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Debate on the Address

[3rd Day]

Debate resumed (Order, 5 June).

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.


4.42 pm

The Secretary of State for Health (Mr Jeremy Hunt): The legislative programme presented to Parliament last week by Her Majesty the Queen builds on four years in which we have not shirked our duty to the British people to restore confidence in disastrous public finances; to lead the country from the deepest recession since the second world war to the strongest growth in the G7; and to implement a plan that secures our long-term economic future. As part of that programme, we have been following a long-term plan to transform our NHS and help it to meet the challenges of an ageing population. However, we must remember that without the difficult decisions made to restore faith in our public finances, the NHS would have been in a very different position.

In Ireland, the health pay bill was slashed by 16% because it ran out of money. In Greece, health spending was cut by 20%. In Portugal, the public were asked to double their personal contribution to the cost of health care, but in England difficult decisions meant that we were able to protect the NHS budget, unlike the Labour party, which plans to cut it in England, and did indeed cut it by 8% in Wales, with disastrous consequences. Labour made the wrong call on the economy and the wrong call on NHS finances. Because we made the right call, the NHS is now doing extremely well in very challenging circumstances.

Later, Members will hear the right hon. Member for Leigh (Andy Burnham) talk about operational pressures facing the NHS. He is right: it is tough out there. This week, we will announce new measures to help the service to meet the challenges that it faces. We will no doubt also hear attempts to politicise what are essentially operational pressures, but what we will not hear is how much better the NHS is doing than it ever did when he was Health Secretary. The facts speak for themselves. Every single day—[Interruption.] This is difficult for Labour Members to listen to, but they would do well to listen. Compared with when he was Health Secretary, every single day we are referring 1,000 more people with suspected cancers to specialists. We are transporting 1,000 more patients—

Andy Burnham (Leigh) (Lab): Will the Secretary of State give way?

Mr Hunt: I am going to make some progress and then give way. The right hon. Gentleman needs to listen. We are doing much more now compared with what was done when he was Health Secretary. If he listens, he might learn something.

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This is what is happening every single day: 1,000 people with suspected cancers are being referred, and 1,000 more patients are being transported in ambulances in emergencies. Every day we are performing 2,000 more badly needed operations, we are seeing 3,000 more vulnerable people in A and E departments, and every day we are providing around 6,000 more GP consultations for members of the public and 10,000 more vital diagnostic tests. At the same time, MRSA rates have almost halved, mixed-sex wards have been virtually eliminated, and fewer people are waiting for 18 or more weeks for their operation.

Andy Burnham: The Health Secretary is standing there claiming everything is fine and giving a litany of successes. Let us just consider cancer care. He said the NHS was worse when we were in government. So that we are absolutely clear, will he confirm that the last set of figures show that the NHS is now for the first time missing its standard of treating cancer patients within 62 days?

Mr Hunt: The right hon. Gentleman should have listened to what I said: I said he was right to say it is tough out there, and I also said that this week we will be announcing measures to help the NHS deal with operational pressures. He talks about how long people are waiting for operations, so let us look at one particular statistic that sums up what I am saying: the number of people waiting not 18 weeks but a whole year for a vital operation. Shockingly, when the right hon. Gentleman was Health Secretary, nearly 18,500 people were waiting over a year, and I am proud that we have reduced that to just 500 people. Those results would not be possible without the hard work and dedication of front-line NHS staff, and whatever the political disagreements today, the whole House will want to pay tribute to their magnificent efforts.

Mr Andy Slaughter (Hammersmith) (Lab): Will the Health Secretary comment on the shambles he has reduced the NHS to in west London, where he is closing A and E departments, like that at Hammersmith on 10 September, while there are inadequate numbers of beds at the only hospital people have been directed to? It means that there is no acute care, and primary care is in such a state that there is an emergency in-year redistribution of money across north-west London. How is he going to sort that out?

Mr Hunt: What is happening in north-west London is going to make patient care better. It involves the seven-day opening of GP surgeries, over 800 more professionals being employed in out-of-hospital care, and brand new hospitals. That is a huge step forward, and the hon. Gentleman is fighting a lone battle in trying to persuade his constituents that it is a step backwards.

This Government recognise the pressure that the NHS is under, as I was telling the shadow Health Secretary. The fact that the population is ageing means that the NHS now needs to perform 850,000 more operations every year than when he was in office, which we are doing. That means that some patients are not receiving their treatment as quickly as we would like, so NHS England is this week announcing programmes to address that, ensuring that we maintain performance

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while supporting the patients waiting longest for their treatment, something that did not happen when he was in office. We will not allow a return to the bad old days when patients lingered for years on waiting lists because once they had missed their 18-week target, there was no incentive for trusts to treat them.

A and Es, too, are facing pressure and are seeing over 40,000 more patients on average every week than in 2009-10. NHS staff are working incredibly hard to see and treat these patients within four hours, and it is a tribute to them that the median wait for an initial assessment is only 30 minutes under this Government, down from 77 minutes under the last Government. However, as we did last year, we will continue to support trusts to do even better both by improving their internal processes and working with local health economies to reduce the need for emergency admissions. This will be led by NHS England, Monitor and the NHS Trust Development Authority.

David T. C. Davies (Monmouth) (Con): We have heard some comments from Opposition Members about waiting times. My right hon. Friend will be aware that fewer than 2% of patients in England wait for more than six weeks for diagnostic treatment, but is he aware that the figure is 42% of patients in the Labour-run NHS in Wales?

Mr Hunt: I am aware of those shocking figures, and I am also aware that the Royal College of Surgeons says that 152 people died on waiting lists in Wales at just two hospitals because they did not get their treatment in time. I gently suggest to the shadow Health Secretary that the Labour party might want to fix what is going on in Wales if it is really serious about patient care, because how Labour is running the NHS in Wales is an absolute disgrace.

Mike Gapes (Ilford South) (Lab/Co-op) rose

Barbara Keeley (Worsley and Eccles South) (Lab) rose

Mr Hunt: I am going to make some progress, and then I will give way.

The NHS is about more than just getting through difficult winters. Looking to the future, this Government will continue to take the bold steps necessary to prepare our NHS for the long-term challenges it faces. There are two key areas for action if we are to rise to this enormous challenge. First, we must never turn the clock back on Francis. The NHS will never live up to its founding ideals if it tolerates poor or unsafe care. The last Government presided over an NHS in which doctors or nurses who spoke out were bullied, in which problems at failing hospitals were brushed under the carpet and in which vulnerable older people were ignored and, tragically, on occasions, treated with contempt and cruelty. This Government have stood up for the patient, championing high standards with a new culture of compassionate care which is now transforming our health and care system.

Alex Cunningham (Stockton North) (Lab): The Secretary of State has already admitted some of his own failures this afternoon. Does he not think that some of the

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money he invested in his £3 billion reorganisation of the national health service could have been used to ensure that the NHS was hitting its targets today?

Mr Hunt: Perhaps the hon. Gentleman would like to look at the facts relating to the actual cost of the reorganisation. The net saving as a result of it has been more than £1 billion a year, and we are now employing 7,000 more doctors and 3,000 more nurses than when his party was in office. Last year, as a result of this programme—

Mike Gapes rose

Mr Hunt: I am going to make some progress.

Last year, as a result of this programme, this Government put 15 trusts—

Mike Gapes rose

Mr Hunt: This might not be something the Opposition agree with, but they should listen. I need to tell the House that we have put 10% of all acute trusts into special measures, and that in each and every one of them the warning signs were there under the last Government. The George Eliot hospital, for example, had one of the worst mortality rates in the country back in 2005. Tameside had to pay £9 million compensation for mistakes in just two years, and at the Queen’s hospital in Romford in 2006, a lady gave birth in a toilet, leading to the tragic death of her child.

Mr Brian H. Donohoe (Central Ayrshire) (Lab): The Secretary of State will be aware of a problem that is affecting thousands of women. It relates to medical implant devices that a court in America has banned. What is he prepared to do to deal with the situation in this country that is affecting thousands of women, both north and south of the border?

Mr Hunt: The hon. Gentleman mentioned to me earlier that he was going to raise that point. I will look closely at the issue, as it sounds like an extremely important one.

I want to look at what has changed under this Government. One of the trusts that has been in special measures is the Basildon and Thurrock University Hospitals NHS Foundation Trust. When the right hon. Member for Leigh was in office, inspectors at the hospital found blood stains on floors and curtains, blood spattered on trays used to carry equipment, and badly soiled mattresses. When the Care Quality Commission published those findings, it was allegedly leant on to tone down its press release. This Government put Basildon into special measures, and it now has 183 more nursing staff. I asked one of those nurses what the difference was. She said:

“It’s very simple. When we raised a concern before, they weren’t interested. Now, they listen to us.”

It gives me great pleasure to inform the House that the chief inspector of hospitals has today recommended that Basildon should be the first trust to exit special measures, and that Monitor has ratified that decision. The hospital has received an overall rating of “good” and has been praised for its excellent leadership. The chief inspector found that the trust had made significant improvements in a number of areas, including maternity

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services, which were rated as “outstanding”—




The Opposition might not care about what is happening at a trust in special measures, but we on this side of the House do.

Mike Gapes: On a point of order, Mr Speaker. The Secretary of State knows very well the issue I am trying to raise, because I raised it during the business statement last week. I want him to respond to an important fact. A leaflet was circulated in my borough on 20 May, two days before polling day. It was quoted in the local papers, and it related to the A and E department at King George hospital in my constituency. I simply want to ask him to confirm whether the announcement from the Secretary of State for Health referred to in the leaflet was made with his authority, or by him, during the week before polling day.

Mr Speaker: The hon. Gentleman is an ingenious and indefatigable Member. He probably knows that I can best describe that as an attempted point of order, because it is not a matter for the Chair. That said—[Interruption.] Order. That said, the hon. Gentleman has made his point forcefully, and it would certainly not be in any way disorderly for the Secretary of State to respond to it if he wished to do so.

Mr Hunt: I am most happy to respond to what—I agree with you, Mr Speaker—is a thinly disguised point of order. I will happily say this: what I said was completely in order because I was simply restating information publicly available on the trust’s website.

I want to go back to talk about Basildon hospital, because of the remarkable turnaround there. Chief executive, Clare Panniker, and her team deserve huge credit for the changes that they have made, which will truly turn a corner for patients who depend on their services.

Mike Gapes: On a point of order, Mr Speaker.

Mr Speaker: Order. I ask the hon. Gentleman to calm himself for a moment. I accept the great importance of these matters, but I hope that this is a point of order rather than of frustration.

Mike Gapes indicated assent.

Mr Speaker: The hon. Gentleman is nodding with great vigour and intensity. Let us hear the attempted point of order.

Mike Gapes: I want to be clear about what the Secretary of State just said. He said, “What I said was”. I seek your advice, Mr Speaker. How can I get clarification from the Secretary of State about whether he made an announcement during the purdah period in the days just before the election or whether it was a previous statement rehashed and reissued from weeks before?

Mr Speaker: The short answer to the hon. Gentleman is that he must use his best devices, both in this debate, where he might have an opportunity to catch the eye of the Chair later, and in Health questions, which, if memory serves me right, are coming up very soon—

Hon. Members: Tomorrow.

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Mr Speaker: As I said, they are coming up very soon, and I am grateful to the hon. Member for Weston-super-Mare (John Penrose) for concurring with my suggestion that “very soon” does indeed include tomorrow. There will also be opportunities at all times for the hon. Member for Ilford South (Mike Gapes) to table questions with the advice of the Table Office. I have known him for 20 years and more, and he is not very readily put off his stride. I have no doubt that he will continue to gnaw at the bone until he achieves an outcome that he regards as satisfactory. Meanwhile, we must continue with the debate and the oration of the Secretary of State.

Mr Hunt: The decision to place 11 trusts into special measures last summer was not taken lightly, but we can see today that it was the right decision. Across the whole NHS, the number of people who think they would be safe in an NHS hospital is as high as it has ever been, the number of people who think that people are treated with dignity and respect has risen by six percentage points over the year and the number of people who think that people are treated with compassion has gone up by eight percentage points. This Government have introduced new chief inspectors of hospitals, general practice and adult social care to oversee the toughest, most transparent and most independent rating system of any country anywhere. We have improved accountability with a statutory duty of candour, and we are supporting staff by publishing ward-level nurse staffing levels for every trust.

