The CCG never went through with those proposals, and rightly so. Since then, however, there has been a constant threat and a worry in my mind about Eastham walk-in centre. I want to make it clear to the Minister that if there is any risk at all of that walk-in centre closing, he will receive representations from me pretty

21 Jan 2015 : Column 279

quickly, because it is an absolutely vital service. Unless we again conceive of the NHS as being there for patients and the public first and think about how to bring these facilities close to people, we will never get an efficient and effective service fit for the next generation. Walk-in centres are absolutely vital. It sends a chill down my spine to hear the shadow Secretary of State say that one in four has closed; if anything, we should be opening more.

Secondly, I want to talk about social care and older people. We all know that we have the benefit of an ageing population in our country. With an older population, we will have a more experienced and expert population. I take it to be a good thing that people’s grandparents and valued members of their family are living longer, but with that comes a responsibility to look after them properly.

I ask Ministers what has happened to the better care fund. What evidence is there that it has been used to find solutions that are really working? All I see on my patch is council cuts and then the consequences turning up at the door of the hospital. Older, more seriously ill people in our community are turning up at A and E, with the distress to them of being there, the consequential responsibility on staff and the worry for families as people lie on trolleys.

We need a much more radical approach. Integration is clearly the answer, but I would like us to go further: I want us to truly address the work force issues in social care. It is not good enough that poverty pay is endemic among those who look after the most senior members of our community. That is not acceptable; nor is the zero-hours culture. We once had that problem in child care, but as a country we took on the responsibility of changing the culture in the work force for the good of our children, and we must do the same for the benefit of our older people.

I will not speak for much longer, Mr Deputy Speaker, but I want to say something about mental health, which should be part of the strategic approach that we must take to change the NHS for the benefit of the next generation. Parity of esteem is of course correct and absolutely right. I take it that there is now cross-party consensus on that issue and that everyone in the House thinks that we should treat mental health as seriously as we do physical health, with no barriers to getting proper treatment. However, I want us to do something else: we need to recognise the interconnected nature of physical health and mental health. It is not just that we also need to treat mental health, but that if we sort out people’s mental health issues and conditions and empower them to live better and happier lives, they will have better physical health and will make better use of the NHS’s scarce resources.

Chloe Smith (Norwich North) (Con): I warmly welcome the hon. Lady’s last point, but why did she not prevail on her Front-Bench colleagues to include it in the motion?

Alison McGovern: I have many conversations with my right hon. and hon. Friends on the Front Bench, but they do not always ask me for a full briefing before they draft their motions, as I am sure the hon. Lady appreciates.

21 Jan 2015 : Column 280

I conclude by saying that with the appropriate use of walk-in centres, a radical approach to social care and real consideration of the interconnections between physical and mental health, the difference we can make to our NHS will be excellent.

4.11 pm

Chris Skidmore (Kingswood) (Con): I thank the Department for recent rises in health care funding in South Gloucestershire. Only yesterday, I received a written answer to a parliamentary question showing that South Gloucestershire CCG will receive £263 million for 2015-16, which is up from £249 million in 2014-15 and from £239 million in 2013-14. That 7% increase in per person funding, from £921 in 2013 to £997 today, is the 16th largest rise out of 211 CCGs. Tomorrow, I will attend the opening of the Leap Valley medical centre in Emersons Green, which is a brand-new, multi-million pound GP centre for the benefit of my constituents in Downend and Emersons Green. Things are therefore looking up for NHS funding in South Gloucestershire and Kingswood.

I was pleased to have a meeting with the Chancellor at which my hon. Friend the Member for Filton and Bradley Stoke (Jack Lopresti) and I convinced him to give £1 million from LIBOR funds to the Great Western air ambulance, about which the chief executive has said that he is absolutely delighted. As the local MP, I have been pleased to be able to push for such improvements in health care.

I want to raise my concerns about the health care situation in Bristol, particularly in relation to Southmead hospital, a brand-new hospital under a £500 million private finance initiative contract that was signed and sealed under the previous Government. As a consequence of the opening of Southmead hospital, Frenchay accident and emergency was closed. It is no coincidence that Southmead has struggled since that closure. As a candidate and as an MP, I fought to keep the A and E open, after the decision to close it was taken in the Bristol health services plan for 2004 to 2006.

I still believe that the closure of Frenchay A and E was an absolute disgrace for our local community. We all know that it happened when the local North Bristol NHS Trust decided to prioritise Southmead over Frenchay because Frenchay’s more expensive land could be used to build a housing estate. We are now seeing the consequence of the reorganisation that took place under the previous Government. It happened despite the fact that 50,000 people signed a petition to get the then Secretary of State, Patricia Hewitt, to refer the decision to the Independent Reconfiguration Panel, which she refused to do. It was a total mistake for the previous Government to decide to prioritise Southmead over Frenchay.

Cossham hospital, another hospital in my patch, was threatened with closure in 2004. The Save Cossham Hospital campaign group was fantastic in opposing that potential closure by the health chiefs of North Bristol NHS Trust as part of the disastrous Bristol health services plan. As a result, Cossham hospital has had a £19-million refurbishment and looks fantastic. I believe that the shadow Secretary of State visited it a couple of months ago.

However, there is a gaping hole, because the minor injuries unit that was promised for Cossham hospital is yet to be delivered. Along with all the parties and the

21 Jan 2015 : Column 281

fantastic Save Cossham Hospital group, which is led by Reg Bennett, we have collected well over 17,000 signatures to call for the minor injuries unit. I have secured several debates in Parliament, as the Minister well knows, to call for a Cossham MIU. Regardless of the status of the minor injuries unit, we were promised it because Frenchay A and E was closing. That decision was taken by the previous Government, as I said, and the final contracts were signed in February 2010.

Having been promised this health resource in Kingswood after Frenchay A and E closed, we deserve to get it. It is too far to get round to the other side of Bristol and there are no proper bus services to Southmead hospital. We must remember that NHS services are funded by the taxpayer, so every taxpayer deserves equitable treatment and access to local health care services. I do not believe that my constituents are getting that because Frenchay A and E has closed and Southmead is too far away. We need our minor injuries unit at Cossham hospital.

Only today, there was a meeting of the public health and health scrutiny committee of South Gloucestershire council. On 19 November, I spoke at the committee in person to call for the decision about the minor injuries unit to be referred to the Secretary of State. The committee agreed in principle. I contacted the Department this week, having had regular meetings with the Health Secretary to discuss Cossham and Frenchay, only to find that no letter has been sent by the committee to the Health Secretary. The Department of Health simply has not received such a letter. Today, it turns out that the committee is yet to refer the decision to the Health Secretary. Without that official referral by the committee, the Health Secretary cannot refer the decision to the Independent Reconfiguration Panel.

