernails, and they can’t or won’t see that filth under fingernails or wherever it is located, is intolerable in hospitals and needs to be eliminated—most especially in infection control units.”

The e-mail continued:

“I had a rant at the…staff for leaving the buzzer button and water out of reach of bedridden patients [i.e. people in beds near to my mother who were calling out to anyone for water]. My mother’s buzzer was also out of reach. I was then told these elderly patients might strangle themselves on a buzzer’s cable.

My mother tells me that if staff are dealing with a patient [e.g. bathroom visit] when the food trolley arrives then sometimes the patient may not get any meal. It is delivered, uneaten, and taken

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away. The idea the patient might still be in the land of the living and come back to their bed later and need some food seems not to bother them”.

A man whose father was on a ventilator wrote:

“There were no issues with the treatment he received, but the comment I received when going to say goodbye to him when the decision was taken by medics to switch off the machine is not one I will ever forget. After going to see him and saying goodbye, the nurse—whose Christian name and face I will always remember—said to me, ‘Can we crack on now?’”

A woman whose husband died of cancer at 53 after, she alleges, years of mistreatment and misdiagnosis wrote:

“When I complained to PALS—”

the patient advice and liaison service, which some hospitals have—

“my initial complaint was ignored. So I complained to the chief exec. I had several meetings with PALS and was told they would do an independent review. This took them two years and they denied any wrongdoing. No proper investigation took place. I then contacted a solicitor and had an expert review of the case. He said the treatment was nothing short of criminal…it has taken me four years of fighting for justice. They have now finally admitted liability for breach of care and duty and causing his death. But what happens to those responsible? Nothing. This was not one mistake, it was a catalogue of errors that went on for 3 years. They should be tried for manslaughter.”

A man whose wife suffered mistreatment wrote that

“she was regularly left to lie in her own faeces for half an hour or longer, and on more than one occasion for well over an hour. This led to a severe rash on her backside to the point that her bottom and the backs of both thighs were red and raw. The buzzer would be left hanging out of reach, either by accident or on purpose…at one point she was lucky enough to be able to reach her mobile phone as she rang me in tears during the middle of the night asking me to ring the high-dependency unit desk as she’d been desperate for a nurse…I had to bring her a fresh bottle of water every evening so that she could sleep with it in bed as the water on her tray was often pushed out of reach after her visitors had left for the night.

She was never weighed when in hospital despite multiple requests of both doctors and family. The staff allowed her muscles to atrophy to the point she could not even get herself out of bed…she was so badly undernourished, many family members doubted if she would ever come out of hospital.”

A woman writing about her mother’s mistreatment stated that

“nurses frequently chatted and laughed at the nurses’ station at night, showing a complete lack of consideration and respect for patients. Standards of cleanliness left much to be desired, and we were sometimes greeted by soiled dressings left lying around and on one occasion, splashes of blood which did not appear to be hers, left over the end of the bed. Generally there was poor liaison between the two hospitals and the GP, with outpatient consultant appointments being sent to my mother’s home address, when she was in hospital dying. We did not complain at the time as we were too distressed by my mother’s condition and after she had died unable to bear reliving her last months.”

A man wrote to plead that the right kind of person is selected and supported for a nursing job:

“I have seen nurses walk onto a ward chatting loudly about their social life, approach a patient and see to his needs while continuing their loud chat, apparently oblivious to the sad human bundle they were treating, as if it was a spare tyre that they were changing. I expect you have seen groups of nurses chatting at the nurses’ station and ignoring patients on their ward who are calling out for a nurse. Yes, we know, some of these will be demented or disorientated souls who do not need medical attention as such and are possibly a regular nuisance, but they are in the care of those nurses and should not be ignored.”

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A woman, who after the experience of her last operation is dreading the next one, wrote:

“Upon being admitted I was placed in a storage area and left for hours in pain, and alone, and very frightened. A specialist came and took a cursory look and said I was to go home and come back the next day. I live alone and was very unwell to say the least. I became very upset and was treated like a naughty child. I then blacked out and upon waking I was in a bed with some very anxious nurses around me…I had blood poisoning. A nurse later stated that, ‘We have lost patients not as bad as you have been’. Later that night my abscess burst. I called a nurse who looked at the bed and then told me to sleep on a clean bit!”

One of the biggest problems is that of patients being starved. One account describes cleaners who

“put trays at the bottom of beds—unhygienic for a start—then come around half an hour later and lift the trays. Nobody checks to see if the patient has eaten it. It is fortunate if visitors or some of the better patients are around to help the more frail. I never saw any staff feed or help patients to sit up...I hope this is not common practice, but sadly I fear it is.”

