6.31 pm

Rachel Reeves (Leeds West) (Lab): The debate that we have called today and the amendment that we are now considering are based on the values and ideals that brought the Labour party into being. They are about securing for all people in this country the dignity of a decent day’s pay for a hard day’s work, so that people can both provide for their family and spend time with them, sharing in the wealth and prosperity that we all help to create. That is why the last Labour Government faced down those on the Conservative Benches who said that extreme low pay was a fact of life and who were happy to live in a world where there were adverts in jobcentres such as the one pointed out to me by a constituent of mine recently. It was advertising for a security guard and it read, “£1 an hour. Uniform provided. Bring your own dog.”

Labour Members were not happy with that world. We set up the Low Pay Commission and we legislated for the national minimum wage, which for the first time put a legal floor, and a rising floor, under the wages of millions of workers, particularly women, below which their wages could not fall.

Today, however, we need to learn from and build on that success. Since this Government took office we have seen the national minimum wage fall by 5% in real terms in just four years and the number of workers stuck on low pay has soared to well over five million. That is more than one in five workers, and one in four women, who are paid less than a living wage.

That is one of many symptoms of an economy that is just not working for working people today. Along with the 1.5 million people on zero-hours contracts, whom my hon. Friend the Member for Streatham (Mr Umunna) mentioned at the beginning of this debate, there are also 1.4 million people in part-time work who desperately want to work full-time; 600,000 people on temporary contracts who desperately want a permanent job; and numerous reports of a pervasive sense of insecurity, which affects not only the lowest paid but workers right up the income spectrum, including those in what were traditionally seen as middle-class or professional occupations.

We have had a number of contributions from hon. Members about the impact that this is having on their constituents. My hon. Friend the Member for Inverclyde (Mr McKenzie) spoke about real wage falls, particularly

11 Jun 2014 : Column 650

for young people, while my hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali) spoke about youth unemployment and the lack of prospects for so many of her constituents. My right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke) quoted Bevan and Beveridge in his speech, and spoke about the Government’s policies leading to extremes.

My hon. Friend the Member for North Ayrshire and Arran (Katy Clark) spoke about the living wage, but also about the insecurity that so many of her constituents face, with 21% paid less than a living wage. My hon. Friend the Member for Newcastle-under-Lyme (Paul Farrelly) spoke about how this Government’s programme was just too timid, and said that they must do much more both to tackle the abuse of zero-hours contracts and to stop this recovery being one that leaves far too many people behind. He speaks with a great track record, having done so much to campaign on rights for temporary and agency workers.

My hon. Friend the Member for Blackpool South (Mr Marsden) spoke about job insecurity, particularly in seaside towns, and the use of sanctions, which often go too far and penalise the wrong people. The hon. Member for Banff and Buchan (Dr Whiteford) spoke about the gender pay gap and how it is often women who suffer the most. My hon. Friend the Member for Wansbeck (Ian Lavery) made an impassioned speech about zero-hours contracts and the restriction of justice that so many people feel. He made an important point about the disconnect that so many ordinary people feel between them and politics and Parliament, which my right hon. Friend the Member for Doncaster North (Edward Miliband) spoke about last week. That is something we must all be aware of and address.

As well as resulting in so much indignity for so many people, the challenges we face also pile pressure on to our social security system, with taxpayers left to foot the bill for wages that do not cover the cost of living and insecure and irregular earnings making it harder for people to keep up with their rent, arrange a mortgage, save for a pension or do all the other things that so many of us take for granted. The bill paid by taxpayers for people being paid less than the living wage has been estimated at a staggering £2.4 billion a year, including £750 million in extra tax credits and £370 million in extra housing benefit. The cost to taxpayers of the number of people stuck in part-time jobs who want to work full time is now £4.6 billion, including £1.7 billion in additional housing benefit, with the cost of housing benefit for people in work rising by a staggering 66% since this Government came to office.

All in all, over this Parliament this Government are set to spend £13 billion more than they budgeted for on benefits and tax credits because too many people have been left out of work for too long and because the squeeze on wages has been so severe. Expenditure on in-work benefits and tax credits is set to go on rising in real terms over the years ahead. That is the price that we are all paying, and will continue to pay, for this Government’s failure to secure a recovery that benefits everybody.

The impact of that on people is so stark, as has been mentioned in other speeches today. My hon. Friend the Member for East Lothian (Fiona O'Donnell) spoke about her constituents feeling left behind, despite the

11 Jun 2014 : Column 651

fact that the economy is now starting to grow again. My hon. Friend the Member for Sheffield Central (Paul Blomfield) made an incredibly powerful speech about the growth of payday lenders and the fact that nobody, especially those in work, should have to rely on that sort of credit to be able to feed their family and pay the bills. My hon. Friend the Member for Harrow West (Mr Thomas) spoke about an alternative world where credit unions are used more widely and supported more and about saving through the payroll, which I think was an important contribution in the debate. My hon. Friend the Member for Walsall North (Mr Winnick) spoke about the fact that far too many people in all our constituencies are being forced to go to food banks in order to support their families.

That is putting strain on our social fabric and the functioning of our democracy, as more and more people are feeling left out and cut out. The gains of growth are going to a privileged few and many are feeling left behind. No one in this House can be happy with the turnout in the local and European election just three weeks ago. If we are to turn that around and restore people’s faith that voting can make a difference, we need to show those who are feeling sidelined and short-changed that we understand their plight and that we will take action to address their worries and problems.

We have heard powerful speeches today about the problems faced by people in low-paid and insecure work, but we have also heard powerful speeches about businesses in our communities doing great things, employing people and growing their businesses. We need to build a stronger and better balanced economy in which growth and prosperity are more fairly shared. I therefore welcomed the speech we heard from my hon. Friend the Member for West Bromwich West (Mr Bailey), the Chair of the Business, Innovation and Skills Committee, who spoke about apprenticeships. My hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) spoke about not enough young people doing vocational subjects at school and college and the need to improve and reinvigorate our careers service.

My hon. Friends the Members for City of Durham (Roberta Blackman-Woods), for Glasgow North East (Mr Bain) and for Blaenau Gwent (Nick Smith) spoke about regional policy, local enterprise partnerships, the failure of the regional growth fund and the importance of creating a proper British investment bank. My right hon. Member for Warley (Mr Spellar) spoke about trade promotion, manufacturing and the need to put British business first. My hon. Friend the Member for Bristol East (Kerry McCarthy) spoke about the creative industries and their impact on our communities and on jobs.

We also heard speeches about small businesses. My hon. Friend the Member for Kilmarnock and Loudoun (Cathy Jamieson) talked about the red tape facing many small businesses and the costs that it imposes on them but also on Government. My hon. Friend the Member for Rochdale (Simon Danczuk) gave a plug to Danczuk’s Deli and spoke about the problems with business rates and the need for a British investment bank.