I call on South Gloucestershire’s public health and health scrutiny committee to get a move on, pull their finger out and send the letter to the Health Secretary. I hope that Ministers will confirm that once they receive the letter, they will be able to refer the decision about Cossham minor injuries unit to the Independent Reconfiguration Panel. It is simply not good enough for the committee to have this month-on-month delay without sending the referral letter to the Health Secretary. People in Bristol have waited too long. They saw Frenchay A and E close, which was a disgrace and will always be Labour’s worst legacy in my local area. We need the minor injuries unit at Cossham hospital and I will continue to fight for it every single day.

4.17 pm

Sir Gerald Kaufman (Manchester, Gorton) (Lab): The national health service is, without doubt, the most precious asset this country possesses. It was created by a Labour Government against, as we should recall at all times, the votes of the Conservative party in this House of Commons.

The Minister who created the national health service was Aneurin Bevan. He did so by immense negotiation, including with the British Medical Association, which he got on board to support and participate in it. As well as having administrative abilities and abilities of persuasion, Nye Bevan was the greatest orator I have ever heard. I met him on a number of occasions and heard him speak. I remember one speech that he made at Labour party conference when a Conservative Government were in power, in which he said of a Minister, “The Marquess

21 Jan 2015 : Column 282

of Salisbury has an ancient lineage. It is almost as old as the Poor Law itself.” Nye Bevan would be horrified that in far too many ways, the national health service has descended to Poor Law levels.

Margaret Thatcher said:

“The National Health Service is safe in our hands.”

This Government’s hands are throttling the national health service. Under this Government, the NHS has had an extremely costly reorganisation that cost £3 billion and provided no benefit at all.

A recent survey of GP services—we all rely on our GPs; heaven knows that I would not be standing here today had it not been for my GP referring me to the national health service—showed that ratings have declined for every aspect of trying to see a GP, including opening hours, waiting for an appointment, and waiting in the surgery. Looking at causes, it pointed out that general practice has had its funding reduced over the past five years, and it is five years since this Government came to power. Too often, the system is blocked by bureaucracy that prevents it from operating effectively at the point of use.

Like other hon. Members, no doubt, I get a constant stream of letters on this issue from constituents, and this morning I received a letter from a constituent about his son:

“I have a son…who has psoriasis and he has had this for up to a year now. He has been putting up with it, but it has come to the stage now that it’s unbearable. It’s all over his body including his private parts too. He had to finish work due to that. He can’t sit down with it…He is not sleeping at night. He is bleeding all the time. He can’t go out. He is always in his bedroom…he is in pain day and night.”

My constituent’s GP referred him as an urgent patient to a local hospital, and he has an appointment for 28 March. He is going through hell, and he will go through two more months of hell before he is seen, let alone treated.

Again and again we get such cases. There was a recent debate and meeting about blood diseases. I have a constituent who has a blood disease. He has HIV and is making no progress at all. It is heartbreaking to read such letters, but it is far more heartbreaking to live through such a situation than it is to read about it or even try to help.

The situation is not only affecting the patients, or in some cases would-be patients. Without the essential contribution of NHS workers the service could not function, but they are being victimised. This year, 60% of NHS workers will get no cost of living pay increase at all. They have had a two-year pay freeze, followed by a 1% pay rise. National health service workers’ pay has fallen by 12% to 15% in real terms since this Government came to office.

As a result of the shortage of funds available to the national health service, very bizarre things happen. I want to draw the Minister’s attention to something that is happening in my constituency and ask him to look into it. I have no great confidence that I will get any response, because at recent Health questions I raised two cases and was told by the Minister that they would be looked into. That was the last I heard from the Department of Health on the subject.

I describe this situation because it is not only a major health issue, but a major community issue. Currently, there is no landing site available in Manchester for

21 Jan 2015 : Column 283

helicopter ambulances for either the Royal Manchester adult major trauma centre or the Manchester children’s hospital paediatric major trauma centre. There is a lack of money to provide a landing ground for air ambulance centres to do their vital work—heaven knows I praise them for it—so there is a plan to have a landing site in a park in my constituency.

Friends of Birchfields Park, the organisation of local residents that looks after the park, had a meeting on Saturday. I promised them that I would raise it in the debate. There will be a landing site in the park, but it is a small park and part of it will be lost. It will be used something like every three days, so there will be disruption the whole time. Apart from the disruption in the park, the site is next to two schools, one of which is extremely near to the proposed landing area. It is a heavily populated area. A ground ambulance must go the site to pick up the patients who are landed, which will affect traffic on an extremely busy road.

One of the most odd things of all is the effect on the park’s nature. Those responsible for suggesting that landing site say:

“The majority of wildlife will evacuate the area proximate to the aircraft due to the noise and displacement of air and downwash during landing and take-off.”

Apart from the affect on the wild creatures, which share this planet with us and ought to have as many rights as we have, the thousands of people who live in the area will be affected. I am not in any way belittling the air ambulance service—it is vital, essential and dedicated—but it is extraordinary that it will be reduced to using Birchfields park as a landing site because it does not have the money to create its own.

All hon. Members pay tribute to the national health service. As I have said, heaven knows I have a greater duty than most in the House to thank the NHS for what it has done. Everybody needs it. It is just about the only service in this country apart from education that absolutely everybody needs. It ought to be given priority, but it has been severely damaged by the Government. That is accepted by the electorate. Every opinion survey shows that the Government are blamed for what is happening to the NHS, and that the electorate are worried about it. Roll on 7 May.

4.29 pm

Mr Simon Burns (Chelmsford) (Con): It is a pleasure to follow the right hon. Member for Manchester, Gorton (Sir Gerald Kaufman), although he would not expect me to agree with everything he has just said.

I listened to the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson) with considerable interest. One thing that struck a chord with me was when, at the beginning of his speech, he said, basically, that the NHS should not be a political football. I could not agree more. It does a great disservice to the people who work so hard—the doctors, nurses and ancillary staff—to provide health care for the citizens of this country, to see it turned into a party political football. Let me explain what I mean by a political football.

The Opposition have, of course, a democratic right to hold the Government of the day to account for their stewardship of the health service, as they do on education

21 Jan 2015 : Column 284

or anything else. Of course, every individual Member of Parliament, regardless of party, has a right to fight for the interests of their constituents with regard to health care if they feel that it is failing their constituents.

Ian Austin: Will the right hon. Gentleman give way?

Mr Burns: No, I will not, because I only have eight minutes.

What I decry, however, is when, in the generality, the health service is used to attack a political party, whether the Government or whatever, simply to try to score cheap party political points. That does a grave disservice to the NHS. As the right hon. Member for Manchester, Gorton said, people in this country love the health service. They believe in it, free at the point of use for all those who are eligible to use it. I, like I imagine millions and millions of taxpayers, have no objection to paying our taxes to have a free health service. To appropriate the four freedoms of Franklin Roosevelt, there is a fifth freedom: the freedom from fear of a medical bill dropping on one’s mat and financially ruining one’s family.