4.5 pm

Mr Charles Walker (Broxbourne) (Con): I pay warm tribute to the right hon. Member for Cynon Valley (Ann Clwyd). That was an incredibly moving speech—we could have heard a pin drop in the House of Commons throughout those eight minutes—and a fantastic contribution to the debate.

I had intended to make a statesman-like speech, but sitting next to me is possibly one of the greatest statesmen, my right hon. Friend the Member for Mid Sussex (Nicholas Soames). I do not want to go out and bat on a losing sticky wicket; I would rather have a general thrash around the field of play. I admit to the right hon. Member for Leigh (Andy Burnham) that I am a Eurosceptic. When I came to the House of Commons, I fell into bad company, including my hon. Friend the Member for Aldershot (Sir Gerald Howarth). Indeed, when I arrived here, I was nursed at the bosom of my hon. Friend the Member for Stone (Mr Cash), so I am a Eurosceptic—[Interruption.]Anyway, I want to crack on.

In 2011, I attended a public meeting in my constituency. We were discussing the future of an urgent care centre. Five hundred of my constituents were there for a lively debate, which ended at about 8.30 pm. I had arranged at 9 pm to travel northwards in my constituency to Hoddesdon to meet 12 or 14 Polish people. As I left the room of what I would regard as fairly natural Conservatives and got in my car to drive up the A10, I thought, “Why on earth am I heading up the A10 to meet 12 or 14 Polish people?”

I was pleased I did. They waited in a circle to see me. We were in a recession at the time, but their eyes were gleaming and glittering. They said, “Mr Walker, this is the land of opportunity. It is fantastic. You don’t just get one job here; you can have two jobs. If you do those jobs really well and do what you are asked to do, you get promoted. This is a fantastic country.” It was so refreshing to see such enthusiasm in the room.

We should have had transitional measures in place when the Poles came over to this country. It was not good enough to say, “There might be 15,000 or 30,000,” when 500,000 ended up coming here. That was a grave error. However, to say that the Poles are somehow

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responsible for the country’s problems is a gross simplification and a fairly disgraceful statement to make. As I have said, I wish fewer had come here, because we should have had transitional arrangements. The infrastructure was not ready to welcome 500,000 people to this country, but I cannot fault them for a second for wanting to come here.

People say that people from eastern Europe want to come to this country to sponge off the NHS and our welfare system. The minority will, but the majority want to work hard and do the best for their families. There are rotten apples from European nations in this country, but there are quite a few rotten apples from this nation in foreign countries—hon. Members might have managed to see that a British fugitive was arrested by Spanish police yesterday on the Costa del Sol.

Immigration is not a uniformly good thing. It tends to work for the middle classes and the upper middle classes, whatever they are now. Basically, it works for people with money. Immigrants work very hard in our restaurants and cleaning our offices. However, immigration does not work so well if people are competing for scarce resources such as health, transport and education. I understand the concerns of people who now face additional pressures on scarce resources. We did not plan well. I do not want to sound overly partisan, but—dare I say—the previous Government did not plan well for the upsurge in immigration, which has created difficulties in our constituencies and a great deal of concern.

In my remaining three and a half minutes, I want to say a few more things about immigration. I am not a soft touch on that matter. I am extremely concerned about the continued underperformance of the UK Border Agency. About six years ago, I made the decision not to deal with immigration cases in my surgeries; I have enough problems from my own electorate to deal with, without having to take up UKBA’s case load as an unpaid officer.

Although our immigration system is improving, it still has a long way to go. It is simply not right that some people in this country should have to wait seven, eight or nine years for a decision on whether they can stay here. That is inhumane—it does not serve them or the taxpayer well. Unfortunately, those people are egged on by fairly ruthless and unpleasant lawyers, who keep lodging appeals and dragging out the process. However, it is we as politicians, of course, who provide the scope and room for those people to pursue those endless appeals processes. We must truncate the appeals process.

Mr Robin Walker (Worcester) (Con): I congratulate my hon. Friend on his excellent speech. Does he agree that a system that does not work and leaves people in limbo is neither efficient nor compassionate?

Mr Charles Walker: I completely agree. Such a system is not efficient or compassionate and does not carry the confidence of the British people. More needs to be done to ensure that our immigration system carries the confidence of the British people, is fair and rewards immigrants who play by the rules. There has to be a premium for playing by the rules. We have to do something about the immigration system; we have to truncate the appeals process and to deal with people more quickly, including removing them more quickly once a decision has been reached.