We also heard some powerful speeches by Government Members, of which I will mention just three. The hon. Members for Macclesfield (David Rutley), for Cleethorpes (Martin Vickers) and for Stourbridge (Margot James) spoke powerfully about businesses in their constituencies and the good that they are doing in creating jobs.

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Those speeches show the difference that can be made and that Labour can make. It is time to set an ambitious five-year target for the national minimum wage so that we narrow the gap between the minimum wage and average earnings over the life of the next Parliament. That would be the effect of the amendment, which would ensure that those who take the shifts and put in the hours in some of the toughest jobs in our economy have a chance of building a decent life for themselves and their families. A Labour Government would beef up enforcement of the national minimum wage, with new powers for local authorities to investigate infractions and larger fines of £50,000 for non-payment. We would also take action to end the abuse of zero-hour contracts, and crack down on agencies that use migrant labour and discriminatory recruitment and working practices to evade and undermine minimum employment standards.

All these measures form an integral and complementary part of the wider path that my hon. Friend the Member for Streatham spoke about, which would secure increased investment in infrastructure and innovation and support the creation of good-quality, high-skilled, well-rewarded jobs and apprenticeships across the country. We need to build an economy that can succeed in the global race to the top on quality and productivity instead of trying to win a race to the bottom on wages and working conditions—sadly, that seems to be the limit of this Government’s ambitions.

We heard evasion and excuses from Government Members, in many cases going back to the arguments of the 1980s and 1990s. The hon. Member for Reading West (Alok Sharma) even suggested that we should be careful about treating employers who do not pay the national minimum wage too harshly in case they did it by mistake. Well, I do not think that is good enough.

Alok Sharma: I hope that the hon. Lady listened to my speech in full. I welcomed the fact that we should be clamping down on rogue employers but said that we also need to make sure that employers who make genuine, one-off mistakes should not necessarily be penalised for that.

Rachel Reeves: I wonder whether the hon. Gentleman is so lenient on people who over-claim benefits. I think we need to get tough on people who are not paying the minimum wage to their employees. It is against the law, it is the wrong thing to do, and it puts pressures on those employees’ families that they should not have to face.

Figures from the Office for National Statistics show that over the past year the richest 1% have increased their share of national income from 8.2% to 9.8%. The top 1% have almost 10% of our national income, while 27 million taxpayers who make up the bottom 90% have seen their share of income fall. Wages have fallen further and further behind prices, as we saw again today, and the number of working families in poverty is set to soar. Only today, the latest figures from the ONS showed nominal pay growing by just 0.7% a year at a time when inflation, as measured by the consumer prices index, was running at 1.8%.

Earlier this week, a report from the Trussell Trust highlighted an increasing number of people in work who rely on their food banks. On Monday, the Government’s own commission on child poverty reported that

“twice as many poor children now live in working homes than in workless homes”

11 Jun 2014 : Column 653

and called for

“real action to tackle low pay, create more secure jobs and enable more people in low-paid jobs to progress in work.”

The same report says that the Government’s latest poverty strategy

“falls far short of what is needed”,

highlighting in particular the

“lack of new action on in-work poverty”,

as outlined by my hon. Friend the Member for Wansbeck. I am afraid that it is the same old story from the same old Tories: tax cuts for the rich and pay cuts for the poor.

Last month, my right hon. Friend the Member for Doncaster North and I met a mum called Rachel Palmer who is affected by some of the things we have spoken about. She works hard so that she can provide for her young son, but she struggles to make ends meet on a minimum wage job in retail. She fought back tears as she told us how hard it was. She said, “You cut all your outgoings, shop at cheaper supermarkets, make batches of food and put them in the freezer, and tour car boot sales and charity shops, but still there’s not enough money.” She said there are lots of people like her who do the right thing and go out to work but “can’t afford simple things.” She said, “You have to choose: do you give your child a nutritious meal, or do you let your standards drop?”

No one should have to make those sorts of choices for themselves or their children. Rachel Palmer is doing the best she can for herself and her young son, and we in this House need to do better for her and her family and millions more families in her position.

This Government have made it clear that they are content with the status quo. Labour Members are determined to aim higher. If the Government will not do more to help those who are struggling to find work and those who are working all the hours they can to provide for themselves and their families but are still struggling, the next Labour Government will. For millions of hard-working families up and down the country, that change cannot come soon enough. I urge this House to support our amendment.

6.45 pm

The Secretary of State for Work and Pensions (Mr Iain Duncan Smith): It is always a pleasure and an honour to conclude a debate on the Gracious Speech. I urge right hon. and hon. Members to oppose the amendment, which I will address later. I congratulate Members on their speeches. I have sat here for some time listening to them and the quality of speeches by Members on both sides of the House was of the highest order, particularly given the time constraint, which was imposed for good and obvious reasons. I congratulate in particular those who had to change their speeches after being addressed by the occupant of the Chair.

I congratulate and agree with my hon. Friends the Members for Norwich North (Chloe Smith) and for Stourbridge (Margot James), who spoke about the importance of youth employment and the way in which we are now driving youth employment up and unemployment down. On support for growth in manufacturing employment, my hon. Friend the Member

11 Jun 2014 : Column 654

for Stourbridge said that manufacturing employment is now growing and improving after a fall of 2.5 million under the previous Labour Government. As my right hon. Friend the Secretary of State for Business, Innovation and Skills said in his opening remarks, we are getting more balance in the economy as a result of the work we have been doing, which is different from what was going on before the recession.

I congratulate my hon. Friend the Member for Worcester (Mr Walker), who talked about the small business measures and measures to get rid of excess zero-hours contracts, which my right hon. Friend the Business Secretary spoke about earlier. Many Opposition Members spoke passionately, and rightly so, about excesses in employment, particularly with regard to zero-hours contracts, but, as my right hon. Friend said, they never once addressed zero-hours contracts throughout their time in government. To listen to them, one would think that zero-hours contracts were an innovation created by this Government and that they began some time last year, but they did not: they were running under the previous Government, and it is only this Government and this Business Secretary who will address the matter, which is what Labour should have done.

As I recall, the last time that the hon. Member for Great Grimsby (Austin Mitchell) and I spoke in the same debate, he urged me to vote against the Government. I did, and look what happened. Today, he advised us that we should borrow more, but I do not think that I will listen to him this time, if he does not mind—it got me into more trouble than I like to think about last time. However, I welcome him to his place and recognise that he also attacked the previous Government for the amount of quantitative easing they oversaw, which he said was wrong.

My hon. Friend the Member for Bournemouth East (Mr Ellwood) was making an effective speech about international matters before he was interrupted. I commend him for managing to get his speech out, regardless of the change in the interpretation of the rules. He made a really important point about the taking of Mosul, which is a terrible issue and we need to deal with it.