Jackie Doyle-Price (Thurrock) (Con) rose—

Barbara Keeley rose—

Mr Hunt: I will give way to my hon. Friend because she is affected by Basildon hospital.

Jackie Doyle-Price: I thank my right hon. Friend for giving way. I am sorry that his congratulations to Basildon hospital were so dreadfully interrupted earlier, because its journey since 2009, when real deficiencies were highlighted, to where we are now with the special measures being lifted is, as he has said, real testament to the leadership of the hospital’s new management and the commitment of the staff. I thank him for the impetus that he has given that process, because it is only by admitting when things go wrong that we can put them right; that is the difference between the Government and the Opposition.

Mr Hunt: I congratulate my hon. Friend for her work campaigning for higher standards at her local hospital, and I agree with her. Why is it that interventions to do with improving safety and compassionate care are coming only from Government Members and that the Opposition are not interested? I just challenge Labour Members on whether they are really on the right side of the big changes that need to happen in our NHS.

Several hon. Members rose

Mr Hunt: I am going to make some progress because we have had lots of interventions. [Interruption.] I am going to make some progress and I have been very generous. [Interruption.]

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Mr Speaker: Order. There is now a kind of institutionalised rowdiness about this debate, epitomised by the hon. Member for Swansea West (Geraint Davies) on the third row. It would be seemly if he would calm himself. I do not refer to people outside this place, but this debate is being keenly attended by a large number of citizens, who would expect Members to behave in as seemly a fashion as I feel sure they do on a day-to-day basis.

Mr Hunt: Despite the amount of work that has been done in the past year, there is still much to do to improve safety and care. According to a study based on case note reviews, around 5% of hospital deaths are avoidable. That equates to 12,000 avoidable deaths in our NHS every year, or a jumbo jet crashing out of the sky every fortnight. On top of that, every two weeks, the wrong prosthesis is put on to a patient somewhere in the NHS. Every week, there is an operation on the wrong part of someone’s body. Twice a week, a foreign object is left in someone’s body. Last spring, at one hospital, a woman’s fallopian tube was removed instead of her appendix. Last summer, the wrong toes were amputated from a patient. This spring, a vasectomy was given to the wrong man. To tackle such issues, we need to make it much easier for NHS staff to speak out when they have concerns. We need to back staff who want to do the right thing, and we are currently looking at what further measures may be necessary to achieve that.

Today, this Government vow never to turn back the clock on the Francis reforms, and I urge the shadow Health Secretary to do likewise when he stands up. Another vital set of reforms that we need to make if we are to prepare the NHS for the future involves the total transformation of out-of-hospital care. We know that prevention is better than cure and that growing numbers of older people, especially those with challenging conditions such as dementia, could be better supported and looked after at home in a way that would reduce their need for much avoidable and expensive care. This year, three important steps have been taken towards that vital goal. First, the new GP contract brought back named GPs for the over-75s—something that was so shamefully abolished by Labour in 2004. Older people often have chronic conditions that make continuity of care particularly important. However, Labour scrapped named doctors, and we are bringing them back.

We are also acting to break down the silos between the health and social care systems with an ambitious £3.8 billion merger between the two systems. The better care programme is, for the first time, seeing joint commissioning of health and social care by the NHS and local authorities, seven-day working across both systems and electronic record sharing, so that patients do not have to repeat their story time after time and medication errors are avoided.

Barbara Keeley: The Secretary of State touches on a couple of issues, including safety, but ignores one of the most important ones, which is nurse-to-patient ratios. A safe patient-to-nurse ratio has been adopted at Salford Royal, and it could be adopted elsewhere. He is now talking about the better care fund. There is no new money in that fund, and if he is worried about pressure on the NHS, surely he should think about the £2.68 billion that is being taken out of adult social care. In my local

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authority of Salford this year, 1,000 people will lose their care packages. How is that good for alleviating pressures on the NHS?

Mr Hunt: Perhaps I can reassure the hon. Lady on those matters. First, the better care fund is the first serious attempt by any Government to integrate the health and social care systems and eliminate the waste caused by the duplication of people operating in different silos. The Government require all trusts to publish nurse-staffing ratios on a website that will go live this month. It is an important, radical change, and we are encouraging trusts to do exactly what she says is happening in Salford. It is important to say that, where other Governments have talked about integration, we are delivering it. We are doing one more important reform: we are taking the first steps to turn the 211 clinical commissioning groups into accountable care organisations with responsibility for building care around individual patients and not just buying care by volume.

From next year, CCGs will have the ability to co-commission primary care alongside the secondary and community care they already commission. When combined with the joint commissioning of social care through the better care fund, we will have, for the first time in this country, one local organisation responsible for commissioning nearly all care, following best practice seen in other parts of the world, whether Ribera Salud Grupo in Spain, or Kaiser Permanente and Group Health in the US—[Interruption.]

Mr Speaker: Order. I say to the hon. Member for Rhondda (Chris Bryant), who has just published an extremely cerebral tome on the history of Parliament, that he should not be yelling and exhorting from a sedentary position as though he is trying to encourage a horse to gallop faster. It is not an appropriate way to behave.

Andrew George (St Ives) (LD): The Secretary of State mentioned the importance of integrating secondary and primary care. He will be aware that the chief executive of NHS England recently addressed the large number of community hospitals with a sword of Damocles hanging over them and whether or not they will continue to exist. He said that that issue should be revisited and, indeed, has argued that community hospitals should be developed and that we should protect that area of care. Does the Secretary of State believe that the chief executive of NHS England is calling for the retention and reopening of community hospitals?

Mr Speaker: Interventions should be brief—the hon. Gentleman is experienced enough to know that.

Mr Hunt: I agree with the new chief executive of NHS England. There is an incredibly important role for community hospitals and, indeed, for smaller hospitals. He was making the point that it is not always the largest hospitals that have the highest standards. One reason why the public like smaller hospitals is that they are more personal, and very often the doctors and nurses know people’s names, which makes a difference. They are also closer to people’s homes and easier to get to for relatives wishing to visit people in hospital.

Several hon. Members rose

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Mr Hunt: I am drawing to a close, so I shall continue by saying that a long-term plan for our NHS that recognises immediate challenges and the need to reform going forward is what the Government have put into practice. It is not easy to implement, but it is the right thing to secure its future, and the right thing for our country. When the right hon. Member for Leigh rises to speak in a moment, he will say—he told The Independent that he would—that the NHS should have been included in the Queen’s Speech, ignoring the Bill to introduce additional child-care subsidies that will benefit thousands of NHS employees and ignoring the impact on NHS finances of the Bill to curb excessive redundancy payments—something for which his Government were largely responsible. He will not mention the straightforward security that the Government offer the NHS by sticking to a long-term economic plan that is working, so that we have the best possible chance to ensure that the NHS can be properly funded going forward.

If the right hon. Gentleman does not address those points, I hope that he will use his speech to show that he has learned from some of the big challenges facing the NHS over recent years. Does he accept that, without the reorganisation of about 20,000 administrators, the NHS would not be able to afford 7,000 more doctors and 3,000 more nurses? Does he accept that, without restoring named GPs, we will not be able to offer the joined-up care to vulnerable older people that he claims to champion? Most importantly, will he say publicly that, without honesty about poor care—honesty that he has repeatedly criticised as running down the NHS—we would not now be turning round 15 failing hospitals such as Basildon? In that spirit, will he categorically retract his statement, as reported in the Health Service Journal last week, that Mid Staffs was a local failure whose significance for the NHS has been exaggerated by this Government? If he does not do so, I have to say that we disagree profoundly on the biggest change that our NHS needs. We can state that change in just three words: put patients first. It is what NHS staff want to do, and they all want support to do it, but it is simply not possible unless they have the administrative and political leadership that puts patients first in every policy, target and announcement. The Government are proud of our record on the NHS: proud of record levels of high-quality care given to record numbers of patients, proud of tough economic choices that enabled us to protect the NHS budget and, most of all, proud of 1.3 million NHS staff who work hard day in, day out, to make our NHS so remarkable. We will not let them or the country down.

5.8 pm

Andy Burnham (Leigh) (Lab): Last week, the Secretary of State told the NHS Confederation that patient safety was crucial to the future sustainability of the NHS. Let me begin on a note of agreement. The Health Secretary is right to continue to send the clearest message to the NHS that patient safety must be its top priority. He knows that he has our support in introducing measures to implement the Francis report and, indeed, learning all the lessons from the terrible failings at Stafford hospital. A question arises that is perhaps more for the Government to answer than the right hon. Gentleman: why is the Secretary of State’s important priority not reflected in the Gracious Speech? It is approaching 18 months since the publication of the Francis report, yet

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many of its recommendations are still to be implemented. The failure to make progress in this legislative programme undermines the Secretary of State’s message today.

The Francis report recommended new legislation to modernise the regulation of doctors and nurses and speed up the handling of complaints. The regulatory bodies said that progress is urgently needed, and they were expecting a Bill in the Gracious Speech to implement those reforms. Not surprisingly, both reacted negatively to the decision to drop it. Niall Dickson, chief executive and registrar of the General Medical Council, said:

“We are disappointed that the government has not taken this opportunity to improve patient safety”,

and Jackie Smith, chief executive and registrar of the Nursing and Midwifery Council, said:

“Both the NMC and the public it protects now continue to be left, indefinitely, with a framework that does not best serve to protect the public.”

I hope the Secretary of State will explain why that Bill was dropped and answer the concerns of Jackie Smith and Niall Dickson.

Mr Hunt: The right hon. Gentleman said he would start on a note of consensus on the Francis report, so does he now retract his comments last week that what happened at Mid Staffs was “a local failure” and that the Government were exaggerating its significance for the rest of the NHS? That was a very damaging thing to have said.

Andy Burnham: The Francis report found that the failing at Stafford hospital was principally a failure of the local board. I served in the previous Government, who inherited problems from the preceding one—care failings at Bristol royal infirmary and Alder Hey, and the Shipman murders. Contrary to what the Secretary of State said today, we acted on those failures to bring more transparency to the NHS. We introduced independent regulation to the NHS. He needs to look at the statements that he has made over the past year and consider whether his response has always been appropriate. He has used language such as

“Cruelty became normal in our NHS”—[Official Report, 19 November 2013; Vol. 570, c. 1097.]

Does he stand by such statements and does he think that is fair to the thousands of NHS staff who give their all every day, doing their best to serve patients?

Mr Hunt rose

Andy Burnham: I will give way to the right hon. Gentleman once more, but he needs to answer those concerns of staff, who feel that he has been running down the NHS.

Mr Hunt: Let me be absolutely clear. I have never blamed NHS staff for what happened at Mid Staffs. I blame the policy failures of the right hon. Gentleman’s Government. It is not just I who say so. Robert Francis said in his report:

“Stafford was not an event of such rarity or improbability that it would be safe to assume that it has not been and will not be repeated”

in the rest of the NHS. He continued:

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“The consequences for patients are such that it would be quite wrong to use a belief that it was unique or very rare to justify inaction.”

Will the right hon. Gentleman now retract his comment that this was “a local failure” whose impact has been exaggerated?

Andy Burnham: I am quite clear in what I said. I said that the finding of the Francis report was that it was a local failure, but of course there were lessons to be learned. That is why I brought in Robert Francis in the first place to begin inquiries at Stafford. The claim that we just brushed everything under the carpet could not be more wrong. The Secretary of State needs to drop it and start dealing responsibly with these issues.

The right hon. Gentleman wanted to distract the House from what I was saying—that a Bill should have been brought forward in this Gracious Speech to modernise professional regulation in the NHS. I quoted strong sentiments from Niall Dickson and Jackie Smith. There was no room for such a Bill, but it is hard to find measures in the rest of the Gracious Speech that may be considered more important than that Bill. The Speech found space, for instance, for measures on pubs and plastic bags, but not on patient safety. There was a time when the Prime Minister used to say that his priorities could be summed up in three letters—NHS. Not any more. Those letters did not appear in the Gracious Speech and received only a cursory mention when the Prime Minister addressed this House.