Where I see the greatest and, to my mind, the most disgraceful attack is in the accusation, which is not new—it was being made in 1979, and, I suspect, before then, but fortunately I am a bit too young to remember exactly—that the Conservative party wants to privatise the health service. We do not and we never have done. As long as I am a politician, and my right hon. Friend the Prime Minister is, we never will. I find it extremely aggravating and hurtful when this cheap shot is made.

One of the examples of privatisation given is the use of the private sector to improve and enhance the health care of our constituents. Let me just explain something. Over Christmas, I read an extremely good new book, which I strongly recommend to the right hon. Member for Leigh (Andy Burnham), if he has not already come across it. “Nye”, by Nicklaus Thomas-Symonds, is the new biography of Nye Bevan. It is a fascinating book, particularly the part about when he was the Minister for Health from 1945 to July 1948 and putting together and negotiating the creation of the NHS. It sets out the arguments he had with the medical profession and others, and the compromises he had to make to establish the NHS. Many people do not realise that even to this day, as a result of those compromises, 95% of GP practices are private small businesses. I do not decry that, because they are treating patients, under the national health service, free of charge.

Historically, a lot of mental health care has been free of charge, but provided by the private sector. In the 1990s, when I was a Health Minister, I remember John Major using the private sector to bring down waiting lists and waiting times for operations. My constituents had no problem whatever with that, providing it was free and kept to the core principle of the NHS. The last Labour Government, the Blair-Brown Government, were quite happy to use the private sector providing it was benefiting NHS patients.

The shadow Secretary of State kindly mentioned—albeit in passing—Chelmsford walk-in centre and suggested it was a great political scandal and the next bandwagon he was going to jump on. May I point something out to him? The walk-in centre was created from the dying embers of his stewardship of the NHS, in March 2010, to be run by a private company. I have no problem with

21 Jan 2015 : Column 285

that, if it is serving NHS patients. However, its sole purpose was to reduce pressures on A and E at the local hospital, and I am afraid it has singularly failed to do that. The use of A and E at Broomfield hospital, just down the road, has increased inexorably and, in that respect, the walk-in centre has failed.

Andy Burnham: I am listening carefully to the right hon. Gentleman. As he knows, I have huge respect and affection for him, but he is arguing that NHS privatisation is a myth and that our accusation is wrong. If he does not mind, I will quote what he said during the Committee stage of the Health and Social Care Act 2012:

“As NHS providers develop and begin to compete actively with other NHS providers and with private and voluntary providers, UK and EU competition laws will increasingly become applicable.”[Official Report, Health and Social Care Public Bill Committee, 15 March 2011; c. 718.]

Why, then, is it a myth that he and his Government have exposed the NHS to a greater risk of commercialisation, marketisation and, indeed, privatisation?

Mr Burns: First, competition was introduced on the current scale by the Blair-Brown Government, and secondly, there is nothing wrong, per se, with competition to get the best providers providing the best care for patients, so long as they keep to the sole ethos of the NHS, which is that that good care be provided free at the point of use for NHS patients. We saw that under his Government and under the Major Government, and this Government have used the private sector to ensure that patients are treated more quickly. We want them to be treated as quickly as possible, and if there is not enough capacity in the NHS, and if a private provider can provide the capacity, I see nothing wrong with that, and neither do most people in this country, if they are treated more quickly.

Returning to the walk-in centre, there were 40,000 attendances last year, 10,000 of which were by people beyond the Mid Essex CCG area. Of the remaining attendances, one third should have been self-caring or using their community pharmacy or 111, which the CCG is paying for, and another third should have been using their community pharmacy or GP, which the NHS is paying for. The CCG was therefore paying twice for the same care for the same patients, which is an utter waste of money. That money should be being used to care for more patients quicker, which is why the CCG has taken the decision it has. It is a rational decision, because the centre is failing to meet the aims it was set up for and instead ensuring that the NHS pays twice for the same patient to be treated. In place of the walk-in centre, there will now be an urgent care service at the local hospital for those people who should be going there. Sometimes, politicians have to do the right thing, regardless of political point scoring. Where it is in the interest of patients and the configuration of services, they should take the right decision, be reasonable and responsible and explain why it is the case.

In conclusion, I am delighted to see the hon. Member for Hackney North and Stoke Newington (Ms Abbott) in her place. I am fascinated to note that the nub of the motion is a call for an extra £2.5 billion for the NHS, which I am sure she strongly supports. What worries and concerns me—she may have a problem when it comes to voting at 7 o’clock tonight—is that the motion goes on to say that it is going to be

21 Jan 2015 : Column 286

“funded by measures including a tax on properties worth over £2 million”.

Given the battle the hon. Lady had on the radio with a member—a right hon. Member— of her party from a southern Scottish constituency, I imagine that she is in turmoil, wondering how to justify that funding from that source.

Ms Diane Abbott (Hackney North and Stoke Newington) (Lab): I am in no turmoil whatever. I will be walking through the Lobby with pride behind my hon. Friends. We cannot know exactly how much a mansion tax, if levied, would raise towards the national health service. What we do know is that the British people who want to save the national health service from the depredations of Government Members have to vote Labour. We have to vote for my right hon. Friend the Member for Leigh (Andy Burnham) to become Secretary of State for Health—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order. We do not need a statement; we have got the message.

Mr Burns: In conclusion, it is sad that the hon. Lady has completely undermined the case and the costings of the right hon. Member for Leigh (Andy Burnham). I have no doubt that when she has swallowed her pride and gone through the Lobby today, she will battle as hard as she is renowned for battling and will hit the leader of her party over the head to try to get him to see common sense and abandon this ridiculous policy that she also thinks is ridiculous.

Several hon. Members rose

Mr Deputy Speaker: Order. I have tried to work within the spirit of the previous announcement, but I think the time has come to introduce the eight-minute limit.

4.41 pm

Mark Reckless (Rochester and Strood) (UKIP): My party believes in an NHS free at the point of use and funded out of general taxation. I support much of what is in the motion today. I, too, would question what it states about outsourcing, as it is not quite clear whether outsourcing will be based on hypothecation in relation to how much the mansion tax raises or on how much the Conservatives happen to be spending. I believe we need to decide the right amount to spend on the NHS and then to commit to it, rather than simply say it should be £2.5 billion above however much the Tories spend—either cutting or increasing. We should make a decision about how much the NHS needs and then fund it properly. I support the principle of joining up adult social care with the NHS, and I thought that the shadow Secretary of State made a persuasive case for a single budget.

Ian Austin: What does the hon. Gentleman think it tells us about his leader’s instincts when he said:

“I think we are going to have to move to an insurance-based system of health care.”?

Moreover, what does he think it tells us about his deputy leader’s instincts when he said that he wanted to

“congratulate the coalition government for bringing a whiff of privatisation into the…National Health Service…the very existence of the NHS stifles competition.”?