I welcome the fact that the hon. Member for Blaenau Gwent (Nick Smith) welcomed the rise in employment in Wales. I will pass on to the Transport Secretary his views about the electrification of the railway to Swansea.

My hon. Friend the Member for Cleethorpes (Martin Vickers) spoke very well about the increase in small business. He rewrote his speech as a result of the ruling from the Chair, and I congratulate him—I do not know whether he is in his place—on making a brilliant five-minute speech with no warning at all.

My hon. Friend the Member for Tamworth (Christopher Pincher) spoke about the good results from business men in his area, and particularly about making sure that small business is supported. My hon. Friend the Member for Dover (Charlie Elphicke) also spoke about that, as well as about the increase in people’s disposable income—that is true—and economic models showing that the UK is now growing faster than any other country.

The hon. Member for East Lothian (Fiona O’Donnell) spoke about abuses of zero-hours contracts. In relation to what she raised earlier, there is no mandation on zero-hours contracts and there are no sanctions. I provide that for clarification and so that she is aware of it.

11 Jun 2014 : Column 655

My hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) welcomed the fall in unemployment and the grant of assisted area status for Fleetwood, which I pass on to my right hon. Friend the Secretary of State for Business, Innovation and Skills, who is in his place. My hon. Friend said we should push on with shale gas, and I fully agree that it has potential benefits for us all.

The hon. Member for Liverpool, West Derby (Stephen Twigg) and my hon. Friend the Member for Ceredigion (Mr Williams) spoke about vocational training. I welcome the speeches of my hon. Friends the Members for Reading West (Alok Sharma) and for Folkestone and Hythe (Damian Collins), who spoke about real falls in unemployment and rises in employment, particularly youth employment, in their areas. My hon. Friend the Member for Warwick and Leamington (Chris White) spoke about growing business and manufacturing.

I welcome the speech of the hon. Member for Rochdale (Simon Danczuk), which was mentioned by the hon. Member for Leeds West (Rachel Reeves). He made me feel very hungry, as I am sure she did, by talking about Danczuk’s Deli. I hope that we can give it more advertising—I can promise him that something in return would be very welcome after three hours on the Front Bench.

My hon. Friend the Member for Macclesfield (David Rutley) said that the Federation of Small Businesses had welcomed the Bill on small businesses in the Queen’s Speech as a “landmark Bill”. I agree that the Bill to protect small business is a landmark measure.

My hon. Friend the Member for Weaver Vale (Graham Evans) spoke about the importance of the fall in unemployment in his constituency. Youth unemployment there has fallen by 41%, which I welcome. Apprenticeships in his area have risen by 27% since he became its Member. I am not sure whether that fact is directly connected to him, but it will not do him any harm in his area.

I congratulate the hon. Member for Kilmarnock and Loudoun (Cathy Jamieson) on the very strong and powerful points she made about taking the burden off small businesses.

In their opening and closing speeches, Opposition Members made no reference whatever to one of the big and important features of the Queen’s Speech, which is the continuation of pensions reform. I will say a few words about that because it is very important. I start by paying tribute to the Minister of State, Department for Work and Pensions, my hon. Friend the Member for Thornbury and Yate (Steve Webb). It is way past time for him to be made right honourable, given the work that he has done—I say that to my hon. Friends—because the work that we have done in concert will leave behind a serious platform of pensions reform. The House will come to recognise that and the fact that his work will have rewarded many people. Obviously, we are ensuring that it pays to work, but also, most importantly, that it pays to save, which is one of our major platforms.

Let me just remind the House what we have introduced since being in office. There is the triple lock on the basic state pension; it is worth about £440 more in 2014-15 than it would have been under uprating by earnings, which was the process we inherited. Under automatic enrolment, more than 3 million people have already

11 Jun 2014 : Column 656

joined pension schemes, and there are more to come. We have capped rip-off charges, banned hidden charges and set minimum quality standards. Vitally, there is a new state pension, which is set above the means-test level, so that those who have contributed at the full rate for 35 years are guaranteed a decent minimum income.

We are now going further, with a pensions Bill that will pave the way for innovation, competition and choice. We will introduce new flexibilities, trusting individuals to use their own money in retirement as they see fit, not as the Government tell them to do. Our consultation on guaranteed guidance closes today. We intend to strike a balance between impartiality and deliverability, alongside robust standards and monitoring.

At the same time, we are enabling the creation of a defined ambition pension, which is wholly compatible with the new flexibilities, to facilitate greater risk pooling, while offering savers greater certainty. There was a degree of confusion on the Opposition Benches when the Minister of State said that he had been looking at that idea for some years. My shadow, the hon. Member for Leeds West, tweeted on 1 June:

“I said last week Labour will legislate to introduce collective pensions. Days later, ministers are following suit”.

I did not know we acted that fast. After all the years that my hon. Friend has been considering the idea, the hon. Lady suggests that we owe it to her that we have brought it in. She recently attacked the Labour leadership for not showing enough passion, but she must not confuse passion with accuracy. I notice that we have the pair of them here: the shadow Secretary of State for Work and Pensions and the shadow Secretary of State for Business, Innovation and Skills.

When we talked about freeing up annuities, there was chaos among the Opposition. During his speech on the Queen’s Speech, the Leader of the Opposition did not mention pensions reform. The next day, the shadow Chancellor said only that Labour would look at the Government’s proposals—he did not tweet at all. The day after that, the hon. Member for Leeds West said that she supported the reforms. By the weekend, the shadow Business Secretary backtracked and said:

“I’m not going to sign a blank piece of paper on your show”.

Later the same day, my shadow also backtracked, saying that Labour supported the reforms, but that they did not go far enough. The Opposition have been in complete chaos and confusion about these landmark pension reforms—some of the most important that will ever be introduced. The reason why they have been in chaos is that they really do not trust people to dispose of their own money, which they have worked for and saved, whereas the Government do.

Throughout the shadow Business Secretary’s speech, he would not accept that any of the problems that we have had over the past four years were caused by Labour’s great recession. My right hon. Friend the Secretary of State for Business, Innovation and Skills reminded him—and it is worth reminding him again—that the recession that happened on Labour’s watch cost the British economy £112 billion and cost 750,000 people their jobs. Youth unemployment increased by nearly a half, long-term unemployment almost doubled in just two years, 5 million people were left on out-of-work benefits and one in five households had no one in work. The shadow Business Secretary wonders why we want

11 Jun 2014 : Column 657

to go on talking about that. We do so because we do not want anyone out there ever to forget that Labour almost destroyed the British economy.

Mr Ronnie Campbell (Blyth Valley) (Lab) rose—

Mr Duncan Smith: No, I do not have time.