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I conclude with a few thoughts. I am a great fan of culture; I have travelled the world and immensely enjoyed other people’s cultures. However, I am also a great fan of our culture, which I think is pretty special—indeed, its promotion and protection are probably why most of us have chosen a vocation in politics. Our culture is often caricatured as being about the royal family and maypoles. Those are important—well, the royal family are; I am not so sure about maypoles—but what is our culture? Our culture, which we should promote ruthlessly, is freedom of speech, freedom of association, freedom of thought and expression, and the rights, protection and promotion of women and minorities. That is what being British is all about and what makes this country so attractive to so many people around the world.

I want to say something that I hope will not be misinterpreted. If people want to come here and make a positive contribution, that is fantastic. But people coming to this country should please value and respect everything that it offers them. It really is a great place. We can celebrate other people’s cultures, but we cannot have separate communities and societies in this country—that is not healthy for us or for those wanting to live here who eventually, I would like to think, integrate and become part of what is still a great place to live.

I am afraid I am running out of time, which probably comes as a great relief to most Members. I would just say that I am a world-expert moaner; if the Prime Minister even thinks about me, it is, “Oh my Lord! There goes Charles Walker moaning away again—the moaner-in-chief.” Actually, however, we are not in a bad place in the United Kingdom. Look at what is going on in Italy, Spain, Greece and Ireland. Things are pretty good here. I am sorry to say this to my Liberal Democrat hon. Friend, the Minister of State, Department of Health, but I am the first to whinge about the coalition. However, we are not actually in a bad place and in the final analysis, we should be grateful for what we have.

4.14 pm

Barbara Keeley (Worsley and Eccles South) (Lab): I welcome the fact that we have a Care Bill to debate. I pay tribute to the hard work of colleagues on the Joint Committee on the draft Care and Support Bill. I also welcome the fact that the Government have taken on board a number of the Committee’s recommendations. However, some have not been adopted. I want to speak about the areas where the Bill could be improved and strengthened: the identification of carers and, as the right hon. Member for Sutton and Cheam (Paul Burstow) mentioned, the clauses relating to young carers.

Roberta Blackman-Woods (City of Durham) (Lab): Does my hon. Friend agree with the National Young Carers Coalition, which has written to all Members pointing out that the Bill does not do enough for young carers and needs to be amended so that there is a greater responsibility for identifying young carers? Does she agree that the Government should have taken heed of her excellent private Member’s Bill and incorporated it into the draft Bill?

Barbara Keeley: I am absolutely bound to agree with that point, and I will come on to it shortly.

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As has been said, we cannot separate the funding of social care from the law on social care. We need to take on board the fact that the Bill will not help those who are struggling without the social care support they need, either today or in the months and years ahead.

The Bill builds on the recommendations of the Law Commission’s review on social care and carers, but we should remember that until the Care Bill, carers had been given rights only through measures in private Members’ Bills: the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004. We should pay tribute to the late Malcolm Wicks, Tom Pendry and my hon. Friend the Member for Aberavon (Dr Francis) for their work on that early legislation to give rights to carers.

When I came to Parliament in 2005, I raised the issue for the first time that GPs and other health professionals needed to identify carers within their practice population. GPs are best placed to help carers at the start of caring, which is when they need that help and advice. It is the GP who deals with the patient with dementia, the patient recovering after a stroke, or the patient with cancer. The GP and primary health care team are, after those life-changing events, well placed to see if there is an unpaid family carer. It is then a simple step for them and their teams to take time to check the health of the carer and to refer them to sources of advice and support. Caring can have a serious impact on the health of carers. In a recent survey of 3,000 carers, Carers UK found that 84% said that caring was having a negative impact on their own health—up from 74% in 2011-12.

I have introduced three private Members’ Bills on the identification of carers, and in September I introduced the Social Care (Local Sufficiency) and Identification of Carers Bill. The Bill had good support in the House. My hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and 11 MPs from across most parties were supporters. We also had support from 27 national charities, the National Union of Students, the business group Employers for Carers and 2,000 individual carers. However, the Government did not support the Bill. In the debate, the Minister of State, Department of Health, who is responsible for care services, stressed that it was best to get everything codified in one place so that one piece of legislation addressed all issues of care and support. However, the Care Bill does not help with the identification of carers; it puts the duty of assessment on to local authorities. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers in any way that makes it a worthwhile exercise for those carers. If the Minister wants to look at the Joint Committee’s web forum on the draft Care and Support Bill, he will see that many of those who commented said that local authority assessments are of little practical help in their caring role.