So what explains the relegation of health down the Government’s list of priorities? One commentator writing last Thursday offered an explanation. He said that

“there was no mention of the health service in the Queen’s Speech. Indeed, the Tories have had little to say on the subject at all recently.

I’m told that there is a precise reason for this: Lynton Crosby has ordered them not to.”

I do not know whether that is true, but it does not look good, does it? It creates the clear impression that the shape of the Gracious Speech had more to do with the political interests of the Conservative party than the public interest of the country.

Mr Barry Sheerman (Huddersfield) (Lab/Co-op): Is not another explanation for the absence of any mention of the NHS in the Queen’s Speech that the Government do not want it? They are quietly privatising the NHS by the back door, so they do not need legislation.

Andy Burnham: I think that that is exactly the reason. They introduced a reorganisation that nobody wanted, that nobody voted for, that put the wrong values at the heart of the NHS and that has dragged the NHS down, and all the while they are softening it up for accelerating privatisation. That is the record on which they will have to stand before the country in less than 12 months’ time. If the Secretary of State can justify that record and breaking the coalition agreement to his constituents, I would be very surprised indeed.

Alun Cairns (Vale of Glamorgan) (Con): Will the right hon. Gentleman give way?

Andy Burnham: No, I am going to make some progress.

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On the day of the Gracious Speech, 60 senior NHS leaders wrote to a newspaper to warn

“that the NHS is at the most challenged time of its existence.”

Just when it needs real leadership, it is being offered a period of drift from an increasingly dysfunctional Government and, sadly, the same is true on public health. The Government should have used this moment to regain the initiative and publish regulations on standardised packaging for tobacco and smoking in cars. Ministers announced on 3 April that they would publish the draft regulations on standardised packaging later that month—that was what the Minister responsible for public health, the hon. Member for Battersea (Jane Ellison), said. They have not, and since then almost 40,000 children have taken up smoking.

The public health Minister wrote to my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), the shadow public health Minister, saying

“we will now push ahead”

with banning smoking in cars following the vote in this House, but we are still waiting. We did not hear anything on public health from the Secretary of State today. When will they show some leadership and set out a timetable for these important measures?

It is not hard to guess the reason for this pre-election period of NHS silence. On every measure that matters to the public, contrary to what the Secretary of State said, the evidence is clear that the NHS has gone downhill under this Government and that it is getting steadily worse.

Geraint Davies (Swansea West) (Lab/Co-op): On the subject of preventive measures, my right hon. Friend might be aware that in Britain today child mortality among those below the age of five is the worst in the western world bar Malta, at one in 500? Washington university explains the cause as the welfare and austerity changes—food banks and the like. Will he comment on the impact of some of the welfare and other changes that have made the very weakest weaker, poor and unhealthier and are making them die earlier?

Andy Burnham: It is well documented that the policies of this Government in a range of areas are damaging the health of the nation, but what we get instead is drift from the Government on public health. There is no momentum at all to improve children’s health and the Queen’s Speech had absolutely nothing to say on it. Where are the measures that the Minister has been proposing? What has she been doing? Why does she not introduce them?

The Parliamentary Under-Secretary of State for Health (Jane Ellison): The right hon. Gentleman will be aware that the legislation for both the measures to which he alludes has already been passed by this House.

Andy Burnham: But regulations are needed. If the Minister does not know that—[Interruption.] It was the Opposition who brought forward the vote on smoking in cars and she committed to introduce regulations to implement it. She cannot duck the question. When will she do that? If she does not realise that she is going to introduce regulations, she needs to go back and do a bit more homework.

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It is not hard to guess why the Government want a period of silence. On every measure, the evidence is clear that the NHS is getting worse. When the Prime Minister was challenged—

Alun Cairns rose

Andy Burnham: No, I will not give way. When the Prime Minister was challenged on the wisdom of his reorganisation, he said that it should be judged by its effect on waiting times—[Interruption.]

Alun Cairns rose

David T. C. Davies rose—

Mr Speaker: Order. The shadow Secretary of State is clearly not going to give way at the moment.

Andy Burnham: The Prime Minister set his own test for his reorganisation: its effect on waiting times. This month, waiting times hit a six-year high. Almost 3 million people are now on the waiting list for treatment, up by half a million since 2010, but that is not all.

David T. C. Davies: On a point of order, Mr Speaker. The shadow Health Secretary does not seem to want to give way to anybody from Wales. Is there any reason for that, and could it be a case of discrimination of some sort?

Mr Speaker: I am always interested in the ingenious interventions of the hon. Gentleman, but that is not a matter for the Chair and I will not speculate on it or in response to the hon. Member for Swansea West (Geraint Davies). We will return to the shadow Secretary of State.

Andy Burnham: I just gave way to somebody from Wales. What is the hon. Gentleman on about?

That is not all. As I said before, the NHS is now missing its standard to ensure that cancer patients start their treatment within 62 days. That will cause huge distress to thousands of families up and down this country.

Another way in which the NHS has got worse, and every patient knows this to be true, is that it is becoming harder and harder to get a GP appointment. It is a common experience for people to ring their surgery early in the morning only to be told that there is nothing available for days. A survey has found that almost half of GPs predict that the average waiting time will exceed two weeks by next year.

The clearest measure of growing problems in the NHS is what has been happening in A and E, which is the barometer of the whole health and care system. Problems or blockages anywhere in the health and care system will manifest, in the end, as pressure in A and E. If A and E is the barometer, what is it telling us? It is warning of severe storms ahead. Hospital A and E units have now missed the Government’s target for 46 weeks running. For the last four weeks, the NHS overall has missed the Government’s target, suggesting that the winter crisis has now been followed by a summer crisis.

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Why is that happening? The fact is that cuts have been made to general practice, social care and mental health, which are pushing more and more people towards the acute hospital and placing it under intolerable pressure. Today, many hospitals are operating way beyond safe bed occupancy levels, and not surprisingly this is taking a toll on A and E staff. Today, we reveal that three times as many A and E consultants left the NHS in 2013, raising the worrying prospect of A and E now being trapped in a downward spiral.

Barbara Keeley: I thank my right hon. Friend for giving way. May I just take him back to the point about GP access, because that is the start of the patient’s journey? In our survey in Salford, we did not find the situation that we had under the Labour Government, where 80% of patients could get an appointment within 48 hours. Now only half our patients can get an appointment within 48 hours, with one in seven having to wait more than a week, which is concerning, and one in five unable even to get through to speak to someone in their GP surgery. This is concerning us in Salford because these are people who may have worries—they may even have cancer and need tests—and they cannot get through to their GP.

Andy Burnham: My hon. Friend is absolutely right—the deterioration in general practice has been marked during the past few years. There have been changes that have disadvantaged patients. Within weeks of taking office, the Government removed the guarantee that patients could have an appointment within 48 hours. That explains the situation that my hon. Friend describes, alongside cuts to funding of general practice to the point that some practices now say they are on the brink of deciding whether or not they can remain open. The Government have responsibility for that situation, but there is not a word from the Secretary of State about it and there is not an acknowledgement that people have severe problems in accessing their GP.

Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab): In my constituency, the minor injuries unit at Guisborough hospital, the minor injuries unit at East Cleveland hospital in Brotton, a walk-in centre and medical centre in Skelton, and a medical centre in Park End—all primary or intermediary level facilities—will be closed, putting further pressure on the excellent but already outlying A and E unit at James Cook University hospital. When I write to Ministers to ask questions and for a meeting, I am told that I have already had too many discussions with them and that I cannot bring it up any further. Will my right hon. Friend please enlighten me about what he would do if he were in power?

Andy Burnham: I will move on to that point. Whenever there is a problem, we are told, “Speak to NHS England.” I am afraid that is not good enough. Up and down the country we are seeing services closed without adequate consultation. NHS walk-in centres continue to be closed, piling more pressure on A and E departments. It is just not good enough. We have seen top-down changes driven through, and the hospital closure clause is on the books, so sadly this will continue.

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It will only change when we have a Labour Government back in control—a Government committed to putting the public and patient voice at the very heart of the NHS.

I was talking about A and E and the reorganisation. We know that Ministers were explicitly warned about an A and E recruitment crisis by the College of Emergency Medicine a couple of years ago, but they said they were too absorbed with the reorganisation to listen or act. That brings me to the nub of the matter before the House: the root cause of the deterioration in the NHS is that reorganisation, which nobody wanted and nobody voted for. It threw the service into chaos just when it needed stability. As we warned, it has damaged standards of patient care. Four years ago the Government inherited a self-confident and successful NHS, with the lowest ever waiting times and the highest ever public satisfaction. Since then it has been destabilised, demoralised and reduced to an uncertain organisation that is increasingly fearful of the future.

Dr Thérèse Coffey (Suffolk Coastal) (Con): The right hon. Gentleman refers to cuts in funding. The only cuts in funding that we have seen in this country have been in the NHS in Wales. With regard to patient satisfaction, I can assure him that the targets left behind by the previous Labour Government did nothing to satisfy patients who were left on the ground by ambulance services because they had already gone past the eight or 19-minute limit. I am afraid that the focus on targets, rather than patients, is something that this Government have had to address.

Andy Burnham: I think that it would behove Government Members to have a bit more self-reflection and humility. The hon. Lady was not a Member of the House at the time, but she may recall that before 1997 people used to spend years on NHS waiting lists, and some never came off them. Over Labour’s 13 years in government we saw waiting lists come down, and down, and down, to the point that, when we left office, they were at their lowest ever level. I am not claiming that the NHS was perfect and did everything right, but it had the highest ever level of public satisfaction. We must have done something right. A bit of balance and accuracy in this debate is just what the NHS needs.

Alun Cairns rose

Mr Sheerman rose

Andy Burnham: I give way to my hon. Friend.

Mr Sheerman: Does my right hon. Friend agree that this destabilisation has reached such an extent that very good hospitals, such as those in Huddersfield and Halifax, have a cloud over them because they might lose their A and E departments? What does that do for morale and culture, which have been so good in those two hospitals? Up and down the country, morale has been shaken to the roots.

Andy Burnham: What I find surprising is that all over the country plans are being developed to close A and E departments. How can that make sense when we are in the middle of an A and E crisis? In west London my

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hon. Friend the Member for Hammersmith (Mr Slaughter) has done much work to raise concerns about the changes to hospitals there.

Alun Cairns: Will the shadow Secretary of State give way?

Andy Burnham: The question I would put to the Secretary of State is this: have the Government looked at the latest evidence? Are they looking at the fact that this year hospital A and E departments have missed his target for 46 weeks? If that is the case, is it safe to proceed with changes on this scale?

Alun Cairns: On a point of order, Mr Speaker. I seek your advice. I am trying to raise a relevant point with the shadow Secretary of State. I want to point out that A and E waiting times in Wales have not been hit since 2009—

Mr Speaker: Order. The hon. Gentleman must not use an attempted point of order to try to make a point that he would make in the debate if he got the chance to contribute. He said that he wanted my advice. My advice to him is that persistence pays and he should keep at it, as I am sure he will.

Andy Burnham: I will give way to the hon. Gentleman before the end of my speech, but not now; I will do so when I am ready, because I want to develop my point, which is this: a successful NHS was thrown into chaos by reorganisation. Four years after Lansley’s big bang, the dust has still not settled. People out there are struggling to make sense of the 440 NHS organisations that have replaced the 163 that the Government inherited. They cannot make it all fit together and so are still sweeping up the mess. It was always nonsense to commission local GP services from a national level. To correct that, NHS England is now suggesting a new round of structural changes. This is the reorganisation that never ends. It is now rumbling into the fifth year of this Parliament. In fixing one problem, I fear the Government are going to create another—a local conflict of interest with GPs commissioning GPs. The truth that they do not like to face is that the former Health Secretary presented a defective and confused plan, and they now know, in their heart of hearts, that instead of pausing it, as they did, they should have stopped it altogether. They did not, and however much they tinker it will never make sense.