21 Jan 2015 : Column 287

Does that not prove that ordinary people who rely on the NHS cannot regard UKIP as being in any sense on their side?

Mark Reckless: It proves nothing of the sort. The hon. Gentleman faces a very strong challenge from UKIP in his constituency from the excellent Bill Etheridge MEP. The policy of our party—[Interruption.] No, let me answer the point. Our policy is determined by our party as a whole. We are committed to an NHS free at the point of use and funded properly out of general taxation. [Interruption.] May I continue? I personally come from a mother and father who met in the NHS; the NHS and supporting it is in my blood. I believe in the NHS as I have described it, and I would appreciate the courtesy of people accepting the sincerity of what I say on that.

I am pleased to see the shadow Secretary of State still in his place as he has been throughout the debate, but when it comes to funding the social care budget, it is a moving target to determine what that budget is. We know the local government settlement for the year ahead, but not for beyond that. We do not know what either a Conservative-led or Labour-led Government might be able to, or choose to, spend on local government, or what proportion might be allocated to public health budgets. It thus strikes me as a significant risk to say, without greater clarity, “This is what the budget will be, plus the sum of £2.5 billion”—the figure selected by the shadow Health Secretary and his party, irrespective of what the baseline is.

Steve Rotheram (Liverpool, Walton) (Lab): Can the hon. Gentleman be absolutely certain of what his party might or might not do should it ever—unfortunately—find itself propping up a Government? Can he assure us that the road to Damascus-style conversion that he is describing represents the view of the whole of his party, and not just his individual view?

Mark Reckless: Yes, I can give the hon. Gentleman that assurance. It is the view of my party, it is the view of the whole party, and it is my own personal view, which is core to my politics and what I came to the House to represent.

The Prime Minister said earlier that I came to the House week after week to discuss the NHS in Kent. Following what could perhaps be described as an endorsement of my approach from the Prime Minister, I now wish to raise some of the issues that have arisen in Medway. One of the problems with the motion is that it makes no mention of introduction of the new GP contract in 2004, which I believe has been a significant driver of increased demand for A and E services.

In Medway, where the proportion of single-handed general practices is significantly higher than the national average, the burden of out-of-hours care falls largely on an organisation called MedOCC. While I would encourage constituents to use MedOCC rather than A and E when that is appropriate, I have one or two concerns about the way in which it operates.

Like the hon. Member for Wirral South (Alison McGovern), we had a young child who was ill, and we sought an appointment. My wife telephoned MedOCC

21 Jan 2015 : Column 288

and we were offered an appointment at a particular time, but were then told that the wait would be an hour and a half. We said “If the wait will be an hour and a half, why do you not give us an appointment an hour and a half later than the one that you have just given us?” However, that was not allowed. We had to wait for an hour and a half, because that was the procedure, and that was the way it had to be. Although we went to the MedOCC clinic because we thought that that was the appropriate service, I would understand it if a constituent in the same circumstances decided to take his or her chances at A and E, where it might even be possible to be seen more quickly.

It is important for an out-of-hours service—in our case, MedOCC—to be flexible and responsive, and to be operated in a way that makes it an attractive and appropriate alternative to A and E, and I shall develop that point further when I meet members of the clinical commissioning group on Friday.

Rehman Chishti: The hon. Gentleman and I share the same hospital in Medway. Will he join me in welcoming the extra £13.4 million that has been given to its A and E department, the extra £6 million of winter funding, and the additional £10 million that has been given to the CCG to help to improve local health services?

Mark Reckless: I do indeed welcome those sums; I pressed for them strongly. I was particularly delighted by the provision of that £13.4 million for the rebuilding of the A and E department, which I think is essential. I am now campaigning for the provision of a further sum of approximately £20 million so that the hospital can build what it describes as an “emergency village”, consisting of short-stay medical wards around the A and E to improve the throughput of patients and the quality of care.

I have also helped the hospital with its efforts to ensure that patients are referred more appropriately, and are not necessarily sent to A and E. If a GP refers a patient to hospital and that patient has a known condition, surely it is better for the patient to go to the relevant ward than to be pushed through A and E, which is not an appropriate environment for someone who has already been assessed by a GP. Similarly, A and E is rarely the right environment for people suffering from dementia. It is best for action to be taken at the nursing home or by GPs, possibly based alongside A and E, who can make a speedy assessment and transfer the person to an appropriate treatment area. I am also pleased by the decision to end the so-called Star system in Medway A and E. The idea was that someone would be assessed by a senior clinician before it was decided what should be done, but that was not happening within a sensible time scale. That system has now been replaced by nurse-led triage, which I think will work better.

I am also grateful for the support we have received from other hospitals, notably the Homerton, which has an excellent A and E department. Medway has benefited from secondments there. It is important that those secondments and that support are integrated with the permanent staff in Medway hospital and the clinical director lead for emergency medicine is key.

We have had extra consultants appointed in emergency medicine at Medway hospital, which I strongly welcome, but I must mention the terms and conditions of emergency

21 Jan 2015 : Column 289

doctors. It is an extraordinarily demanding specialty and doctors working in it rarely have the opportunity to take on private work, which is a consideration for some but not all doctors when they make their choice of specialty. To encourage more doctors to come in to this field, should we consider changes to the lockstep consultant contract so that doctors in the extraordinarily demanding area of emergency medicine can perhaps receive more pay than others who are in specialties that are not as extraordinarily demanding, to which some might have been attracted by the potential for private earnings that they could not make in emergency medicine?

The Secretary of State tells me that what is actually required is more holidays for A and E doctors. That might be the case, but it would require pulling more doctors in to emergency medicine to cover for colleagues on holiday. I question a system in which high numbers of agency staff are used for a day or a week. Hospitals with problems in A and E and that have problems attracting people can fill places with those staff by paying very high rates, but they do not necessarily gel as a team or provide support in anything but the short term. We need to make emergency medicine attractive for doctors.

Finally, on the question of Monitor and the CQC, Medway hospital is a foundation trust. That happened in a largely box-ticking and financial exercise under the previous Government that ignored the death rate being one in 10 higher than it should have been, as mentioned by the hon. Member for Gillingham and Rainham (Rehman Chishti). Although Monitor has been reasonably sensible in its approach to Medway, it cannot come and run the hospital. We had to look to the board to do that. Similarly, the CQC has made some sensible interventions, for example on A and E, but in 2012 it said that Medway was a good hospital that was meeting all its standards. I believe that many of the problems we are seeing were in place then but were not identified by the CQC. My party wants to replace some of the alphabet soup of bureaucracies and regulators, such as Monitor and the CQC, with directly elected health boards that could, we believe, oversee these things better.

4.52 pm

Paul Maynard (Blackpool North and Cleveleys) (Con): It is intriguing to follow the hon. Member for Rochester and Strood (Mark Reckless). I will leave my intrigue at that point and focus on the debate rather than him.