Under this Government, there is record employment. More than 30 million people are in work. Employment is up this quarter, with the largest rise on record. It is up 1.7 million since the election. Record numbers of women are in work. There is record private sector employment, which is up by 2 million since the election. Three quarters of the rise in employment is made up by full-time jobs. Over the past year, more than three quarters of jobs went to UK nationals, reversing the damaging trend of Labour’s last five years in office.

I close today’s debate on the Queen’s Speech with a very simple point: we cannot trust Labour to be in control of the British economy ever again. The Government are helping people into jobs and ensuring that those who work hard and save all their lives are properly rewarded. To set the record completely straight, there are now more people in work than ever, more women in work than ever and more people in private sector work than ever. Youth and long-term unemployment is falling, and we have the lowest rate of workless households since records began. The Queen’s Speech allows us to build on our success, not Labour’s failure. I commend it to the House.

Question put, That the amendment be made.

The House divided:

Ayes 247, Noes 306.

Division No. 1]


6.59 pm


Abbott, Ms Diane

Abrahams, Debbie

Ainsworth, rh Mr Bob

Alexander, rh Mr Douglas

Alexander, Heidi

Ali, Rushanara

Allen, Mr Graham

Ashworth, Jonathan

Austin, Ian

Bailey, Mr Adrian

Bain, Mr William

Balls, rh Ed

Banks, Gordon

Barron, rh Kevin

Bayley, Hugh

Beckett, rh Margaret

Begg, Dame Anne

Benn, rh Hilary

Benton, Mr Joe

Berger, Luciana

Betts, Mr Clive

Blackman-Woods, Roberta

Blenkinsop, Tom

Blomfield, Paul

Blunkett, rh Mr David

Brennan, Kevin

Brown, Lyn

Brown, rh Mr Nicholas

Brown, Mr Russell

Bryant, Chris

Buck, Ms Karen

Burnham, rh Andy

Byrne, rh Mr Liam

Campbell, rh Mr Alan

Campbell, Mr Ronnie

Caton, Martin

Champion, Sarah

Chapman, Jenny

Clark, Katy

Clarke, rh Mr Tom

Clwyd, rh Ann

Coaker, Vernon

Coffey, Ann

Connarty, Michael

Cooper, Rosie

Cooper, rh Yvette

Corbyn, Jeremy

Crausby, Mr David

Creagh, Mary

Creasy, Stella

Cruddas, Jon

Cryer, John

Cunningham, Alex

Cunningham, Mr Jim

Curran, Margaret

Danczuk, Simon

Darling, rh Mr Alistair

David, Wayne

Davidson, Mr Ian

Davies, Geraint

De Piero, Gloria

Denham, rh Mr John

Dobbin, Jim

Dobson, rh Frank

Docherty, Thomas

Donaldson, rh Mr Jeffrey M.

Donohoe, Mr Brian H.

Doran, Mr Frank

Doughty, Stephen

Dowd, Jim

Doyle, Gemma

Dromey, Jack

Dugher, Michael

Durkan, Mark

Eagle, Ms Angela

Eagle, Maria

Edwards, Jonathan

Efford, Clive

Elliott, Julie

Ellman, Mrs Louise

Engel, Natascha

Esterson, Bill

Evans, Chris

Farrelly, Paul

Field, rh Mr Frank

Fitzpatrick, Jim

Flello, Robert

Flint, rh Caroline

Flynn, Paul

Francis, Dr Hywel

Gapes, Mike

Gardiner, Barry

Gilmore, Sheila

Glass, Pat

Glindon, Mrs Mary

Godsiff, Mr Roger

Goodman, Helen

Greatrex, Tom

Green, Kate

Greenwood, Lilian

Griffith, Nia

Gwynne, Andrew

Hain, rh Mr Peter

Hamilton, Mr David

Hamilton, Fabian

Hanson, rh Mr David

Harman, rh Ms Harriet

Harris, Mr Tom

Hendrick, Mark

Hepburn, Mr Stephen

Heyes, David

Hillier, Meg

Hilling, Julie

Hodge, rh Margaret

Hodgson, Mrs Sharon

Hoey, Kate

Hood, Mr Jim

Hopkins, Kelvin

Hosie, Stewart

Hunt, Tristram

Irranca-Davies, Huw

Jackson, Glenda

James, Mrs Siân C.

Jamieson, Cathy

Jarvis, Dan

Johnson, rh Alan

Johnson, Diana

Jones, Graham

Jones, Mr Kevan

Jones, Susan Elan

Kane, Mike

Kaufman, rh Sir Gerald

Keeley, Barbara

Kendall, Liz

Khan, rh Sadiq

Lammy, rh Mr David

Lavery, Ian

Lazarowicz, Mark

Leslie, Chris

Lewell-Buck, Mrs Emma

Lewis, Mr Ivan

Llwyd, rh Mr Elfyn

Long, Naomi

Love, Mr Andrew

Lucas, Caroline

Lucas, Ian

MacNeil, Mr Angus Brendan

Mahmood, Mr Khalid

Mahmood, Shabana

Malhotra, Seema

Mann, John

Marsden, Mr Gordon

McCabe, Steve

McCarthy, Kerry

McClymont, Gregg

McDonagh, Siobhain

McDonald, Andy

McDonnell, Dr Alasdair

McDonnell, John

McFadden, rh Mr Pat

McGovern, Alison

McGovern, Jim

McGuire, rh Mrs Anne

McKechin, Ann

McKenzie, Mr Iain

McKinnell, Catherine

Meacher, rh Mr Michael

Meale, Sir Alan

Mearns, Ian

Miller, Andrew

Mitchell, Austin

Moon, Mrs Madeleine

Morden, Jessica

Morrice, Graeme


Morris, Grahame M.


Munn, Meg

Murphy, rh Mr Jim

Murphy, rh Paul

Murray, Ian

Nandy, Lisa

Nash, Pamela

O'Donnell, Fiona

Onwurah, Chi

Osborne, Sandra

Owen, Albert

Paisley, Ian

Pearce, Teresa

Perkins, Toby

Phillipson, Bridget

Pound, Stephen

Powell, Lucy

Qureshi, Yasmin

Raynsford, rh Mr Nick

Reed, Mr Jamie

Reed, Mr Steve

Reeves, Rachel

Reynolds, Emma

Reynolds, Jonathan

Riordan, Mrs Linda

Ritchie, Ms Margaret

Robertson, John

Robinson, Mr Geoffrey

Rotheram, Steve

Roy, Lindsay

Ruane, Chris

Ruddock, rh Dame Joan

Sarwar, Anas

Sawford, Andy

Seabeck, Alison

Sharma, Mr Virendra

Sheridan, Jim

Shuker, Gavin

Skinner, Mr Dennis

Slaughter, Mr Andy

Smith, rh Mr Andrew

Smith, Angela

Smith, Nick

Smith, Owen

Spellar, rh Mr John

Straw, rh Mr Jack

Stringer, Graham

Stuart, Ms Gisela

Sutcliffe, Mr Gerry

Tami, Mark

Thomas, Mr Gareth

Timms, rh Stephen

Trickett, Jon

Twigg, Derek

Twigg, Stephen

Umunna, Mr Chuka

Vaz, rh Keith

Vaz, Valerie

Walley, Joan

Watts, Mr Dave

Weir, Mr Mike

Whiteford, Dr Eilidh

Whitehead, Dr Alan

Williams, Hywel

Williamson, Chris

Wilson, Sammy

Winnick, Mr David

Winterton, rh Ms Rosie

Wishart, Pete

Woodcock, John

Woodward, rh Mr Shaun

Wright, David

Wright, Mr Iain

Tellers for the Ayes:

Phil Wilson


Nic Dakin


Adams, Nigel

Afriyie, Adam

Amess, Mr David

Andrew, Stuart

Arbuthnot, rh Mr James

Bacon, Mr Richard

Baker, Norman

Baker, Steve

Baldry, rh Sir Tony

Baldwin, Harriett

Barclay, Stephen

Barker, rh Gregory

Baron, Mr John

Barwell, Gavin

Bebb, Guto

Beith, rh Sir Alan

Bellingham, Mr Henry

Benyon, Richard

Beresford, Sir Paul

Berry, Jake

Bingham, Andrew

Binley, Mr Brian

Birtwistle, Gordon

Blackwood, Nicola

Blunt, Crispin

Boles, Nick

Bone, Mr Peter

Bottomley, Sir Peter

Bradley, Karen

Brady, Mr Graham

Brake, rh Tom

Bray, Angie

Brazier, Mr Julian

Bridgen, Andrew

Brine, Steve

Brooke, Annette

Browne, Mr Jeremy

Bruce, Fiona

Buckland, Mr Robert

Burley, Mr Aidan

Burns, Conor

Burns, rh Mr Simon

Burstow, rh Paul

Burt, rh Alistair

Cable, rh Vince

Cairns, Alun

Carmichael, Neil

Carswell, Mr Douglas

Cash, Mr William

Chishti, Rehman

Chope, Mr Christopher

Clappison, Mr James

Clark, rh Greg

Clarke, rh Mr Kenneth

Clegg, rh Mr Nick

Clifton-Brown, Geoffrey

Coffey, Dr Thérèse

Collins, Damian

Colvile, Oliver

Cox, Mr Geoffrey

Crabb, Stephen

Crouch, Tracey

Davey, rh Mr Edward

Davies, Glyn

Davies, Philip

de Bois, Nick

Dinenage, Caroline

Djanogly, Mr Jonathan

Dorrell, rh Mr Stephen

Dorries, Nadine

Doyle-Price, Jackie

Drax, Richard

Duddridge, James

Duncan Smith, rh Mr Iain

Ellis, Michael

Ellison, Jane

Ellwood, Mr Tobias

Elphicke, Charlie

Evans, Graham

Evans, Jonathan

Evans, Mr Nigel

Evennett, Mr David

Fabricant, Michael

Farron, Tim

Featherstone, Lynne

Foster, rh Mr Don

Fox, rh Dr Liam

Francois, rh Mr Mark

Freeman, George

Freer, Mike

Fullbrook, Lorraine

Fuller, Richard

Gale, Sir Roger

Garnier, Sir Edward

Garnier, Mark

George, Andrew

Gibb, Mr Nick

Gilbert, Stephen

Gillan, rh Mrs Cheryl

Glen, John

Goldsmith, Zac

Goodwill, Mr Robert

Graham, Richard

Grant, Mrs Helen

Grayling, rh Chris

Green, rh Damian

Greening, rh Justine

Grieve, rh Mr Dominic

Griffiths, Andrew

Gummer, Ben

Hague, rh Mr William

Halfon, Robert

Hames, Duncan

Hammond, rh Mr Philip

Hammond, Stephen

Hancock, Matthew

Hands, rh Greg

Harper, Mr Mark

Harrington, Richard

Harris, Rebecca

Hart, Simon

Harvey, Sir Nick

Haselhurst, rh Sir Alan

Hayes, rh Mr John

Heald, Oliver

Heaton-Harris, Chris

Hemming, John

Henderson, Gordon

Hinds, Damian

Hoban, Mr Mark

Hollingbery, George

Hollobone, Mr Philip

Holloway, Mr Adam

Hopkins, Kris

Horwood, Martin

Howarth, Sir Gerald

Howell, John

Hughes, rh Simon

Huppert, Dr Julian

Hurd, Mr Nick

Jackson, Mr Stewart

James, Margot

Jenkin, Mr Bernard

Jenrick, Robert

Johnson, Gareth

Johnson, Joseph

Jones, Andrew

Jones, Mr Marcus

Kawczynski, Daniel

Kelly, Chris

Kennedy, rh Mr Charles

Kirby, Simon

Knight, rh Sir Greg

Kwarteng, Kwasi

Lamb, Norman

Lancaster, Mark

Lansley, rh Mr Andrew

Laws, rh Mr David

Leadsom, Andrea

Lee, Jessica

Lee, Dr Phillip

Leech, Mr John

Leigh, Sir Edward

Leslie, Charlotte

Letwin, rh Mr Oliver

Lewis, Brandon

Liddell-Grainger, Mr Ian

Lloyd, Stephen

Lopresti, Jack

Loughton, Tim

Luff, Sir Peter

Lumley, Karen

Macleod, Mary

Main, Mrs Anne

Maude, rh Mr Francis

Maynard, Paul

McCartney, Jason

McCartney, Karl

McIntosh, Miss Anne

McPartland, Stephen

McVey, rh Esther

Menzies, Mark

Metcalfe, Stephen

Miller, rh Maria

Mills, Nigel

Milton, Anne

Mordaunt, Penny

Morgan, rh Nicky

Morris, Anne Marie

Morris, David

Morris, James

Mosley, Stephen

Mowat, David

Mulholland, Greg

Mundell, rh David

Munt, Tessa

Murray, Sheryll

Neill, Robert

Newton, Sarah

Nokes, Caroline

Nuttall, Mr David

O'Brien, rh Mr Stephen

Offord, Dr Matthew

Ollerenshaw, Eric

Opperman, Guy

Ottaway, rh Sir Richard

Paice, rh Sir James

Parish, Neil

Patel, Priti

Paterson, rh Mr Owen

Pawsey, Mark

Penning, rh Mike

Penrose, John

Percy, Andrew

Perry, Claire

Phillips, Stephen

Pickles, rh Mr Eric

Pincher, Christopher

Poulter, Dr Daniel

Prisk, Mr Mark

Pritchard, Mark

Pugh, John

Raab, Mr Dominic

Randall, rh Sir John

Reckless, Mark

Redwood, rh Mr John

Rees-Mogg, Jacob

Reevell, Simon

Reid, Mr Alan

Robathan, rh Mr Andrew

Robertson, rh Hugh

Robertson, Mr Laurence

Rogerson, Dan

Rudd, Amber

Ruffley, Mr David

Russell, Sir Bob

Rutley, David

Sanders, Mr Adrian

Sandys, Laura

Scott, Mr Lee

Selous, Andrew

Shapps, rh Grant

Sharma, Alok

Shepherd, Sir Richard

Simmonds, Mark

Simpson, Mr Keith

Skidmore, Chris

Smith, Chloe

Smith, Henry

Smith, Julian

Smith, Sir Robert

Soames, rh Nicholas

Spelman, rh Mrs Caroline

Spencer, Mr Mark

Stanley, rh Sir John

Stephenson, Andrew

Stevenson, John

Stewart, Iain

Streeter, Mr Gary

Stride, Mel

Stuart, Mr Graham

Stunell, rh Sir Andrew

Sturdy, Julian

Swales, Ian

Swayne, rh Mr Desmond

Swire, rh Mr Hugo

Syms, Mr Robert

Tapsell, rh Sir Peter

Teather, Sarah

Thornton, Mike

Timpson, Mr Edward

Tomlinson, Justin

Tredinnick, David

Truss, Elizabeth

Tyrie, Mr Andrew

Uppal, Paul

Vaizey, Mr Edward

Vara, Mr Shailesh

Vickers, Martin

Villiers, rh Mrs Theresa

Walker, Mr Robin

Wallace, Mr Ben

Walter, Mr Robert

Ward, Mr David

Watkinson, Dame Angela

Weatherley, Mike

Webb, Steve

Wharton, James

Wheeler, Heather

White, Chris

Whittaker, Craig

Whittingdale, Mr John

Wiggin, Bill

Willetts, rh Mr David

Williams, Mr Mark

Williams, Roger

Williams, Stephen

Williamson, Gavin

Willott, Jenny

Wilson, Mr Rob

Wollaston, Dr Sarah

Wright, Jeremy

Wright, Simon

Yeo, Mr Tim

Young, rh Sir George

Zahawi, Nadhim

Tellers for the Noes:

Mark Hunter


Mr Sam Gyimah

Question accordingly negatived.

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7.13 pm

The debate stood adjourned (Standing Order No. 9(3)).

Ordered, That the debate be resumed tomorrow.