Mrs Moon: Last week, I had a telephone call from a young man who is caring for his father. His father has the same condition as my husband, and he contacted me because of the debate we had on dementia. He told me that he had phoned his social services department twice and the psychiatric nurse twice to ask for help and support. He did not know where to turn. Is this not increasingly the problem? There is just no money: no money to provide the assessments and no money to provide the care if those assessments are carried out.

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Barbara Keeley: I agree with my hon. Friend: it is about carers knowing where to go for that help and support when they are so desperate.

In contrast to assessments, projects that work within primary care to help identify carers are producing outcomes that are genuinely helpful to carers. I spoke at an event last Friday organised by Salford carers centres for staff from those teams. The staff will help to identify carers and refer them to help and support. They will have a list of agencies and know where to go.

Paul Burstow: The hon. Lady is making important points about carers—an issue on which she has campaigned consistently. Would she join me in welcoming the announcement from the Royal College of General Practitioners over the weekend about the priority it wants attached to carers and the guidance it is now issuing to GPs to ensure that they do more? One in 10 of a typical practice’s patients are carers, so they could do a great deal more by identifying them.

Barbara Keeley: Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers

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services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

Norman Lamb: I look forward to visiting the hon. Lady in her constituency on Thursday and discussing this matter further. I totally agree with her concerns about young carers, and will seek to meet the children’s Minister to discuss it further. It is really important that we get the framework right.

Barbara Keeley: Indeed, but a cross-party approach did not convince the children’s Minister in Committee, which is why I am stressing it today. It is very important. I welcome the Minister of State’s assurance just now, but he has given assurances before. We cannot let the opportunity presented by these two Bills pass. Younger carers and their organisations feel that the coalition Government are leaving them out of the equation. At the moment, the threshold for an assessment is higher for young carers than for adult carers. In its evidence to the Joint Committee, the Law Commission said that the inclusion of clauses on young carers was an important area of improvement for the draft Care and Support Bill. Frances Patterson QC told us that the Bill should make provision for services for young carers as well as their assessments, and that the assessments were of limited use for young carers.

The picture of provision for young carers is now very confused, and it is a priority for Parliament to sort it out. It is not good enough to have this partial recognition of young carers in the Care Bill or to have the children’s Minister rejecting cross-party amendments on provision for young carers. The Minister of State, who is responsible for care services, has said several times that he wants a single statute. If that single statute is the Care Bill, it has to deal with young carers properly. It is plainly wrong that it does not. I am grateful for his intervention, but we need to get this right. Does he still support a single statute, and if so, can we get it right for young carers?

I welcome the steps being taken in the Care Bill, but it must be strengthened and improved in the ways I have outlined, because things such as assessments are not very helpful for carers and young carers, if that is all we are offering. As was said earlier, older people face continuing increases in home care charges. The number of people receiving publicly funded care has fallen by 7%. Unmet need is soaring, which is putting pressure on carers and our acute services. We need a bold response to the crisis in care, greater investment in social care and genuine integration of health and care services.

4.24 pm

Mr Edward Leigh (Gainsborough) (Con): I represent a Lincolnshire seat. I wish to say a bit about opinion in Lincolnshire and relay it to the House, if Members are not already aware of it from the local election results.

Coincidentally, today is the feast day of St Earconwald, who was born in 693 in Lindsey, north Lincolnshire. Various miracles were attributed to him. For example, when he was elderly and in his wheelchair, the wheels fell off but it kept going. I am reminded of how the coalition still keeps going, despite its wheels occasionally

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falling off. I think we may come to a time before the end of this Parliament when, such is the divergence of opinion—perfectly honourably felt—between very honourable people such as the Minister on the Front Bench and me, that for the sake of the nation we may have to bring this coalition to an end and honestly put our separate programmes to the people.

Chris Ruane (Vale of Clwyd) (Lab): When?

Mr Leigh: I have no idea when that will happen.

I said I wanted to talk about opinion in Lincolnshire. Despite all the Government’s success in their central aim of attempting to cut the deficit—we have cut it by a third—people there undoubtedly feel that their voice is not being heard. We have to listen to that voice. If I may be forgiven for being party political for a moment, I should point out that there is absolutely no enthusiasm for the Labour party, because people have not forgotten who created the borrowing mess we are in. We heard a lot about plain packaging from the right hon. Member for Leigh (Andy Burnham), who led for the Opposition today, but the whole Labour party is plain packaged. We have no idea, frankly, what it will do.

Barbara Keeley: I cannot speak for all parts of the country, but I campaigned in the recent county elections in Lancashire and there was huge enthusiasm for the Labour party.

Mr Leigh: We will have to see what happens in various parts of the country.