That is why the only Bill in the Gracious Speech with any link to health is the one that tries to clear up the mess of reorganisation. The small business, enterprise and employment Bill restricts redundancy payments to public officials. If ever there were a Bill that locked the stable door after the horse had bolted, this is surely it. When the Health and Social Care Act 2012 went through the House, there were repeated warnings from Labour Members, including my hon. Friend the Member for Leicester West (Liz Kendall), that the reorganisation would result in primary care trust staff being made redundant and then rehired, with, as a result, a huge waste of NHS resources. In June 2011, the Leader of the Opposition challenged the Prime Minister in this House on precisely that point. The Prime Minister failed to act on the warning. As a result—these are shocking figures; Government Members should listen

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to them—over 4,000 people have subsequently been made redundant and then rehired within the NHS. In the first three years of the reorganisation, there have been over 32,000 exit packages, averaging £43,500, and 2,300 six-figure pay-offs, 330 of which were worth more than £200,000. The total bill is £1.4 billion and counting. What a scandalous waste of NHS resources when people are waiting longer for cancer care.

We always know when this Government are on the ropes: it is when they furiously try to blame the previous Government. This time, they cite employment contracts, but that excuse will not wash. Given that they were explicitly warned about this when their health Bill was going through the House before the reorganisation took place, people will ask why on earth they did not bring forward the measures on redundancy in this Queen’s Speech before the NHS reorganisation, not after it. It all adds up to mismanagement of the country’s most cherished asset on a spectacular scale.

Alex Cunningham: I would like my right hon. Friend to know about Port Clarence, a very isolated community in my area which lost the nurse it had for four hours a week. People are having to go through a tremendous tangle within the NHS to find out who is responsible. The local doctors cannot commission the service because they provide the nurse, so they have to go to NHS England, yet we cannot get any progress. It is a terrible state of affairs.

Andy Burnham: This is the point. The NHS is still struggling to make sense of the mess that the Government inflicted on it. Just when it needed clarity and leadership, what did it get? It got drift and chaos. That is the problem it is struggling to deal with.

The redundancy payments did not only cost £1.4 billion; they have also cost the NHS dearly in lost morale. I ask the Secretary of State to imagine how these redundancy payments and six-figure pay-offs look to the staff to whom he has just denied a 1% pay increase—an increase that would have cost a fraction of that £1.4 billion. The truth is that he does not know how they feel because he refused to meet front-line staff protesting about his decision at the NHS Confederation conference. Well, I did meet them, and I can tell him how they feel. They find it truly galling and feel that they have been singled out by the Secretary of State, whose decision seems like a calculated snub. May I suggest that he urgently reconsider this approach and find the time to sit down with staff representatives? Right now, a fragile NHS simply cannot afford a further drop in staff morale. The Chancellor promised this increase and the pay review body judged it affordable; the Secretary of State should honour it.

The truth is that a whole lot more is needed if the NHS is to be put back on track. It finds itself today in a dangerous place. It is facing escalating problems but has a Government who will not talk about them.

Simon Hart (Carmarthen West and South Pembrokeshire) (Con): I want to alert the House as to why the right hon. Gentleman has not at any stage mentioned the performance of NHS Wales, which on every measurement but one is underperforming its equivalent in England, and which is run not by a previous Labour Government but a current Labour Government.

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Andy Burnham: My shadow responsibilities do not extend to the NHS in Wales, but the Government have spent a year or more running it down. Just a few weeks ago, a Nuffield Trust report said that the picture was more mixed and that there were some areas in which the NHS in Wales was better than the NHS in England and vice versa. The Government need to look at themselves and to be fair to NHS staff, and not constantly repeat the mantra of running down the NHS in Wales and in England.

It was to prevent the NHS from being in this limbo—this silence—that we have brought this debate to the House. Until the Government face up to some of the problems caused by their reorganisation, the NHS will not be able to move forward. In the remainder of my time, I want to focus on two areas—leadership and competition—where uncertainty urgently needs to be removed.

First, on leadership, one of the major flaws of the Health and Social Care Act is that it has created confusion on that most fundamental question of all: who is in charge? Ever since the Act was passed, I have been told of continued tension between Ministers and NHS England. Ministers have repeatedly tried to instruct and overrule, ignoring the independence of NHS England for which they legislated. The problem is that thousands of NHS staff are left receiving mixed messages as to who is in charge.

I want to illustrate that point with reference to the growing crisis in mental health services, which the Secretary of State did not mention once. There are reports of growing problems in accessing mental health care and, in particular, a dangerous shortage of crisis beds. Despite that, NHS England has made a decision on the tariff which will lead to even deeper cuts to mental health care than to the rest of the NHS. This takes the NHS into new territory, because for the first time, as far as I can see, there is a direct contradiction between Department of Health policy and NHS England policy. The Government claim to support parity between mental and physical health, but their NHS policy is actively widening the disparity.

Therefore, in mental health—a policy of growing importance—we have complete confusion. People still look to Ministers to sort it out, but they have legislated themselves into the position of bystanders, shouting on the sidelines with the rest. The care Minister took to Twitter, no less, to vent his disgust at the “outrageous decision” by NHS England. People up and down the land will see that and say, “You’re the Minister! Don’t just tweet—do something about it!” The fact is that Ministers should have the power to enforce their own policy of parity, but in the interim NHS England should reconsider the decision to inflict cuts on a mental health system that is already in severe distress.

In the end, the answer to this uncertainty is simple: the Government should be legislating in this Gracious Speech to correct the flaws of the Health and Social Care Act and restore the Secretary of State’s duty to provide a comprehensive universal service. At a stroke, everyone would know where they stand and who is in charge, restoring grip and leadership in the NHS when it faces one of the most uncertain periods in its history.

The second area about which there is still considerable confusion is that of competition policy. When the Health and Social Care Act was going through, the Government’s mantra was that GPs would decide how best to organise

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care, but that is not what has happened in practice. Section 75 regulations are forcing commissioners to put services out to competitive tender when they do not think it necessary. That is leading to protracted legal disputes and millions spent on competition lawyers.

The nonsense that the Health and Social Care Act has inflicted on the NHS was plain for all to see last year when the then Competition Commission intervened in the NHS for the first time in its history to prevent collaboration between two NHS hospitals on the grounds that it was “anti-competitive”. What nonsense this is. It was succinctly summed up by the chief executive of the NHS, who said that

“you’ve got competition lawyers all over the place…We are getting bogged down in a morass of competition law causing significant cost in the system and great frustration for people in the service about making change happen. In which case, to make integration happen, we will need to change the law.”

That is precisely what this Gracious Speech should have done: change the law to help the NHS get on and make the changes it needs to make and remove the competition policy, which is fragmenting the NHS, not integrating it. That is the challenge the Government have ducked completely. The problem is that if they stay on this path, the NHS will head in the wrong direction. This Government and their Health and Social Care Act have placed the NHS on a fast track to fragmentation and privatisation when the future demands the integration of care.

The Opposition are clear that the market is not the answer to 21st-century care. The NHS now needs solutions of scale to rise to the increasing challenges that it faces. The NHS needed such leadership in this Queen’s Speech, but it was offered nothing. Instead, this Queen’s Speech leaves it lumbered with a Health and Social Care Act that puts competition before collaboration and the NHS on the wrong path for the future. The NHS urgently needs a Government who want to talk about the issues it faces and to get on with the job of securing its future. Let there therefore be no doubt that the next Labour Queen’s Speech will repeal the 2012 Act and pave the way for the full integration of health and social care.

I am coming to the end of my speech—I need only a couple more moments—but I will give way to the hon. Member for Vale of Glamorgan (Alun Cairns), as I promised.

Alun Cairns: I appreciate that some light-hearted comments have been made on both sides of the House, but my constituents have to wait longer for treatment, particularly for cancer care, as they do not have access to a cancer drugs fund. Will the right hon. Gentleman use all his influence with the Welsh Health Minister to get him to look at introducing such a fund so that my constituents have the same access as people in England?

Andy Burnham: That is obviously a matter for the Welsh Government, but let me provide some clarity on the issue of cancer care. In Wales, 92% of people start their cancer care treatment within 62 days, compared with just 86% in England. I ask the Conservative party to think about that, given that it has constantly run down the NHS in the hon. Gentleman’s own country and constituency, and has misrepresented the outstanding job it does to treat patients with cancer.

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We will legislate for an NHS that has the right values back at its heart: collaboration before competition, people before profits. We will ask the NHS to lift standards in social care, working to bring an end to the culture of 15-minute visits. We will make sure that people can access care closer to their homes, giving patients clear rights, such as the right to see a GP within 48 hours. This is a plan to put the NHS back on track, and it shows why a Labour Government cannot come a moment too soon for the NHS.

Several hon. Members rose

Madam Deputy Speaker (Mrs Eleanor Laing): Order. The House will be aware that a great many colleagues desire to take part in the debate this evening and that time is limited. I am afraid that I therefore have to impose a time limit of eight minutes.

5.42 pm

Dr Liam Fox (North Somerset) (Con): Perhaps I may allow the House a slightly more bipartisan interlude by concentrating for the moment on a different part of the Gracious Speech, which is the part relating to our country’s national security. I was delighted to see in the Gracious Speech the Government’s commitment to the NATO alliance, which is underpinned by the hosting in Wales of the NATO summit later this year.

From 4 April 1949, when it came into being, NATO has become the major instrument of stability and security in Europe. It has taken in newly emerging democracies, such as Greece and Spain. It has been extended to countries formerly in the Warsaw pact, creating a far more safe and stable continent. It has embraced countries such as Norway in the far north and Turkey, giving us security in places where we perhaps have greatest strategic vulnerability.

However, as we approach the summit in Wales, we need to accept that there are big weaknesses inside our major military alliance. To an extent, the political and military roles that we clearly understood during the cold war have dissolved away, and western countries existing in peace and freedom have become fat on the prosperity and security that they have come to take for granted. Only four members of the NATO alliance currently meet the 2% of GDP floor of spending that they undertook to meet when they joined and, as a consequence, the European continent gives a lower priority to defence and is ever more addicted to welfare. As the Prime Minister and Chancellor Merkel have regularly pointed out, we have now reached a situation in which the European Union represents 7% of the global population, 25% of global GDP and 50% of global social spending. That picture is utterly unsustainable. It is a situation in which the pressures of defence have become great.

Of course, NATO has had recent success in the way it took charge of operations in Afghanistan, what it did in response to the invasion of Kuwait and, perhaps more successfully, what happened in the Balkans. However, not long ago the Libyan conflict showed us how many weaknesses the alliance has. We did not have enough of some key assets—such as intelligence, surveillance and reconnaissance, or air-to-air refuelling—to the extent that we would not have been able to carry out the Libyan campaign without the United States being on board. Such is the current weakness of European NATO.

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We are confronted with a growing threat in the shape of Putin’s Russia, and we have stood by and watched serial bad behaviour from the Putin Government. They cut off gas to Ukraine, in breach of the NATO-Russia treaty, and we did nothing. We saw a cyber-attack on Estonia, and we did nothing. Russia invaded Georgia, parts of which it still occupies, and we did far too little. I am afraid that the signal the House sent after the debate on Syria only gave Putin the understanding that further aggression would not be rewarded with real resistance by the west, and I am afraid that the events we have seen in Ukraine are, at least partly, a result of how such decisions have been interpreted. We must be careful to ensure that our behaviour does not further reinforce that position.

We have allowed wishful thinking on Russia to replace critical analysis. We have all wanted to see Russia develop as an open, democratic, pluralistic system, but that is not going to happen, at least not under the current regime. The quicker we understand that, the better for the wider security picture. It is a bullying and thuggish regime that is not likely to change. Its modus operandi is clear: it pumps money into regimes or city states—wherever it can—to try to encourage them to be more Russia-friendly. It issues huge numbers of Russian passports to citizens in those places and then claims that it has to defend them.

The whole debate about the Ukrainian crisis misses one essential point: it is not to do with strategic or even tactical interests; it is a direct challenge to international law. Putin has said that the protection of ethnic Russians—not even Russian citizens—lies not with the states in which they live, or with the laws, constitutions or forms of government of such states, but with an external state, Russia, which can intervene to protect ethnic Russians wherever they may be. If we allow that to stand, there will be no international law, because it will sweep away every norm of international behaviour that has been accepted since world war two.