NHS Health Services in Guisborough, Skelton, Brotton and Park End (Middlesbrough)

7.14 pm

Tom Blenkinsop (Middlesbrough South and East Cleveland) (Lab): The petition states:

The Petition of residents of the UK,

Declares that the Petitioners believe in fighting to defend the NHS, believe in fighting to defend the NHS services in East Cleveland and Park End, Middlesbrough, and oppose cuts inflicted by the Conservative-led government’s Health and Social Care Act 2012; further that the Petitioners believe that proposals to scrap GP services at Skelton Medical Centre should be abandoned; further that proposals to scrap GP services at Park End Medical Centre should also be abandoned; further that the Petitioners believe that South Tees clinical commissioning group’s plans to close East Cleveland Hospital’s and Guisborough Hospital’s minor injuries units is short-sighted given the £30 million deficit of South Tees Hospitals NHS Foundation Trust; and further that the Petitioners condemn South Tees clinical commissioning group’s decision to close Skelton’s NHS walk-in centre.

The Petitioners therefore request that the House of Commons urges the Government to encourage NHS England and South Tees clinical commissioning group to reverse plans to close Park End Medical Centre, Skelton Medical Centre, its NHS walk-in centre and East Cleveland and Guisborough Hospital’s minor injury units.

And the Petitioners remain, etc.


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Localised Health Care

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

7.16 pm

Stephen Barclay (North East Cambridgeshire) (Con): The new chief executive of the NHS was right two weeks ago to highlight the need to reshape the NHS around the priorities of patients, particularly elderly patients. As Simon Stevens pointed out:

“Two thirds of hospital patients are over retirement age.”

A solution to his challenge could be piloted in the perhaps unlikely setting of the Cambridgeshire fens, a rural area where we need clearer leadership in reshaping services in the way he articulated in that speech. Patients in North East Cambridgeshire continue to travel to hospitals for appointments that could take place in the community or even in their own homes. That would save them transport and parking costs, be less exhausting and more convenient, reduce the risk of secondary infections in hospitals and increase the likelihood that family and friends could support them throughout the pathway of their treatment.

In parallel, GPs are currently under considerable pressure in rural communities such as North East Cambridgeshire, where they are having to juggle the issues of accessibility, quality and affordability with the national challenge of rising demand, an older population and increasingly complex health needs. Yet GPs continue to undertake work that could be prevented through better use of other NHS resource, lightening our GPs’ workload and streamlining part of their workload through the use of equipment and better IT. However, too often the fractured lines of accountability in the NHS and the different tiers are getting in the way of the urgent need to localise health delivery outputs so that patients can receive treatment in the community and at home, rather than incurring journeys to hospital.

I want to start with a paradox. You may recall, Mr Speaker—perhaps with a shudder, as though it was a bad dream, rather than with the fond sigh of recalling happy memories—that the Health and Social Care Act 2012 was debated extensively in this House two years ago. However, once legislation becomes law, there is a tendency for Parliament to assume that the job is done—that it has been implemented and that therefore nothing further is required. But if we look at the variance in performance of clinical commissioning groups—and, indeed, NHS regional teams—and how the 2012 Act has been implemented, we see that much work remains to be done.

At the heart of the 2012 Act was a great advantage to patients. It was about empowering GPs and clinicians, who best understand the needs of their local community and patients, to act as informed buyers on their behalf, to drive innovation, challenge existing practice, change behaviours and shift treatment from hospitals into the community. The danger is that the great advantage of that legislation, which was debated at great length under your stewardship, Mr Speaker, has now slightly slipped from focus, as the media caravan and the political debate move on to other things. We are at risk of missing out on the central prize, which is how better to innovate and deliver things in a way that advantages patients more.

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I want to share three examples of where the current delivery of patient services appears illogical. The first concerns patients suffering from the distress of cancer—you will have them in your constituency, Mr Speaker—and facing tiring journeys to hospital. I had the honour of opening at St George’s surgery in Littleport last month oncology services delivered in the community by Addenbrooke’s nurses: instead of the patients travelling to Cambridge, the nurses come to deliver those services in a more convenient and friendly setting. But where is the drive to ensure that that model is now rolled out by Hinchingbrooke nurses into Doddington, by Peterborough hospital nurses into Whittlesey, by King’s Lynn nurses into the North Cambs hospital? Where is the urgency, while cancer patients continue to make those journeys at cost—in petrol, parking, tiredness and other ways in which their needs are not met? It is time that we accelerated that change to meet the challenge that Simon Stevens has set out.