It is said that this is a thin Queen’s Speech. As a Conservative, I do not object to a thin Queen’s Speech. I do not object to deleting unnecessary legislation either, whether on minimal alcohol pricing or plain packaging. I view all these as creatures of the nanny state, so it is good conservatism that we are not introducing them. However, if we are to have a Queen’s Speech that is, shall we say, somewhat light and has lots of room in it, that means there are various other things that we could do. One thing we do not need to do, I would have thought, is persevere with the Marriage (Same Sex Couples) Bill. I will not repeat all the arguments, but this is an area where many people in Lincolnshire feel that their opinions are being not represented.

If anybody wants to look at an excellent article on this subject, they should read Charles Moore’s in The Daily Telegraph on Saturday. There is a real problem. We are trying to deal with an economic crisis and the very first thing we will do after this Queen’s Speech debate—although it was not mentioned in it; as far as the Government are concerned, this is the Bill that dare not speak its name—is have two days on same-sex marriage. The Bill will then go to the House of Lords. There are enormous, complex issues at stake for the Church of England. I have no doubt that we are moving to a world in which the Church of England will be allowed to conduct only religious marriages, but will not be able to complete them. They will have to be completed by the state because of equality legislation. These are serious issues. The Government could easily mend fences with many of their supporters by putting the Bill out to further consultation.

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Steve McCabe: If the coalition survives longer than the hon. Gentleman suggests, does he think that next time round it might be an idea for the Government to have a debate and then produce a Queen’s Speech, rather than producing a Queen’s Speech and then having a debate about what should not be in it?

Mr Leigh: That is an interesting argument. I have appended my name to the important amendment to the Queen’s Speech, and we should have a serious debate on the issue. This is not Conservative Members of Parliament obsessing about Europe; this is a real issue for people. It is no longer a dry as dust issue.

In Boston, a seat with a 12,000 Conservative majority, UKIP won nearly every council seat two weeks ago. Unlike my hon. Friend the Member for Stone (Mr Cash), the people there are not particularly worried about all the details of European legislation, but they are worried about immigration. I echo what my hon. Friend the Member for Broxbourne (Mr Walker) said in his very measured speech: people in Lincolnshire are not closet racists. They welcome Polish, Lithuanian and Latvian people, but they want their public services to be supported, when, on the coast of Lincolnshire, public services are overwhelmed. Since 2004, 1.1 million have arrived in this country from eastern Europe, and we have to address that issue.

Mrs Anne Main (St Albans) (Con): Will my hon. Friend give way?

Mr Leigh: I am sorry; I have only a short time left.

Speaking personally as a comfortable, middle-class person living in the hinterland of the beautiful Lincolnshire wolds—where, incidentally, we held all the seats we were defending—and in a comfortable part of London, I have no angst about Poles. They are hard working, and I think that most of them will go back. Their religion is estimable, and I have no complaint whatever against them. But we should listen to the people who are worried about public services, and this is therefore a European issue.

I personally believe that we should listen to those people and that we should have a referendum. I would also say to my right hon. Friend the Member for Mid Sussex (Nicholas Soames) that I believe that the Prime Minister is absolutely a man of honour and a gentleman, and there is no doubt in my mind that if he is still Prime Minister in 2017 we will have that referendum. The trouble is that ordinary people—if I may use that expression—do not think like us. They do not think in terms of four-year Parliaments; they think about now. The question they ask is, “If this is such an important issue, why can’t we have a referendum in the next two years?”

There should at least be a mandate referendum that we can put to the British people, asking whether we should have a new relationship with Europe based on political co-operation and economic free trade. If we fail to listen to the people, we will create a sense of alienation and, despite all our success in driving through the Government’s central economic policies and tackling the deficit—the reason that the coalition was created and what we are really about—that would eat away at

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the support for the coalition. A sense of alienation is created when people are worried about their public services.

People are worried about other issues as well. In the middle of my constituency, the Government are erecting wind turbines more than 150 metres high—taller than the highest point in the Lincolnshire wolds—that are being paid for by ordinary people living in terraced houses in Gainsborough. They are paying £100 a year, and the money is going straight into the pockets of rich farmers, all in the name of dealing with global warming—if indeed there is global warming, if indeed carbon emissions are causing it and if indeed wind farms will make any difference. That all adds to people’s sense of alienation.

People also worry about the budget for international development. I am personally in favour of spending money on international development, but we have a commitment to spend 0.7% of our gross national product, for which there is no scientific basis. As we reduce the number of staff in the Department for International Development, we are loading more burdens on the remaining staff to hand out more money. That is simply not good economics. It is not a good way to run a Department.