Geraint Davies: President Obama has made it clear that he is against Britain leaving the European Union or Scotland leaving the UK. What does the right hon. Gentleman think President Putin’s position would be on those issues?

Dr Fox: With all due respect to anybody outside our own borders, what the United Kingdom decides to do is a matter entirely for the United Kingdom, and what Scotland decides to do is a matter for Scotland. Nevertheless, since the hon. Gentleman asked me what I think about President Putin’s view on those issues, I will tell him what I think about Scotland. Any fragmentation would be not only a fragmentation of our country’s defences but a potential weakness inside NATO, and that is unlikely to help or give comfort to anyone other than those who are a potential threat to our national security. The hon. Gentleman raises an important point, in that events that take place inside the United Kingdom may well have resonances that are not naturally considered when decisions are being taken.

I want briefly to mention another area of national security of which the House must be very cognisant: the changing nature of the threats we face. We have gone from state threats in the cold war to the domestic terror threat we faced from the IRA, and we now face a transnational terrorist threat. That threat has come at a

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time when we have seen a huge growth in the internet, which allows a lot of the enemies of this country to hide. Back in 1995, when President Clinton was President of the United States, there were 130 websites in the world; at the end of 2012, there were 654 million. That is a lot of places for our enemies to hide.

Our security services need to be able to operate in the same environment as our enemies, and that to me was the essence of the great betrayal of Snowden. We depend on a moral and legal relationship between our employees and the Governments of our allied states to maintain our security, and there were three elements to what Snowden did. The first was his disclosure about the extent of National Security Agency surveillance. Had he done that inside the law it would have been a legitimate debate in a democracy, but to go further and set out the means by which our security forces carry out their business, or even potentially to set out the names of particular operatives, goes well beyond what is acceptable. In my view it goes from legitimate debate into the business of treason.

We do not have massively overwhelming security apparatus in this country. We spend 0.3% of Government spending on all our agencies put together, which is what we spend on the NHS every six days. We have good, strong oversight of our security services in this country that we should be proud of, but we must be clear when it comes to national security that peace and security are not the natural state of the world. Those things have to be fought for with every generation, and we have a responsibility to fund that appropriately. We can have neither such restricted freedom that we start to become what we claim to oppose, nor go off on a libertarian rant that takes us to a place that leaves us far less secure than we ought to be. If we get that balance right, we will be doing our duty in this House.

5.51 pm

Mr Peter Hain (Neath) (Lab): I wish to speak specifically about the pensions tax Bill and the private pensions Bill in the Queen’s Speech. The Government have proposed the biggest reform to pension tax rules in nearly a century. There is no denying that it is popular to give citizens—especially those with small pension pots—the choice to take lump sums that may be more beneficial to them than eking out a living from the small annual payments on which they would otherwise rely. Paying off a mortgage or a loan on retirement by drawing down a lump sum may well be better for such pensioners, but there is real danger in destroying good annuities. That has been going on for a few decades now, and is bequeathing a nightmare that Government policies are nowhere near capable of preventing.

We have a rapidly ageing population that is dumping a huge additional burden on the young, many of whom are already leaving university with massive debts thanks to this Government’s dysfunctional policies. Now they will be saddled with subsidising through their future taxes older people who are being encouraged to live for today and not protect themselves for tomorrow.

The closure of defined benefit schemes and the shift towards defined contribution schemes has been an utter catastrophe. Accelerated further by record demographic changes, that shift is a worldwide phenomenon and a

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product of the neo-liberal orthodoxy worshipped by the right hon. Member for North Somerset (Dr Fox), which has gripped Governments from the era of Margaret Thatcher and Ronald Reagan, and which this Government still seem to be in the grip of. In the US, for example, the number of defined benefit schemes halved in under 30 years, while direct contribution schemes tripled. Australia, also worshipping such neo-liberalism, saw an 80% reduction in the number of workers covered by defined benefit schemes from the 1980s.

That is the background, but there are disadvantages to the new pension freedom. For example, people might decide to spend all their pension savings at the point of retirement, dooming themselves to poverty later in life. Having saved into a pension fund, received tax relief for many years and reached retirement with a pot of money, they might be tempted to blow the lot at once, meaning that they will never have the benefit of the extra income that they would otherwise have had as they got older. If that happens, the tax relief they receive would not fund a pension, and employer contributions that they may have received along the way would end up funding immediate consumption, rather than providing a long-term income. We know that some people will do that; we do not know how many but we hope the number will be relatively low. Pensions expert Ros Altmann suggests that about 7% of people currently say that they would spend it all. In truth, it impossible to predict that accurately.

Geraint Davies: I am sure that my right hon. Friend is a supporter, as I am, of the idea of a British investment bank. Does he think that the Chancellor should have set up tax incentives to encourage people who have liberated their pension pots to reinvest in a British investment bank and create jobs and wealth for the future, instead of it being blown on everyday consumption?

Mr Hain: That is a very good point.

The new flat-rate state pension, which is cited in mitigation for this new approach to pensions, still means that a lot of people will fall back on the state having spent all their pension savings. Around 20% of pensioners will still be on means-tested benefits even after the new system starts. People might also try to game the system by taking all their pension money and recycling it into a new pension fund, getting more tax-free cash and another lot of tax relief. That could mostly benefit those who are reasonably well-off with high incomes in later life, and it could be costly in extra Exchequer spending on tax relief.

This is mainly a market problem, and it should perhaps have been possible to reform that market without the draconian retreat from annuities proposed by the Government. Would it have been possible to insist that insurers are obliged to treat customers fairly, and ensure they would be liable if they did not carry out suitability checks to identify which type of annuity was best and offer a good rate? Would it have been possible to reform the way annuities work, and allow more freedom but not complete freedom? What protections will be built into the new system to ensure that unsophisticated consumers are not left at the mercy of product providers offering poor product choices, or higher risk products that people simply do not understand and through which they end up losing significant sums? The Financial

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Conduct Authority needs to be on top of that right from the start, but judging by past form can we be confident of that? I have very serious doubts.

If guidance is delivered by product providers, those providers are liable to entice their customers towards more poor-value products. Experience shows that they will do whatever they can to try to keep customers’ money, or give them poor value and make extra profit. The annuity market has worked poorly for years, with rising profits to insurers and reducing value for customers. How will the Government ensure that the new products developed finally offer good value, and that the charges are fair and terms reasonable?

The Government are right to legislate to permit collective defined contribution pensions, but I warn Ministers about over-hyping the benefits. In principle, such pensions ought to be better for employers than traditional final salary schemes and better for workers than traditional defined contribution schemes, but in practice they still suffer from market and actuarial risks. Ros Altmann points out that lower earners may subsidise higher earners, and younger members may subsidise older members. The new pension freedoms to take most, if not all, of the pension pot in a lump sum, however attractive and justified that may be to certain people, may also mean that people prefer pure defined contribution schemes that they can access in retirement if they wish. Collective defined contribution schemes, admirable as they may be in principle, usually mean that people cannot just take the cash, which means they may well be less attractive for members.

My challenge to the Government is this: rather than leaving the private pension system to market providers and their whims, why not build a new system that works? We need a system with longevity that savers will understand and find confidence in—a lack of confidence in this Government’s approach to pensions is something that I imagine savers and I share. While the Chancellor’s right hand further fragments and individualises pensions through these tax proposals, the pension Minister’s left hand makes legal collective direct contribution pensions. Why should any employer move to that collective system when they can see the Treasury going down precisely the opposite route? I doubt whether many will do so.

The Government are not doing anything like enough to face up to the time bomb of our ageing society and the whole person social care that the shadow Health Secretary eloquently advocated, or anything like enough to face up to the pensions needed to underpin the new life that is rapidly overtaking us, and the whole person care necessary to protect us. The whole Government philosophy of leaving private pensions to the market and saying to citizens, “Effectively, you are on you own” has failed abysmally in the past, just as I believe it will fail abysmally in the future at a terrible cost to all of us—pensioners, taxpayers and the public in general. I urge the Government to look again and come back with proposals that really begin to meet the scale of both the pension challenge and the whole person care challenge that haunts the whole of this country.

6 pm

Sir Peter Luff (Mid Worcestershire) (Con): I am sure it would be churlish of me to consider for a second that the speech by the right hon. Member for Neath (Mr Hain) owes anything to his new-found interest in pensions following his decision to retire from this place at the

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next election. I am glad he is following my example, but I am sorry to hear that he will be lost to this place. I have not always agreed with him, but I have always liked and admired him. I am sure he will be missed by this House and by his constituents.

Last year, I had the honour to propose the Gracious Speech, a task ably performed this year by my hon. Friend the Member for Portsmouth North (Penny Mordaunt). Like me, she got her loudest laugh for a joke about genitalia, which probably says all one needs to know about this place.

I was tempted to tear up my prepared remarks—they are not on health, but on the health of our democracy—thanks to the rather shockingly partisan speech from the shadow Secretary of State. I will not be tempted down that path, but I will make one point on health. My father-in-law died over Christmas in a national health service hospital. He had spent nine weeks in two different hospitals on five different wards, always receiving outstanding medical care but never that full personal, human and true compassionate care that the Secretary of State spoke about in his opening remarks. I wish him every success in his campaign to drive compassionate care in the NHS, because it desperately needs it.

I hope it goes without saying that I strongly support the coalition Government and their achievements, so I shall pass over that section of my speech in the interests of the eight-minute limit. I will simply say this: the Queen’s Speech is not the most radical of recent times, but that is not necessarily a criticism. It contains good and worthwhile measures that I applaud warmly. Indeed, I think the desperate search by politicians for novelty, sometimes engendered by the 24-hour media questing sensation, can actually work against genuinely good government.

I want to set my remarks in the context of 2015, which is not just an election year but an important year for Parliament. It would have been good if the Gracious Speech had made at least passing mention of the fact that in 2015 we will celebrate two important anniversaries: 750 years since the de Montfort Parliament of 1265, and 800 years since the sealing of Magna Carta in 1215. I know that you, Madam Deputy Speaker, have worked very hard with Sir Robert Worcester on the Magna Carta 800th Committee. Magna Carta embodies the principles that have underpinned the emergence of parliamentary democracy and the legal system in the UK and across the world: limiting arbitrary power, curbing the right to levy taxation without consent, holding the Executive to account and affirming the rule of law. De Montfort’s Parliament 50 years later flowed almost inevitably from just those principles.

I have the privilege to be the Commons Chair of the Speaker’s Advisory Committee on the 2015 anniversary, alongside Lord Bew from the House of Lords. These anniversaries provide a special opportunity for all of us in this place to engage the public in the history and purpose of our democracy. Parliament’s programme for 2015 will increase public understanding of the fact that Parliament’s work really matters to them, raising awareness of Parliament at work on a local level, particularly with young people. I hope hon. Members will participate in an initiative we are launching with individual schools in our constituencies later this year.

The celebration of and debate on Magna Carta and our emerging Parliament should serve to remind us of perhaps neglected fundamentals. Democracy is not just

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about voting once every four or five years for a local council, Parliament or the European Parliament. The first condition of democracy is the establishment of freedoms and rights in a society that can be upheld independently of the ruler or ruling elite. Voting comes next. That leads me to my three main concerns about the Queen’s Speech: the consequences for defence, liberty and the local experience of democracy.

On safety overseas, the Queen’s Speech said surprisingly little. My right hon. Friend the Member for North Somerset (Dr Fox) made a powerful speech, saying many of the things I wished to say. In the year in which British troops end their combat mission in Afghanistan, we might have hoped for more on defence in the Gracious Speech. The UK has committed to spend 0.7% of GDP on international development. I welcome that, but why do the Government, who already spend more than 2% of GDP on defence in accordance with NATO guidelines, seem so reluctant to commit formally to this target? Why do they not do more to engage our European colleagues in meeting that target too? Why did the Queen’s Speech not say something about the preparatory work for the next strategic defence and security review? We need a debate on Britain’s place in the world, a debate that would inform the Scottish independence referendum and our relationship with the EU. An open debate ahead of the SDSR would be invaluable, and it would have been good to see a commitment to that in the Queen’s Speech.