It is a shame that the shadow Secretary of State has left the Chamber, as I was about to say something relatively pleasant and polite about him—he will not hear it now. When he came up to Lancaster and Fleetwood a few weeks ago he joined me in praising my local A and E department, which had seen 97% of patients within four hours, the fifth best performance in the country that week. That is a superb achievement given the complex health economy in Blackpool. It is very rare that we are at the top of a league table for the right reasons in Blackpool, whether that is for football or for health care, so I welcome that.

It was interesting to note a more hidden and nuanced message in what the shadow Secretary of State had to say. The medical director of Blackpool Victoria says that between April and September 2014, 36% of those arriving at A and E did not need to be there. They could have received their diagnosis or treatment somewhere

21 Jan 2015 : Column 290

else, and the cost to the hospital was calculated at £842,000. The message I draw from that is that we still have an immense amount of work to do to ensure that people know where to go for the right treatment at the right time. It is, of course, incumbent on us to ensure that those alternatives are resourced, that people know where to go and that people have confidence in the alternatives.

We have not spoken enough today about pharmacies. Pharmacy trade bodies and the industry put so much into lobbying Members on both sides of the House, but I think it will require another decade or so of intensive lobbying of MPs before we finally get the message that it is far better to have first recourse to the local pharmacist to see whether one needs to go further in seeking appropriate health care. I rely on regular repeat prescriptions for my epilepsy, and I have saved myself many a GP visit by asking a question at my local pharmacy. We are overlooking the most basic corner-of-our-street access point for primary health care, and we should not forget it.

I want to praise another Member of a different political party from mine, and he is sitting on the Government Front Bench: the Minister of State has already been praised today for his approach to mental health care. It is warmly welcomed, particularly in a town such as Blackpool. Our new 74-bed harbour unit is about to open on the edge of the town. It has been long-awaited, and is much-needed following some of the appalling standards of care at the Parkwood unit over the past decade.

The Minister will know that he faces great challenges. I could easily have come here today and read out a number of immensely tragic cases involving young people not getting the appropriate mental health care. He still faces a battle with the profession, because clinicians differ over their assessment of this issue. I see far too many young people with some learning disorder who are somewhere on the autistic spectrum, where the clinician refuses to accept that they can both have a learning disorder and a mental health problem. They fall into that gap and are batted backwards and forwards between different providers. There must be a battle in the medical profession over how to reconcile those two different forms of clinical diagnosis.

Another point I want to raise—I have far more than I will be able to get into my remaining four minutes—was mentioned by my right hon. Friend the Member for Chelmsford (Mr Burns). I was struck by the shadow Secretary of State’s sudden enthusiasm for the walk-in centre in Jarrow—his instant commitment that it would be saved were Labour ever to come to power. We then heard from my right hon. Friend that these things are sometimes trickier than that—that there is more nuance, perhaps. We in this Chamber often think we know it all—don’t we? We think we know everything there is to know and that we can learn nothing from anybody else about anything in our constituency—that we are the sole experts of what is right. Occasionally it would be nice to listen to the clinicians. There might actually be a clinical argument for why a particular unit has to open, close or reconfigure, but all too often debates on the reconfiguration of services become a political football—which is exactly what my right hon. Friend was saying.

A good example is the stroke unit in Blackpool. It has been a controversial addition because it was designed to serve the entire north-west. Patients were coming

21 Jan 2015 : Column 291

down the M6 from south Cumbria, past four or five other hospitals, to get higher quality treatment in Blackpool. As the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) chuntered during the Secretary of State’s speech, the important point is that it was about outcomes. People were going to have a better chance of survival if they went to the stroke unit in Blackpool rather than their local A and E. Yet when that was debated, it was very hard to tease out the medical arguments in favour of this innovation, because all too often we were more concerned about focusing on saving bricks and mortar in our own backyards rather than on what is actually best.

Steve Baker: Does my hon. Friend agree that the two brands in the NHS that the public really understand above all are A and E and GPs, and all the time we are talking about A and E we are getting away from the fact that sometimes care is better provided in a specialist stroke or heart centre?

Paul Maynard: My hon. Friend makes an important point, which is that so many different terms are used and answers given in this Chamber and elsewhere about where patients need to go. What they actually want is reassurance and confidence that when they go somewhere they will get the right treatment at the right time that solves their problem. They do not want it to be overcomplicated, and neither do we.

We have heard a lot of criticisms of this Government’s health reforms—they seem to be very unpopular on the Opposition Benches in particular—but let me highlight two that have been very good. One of them goes back to my younger days—when I had a finer figure, perhaps. My first proper job—Opposition Members will not like this—was as a health policy officer in the Conservative research department in 1999, so I listened with delight to the right hon. Member for Holborn and St Pancras (Frank Dobson) telling me all about the wonders of his time, because I scrutinised it quite carefully on a daily basis. I used to get a monthly present from the Association of Community Health Councils for England and Wales in the form of the London “Casualty Watch”, a monthly census of trolley waits in London accident and emergency departments. It was a pretty thick document. The census detailed page after page of trolley waits of more than 24 hours, and it was a shocking indictment of how Labour was running the NHS at that time.

That situation led to one of the Labour Government’s most shameful decisions: to abolish community health councils. I know that many Labour Members are embarrassed about that even now. One of the great things about our health reforms is that we have brought back Healthwatch, which has proved to be a thorn in the side of local health providers, of Members of Parliament and of the Government. We have brought back the ability of ordinary patients to affect the nature of the care in their communities. That is happening right now in Blackpool, and it is making a difference. I am delighted about that.

Another positive element involves putting public health matters into the local council. As I have said, Blackpool faces immense public health challenges, but putting Dr Rajpura, our local director of public health, into the

21 Jan 2015 : Column 292

council has been a tremendous success. It has helped to pull together all the disparate strands within the town as we face those challenges. Again, this has happened only as a result of our health reforms.

Another example that I want briefly to mention is the fact that some of our local nurses at the hospital have spun out their rehabilitation service into a community interest company called Spiral, which is now winning awards for the quality of its patient care. I am concerned that, if Labour were to reverse all these changes, the good things we have achieved would be washed away and lost, and the people who would suffer would be my constituents, including those who have turned to Spiral for their rehabilitation. That is my real concern.

5.1 pm

John Woodcock (Barrow and Furness) (Lab/Co-op): I want to talk about the situation in hospitals across the Morecambe bay area, and I shall start with the inquiry into neonatal deaths at Furness general hospital. The inquiry is led by Dr Bill Kirkup, who distinguished himself as a member of the independent Hillsborough inquiry panel. It has now heard from more than 100 witnesses, of whom I was the first, over a period of nine months. That has involved regular long trips from Barrow to Preston for the grieving families, who have had to relive those deeply traumatic periods in their lives in great and painful detail.