I do not believe we should ring-fence the budget of any Department. We should spend wisely and carefully on the right things at the right time. Whether we are talking about same-sex marriage, about the EU referendum or about the DFID budget, we must recognise that people are feeling a sense of alienation, and that good, strong Conservative voters do not feel that their Government are representing them all the time. Let us also put the focus on the Labour party, but let us concentrate on the core issue of getting rid of the deficit. Let us make that the successful mission of this Parliament.

4.34 pm

Valerie Vaz (Walsall South) (Lab): It is a pleasure to follow the hon. Member for Gainsborough (Mr Leigh) and to speak in the debate on the Gracious Speech to both Houses of Parliament.

I do not know about you, Madam Deputy Speaker, but I sense some confusion or dysfunction in the air—it started with the weather: first, we thought it was spring, and then found that it was not—which seems to have got down to the Government. Let me provide some examples. The Government want us to build more conservatories, but at the same time they are asking people to downsize to other properties. Over lunches, they are giving the benefit of the doubt to some companies minimising their tax bills, yet are not giving the benefit of the doubt to those who have to turn up to Atos assessments—even though they are in a wheelchair or have other long-term conditions. That is very dysfunctional.

Mr Qatada has been given £500,000 in legal aid, when he could have fought his appeal from abroad, but, with the cuts in legal aid, my constituent, Mrs Pressdee, cannot find a legal aid lawyer to help her from losing her home. What about the statement that Eton produces people who dominate Government because of their commitment to public service? I always thought there was a link between Eton and the Labour party, the Woodcraft Folk, the girl guides and the boy scouts, which are all committed to public service. Curiously,

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however, the number of public sector workers, who have a commitment to public service, has been decreasing over the last 13 quarters.

Let us deal with the commitment in the Gracious Speech to the reform of long-term care. This can be achieved only on the back of moving money from the health budget to social care, which the previous Secretary of State for Health had already started to do. This commitment in the Gracious Speech has been made against the backdrop of nurses and junior doctors saying they need more staff and that they are overstretched, but there is no commitment to staffing ratios.

About £10 million was spent on the Francis report, but its recommendations on the health service they have been practically discarded by this Government. Instead, the Secretary of State for Health is suggesting what can be described only as a vanity policy—he wants a chief inspector of hospitals. He was unable to tell me how much the chief inspector would earn, where the budget was coming from, whether this counted as committed spending, whether the Treasury knew about it, or whether it was to be taken out of the Care Quality Commission budget. This was not a recommendation that either Robert Francis or the Health Select Committee made. The Health Service Journalsurveyed senior people in the hospital sector, 73% of whom said they did not believe hospital inspectors would be effective. This is a headline vanity policy.

The Francis report was not about sticks or the smack of firm government, but about a change in culture. Francis said that there should be one organisation undertaking the monitoring of organisations’ ability to deliver compliance of fundamental standards. At the moment, we have the CQC, Monitor and now the chief inspector who will apparently have the power to close hospitals. The Secretary of State made a comparison with Ofsted earlier, so let us remember Helen Mann, a head teacher who was so terrified of an Ofsted inspection downgrading her school from outstanding that she hanged herself. Is this what we want our public servants to do? In any case, it was not Ofsted, but the hard work of teachers and pupils that drove up standards. Here is the chaotic part: for a top-performing hospital, there will be lower regulation. How can that be fair? The Secretary of State was unable to tell the Select Committee how long these top-performing hospitals would be able to keep their top rating. That is a recipe for chaos. And what will be monitored? Again, the Secretary of State was unable to say. Will it be mortality rates, success in surgery or what?

I would like draw hon. Members’ attention to an article by Professor Nick Black in The Lancet in March 2012, in which he discusses the myth that grew up—that productivity in the NHS was falling—and warned of the dangers of using one set of indicators. That is exactly what happened at the Leeds hospital. The Secretary of State has conceded that the data were not verified when Sir Bruce Keogh made the decision to close children’s heart surgery, leaving parents and professionals confused and anxious. Whoever has the ear of the chief inspector and has their own data could therefore damage a hospital.

Let me deal now with the Gracious Speech’s reference to improving the water industry. Members may like to know that Thames Water, which is controlled by an Australian bank, now proposes to recycle sewage water

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for drinking, yet fails to mention investment in infrastructure or the leaking pipes that caused the shortage in the first place. All that was despite the fact that the company had made £552 million in profit by the end of March 2013. I ask the Government to look further into that.

This Gracious Speech should be based on justice, tolerance and the rule of law, yet all that is being undermined. The gracious people of this country, on whose behalf the Gracious Speech was made, deserve better.