On liberty, the Bill to strengthen the powers to prevent modern slavery and human trafficking is an excellent one to enact in the year of Magna Carta’s 800th anniversary. The work of the Gangmasters Licensing Authority has made a major contribution in my constituency to reducing the exploitation of those working in the farming and horticultural sectors, but much more remains to be done. I am proud to support a Government who are putting such an enlightened and important piece of legislation on the statute book. When we think of personal liberties, we should recall that of all Magna Carta’s many clauses only four remain on the statute book today. Two of those, clauses 39 and 40, are about no freeman being imprisoned except by the lawful judgment of his peers, and no one being denied justice.

I welcome the action on modern slavery, but I must sound a loud warning note on legal aid, for which further changes are planned in this Session, including secondary legislation on Crown court advocacy fees. We must recognise that access to justice is not just a Magna Carta right, but a fundamental part of our democracy. We cannot lecture authoritarian states on their lack of democracy if our own system is denying ancient rights to our citizens. If the state proceeds against an individual unreasonably, as has manifestly happened on several occasions recently, the individual should have the proper means to defend himself or herself against those proceedings. The legal aid bill is tiny: at £2 billion, it is just one-twelfth of the £24 billion housing benefit bill. In other words, an 8% saving in housing benefit would pay for the whole legal aid bill. This Parliament should be profoundly concerned that injustice will grow and families will suffer if deep cuts to legal aid are made. In the run-up to the commemoration of Magna Carta, we should be especially heedful of such things.

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My final remarks perhaps reflect my deepest concern about democracy in our country. I end with one measure of direct relevance to my constituents and their sense of justice and fair play and the upholding of their democratic rights: the planning system. This one issue has done more to disillusion many of my constituents about the reality of local democracy than any other I am aware of. I agree we need to build more houses both nationally and locally. The three councils of south Worcestershire—Wychavon, Malvern Hills and Worcester City—agree with that view with passionate conviction, but I worry about exactly what is meant by the commitment in the Queen’s Speech to increase housing supply and home ownership by reforming the planning system.

A packed meeting at Badsey Remembrance hall on Friday was powerful evidence of the sense of betrayal that people in many parts of England feel about the collapse of local planning policies. Indeed, I believe my party has lost more voters to UKIP over this breakdown in planning than over the EU. At Friday’s meeting, attended by parish councils and residents from across the Vale of Evesham and throughout Wychavon, I told the audience about what was being done and our great success in building houses—some three times the national average in my constituency—in south Worcestershire. Our area is pulling its weight. We want to build houses in the quantities needed, but where local people believe they should be built and not where developers decide. It is the developers who have the whip hand in my constituency. Through no fault of my council, we are being punished for not having a local plan in place. The only reason we are late is that the Government failed to abolish the old top-down system of regional spatial strategies in good time. We followed Government policy, but we are being punished for doing so.

Wychavon district council wants to do the right thing and build the new homes that we need, but still the Planning Inspectorate makes it clear that it expects even more. The result is a demoralised district council and angry communities. All the inspectorate needs to do is say that planning permissions already granted will count against our target and commit to ensuring that our new local plan can be the test of new applications from developers now, not when it finally comes into effect.

At Badsey on Friday night I was given a bag of Vale of Evesham soil. The person who gave it to me wanted it to remind me of the valuable horticultural land being lost to unplanned development. It reminds me of much, much more: it is the soil of the county where the founder of our parliamentary democracy, Simon de Montfort, died. It stands for the liberty of the people. It is our sacred duty in this place to protect it.

6.8 pm

Ann Clwyd (Cynon Valley) (Lab): This is the seventh occasion I have quoted from patients’ letters on the NHS. They are patients from all over the country. In some cases I will name where they come from, because they have given me their permission to do so.

A few weeks ago, when I gave evidence to the Select Committee on Health, I was asked whether things had changed as a result of the report I produced jointly with Professor Tricia Hart last year. The only way I could answer was to say that I will know that things have changed when the letters stop. I am afraid the letters have not stopped: they keep coming, and while they keep coming I shall continue to quote from them.

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I received a letter from a woman who went to see a friend in hospital. The friend was given an enema while she was there. The letter states:

“Myself and other visitors therefore waited outside while this took place. The nurse then disappeared for forty minutes. When I questioned the nurse about being away for so long she explained that there are two other staff members on the ward but they are not qualified to carry out this procedure…I then waited outside again while she was changed. Once this was finished I noticed that her nightgown had not been changed, so therefore assumed it was clean. The next morning when I arrived with a clean nightgown, she was still in the previous day’s clothing and was not changed until she had been washed. Later, when I was going home, I found the previous nightgown shoved into a cupboard in a plastic carrier bag. The nightgown was completely soiled, so it was evident that she had been left wearing this from roughly 2pm and throughout the night. I reported this to a nurse who said she could not explain why this had happened.”

This illustrates again the importance of patients in hospital being shown dignity.

Another letter concerns a wife visiting her husband in hospital:

“The oxygen mask he had on had slipped down off his nose so many times it had blistered it, his wife had to put plasters from the pharmacy on herself. On his bed table at the foot of his bed was a pack of sandwiches, bottle of fizzy drink, a urine tray with urine in it and standing in that was a urine bottle half filled with urine…The man 2 beds up soiled his bed, stripped naked and walked round the ward with excrement all up his legs. Out of the ladies toilets came a lady crawling on her hands and knees with her underwear round her ankles, 2…nurses picked her up, said she was a naughty girl and dragged her up the ward. Then 5 minutes later out of the other door first appeared a walking stick, then a little man wearing a nightgown and a hat with a bobble on the top, stick in one hand and dragging his soiled nappy full of excrement behind him past”

her husband’s bed.

Another letter said:

“I have been waiting for over three months for a colonoscopy at Singleton hospital, Swansea. I have pains in my stomach. I attach an e-mail received from the Health Board stating that the waiting list for urgent endoscopies in Swansea is 35-40 weeks. No estimate is given for non-urgent endoscopies. I find the situation scandalous. If you wish to publicise this appalling state of affairs and use my name, you can do so.”

The health board wrote to the man saying:

“Unfortunately, the Endoscopy department is experiencing a backlog of patients waiting for appointments, due to the ongoing demands on the service. The current waiting time in Swansea for an urgent endoscopy can be up to 35 to 40 weeks. Plans are in place to address the backlog over the coming months. In the meantime if you are experiencing symptoms which you are concerned about, they would suggest you make an appointment to see your General Practitioner”.

Another letter states:

“My mother aged 85 was admitted to hospital…and treated as an in-patient for 3 weeks for a badly sprained wrist. My concerns about the longevity of the injury and lack of improvement, continued pain and swelling were ignored and only after an official complaint was made…by me did medical staff agree to re x-ray the wrist, where upon it was found to be badly broken. Whilst still an in-patient…when her wrist was due to be set, my mother’s call for assistance to help her to the bathroom went unanswered and she fell in the ward. I was not contacted by the hospital and advised of her fall. When I made it known to staff that I knew she had fallen I was told ‘it was nothing, a little fall and there was no injury’. My mother was discharged…I had to call out her GP”

a couple of days later

“since she was experiencing severe groin pain. Over the weekend the intensity of pain increased and my mother could no longer walk. She was taken by ambulance to Morriston Hospital, an

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x ray revealed a fracture of the pubis and my mother was again admitted as an inpatient that evening.”

She then talks about the standards of medical attention, stating that the

“care received was negligent, her treatment was inappropriate and exacerbated her injury. The consequence for my mother is long term and permanent impairment of mobility and quality of life.”

Another letter concerns someone admitted to a hospital in north Wales:

“Doctors were rarely seen especially not at weekends, equipment had to begged and borrowed from other wards. I feel that when he was admitted he was seen as a very old man who was probably not going to survive…He’d always been a positive, uncomplaining sort of person. It was subsequently discovered that he had an ulcerated digestive tract so forcing him to eat, as was initially happening, was bordering on the cruel.”

Finally, a letter states:

“I went to the GP last February and was diagnosed with a prolapsed womb. I was put on the proverbial waiting list. After two months I rang the Princess of Wales hospital to ask how long to my appointment. I was told the earliest I would be seen would be end of August possibly early September! A few weeks ago against all my labour principles and out of sheer anxiety of the unknown I paid £150 to see a gynae consultant (this was in one week of phoning for an appointment!) The consultant confirmed I had a prolapse, I would need a hysterectomy and a bladder repair…I was then told if I paid privately I could have the operation in two weeks!”

at a cost of £6,646. The letter continued:

“However this is the punch line. If I wanted to be put on the NHS list it would be 9/10 months! That means from seeing my GP to surgery will be 18 months. I can not believe it! I refuse to go privately; I want NHS treatment. My condition is now impacting on my everyday life…without going in to the finer details it is undignified. I went back to my GP last week asking her to expedite my referral.”

That is one of many shocking cases, and I could fill the next five hours reading out the others I have received.

6.16 pm

Richard Benyon (Newbury) (Con): It is a great pleasure, but a daunting prospect, to follow the right hon. Member for Cynon Valley (Ann Clwyd), who is a model of dignity for the House and has shared some truly horrific experiences with us. I want to talk mainly about public health, but before I do so, I should like to raise an issue that is not unrelated to what the right hon. Lady has mentioned.

I have been fascinated by the fact that the Mid Staffs issue has not resonated as a major concern with the vast majority of people in this country. Perhaps I missed it; perhaps it is there just under the radar. To me, it should be seared on our collective conscience as a nation. If 1,200 had wrongfully died, say, in police custody or in some other area of direct Government responsibility, there would be crowds of people out on the streets. Yet this was a collective failure and a national failure. Irrespective of what has been said in certain journals by certain Members, this was not a local issue, but a national one in which neglect, incompetence and something called cognitive dissonance was allowed to fester—and people died in large numbers.

We rightly revere the NHS. As with my hon. Friend the Member for Mid Worcestershire (Sir Peter Luff), I have had recent experience of a close relative being treated in the NHS, and I have nothing but praise for the staff who treated him. Where there is failure, and when people are treated in the sort of way mentioned by

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the right hon. Lady and dignity and care fall by the wayside, we have to act. I believe that the implementation of the Francis report is a major step on that road. I applaud the Secretary of State for his determined approach to put patients first, by putting in place measures, individuals and safeguards so that Mid-Staffs does not happen again.

As I said, I want to talk about public health, which I believe is so important to how we are going to be able in the long run to afford a national health service. So much of that is about diverting people away from needing it. It is also about addressing inequalities. I have worked hard with other Members to make sure, for example, that rural areas are not left aside. When I was the Minister with responsibility for rural affairs, my hon. Friend the Member for Beverley and Holderness (Mr Stuart) raised the issue of stroke treatments in his constituency. It is, of course, much quicker and easier for a stroke therapy consultant to spend all their time in Hull, dealing with many more cases in one day, rather than getting out into the rural areas. Addressing those health inequalities is now, however, for the first time a statutory requirement. That is a major step forward. It does not just involve national bodies such as NHS England and Public Health England; local care commissioning groups and local authorities are ensuring that inequalities are addressed.

Mr Kevan Jones (North Durham) (Lab): I agree with the hon. Gentleman that there is a specific need in rural communities. Does he support the Government’s action in taking need out of the assessment for public health funding, which has meant that areas such as mine in the north-east have lost funds that have been redistributed to wealthier areas in the south?

Richard Benyon: I do not know what happens in the hon. Gentleman’s part of the north-east, but I can tell him that there is now a real drive to deal with the problems in the constituency of my hon. Friend the Member for Beverley and Holderness. My hon. Friend felt that his constituents were getting a raw deal under the old system, and there is now a statutory requirement for that to be addressed.

The new responsibility for public health means a great deal to us as constituency Members. The West Berkshire health and wellbeing board, ably led by Councillor Marcus Franks, is taking the initiative locally, not just dealing with massively important issues such as reducing smoking but encouraging, through a partnership approach, lateral thinking and the tackling of disease and illness before they happen. We must ensure that that happens at local level as a result of legislation that has been introduced in the past.