There has been a lot of talk about politics today, and about its relationship with the national health service. I do not think we should deny the real differences between our parties; we should be prepared to debate them and to put the choice before the British people at the election. That will involve disagreement, argument and debate. However, it pains me to hear the Secretary of State accuse me and other Opposition Members of being selective in the way in which we talk about the problems in the NHS. I have to say to him that I do not care if the Morecambe bay inquiry turns out to be politically difficult for any side. As the Minister of State, the right hon. Member for North Norfolk (Norman Lamb), knows, I helped to secure the inquiry on behalf of the grieving families, who, with great persistence and determination, persuaded me of the need for an independent examination to run alongside the criminal inquiry, rather than taking place subsequently. I am determined to get to the truth, and I am determined that lessons should be learned, no matter how painful they might be for anyone.

The Secretary of State is no longer in his place, but if he wants to stamp out shabby political point scoring I advise him to have a word with his colleague, the hon. Member for Morecambe and Lunesdale (David Morris). It is a shame that the hon. Gentleman has not attended this debate to stick up for his own local A and E, which I know is facing real pressures. The last time the inquiry was in the news, the hon. Gentleman used those neonatal deaths—which did not relate to his constituency or to the hospital there—to call for the resignation of the shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham). I am sorry to speak so frankly, but if someone is prepared to use the deaths of babies for this kind of political stunt because someone in Tory central office suggests it or just because they themselves think it is a good idea, there is not much they will not do. So just as the families, who have gone through so much in their grief, will not forgive

21 Jan 2015 : Column 293

anyone who does not face up to the full gravity of the findings that are coming, so I will not forgive anyone who uses this inquiry for political sport.

For all the problems, and I understand that the inquiry may well make difficult reading, we in Morecambe bay and at Furness general hospital are not the next Mid Staffs. There will be no excuse for anyone who allows the destabilisation and turmoil that the region has suffered to be recreated in Morecambe bay just because it fits the narrative composed by Lynton Crosby or some election agent in Downing street. I hope I will get some assurance from the Minister on that point in his winding-up speech. It is also important that this inquiry, which I understand is to report in the middle of next month, is dealt with fully but is not allowed to divert focus from the real problems the trust is enduring now and the need for a proper funding solution to put our hospitals on a more sustainable footing.

Let me briefly address the pressures currently being felt in Morecambe bay. Ambulances have been mentioned, and the hon. Member for Blackpool North and Cleveleys (Paul Maynard), whom I have the pleasure of following, spoke of his local hospital in Blackpool. Patients in south Cumbria will often travel by ambulance to Blackpool. Sometimes that is a good thing, because of the real expertise available, but too often recently ambulances have been diverted from where they are needed in south Cumbria to serve the Blackpool area because of shortages there. On 5 and 6 January, two ambulances, one serving Ulverston in my constituency and the other Millom in the constituency of my hon. Friend the Member for Copeland (Mr Reed), had to come to Fylde and the Blackpool area. Obviously, once they were there they were required to serve other patients needing help in the Fylde and Blackpool area, leaving the service in south Cumbria severely stretched—and all this when the beginning of January had seen a 25% year-on-year increase in ambulance call-outs across the north-west. We urgently need from the Government not only action to relieve the pressure on accident and emergency departments, but a recognition that areas such as Furness, which are out on a limb, can end up in a difficult situation because of ambulances being redirected around the country.

There have been real pressures on A and E in my constituency, as there have been across the country. Two weeks ago, when this issue last flared up in the Commons, the University Hospitals of Morecambe Bay NHS Foundation Trust was cancelling all non-urgent operations so as to be able to deal with the crisis in A and E. I have spoken to people in the trust today and they say that the situation has eased a little in recent days but remains fragile. All these problems must be addressed, but I have repeatedly pressed the Government on this. I was so grateful to the shadow Secretary of State, on his recent visit to Morecambe, for the assurances he gave on recognising the unique geographical situation of Morecambe bay and the funding priority it would get under a future Labour Government. Our population of 300,000 is spread out across the Morecambe bay area and the transport links are difficult. If things are to be easier, our area ought to be more compact and served by one big general hospital, and it cannot survive with the three hospitals it has unless very severe cuts in services are made. We are still waiting for an answer from the Government on whether they will recognise that case and provide us with the long-term extra funding that our area needs.

21 Jan 2015 : Column 294

5.9 pm

Steve Baker (Wycombe) (Con): I begin by paying tribute to the staff and leadership of Buckinghamshire Healthcare NHS Trust. The trust went through special measures as a result of the Keogh review, when it was found to have high mortality, and they have done a sterling job of turning the trust around. On my visit recently with my right hon. Friend the Secretary of State for Health, I found a renewed enthusiasm and optimism in the trust, and I am very grateful to the staff and leadership for delivering that outcome.

When the right hon. Member for Leigh (Andy Burnham) opened the debate, he asked for shared solutions, striking a markedly different tone from the usual partisan pose. I shall suggest some shared solutions later in my speech. But normal service quickly resumed. The right hon. Gentleman spoke of stories of failure. There are, of course, some stories of success, and I shall mention a few. England’s NHS has the best measured emergency care performance of any western nation, according to NHS England. Dr Sarah Pinto-Duschinsky, director of operations and delivery for NHS England, said:

“In the week ending December 28th A&E attendances were up more than 31,000 on the same period last year, meaning we successfully treated more patients in under four hours than ever before.”

I will come to why in a moment.

The Government have allocated an additional £700 million to cope with winter pressures. The College of Emergency Medicine said:

“This represents the largest annual additional funding yet seen.”

In the course of this Parliament, the NHS budget will have increased by £12.7 billion in cash terms. This additional winter pressures funding has paid for 2,500 additional beds in acute and community treatment and the equivalent of 1,000 doctors. There are almost 1,200 additional A and E doctors, including an additional 400 A and E consultants and 1,700 additional paramedics since 2010. Some 850,000 more operations are being delivered by the NHS each year compared with 2010, and numbers waiting longer than 18, 26 and 52 weeks to start treatment are lower than they were under the previous Government. It cannot reasonably be said that that is a continuous record of failure. There are considerable successes under this Government.

In an intervention on my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard), I mentioned branding. One of the things that we could do is continue to tell patients that they should go where treatment can best be provided, but we see that patients stubbornly insist on going to hospital. The brand A and E is well understood; people know that if they have an urgent problem, they can go to A and E. It will take years of persuasion before people behave differently, and I do not think we should keep on persuading people to want something other than the preference they are clearly displaying by their behaviour, which I shall return to.

Let us not forget the legacy that the Government have had to cope with, including the grievous financial position that they inherited. Let us not forget that around the world special monetary measures are still in place to ensure that Governments can keep spending. We have had problems with patient care. I alluded

21 Jan 2015 : Column 295

earlier to the turnaround in Buckinghamshire; across the country, there have been special measures and turn- arounds. The BBC reported that a probe into whistleblowing has been swamped by people getting in touch. The Government have had to deal with an enormous range of cultural problems and turnarounds.