4.39 pm

Nadine Dorries (Mid Bedfordshire) (Con): My speech will be in two halves. I shall talk first about health care issues, as this is a health debate.

I welcome the Care Bill, particularly its commitment to social care. I feel that words such as “compassion” are sometimes missing from our discussions on health care. Before I say more, let me welcome publicly, for the first time, the right hon. Member for Cynon Valley (Ann Clwyd) to her position as head of a review body that will examine NHS complaints.

As many Members know, I was a nurse in a former life, and it was a profession that I absolutely loved. I was, I think, a committed nurse. I lived in a nursing home, and often worked for more hours than I was supposed to. I would go into the hospital on my days off to visit patients who had no relatives. I was not alone in that; most of the nurses in my nursing home behaved in the same manner. I pay tribute to a nurse who started work on the same day as me, on 5 November 1975: Helen Windsor, who contacted me recently. For all these years, she has been delivering the same committed care that she delivered in 1975.

I suppose many people will say that that was a long time ago, and it was, but I think that qualities such as compassion, kindness and caring are timeless. It does not matter when they were being delivered; they should be delivered in the same way today. Unfortunately, however, I—like many other Members—regularly receive complaints from constituents about the standard of nursing care. I mentioned Helen Windsor because I want to pay tribute to the nurses who deliver good care.

I recently visited a constituent in hospital, an 89-year-old man with no relatives. It was interesting that the right hon. Member for Cynon Valley mentioned nail clippings, because I had already written down that I intended to raise the subject. That constituent was agitated because his nails were serrated and were catching on the cardigan that he was wearing as he sat in his chair. When I asked the nurse whether she could cut his nails—he said that he had been asking for it to be done himself—she replied “No, I can’t. We are not allowed to do that.” So I took an emery board out of my handbag and filed his nails myself. I know that sometimes, as Members of Parliament, we feel that we are social workers, but I had never imagined that I would extend my role to the nail care and general hand hygiene of a constituent in hospital—but I did.

Unfortunately, on a number of occasions recently I have sat in a hospital and witnessed nursing care being delivered to my own daughter. Only a few weeks ago, when she was on a hospital trolley waiting to go into the operating theatre—distressed, anxious, upset—we witnessed nurses holding conversations over her head about intimate details of their love lives and their social lives, which,

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while she was in pain, my daughter had no interest in hearing. Not only was she subjected to those intimate details of their private lives; she was also subjected to a lack of care. She was completely ignored on that trolley. Yes, she was about to go into an operating theatre and be dealt with, but it is when patients are in that condition that they need nursing care most. They need to be reassured. They need to be calm. They need to know that everything is going to be OK. However, there was no interest in that.

The most appalling thing that happened was that, just before my daughter went into the operating theatre, one nurse told the other that she was going to the bathroom, and then gave exact details of what she was going to do there. I cannot think of a more polite way of putting it in the Chamber. It was a totally inappropriate conversation to be having outside the doors of an operating theatre.

A constituent who recently came to see me in my surgery told me that, when in hospital following a road traffic accident, she had noticed after a few days that her bottom sheet had not been changed and was bloodstained. Each day she wrote the date around the border of the bloodstains. When she left hospital 10 days later, she left that bottom sheet for the nurses to see, with the dates written in a pattern around the bloodstains. During those 10 days, no sheets had been changed. We used to change the sheets every day, and that was possibly excessive, but I think that, given that we are constantly trying to find ways in which to deal with, beat and get on top of hospital-acquired infections, bloodstained sheets indicate a lack of care.

I do not want to labour the point about complaints, because I know that a number of other people have already done so, and I feel that it is now the remit of the right hon. Member for Cynon Valley. Rather, I want to discuss immigration and its impact. We send £53 million per day to Europe, which limits our dealings with the rest of the world—in fact, the Prime Minister is trying to tackle that issue today. Labour will not commit to a referendum. Do Labour Members not see that that £53 million a day could be spent on dementia care, on Alzheimer’s care, on young carers? There are so many things we could do with that money.

People were asked one question when we went into the Common Market: do you want to go in, yes or no? They should be asked the same question to exit. If we can go to the electorate on behalf of the Liberal Democrats with a referendum on the alternative vote in a matter of months, why do we have to wait years to offer them a referendum on an issue as big as the European Union? Do we not realise what a self-serving, self-interested bunch we seem to people out there, when we can call an expensive national referendum on AV, yet obfuscate and delay on the question of European Union membership?