I was pleased to be one of the authors of the natural environment White Paper. We worked closely with the Department of Health, with the aim of helping people to understand the healing benefits of nature and the great outdoors. Initiatives such as Walking for Health have created a virtuous circle. Improved health has led to greater companionship and less isolation, and organisations such as the University of the Third Age have improved the quality of life for lonely and, in some cases, elderly people—and, of course, there is the additional

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benefit of a lower health care bill for the taxpayer. All that is crucial to our objective of diverting people from health services.

About 20 years ago, a health service manager said to me, “The trouble is—from my point of view—that clever people keep inventing expensive new cures which we have to fund. People survive longer as a result, and that means yet more costs, because they will need the NHS at a later stage.” I think that he was being light-hearted, but it was probably just a half-joke. His point was this: if we, as a society, are to be able to afford the NHS that we want in the future, whichever party is in government, we must continue to divert people from it by keeping them healthier. The lateral thinking to which I referred earlier has never been more important.

I applaud the housing association that, working with its local health and wellbeing board, identified a large number of elderly people who were being admitted to hospital following accidents in the home. Simply employing a handyman to do some work in their sheltered accommodation resulted in a reduction in the number of injuries, particularly serious injuries such as broken hips, from which many people do not recover.

Another initiative in my area is “brushing for health”. Good oral health is vital, and my local health and wellbeing board has launched a programme involving Sure Start and other children’s centres, encouraging children to adopt diets that are lower in sugar and to brush their teeth more regularly, and ensuring that they will have access to a dentist. Promoting that initiative will mean that less national health dentistry will be required in the future.

On Saturday, I was delighted to launch the Newbury dementia action alliance. We know that 800,000 people in this country are living with dementia, and that it is costing the country £23 billion a year. It is great to hear that the G7 world leaders are getting together and making dealing with dementia one of their priorities, but what does that mean in our constituencies? It means, at local level, stimulating the minds of dementia sufferers, supporting their carers, ensuring that healthy living is part of the norm and involving organisations such as the fire service and the police.

That was a very quick canter around the importance of public health. I am running out of time, but let me end by saying that when we talk about health, we must not just talk about the important factors that surround the core of the national health service. We need to prevent people from becoming ill in the first place, and that is why the Government’s concentration on public health is so welcome. There is, of course, much more to be done, but a very important change has been made.

6.25 pm

Mr Nicholas Brown (Newcastle upon Tyne East) (Lab): It is a pleasure to follow the hon. Member for Newbury (Richard Benyon). Let me begin where he left off. For the past two years, along with other Members of Parliament representing the north-east and Cumbria, I have been arguing against attempts to alter the health service’s funding formula and reallocate funding, taking it away from deprived areas with poorer health outcomes and giving it to more affluent areas with better health outcomes. Last year, the Government’s original proposals would have led to a reduction of £230 million in the annual health funding of the north-east and Cumbria.

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NHS England eventually opted for inflation-proofed increases for all clinical commissioning group areas, along with extra increases for some favoured clinical commissioning groups in more affluent parts of the country. I should welcome an assurance from the Minister that we will not have to go through that fight again.

The Government’s top-down reorganisation of the national health service is riddled with gaps and negative consequences. It has significantly increased pressures on A and E departments, which have now become the default places to visit if people need to see a doctor within days. It is no longer possible to make an appointment with a GP a day or so in advance, and many people have to wait several weeks for an appointment. There are arbitrary, cost-influenced restrictions on procedures and treatments, leading to a postcode lottery whereby some services are free in certain parts of the country but not in others.

Clinical commissioning groups are reported to have spent more than £5 million on competition lawyers to try to navigate competition law in relation to commissioning services. More than £1.4 billion has been spent on redundancies in the NHS, only for thousands of people to be re-hired under the new structures. I understand the latest figure is over 4,000. That point was made forcefully by my right hon. Friend the Member for Leigh (Andy Burnham) in his opening speech, and I support every word that he said.

There has to be an answer to this, and it is not coming from the Government. Health Ministers are increasingly hiding behind NHS England when it comes to big policy questions relating to the NHS, and more and more answers to parliamentary questions are being referred away from the Department and to unelected, largely unaccountable bodies. There is also the overarching issue of GPs’ now having key functions as commissioners, as well as functions as providers of services that are being commissioned. The obvious conflict of interest is corrosive to the ethical underpinning of the NHS.

I have the honour to represent the Freeman hospital and its internationally renowned heart units, including its high-achieving children’s heart unit. In the 2001 review of the Bristol children’s heart unit, Professor Sir Ian Kennedy clearly stated that England needed a smaller number of centres of excellence to undertake the complex, highly skilled procedures involved. No one has refuted his arguments, but, 13 years later, we are no closer to achieving the outcome that he said was desirable.

We cannot, and should not, let that issue drift. The Government have an obligation to set out a clear way forward that is compatible with Sir Ian’s recommendations, and to do so on the merits of the medical arguments and not on the basis of political expediency. The delays in addressing the issue over the four years of the current Parliament pose the risk that it will extend beyond the next general election, yet we are no clearer about the future of children’s heart units in England. Again, a response from the Minister on the issue would be welcome.

I want to raise the recommendations of the NHS Pay Review Body and the blocking of the recommendations by the Government. That decision comes after a two-year pay freeze and significant pay restraint following the two-year period. When factored against inflationary pressures, nurses’ pay has fallen by 10% in real terms over the past four years. Alongside that, contributions to the pension arrangements have increased, coming out of take-home pay.

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The Government should not treat individual increments as if they were pay rises. Forty-five per cent. of nurses do not receive an increment. The Government should not set the NHS Pay Review Body recommendations to one side. They are wrong to insist instead on an offer of a 1% non-consolidated payment for this year, followed by a 2% non-consolidated payment for the following year. If nothing else happened at the end of this period, the nurses would be substantially worse off than they are today. These are pressing issues for the national health service.

I should like to make a more general point about the Queen’s Speech’s failure to touch on the most significant problem facing the north-east of England. Unemployment in the region remains the highest in the country, at 10.1%. Despite recent national falls in unemployment, it remains stubbornly high in the north-east.

The unemployment rate for the region has actually increased in 2014. There is a continued need to create sustainable well-paid jobs through private sector economic development in the region. The tragedy is that the parties do not quarrel about this: we agree on what needs to be done. The issue is doing it. Youth unemployment remains high and more needs to be done to open up opportunities to work and training.

Four years ago, the Government made sweeping changes to the delivery of economic development in the English regions. The Government’s reorganisation is not working for the north-east of England. Apart from the projects that were already under way under the last Labour Government, the present arrangements have little to show. Governments often make their largest mistakes in their first 100 days. Having abolished the regional development agency and Business Link, the Government have spent the last four years trying to set up structures that will carry out the functions that those bodies used to undertake, and in our region the efforts so far have achieved very little. This matters because it is our region’s core problem.

The Government’s original idea was that the new localism contained the answer to the north-east’s economic development questions. The coalition Government argued that the setting up of new locally based bodies would be the right way to provide economic development at local level. Over the past four years, the means has become the end. All energies have been focused on those structural questions. The purpose for which they were originally intended has been almost completely lost sight of. A single Minister needs to get a grip of these arrangements, which now span a range of different Departments, and force them to focus on specific economic development initiatives.

These are important issues. Now that the House has committed itself to fixed-term, five-year Parliaments, it is likely that all future final Sessions will have something of the character of this one. There is something unsatisfactory about it all. I feel that some of the big questions and the attendant debate are slipping away from Parliament.

6.33 pm

Priti Patel (Witham) (Con): It is a pleasure to speak in the debate because it is a Queen’s Speech that will help to deliver a stronger economy for this country and better and stronger public services. Four years ago, this

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Government embarked on a radical and necessary programme of measures to turn the fortunes of this country and our economy around. For 13 years, my constituents were betrayed and let down by the previous Government, as taxes rose while unemployment soared, the economy went into meltdown and public services wasted taxpayers’ money on a colossal scale.

It is a tribute to this Government’s economic focus and policies that we have been able to turn things around. Ministers have implemented many clear measures. For example, unemployment in my constituency is now almost half the level it was when it peaked under the previous Government in 2009. These are the positive policies that I bring to today’s debate on the NHS. It is a testament to this Government’s commitment to the NHS that we are now seeing an increase in spending.

I heard the opening speeches in the debate, including by Labour Members. It is appalling that the Labour party likes to talk as though it owns the NHS politically. That is wrong. Labour should listen to some of the facts not just in my constituency but in the eastern region. The fact is that Labour went into the last general election with plans to cut NHS spending—we have heard about the impact of that in Wales—while we have continued to invest in the NHS. While Conservatives recognise the increasing pressures that the country faces from demographics and the health care needs of the public—

Lyn Brown (West Ham) (Lab): Will the hon. Lady give way?

Priti Patel: I want to develop my discussion and go into more detail on the NHS. More investment in the NHS is required. This is not about cutting services, including front-line services, or funds. It is about expanding the NHS in the right way and, as the Secretary of State said, putting patients first and moving away from the bureaucratisation of the NHS.

Lyn Brown: Will the hon. Lady give way?

Priti Patel: Let me continue.

There were classic examples of that not just in my constituency but more widely in Essex. We heard earlier about Basildon hospital. In my constituency, one primary care trust saw its number of managers and senior managers increase tenfold over a decade. At the same time, it failed miserably to recognise the health needs of my constituents; we have a growing population as well as an ageing population. I had cases in 2010 where patients were denied access to life-saving hospital treatment and access to drugs because the PCT sought to prioritise spending on the bureaucracy of the NHS, rather than front-line patient care.

In Witham town, at the heart of my constituency, there is a chronic shortage of locally accessible health care facilities. All the talk by Labour and the slogans referring to “record investment” under Labour translated into nothing in my constituency. Under the previous PCT and the previous regime, we had consultation after consultation but no new services were created.

Lyn Brown: Will the hon. Lady give way?

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Priti Patel: Just a second. Our GPs are among the most highly subscribed in the country, with 2,200 patients per GP compared to the national average of 1,500—that is over 40% more patients per GP than average. Not only did Labour fail to plan, but the former PCTs have left a chilling legacy of debt and financial mismanagement, which has held back our new clinical commissioning group from providing innovative solutions and new local health care.

I thank NHS England, the Department of Health and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter). They have been incredibly accommodating and are looking to create local solutions and to expand front-line services in Witham town. We have been looking at bringing in a new, purpose-built medical centre in the town, which would provide new and integrated primary care services and make services more accessible for local people. Such a centre could even go as far as integrating our local ambulance services, too, in order to bring greater collaboration and integration across our local NHS, which is needed.

These provisions do not need to be included in legislation. This is not about new legislation in the Queen’s Speech. This is about a commitment at the grass roots from health providers and GPs to get on and start delivering these services. We did not have that commitment before.

Another example of where we were completely neglected is the East of England Ambulance Service. It is a fact that we have had endless problems. That was down to a culture of mismanagement. Front Benchers will be familiar with the crisis that we had in our ambulance trust. We had great paramedics who were doing a very difficult job, but they were being let down by hospitals, A and E, and the target culture. The service was worse than poor; it was inadequate. The trust is now recovering, thanks to Dr Anthony Marsh. Last Thursday night, I joined the ambulance trust and its team from Witham ambulance station on patrol and I cannot praise them enough for the work they do. It was interesting to see the handover in patient care as we turned up at Broomfield hospital and Colchester general hospital. We need greater integration so that we are putting patients first in the provision of front-line services.

Colchester hospital has been held back because of the legacy of the culture of targets. Because of the problems we had with the East of England Ambulance Service, Colchester hospital had a target-driven culture that led to horrific examples of falling standards of care and data being manipulated. Investigations are taking place now. While what has happened at Colchester is nowhere near as damaging as what we have seen at other hospitals such as Mid Staffordshire, it shows what happens when targets overtake the delivery of quality front-line patient care. This should not be about bureaucracy, inputs or targets. We need an integrated approach so we deliver effective front-line patient care.