That brings me to solutions—first, funding. In Buckinghamshire there are pockets of real poverty. In my constituency in Micklefield, Castlefield, Oakridge, Bowerdean and Disraeli there are—by anyone’s standards —pockets of poverty and deprivation, but we suffer on funding because of how it has historically been calculated. It is time for us to look seriously at where the demands on A and E are coming from, and to reorientate funding towards the human factors producing that demand—that is, ageing. Where there are older populations, they should be properly funded. It is a simple matter of treating people humanely, decently and—dare I say it—equally.

Secondly, it is time for us to take seriously the documents of NHS England. I am talking about not just the urgent care review, which I have in my hand, but the “Five Year Forward View”. What we see emerging now is a clear vision of where places such as Wycombe should go. It is becoming increasingly obvious to me that we will never manage to achieve the return of an old-style A and E to Wycombe hospital. The clear reason for that, as set out by NHS England, is that the NHS is moving in a different direction. The urgent care review includes a clear model of future urgent care, with major emergency centres, emergency centres and urgent care centres.

I am not able to tell the hospital trust and the clinical commissioners what they should do, but if I could I would now have a clear understanding from NHS England’s own documents of what should be done in Wycombe. We have a very expensive public finance initiative hospital, and we need to make the most of it for the 20 years-plus that are left to run on it. We should have an urgent care centre, an enhancement of the current minor injuries unit, a pharmacy, GPs, social services, nurse practitioners, and a full set of services and diagnostics in Wycombe named in a way that the public can understand. We should be proud of the centre and encourage people in Wycombe to present there if it is the best thing for them to do. We should not turn off the 111 service, and we should provide the services that people need in the places where they present.

We cannot go on for ever pretending that we will re-educate the public to want something different; that is not going to happen. I am not suggesting that we have an enormous new surge in admissions—nobody wants that. What we should recognise is that the vast majority of people, when they are in difficulty, want quick reassurance. If the people of Wycombe were in charge, they would want our hospital to have a full range of diagnostic and treatment facilities available to them all year round, giving them peace of mind. They would not want poor quality care. I think most people would accept being stabilised and moved to the place that could give them the best care.

We have a heart attack and stroke unit. I do not suppose that many people in Aylesbury, where there is an A and E unit, would be very happy if they realised that in the event of a heart attack or stroke, they would

21 Jan 2015 : Column 296

be coming to Wycombe. But that is the point. A huge amount of confusion, waste and anxiety is being wholly unnecessarily created despite the fact that NHS England, through the forward view document and the review of urgent care, has set out a clear trajectory on how to give the public peace of mind and the right treatment in the right place—yes, close to home, but also making best use of the PFI hospitals, which are a millstone around the NHS’s neck. We should do the absolute best we can to get best value for money, which means a new generation of urgent care centres in places such as Wycombe.

5.17 pm

Angela Smith (Penistone and Stocksbridge) (Lab): I feel privileged to take part in this important debate, which has focused on how the state of the NHS is playing out in Members’ local areas. The contribution of my right hon. Friend the Member for Manchester, Gorton (Sir Gerald Kaufman) encouraged me to reflect on just how recently the NHS was formed. It was launched by Nye Bevan on 5 July 1948, which means that anybody alive today who is in their late 60s or older would have been born before the NHS was created.

My parents, for instance, were war babies, born well before the NHS was launched. That reflection serves as a reminder not just of how recent the NHS is, but of how easy it might be to let the NHS slip away from our grasp. It is not something that we can take for granted. It is the responsibility of all of us in this place who truly believe in the NHS not only to fight for its survival—that is not good enough—but to see it strengthened and always fit for the challenges of our time. Currently, those challenges are many.

In an intervention earlier, I referred to the sickness and absence levels beginning to emerge across the country, including in Barnsley, in my constituency, and in Sheffield, and how much that is costing the NHS, but also how much it reflects the problems that the NHS faces.

I want to focus briefly on ambulance services, because they have not featured very much in today’s debate yet they are a pressing issue in my constituency. I represent an outlying area of South Yorkshire, which extends well into the national park. It is predominantly rural and is suffering from serious problems. I will use two cases to demonstrate the problems that we are facing.

Mr Offord collapsed on 16 April 2013, at approximately 11 pm. A 999 call was made, but a double-staffed ambulance did not get to Mr Offord until 11.25, by which time he was in respiratory arrest. On being transferred to the floor from the sofa, he was determined to be in cardiac arrest. He died the following day. The coroner ruled that there was a serious lost opportunity in the failure to consider alternative sources of support for a lone paramedic—the first response to the call—and that Mr Offord would probably have survived if he had received medical attention earlier. Mr Offord’s family, obviously very distressed, have settled that case out of court, but they want a wider justice for their son and brother. They want to see ambulance services and response times improved.

Mr Bailey, who I mentioned in my parliamentary question earlier today, collapsed in a shop. As I said, it took an hour and four minutes—and it was a Red 2 priority call—for an ambulance to get to him, despite the fact that the symptoms described in the emergency

21 Jan 2015 : Column 297

call were apparently those of a stroke; indeed, he had suffered a major stroke. This detail is horrific, but I must place it on the record: he had to have part of his skull removed because of the severity of the stroke. In summary, the dispatcher made two errors, which contributed to the delay in an ambulance attending to Mr Bailey, and—these are the words of the Yorkshire ambulance trust itself—“no checks” were

“made for an available ambulance from 13:31 until 14:03; and no allocation”

was made

“of one of the nearer ambulances identified at 14:11.”

All the ambulance trust has to say is:

“Please pass on my sincere apologies to both Mr and Mrs Bailey for the errors and the delay caused.”

Mrs Sharon Hodgson (Washington and Sunderland West) (Lab): I am so pleased that my hon. Friend has raised this important issue. I have had so many people write to me about the state of the ambulance service. One gentleman, over a year ago, had to wait for two hours. I have also been contacted by a whistleblower from the call centre who is discouraged from sending ambulances—they have to dig and try and find any way. Does my hon. Friend agree that this is desperate and needs to be sorted out?

Angela Smith: I thank my hon. Friend for that intervention and I am really sorry to hear of the cases she raises. The situation really does need to be sorted out, because the Yorkshire ambulance trust goes on to say that

“the service was experiencing a high level of demand in the South Yorkshire area around the time of Mr Bailey’s incident. Overall, demand was 12% above predicted levels and the level of ‘Red’ call demand was 55% above predicted levels…Rising demand on all health care resources continues which requires changes to deliver improvements in urgent and emergency care.”

I shall say no more about Mr Bailey’s case because it will be referred elsewhere and it may well go to law—I have simply set out the facts of the case as they have been put to me—but the point is this: why are we experiencing these problems with response times in the ambulance service? Why are we hearing, week after week in Prime Minister’s questions and on the Floor of the House in other debates, that the ambulance service is letting people down—even in the most serious cases, when people are going into cardiac arrest or having a major stroke?