Secondly, there is intravenous therapy—the delivery of antibiotics through a drip. You will no doubt be staggered, Mr Speaker, to know that patients in Cambridgeshire are being admitted to hospital for five to seven days simply to have antibiotics three times a day, when we could train community nurses to deliver that service in the rural community. That is not only a huge waste of money but, more important, we are putting patients at risk of secondary infections in hospital, as well as providing a less convenient service for them. When some areas of the country have shifted in that way, I cannot see any reason why it has not been adopted in Fenland in north-east Cambridgeshire. It is simply illogical that we still require patients to be admitted for such a straightforward treatment.

A third area is near-patient blood testing. Again, Mr Speaker, this will no doubt be an issue that GPs in your constituency have to deal with. If someone has a suspected blood clot, they are often currently put in an ambulance and sent to hospital. Yet for just £3,000, we could have machines in GP surgeries to provide the results straight away. It would not take that many saved ambulance journeys and the cost of admissions to hospital to start to pay that back. It might be that businesses in the community would be willing to work with the GP practices to deliver that equipment, but the leadership is not accelerating the roll-out of such an approach.

Next week, supported by my local papers—the Cambs Times, Wisbech Standard, Fenland Citizen and Ely Standard—I will launch a community campaign, identifying a range of issues, such as the three I have provided a flavour of today, in respect of which patients want these services back in the community to deliver better clinical outcomes in a more cost-effective way. It seems remarkable that this holy grail, sought by the NHS, is not being grasped with the urgency it demands.

In parallel, we need to recognise that our GPs are under significant pressure. Let me flag up three areas where innovation and reform are needed. The first is health trainers, which have been proven as a means of relieving and preventing pressure on GPs. Yet in Chatteris, Doddington and Manea—areas with significant health needs—we still do not have health trainers to relieve pressure on our GPs. The Minister will know that the National Audit Office highlighted how smoking cessation and other programmes have an important role to play in addressing health inequalities among different regions.

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Secondly, I am sure you will be as surprised as I was, Mr Speaker, to discover that within Cambridgeshire the area with the highest health needs is the area that gets the least money. I defy anyone, including the Minister, to explain that. It is largely down to historical reasons and the fact that the clinical commissioning group needs to reallocate funding. The Cornerstone practice in March receives just £62.50 per patient. The county average is between £75 and £80, and the highest-paid practice in Cambridgeshire receives £120. I know that the Minister faces constraints in terms of the overall budget, and of course the Government deserve credit for the fact that NHS spending in England—unlike that in Wales—has been ring-fenced, but I think that the funding allocation needs to be examined.

Finally, let me say something about a much maligned Cinderella service. At present, 65% of the children in my constituency who need mental health services must wait longer than 18 weeks. I know that, as a clinician, my hon. Friend will recognise the seriousness of that. As he will appreciate, it can lead to self-harm and even to suicide, and can damage life chances by affecting exam results, for instance. Furthermore, there are still problems relating to the handover from adolescent to adult mental care. The issue of mental health simply must be addressed if we are to tackle some of the health inequalities in North East Cambridgeshire, and, above all, if we are to meet the challenge set by Simon Stevens in relation to the reshaping of our services. I know that the Health Committee is examining mental health provision, and I hope that it will take account of the points that I have made.

The Health and Social Care Act allows us to deliver the benefits that I know my constituents want by reshaping community health care. The chief executive of the NHS has recognised the need to use levers within the service—such as the assurance role of NHS England, and the role of clinical commissioning groups—to deliver that reshaping, and my campaign next week will demonstrate that patients themselves want that to happen. I hope that the Minister will use his good offices to help the leadership to accelerate the innovation that is needed, so that community health care, which is currently languishing in the slow lane of change, can deliver the more patient-centred, localised treatment that will provide not only the best possible clinical outcomes for patients in North East Cambridgeshire, but the best possible value for money.

7.27 pm

The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter): I pay tribute to my hon. Friend the Member for North East Cambridgeshire (Stephen Barclay) for securing the debate and for his strong advocacy on behalf of his constituents and local patients. As he has continually reminded the House since his arrival here—I arrived at the same time—we, as a coalition Government, understand the importance of spending public money wisely and investing every possible penny in front-line patient care.

My hon. Friend raised a number of points, and I did not disagree with a word of what he said. In particular, he was right to emphasise the need for a radical transformation of the way in which we deliver care over

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the next five to 10 years. We need to deliver more care in the community, closer to people’s homes. It is a question not just of good health care economics, but of good patient care. It is right for people with complex care needs—people with diabetes, dementia and cancer—to be cared for as close to home as possible. That requirement is all the more acute and important in some of our more rural communities, such as my hon. Friend’s constituency in the fens.

We should bear in mind the challenge laid down by the former chief executive of the NHS and echoed by the current chief executive, Simon Stevens. We must ensure that we spend the NHS budget more wisely, and direct more money to front-line patient care. There have been real-terms increases in the budget, and, as a coalition, we are all proud of the fact that we are investing more money in the NHS even in difficult economic times. Nevertheless, we must ensure that that money is spent more wisely, and that the way in which care is delivered continues to become more efficient. We have an ageing demographic, and the effects of that are often experienced more acutely in rural areas. Our technology is continually improving, and patients rightly have rising expectations of the quality of care that they will receive. We must therefore ensure that we deliver care more effectively, and in a more patient-centred way.

To meet that challenge, more needs to be done on NHS procurement at local and national levels, as my hon. Friend highlighted. The Government support that. We need to do more in the health service to ensure that we reduce unnecessary administration and bureaucratic costs and back-office services. He highlighted that as a challenge for his local health economy.

It is crucial that we transform the way we deliver care. That means breaking down silos in Cambridgeshire and elsewhere, particularly between the hospital sector—Addenbrooke’s and Peterborough city hospital, for example—and the health care that is commissioned and delivered in the community by CCGs. That also applies to the social care sector run by the local authority. It is important that Cambridgeshire county council—my hon. Friend outlined the challenges—plays a key role in helping to transform the ways in which services are delivered. Sometimes, it will not be possible to decide whether an elderly and frail person in Cambridgeshire should receive care that is provided by social services or by the NHS. It is the same person; it is the same patient, and it is time that local authorities and the NHS dropped the silo working mentality, worked together and focused the money and attention on the patient. The better care fund that the Government are setting up will come into force next year. That will provide about £3.8 billion specifically to promote better integration of health and social care. I am sure that will be of great benefit in Cambridgeshire, including in the rural communities that my hon. Friend represents.