We struggled in the eastern region, and in Essex in particular, with the NHS legacy of the previous Government. It has been a real challenge for all health care professionals—I have mentioned our hospitals and the ambulance trust—and these are individuals who are dedicated to serving patients and doing the right thing, but they have been held back. The innovations and the NHS reforms, as well as the new investment being provided, will help to secure new services for my constituents and a more patient-friendly approach in Witham town.

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6.41 pm

Siobhain McDonagh (Mitcham and Morden) (Lab): Today I would like to add my voice to those of all who have expressed disappointment and surprise that the Queen’s Speech contained not one word about the NHS. Last month’s local elections in Mitcham and Morden, and in large parts of London, were dominated by the issue of health. The verdict was overwhelming: overnight, Merton went from no overall control to Labour control, with the people of Mitcham and Morden electing 30 Labour councillors out of 30 for the first time in history. In large parts of Merton one issue stood out: the future of my local general hospital, St Helier. Anyone driving through Morden will see hundreds of signs in front gardens and windows—yellow signs with a red heart in the middle, all saying “Save St Helier.”

The Government should have used the Queen’s Speech to listen to the people. Labour would introduce an NHS Bill; the Government included not a word about the NHS. During the local election campaign, Merton’s Conservatives said that, no ifs, no buts, St Helier was safe. Their leader proclaimed that

“St Helier Hospital has been saved”,

but St Helier has been under attack for years under this Government. In 2011, the local NHS said the Government had told it to

“deliver £370 million savings each year...around 24% in their costs.”

A new body called Better Services Better Value was set up. It announced it would close A and E and maternity units across south-west London and Surrey, and St Helier would also lose its intensive care unit, paediatric centre, renal unit and 390 in-patient beds. A save St Helier campaign was launched, and the petition has now been signed by more than 13,000 of my constituents. Three local campaigners—Sally Kenny, Stan Anderson and Mary Curtin—decided the issue was so important that they should stand in the local elections in Lower Morden as residents whose primary aim was to save St Helier. Given the backing they had from Councillor Stephen Alambritis, the Labour leader of Merton council, they stood for Labour. Just before the election, doctors in Surrey, where Epsom hospital was also threatened, vetoed the plans. BSBV was wound down in ignominy. It seemed we had won a reprieve, but when the huge banner covering the front of St Helier hospital that said

“Coming soon—We’re spending £219m on a major development”

was taken down, residents realised that victory was only temporary.

The best any of us could hope for was a few years’ peace and quiet. As it happened, the reprieve lasted until only five days after the election, when the local NHS published a new five-year plan that it says will

“change the way we deliver health services”.

Far from listening to the people, who voted in unprecedented numbers to save St Helier, it ignored the verdict of the people. The plan describes the

“likely need to reconfigure maternity and neonatal services”.

Of course, “reconfigure” is just a euphemism for closures, and it suggests that A and E units will be downgraded by 2018, with what it describes as the introduction of two levels of emergency departments—major emergency centres and emergency centres. The plans do not say

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which maternity units will be “reconfigured” or which A and Es will be downgraded to emergency centres, rather than full-blown A and Es, but, after years at risk, nobody thinks St Helier’s future is secure.

The leader of Merton council, who won an overwhelming mandate just weeks ago, is so angry that he has told the chair of Merton’s clinical commissioning group, who has headed the local NHS throughout BSBV, that the people had spoken and his job was no longer tenable. Councillor Alambritis said:

“BSBV has been a fiasco and the voters of Merton delivered a devastating verdict...Ultimately, responsibility lies with the Chair, and he has to go…Merton’s residents have demanded change, and the Chair needs to respond to that”—

and so should the Government. They have spent the last four years undermining, rather than strengthening, our NHS.

In 2010, the Conservative party manifesto said it would stop the centrally dictated

“closure of A&E and maternity wards, so that people have better access to local services, and give mothers real choice over where to have their baby”.

The people of Merton remembered that quote, and it is no wonder they voted the way they did a fortnight ago.

This is a democracy. The Government should respect the ballot box. My constituents do not want a Queen’s Speech that has not got a single word to say about the NHS. They want a Queen’s Speech to save St Helier, and save our NHS.

6.46 pm

Jackie Doyle-Price (Thurrock) (Con): I have reflected on the comments of the hon. Member for Mitcham and Morden (Siobhain McDonagh) and I really must tackle head-on the belief that because there is no Bill on the NHS, that is a weakness. The reality is that the NHS does not need more legislation. What it needs is good leadership and good performance management so that it delivers what we want it to deliver for our constituents. We will not improve the care of patients by sitting on these Benches and pontificating and giving the benefit of our experience. What we need to do is empower real practitioners to actually deliver change.

Siobhain McDonagh: May I inform the hon. Lady that many of my constituents in Mitcham and Morden believe the withdrawal of clause 119 from the Care Bill would have done a lot for their NHS?

Jackie Doyle-Price: I cannot agree with the hon. Lady. The important thing is that Government Members make it clear to the NHS that we expect it to put the interests of patients at its heart. I want again to draw attention to what has happened in Basildon and Thurrock university hospitals trust because it is perhaps the best example of the profound change we have had in NHS culture over the last five years. We now have a Government, and leaders within the NHS, who are finally prepared to face up to what is going wrong and to deal with it, rather than to cover up, be complacent and say, “We’re no worse than anyone else.”

I have to say that it has been a turbulent journey for those of us involved in Basildon hospital over those five years. The shadow Health Secretary, who is not in his place, will recall coming to this House in 2009, at the

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same time as he spoke about Mid Staffordshire, to highlight exactly what was going wrong at Basildon. Since then I have had a number of conversations with senior managers in which I was told, “Well, we’re no worse than anyone else. You’ll find this everywhere.” That was not good enough, but after two and a half years of not making any progress at all, Members of this House had very robust discussions with Monitor and said, “This needs proper intervention.” That led to a complete change in the leadership. A new board was appointed that was more inclined to give challenge where it was due. We had a leadership team that put stronger emphasis on good clinical leadership, and a chief executive was appointed who was determined to make sure that Basildon hospital delivered the standards of care that all patients deserve. What we have had is cultural change, and cultural change comes from leadership; it does not come from legislation. As I have said in many contexts, any organisation is a creature of the person at its top, so when we get good leadership in individual hospitals we get a step change in performance.

I also wish to pay tribute to the Secretary of State for the continued emphasis he places on patients, because when the head of the NHS—the person operationally responsible here in Parliament for performance—is articulating that, it will spread the cultural change which will deliver the real change in performance. I pay tribute to Clare Panniker, Basildon hospital’s current chief executive, who has delivered this significant change in the 18 months she has been in post. She has taken Basildon from being one of the worst performing hospitals to a position where it is coming out of special measures. She has been ably supported by the chairman of the trust, who has also been prepared to give a robust challenge and to stand behind her when she was doing so. Most of all, I wish to pay tribute to all the staff at Basildon. It has not been easy for them—it has not been good for their morale to see in the newspapers regular reports of the latest horror story of poor care within the trust—but they have reacted to the cultural change that Clare Panniker has brought. They have bought into it and given good, honest feedback, and I no longer get whistleblowing letters from staff about the latest incident. They have procedures to act on things and the management then implement that change. It says a lot about the commitment of the staff in that hospital that they have bought into that process and delivered us to where we are now. We all need to learn that sunlight is indeed the best disinfectant. It is not good enough to pretend that there is not a problem when there so clearly is, and it is important that we continue to put patients at the heart of the NHS. Only by doing that will we be able to ensure that the incidents witnessed at Mid Staffs and Basildon will become a thing of the past.

I wish to turn my attention to another issue that was not mentioned in the Queen’s Speech but which is on the Government’s legislative timetable for the coming year: the plan to introduce standardised packaging for tobacco products. I have to say to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) that it is a very bad idea. I fully support the policy objectives of tackling tobacco consumption and, in particular, of dissuading and preventing children from ever taking up smoking,

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but I have worries that this tool is not effective and that its unintended consequences may bring about worse health outcomes than doing nothing at all. Sir Cyril Chantler is said to have examined that as part of his review, but I am not persuaded of the evidence. In particular, I believe that introducing standardised packaging will worsen the public health outcomes if unregulated illicit tobacco products replace the regulated ones. We all know how toxic regulated cigarettes are, but when unregulated products enter the market the health outcomes will be very much worse.

Sir Cyril Chantler has concluded that Her Majesty’s Revenue and Customs has been very effective in tackling contraband and illicit tobacco, and he has cited figures going back to 2001. Although they show an improvement, the nature of the problem has changed over that period. European Union enlargement took place during that time and there was an immediate rise in the amount of illicit tobacco, but that has been tackled, mainly through co-operation with tobacco manufacturers. That illicit tobacco was also a legal product, whereas the illicit tobacco coming into this country today is not from Europe and it is not from regulated markets; it tends to be made in places such as China and Indonesia. Some of these products are extremely nasty, with tobacco rolled with whatever is available and containing high levels of tar. I commend The Sun for the exposé it ran last week in which an illicit producer from Indonesia explained just how toxic some of his products are and how standardised packaging will help him make money by reducing the costs of production.

Alex Cunningham: The Government’s own inquiry showed that there would not be an increase in the amount of illicit tobacco traded in this country. Does the hon. Lady not trust her own Ministers and the report they commissioned?

Jackie Doyle-Price: I was quoting that report and challenging its conclusions, which are based on a flawed analysis of the market—that is what I have been trying to explain. No, I do not trust that report. It is superficial and it has been put together with a particular agenda. As I say, it will lead to unintended consequences which will be very bad for public health.

My constituency contains Tilbury docks and the Purfleet ferry terminal. Despite the best efforts of Border Force, Essex police and the port of Tilbury, these products are getting through. Despite large seizures every week, Border Force does not believe that it is getting even 10% of the illicit product that is coming into the marketplace. It is estimated that one in three cigarettes smoked in London are illicit, and a good proportion of them will come through the ports in my constituency. Standardised packs will inevitably reduce costs for illicit manufacturers, who will be able to produce the product without differentiation in brand. I believe this proposal is a charter for a lot of very nasty people to make a lot of money, and if they do, the health outcomes we wish to see will not be achieved.

Let us be frank: we are talking about packets of cigarettes sold from holdalls behind pubs for a couple of pounds. Children do not start smoking by walking into their newsagents and picking a branded product; they are introduced to smoking via that holdall, at the back of the bike sheds or at the back of pubs. When

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cigarettes become that cheap, because of the proliferation of illicit products in the market, these children will be smoking some very nasty things. I ask Ministers to think again, because this is not the best tool for achieving a reduction in smoking and there will be unintended consequences for public health. I ask this Minister to sit down with Border Force and understand just how difficult the fight is that it is waging against serious organised crime and smuggling.

6.56 pm

Mr Ronnie Campbell (Blyth Valley) (Lab): Interestingly, health is not even covered in the Queen’s Speech, but we are debating it so I will say a few words about it. The good news is that my granddaughter has just been accepted by Liverpool university to study midwifery, so that is some compassion coming back into the health service. The bad news is that on Friday I had a meeting with GP commissioners who came to see me because they are teetering on the edge. I am talking about the Northumberland commissioners who are running the doctors consortium. They had a budget, worked to it and were doing all right until the Government came along and clawed money back. I would not mind if the Minister tried to say why the Government clawed money back from them; I would be interested to know that.

We know what is happening in the health service and we know why there is no Bill. Since this Government came to power we have seen creeping privatisation; no corner of the health service is untouchable as far as privatisation is concerned. Sometimes I just wonder what is going to happen in the next few years—God forbid if the Tories get elected again, with this lot here in charge. Are we going to be paying for our health service? Are charges going to be put on the health service? That is a good question to ask to see whether we can get a denial from the Government—

David T. C. Davies rose—

Mr Campbell: Sit down, you will have your Welsh question in a minute. It would be good if the Minister could deny that he has any intention of charging for any services in the health service in the future, because they are creeping in little by little. As for the nurses—the people who run the health service and do all the work—their miserable wage rises are absolutely disgraceful and this Government should be ashamed of taking even that 1% away from them; they should get more but the Government are not even going to give them the 1%.