It is no good saying that people are not interested in this issue, because they are: it is the subject of almost every other question I am asked when I go out in my constituency. People now know exactly how much we are spending on the European Union, and they do not believe that leaving will cost us 3 million jobs. They would like a piece of the action in China, which reported growth of some 9.5% in the past year. They want some of the action taking place in the BRIC countries. That is where they want to trade—not in a sick and failing Europe that is getting sicker by the day.

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I want to add my voice to those who have spoken out on this issue, and I would definitely join the two Cabinet Ministers in voting to be out. I would vote no tomorrow, and I know many of my constituents would. I completely support the measures in the health Bill in the Queen’s Speech, which will be well received by everybody, but I want to add my voice to the case for an in/out referendum. We must find a way to deliver that. We know that the Prime Minister means what he says; but if we can do it on AV, we have to do it on the EU: otherwise, people will not believe us.

4.47 pm

Mr Kevin Barron (Rother Valley) (Lab): I have to say to the hon. Member for Mid Bedfordshire (Nadine Dorries): welcome back to the Conservative party. I heard what she has been saying today from the Conservatives about 20 years ago. It led to their spending 13 years in opposition, and I hope it has the same result in a couple of years’ time. I look forward to that.

This debate seems to be more about what is not in the Queen’s Speech than what is, but immigration and access to the national health service are addressed, and the tone of this debate has been quite distasteful. We know that, from time to time, some of our constituents go to work in other European economic area countries; they pay their taxes and social insurance contributions there, and as a consequence they are allowed to obtain health care in those countries. Immigrants are not coming to this country to use our national health service, and they do not use it for free: they pay, as they should.

We need be very careful when we talk about people moving around Europe. Tens of thousands of our fellow citizens have gone to live in Spain, Portugal and France, not to work but to retire. If they return to this country en bloc, consider the impact on the health service, social care and care for the elderly. We need to have a rational debate on this issue.

Mrs Main: In the last Parliament, I was privileged to serve on the Communities and Local Government Committee. We produced a report on community cohesion and integration under the right hon. Gentleman’s Government. It said that the pace of change, the resources and facilities were all wrong, and many of the communities we visited said that. He needs to show a little humility when talking about immigration and numbers, because his own Government condemned the situation in that report.

Mr Barron: It was not a Government report but a Select Committee report, and I do not remember it, quite frankly.

Community cohesion is important and has been important in this country for centuries—not just since we joined the European economic area or the EU expanded to 27 countries, with people having the right to come and work here, as indeed we have the right to go out and work in other EEA countries. A lot of this debate is distasteful and is not the truth. In a recent by-election, a political party that is not represented here and I hope will not be was saying that, as of January next year, probably nearly half the population of Bulgaria will

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come and work in this country. That is nonsense, and neither Back Benchers nor Front Benchers should have a knee-jerk reaction to that type of debate. We should have sensible debates about what immigration does or does not do in this country.

Nadine Dorries: Can the right hon. Gentleman provide evidence for his numbers? Can he tell us how he knows what the numbers will be? Can he quote from some extensive research that proves this?

Mr Barron: I was quoting from the rhetoric put into the daily press during the Eastleigh by-election. I think the figure given was that about 3 million Bulgarians will be coming to this country—

Nadine Dorries: How does the right hon. Gentleman know that that is not the figure?

Mr Barron: If the hon. Lady will keep quiet, I can tell her that that was what was said, but there are fewer than 8 million Bulgarians living out there. Many Bulgarians have been living and working in this country for many years, because they met criteria outwith the criteria laid down when Bulgaria and Romania joined the EU. The whole debate is disgraceful, and we should get it into some perspective.

Sir Gerald Howarth: Will the right hon. Gentleman give way?

Mr Barron: No, I have given way twice and I am not going to give way any more.

What is not in the Queen’s Speech? Public health has been mentioned by several people. I served on the Bill Committee for what became the Health and Social Care Act 2012. I will leave the reorganisation of the NHS for another day, but at the time the Bill was going through, the defence given by Ministers was, “What we will start doing is putting real measures down, and for the first time ever we will put in statute a responsibility to reduce health inequalities in this country.”

Two policies that most people involved in and concerned about public health thought would be in the Queen’s Speech are absent. One is the minimum pricing of alcohol, which was talked up by the Prime Minister over many months. There is evidence that it will stop some people drinking excessively. I served on the Health Committee in the previous Parliament, and just before the general election we published a report on alcohol. People ought to read it to see exactly what is happening. One of the worst statistics was on the people who are likely to die from alcohol-related diseases—certainly cirrhosis of the liver. Thirty years ago, they were people like me—men in their 60s—but now, men and women in their 20s are dying of that disease. This House has a responsibility to do something about that.