From an NHS perspective, there are three components to transforming the way services are delivered and to breaking down those silos. It is important we have the right leadership on the ground to deliver improvements. I know as a fellow east of England MP that we have had challenges sometimes in that regard. We need the right leaders to drive change. My hon. Friend was right to highlight that the changes under the Health and Social Care Act mean that we have clinical leadership through CCGs. That will bring benefits because decisions and

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resource allocations are being made by clinicians who understand where the money is best spent to improve patient care.

We also need the leadership from NHS England teams at an area level to be effective. I hope that my hon. Friend will agree that all MPs in Cambridgeshire and elsewhere need to hold those local area teams to account. We need to ensure that they are working to do their bit to support the clinical leadership on the ground at CCG level.

Hospital providers at Addenbrooke’s, Peterborough city hospital and elsewhere need to come together and work with the CCGs to deliver care. When we talk about delivering care in the community, one of the key aspects is having a work force who work across hospitals and the community—across both primary and secondary care. Far too often, a work force who work in, say, cancer services are based just in the hospital. In commissioning services, we need to recognise that the work force need to be commissioned across primary and secondary care. One example would be to have more specialist nurses in diabetes who not only work at the hospital base but are commissioned across the community. It is important to ensure that my hon. Friend’s CCGs work with the hospital provider, particularly Addenbrooke’s, a centre of international excellence, to deliver more holistic care for people with long-term conditions, and that the work force are not just based in the hospital but go out to where the patients are in the community. That is key to delivering improvements in care.

I want to highlight some of the important local issues that my hon. Friend has raised. I was pleased to hear him make the point about the St George’s surgery and that chemotherapy services are being delivered in the community. His constituents should be proud that they have a GP surgery that is delivering that sort of care in the community. Some of the sickest people, who often struggle to travel to hospitals, are being looked after close to home and receiving high-quality care in the local GP surgery. That sort of care needs to be regularly offered in the next five to 10 years in many more GP surgeries—not as an exemplar, but as a regular example of what good practice and good health care looks like. That is transforming services and delivering more care in the community. My hon. Friend should be very proud of the part he has played in helping to make that a reality, and proud of the fact that his constituents have a service many other people will be looking forward to having in the future.

We must also have the right preventive care so that people who do not need to go to hospital do not go there. My hon. Friend talked about intravenous therapy. Someone with an infection from a leg ulcer, for instance, who will need IV antibiotics could be given them in the community. Traditionally those patients have ended up in hospital not because that is the right place for them to be, but because the care in the community to provide IV antibiotic therapy was not available. That is not good for patients, nor is it good health care economics—it is expensive for the NHS. That is exactly the sort of service older people with complex care needs require, particularly in rural communities. I know my hon. Friend’s CCGs will want to prioritise that in the months ahead.

My hon. Friend highlighted the importance of having close-to-home blood testing facilities. Many older people may be on warfarin for atrial fibrillation or other medical

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conditions. It is important that for that, and other simple blood tests, the person is treated and looked after close to home by their general practice. In rural areas, particularly in Cambridgeshire and Suffolk, where my constituency is, the GP surgery is often the hub of care, so the more we can do to provide care in those environments and close to home, the better it will be for patients.

We will also find that more patients will turn up for their appointments. One of the major causes of non-attendance at appointments in rural areas is that frail older people struggle to get to where the care is. If that care is delivered by their GP much closer to home, that saves the health service money and makes those services much more accessible. Every general practice should be offering simple services such as blood testing and supporting patients with the management of warfarin. I am pleased my hon. Friend will be championing a campaign to make this a reality throughout Cambridgeshire.

If we are to deliver better services in the community, we must have the right training in place for our work force. We need to have a work force who have the right skills to look after people with complex care needs. Under our health care reforms, we now have Health Education England, with a £5 billion budget. At a local level there are now local education and training boards, which are responsible for delivering the right sort of training to staff in each locality. A particular priority for the local education training board in the east of England is recognising the rurality of places such as Cambridgeshire and making sure there is specialist training in dementia and other care areas that addresses the needs of rural communities and ensures that people can be treated close to home. We must have the staff with the right skills to make sure that that happens.

In that respect, there will be more specialist training for GPs in mental health and children’s health care. Much of GPs’ work load is in those areas, and it is extraordinary that in the past not all GPs have had the right training. Thanks to the changes we have made through the mandate to HEE, in future we will ensure not only that there are bespoke courses for GPs to specialise in these areas, but that the whole skill set of all GPs going through training is improved to provide better community-based care. That will bring benefits to my hon. Friend’s constituents.

My hon. Friend is right that the NHS has received real-terms increases in funding in this Parliament, and we are proud to have delivered that. Every CCG, including in Cambridgeshire, will be receiving increased funding. I can understand the frustration that perhaps the progress on changing the funding formula in accordance with the independent review findings has not been as quick as some of us representing more rural communities would have liked, but that is moving in the right direction. The funding formula is now set independently, away from political interference, and according much more to health care need rather than political drivers Ministers or others may set. We will see a funding formula that will be allocated much more in line with local health care needs, but NHS England will have an opportunity again this year to examine rurality as a factor in allocating the funding formula.

I hope my hon. Friend is reassured by some of the points I have made. More importantly, what has come from this debate is that we have seen that he is a

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champion for the local NHS and for local patients. In his work on the Public Accounts Committee, not only does he recognise the importance of spending taxpayers’ money wisely and putting money into front-line patient care, but he understands the long-term challenges involved in transforming care. We need much more collaboration between different GP surgeries. Local commissioners need to lead that, we need more back-office sharing to reduce costs in GP surgeries, and we need better management of estates. We recognise that many GPs are small businesses in their own right, but small businesses may need to work together in a publicly funded health service to realise economies and free up more money to deliver better patient care; and we need to invest in telehealth, telemedicine and the right technology to support people with long-term conditions at home.

We also need to ensure that the better care fund that comes into effect next year is used effectively to join up what social services do with the NHS, to focus more attention on the patient and to break down the historical silos between the NHS and social care. We also need to

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ensure that commissioners, involved in clinically led commissioning, drive this process. They need to challenge other commissioners to do the right thing and make sure that patients are always at the centre of what happens. That is the objective, it is what needs to happen, and I know that my hon. Friend will be championing the cause locally. The goal is there and I know that he will be at the heart of the debate locally to break down those silos and to transform radically the way care is delivered, because he cares about his local patients, and I know that his local clinical commissioning groups do too.

There will be different ways of doing things in future, but they will of course be to the benefit of patients. I am delighted that he is championing this agenda, and he can count on my full support and the support of the Government in taking it forward. Once again, I congratulate him on securing this debate and on the leadership he is showing to support his local NHS in delivering better care for patients.

Question put and agreed to.

7.42 pm

House adjourned.