We need to establish the reasons, and I suggest that there are three obvious ones. There may be more—there may be problems with the management of ambulance services, and in many cases there clearly is a problem in the case of YAS—but I would suggest that there are three obvious problems. One problem is the increasing difficulty that people have in getting access to GPs’ surgeries. The evidence was laid before the people present for this debate earlier, by the shadow Secretary of State, so I will not go through it again.

Secondly, there has been the closure of NHS Direct and the establishment of NHS 111. There is no way that NHS 111 can be compared with NHS Direct; it is like comparing apples and pears. I have used NHS Direct in the past. It was a superb service that enabled me to decide which was the appropriate place to go to for my treatment and to get the right treatment at the right

21 Jan 2015 : Column 298

time. I can assure hon. Members that the one place I did not end up, having used NHS Direct, was A and E—that would have been the last place I had to go to.

Thirdly, social care cuts represent one of the most fundamental problems of our time. As my right hon. Friend the Member for Wentworth and Dearne (John Healey) said, £1 in every £10 has already been cut from social care budgets. It is obvious, even to the most disinterested observers of the debate on health, that cutting social care budgets at local authority level will ultimately impact on the health service. I was in local government for 10 years, and I saw for myself the importance of the local authority and the local NHS working together to enable elderly people to stay in their own homes and to keep them out of the health system—the acute health system, in particular—as much as possible.

The shadow Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), outlined what needs to be done in the very long term, strategically, to get the NHS in the right shape. He also outlined the more immediate actions that a Labour Government would have to take if they gained power in May: providing more clinically trained staff to handle NHS 111 calls; restoring the GP guarantee of an appointment within 48 hours; and ensuring that councils, the NHS and the local voluntary sector work together to identify older people at the highest risk of hospital admission and link them up with the right support. I cannot wait for 8 May to see that strategy for the short term being put in place.

Ambulance services are crucial to the trust that people have, and need to have, in their local health services. One can broadly measure the trust that people have in their local health service by how much they can rely on their ambulances. Everybody likes to think that if they need an ambulance they will get one, and get it quickly. I was disappointed this afternoon that the Prime Minister used my question to indulge in petty political point-scoring. These issues are too serious for that. He did not even express sympathy for the family affected and instead made a cheap point about NHS staff. That was disgraceful. It is not good enough, and it is not good enough—

Mr Deputy Speaker (Mr Lindsay Hoyle): Order.

5.27 pm

Jeremy Lefroy (Stafford) (Con): It is a pleasure to follow such thoughtful speeches, in general, on this subject. I thank all the staff at the accident and emergency departments that serve my constituents, whether at County hospital in Stafford, Royal Stoke University hospital, New Cross hospital in Wolverhampton, or Manor hospital in Walsall.

On many occasions in the House over the past few years, the tragic events in my constituency have been referred to. Whenever they are referred to from now on, I would like people to acknowledge the enormous progress to improve health services that has been made in Stafford at what is now County hospital and throughout my constituency. It is absolutely vital that we remember what is happening now as well as where we have come from. Let us not forget that out of the Francis report has come the tremendous emphasis on patient safety and compassionate care that is vital for all our constituents. I do not want Mid Staffs to be used just as shorthand

21 Jan 2015 : Column 299

for something that was clearly very poor care; it should also be shorthand for the huge improvements that have been made by the people working there and the NHS staff in many other hospitals throughout the country.

I would like to look in a bit more detail at what this motion proposes and the reasons we are currently suffering from the huge demand on accident and emergency services, particularly in relation to out-of-hours GP services and delayed discharges. Regarding the pressures on A and Es, it has rightly been said that there are 600,000 more attendances every year, but we are finding that there are 4,000 more admissions every week—some 200,000 a year. That indicates the seriousness of the situation, because people are not admitted to hospital unless they are in a fairly serious state or seriously unwell. It shows that we are now entering a phase in which the baby boomer generation needs more acute care. We welcome the fact that people now live a lot longer, but the fact is that when people get ill in later life, they tend to be acutely ill and to have complex needs, and that results in their admission to hospital.

The right hon. Member for Holborn and St Pancras (Frank Dobson) mentioned the ratio of beds to population in the UK. We have one of the lowest ratios in Europe—we have a very efficient health service—but the idea that we can get an even lower figure is pie in the sky. In fact, we ought to go marginally in the opposite direction. We should certainly consider increasing the number of beds. Let us not forget that our patient stays in hospital are shorter than most comparable figures across Europe.

We need to bear in mind that we will get more and more admissions, and we need to have the capacity for that. As I remember only too well, I argued a few years ago that the design for the new hospital in Stoke-on-Trent would make it too small; indeed, it is too small, and we are now increasing the number of beds there.

The King’s Fund has said that only 55.4% of patients say that they know whom to contact for out-of-hours services, and such a lack of information or lack of clarity has already been mentioned. We need something straightforward and simple, and frankly, it must be available 24/7, because emergencies happen 24/7. That is why I have pushed for my A and E to reintroduce 24/7 care, rather than its current 14/7 care. People have to look at the clock to check whether it is nearly 10 pm, and then ask themselves whether the A and E will still be open or whether they will need to go elsewhere. They avoid going to another hospital because our A and E is so good, so they delay going until 8 am, by which time they may be in a worse condition. If the facility is for emergencies, it needs to be open 24/7. I welcome the fact that we will soon get an overnight doctor service. A and E needs to return to 24/7 not only in my case, but in other centres that do not offer a full-time service.

Steve Baker: Does my hon. Friend agree that putting GPs into such centres provides the possibility not only of having integrated care, but of treating most people who present overnight, when an A and E consultant might not be available?

Jeremy Lefroy: I entirely agree, which is why I welcome the introduction of an overnight doctor-led service at the County hospital in Stafford, even though I would

21 Jan 2015 : Column 300

like such services to go further. A parent whose child is sick with a temperature may not want to be a burden on the ambulance service by calling one out but will still want to be seen at that time, rather than having to wait until morning, so being able to go to such a service gives them reassurance. If the child is particularly unwell, they can then be referred to a specialist centre, but otherwise the parent can be reassured that they can wait until the morning. Such matters are vital for our constituents.

It is, indeed, a problem to get GP appointments, and it is vital that the issue is sorted out. There are wide discrepancies. In the practice I attend, I can get an appointment the next day not just because they want the local MP to be seen, but because they are very well organised and their patient load is not huge. That is simply not the case in other practices, and some people in my constituency have to wait two or three weeks for an appointment. The problem must be sorted out, and there must be evenness across the country.

GP surgeries put an additional pressure on A and Es. The statistics show that the patients of some GP surgeries attend A and E far less often than those of other surgeries, because such GPs take the time to have longer appointments and take the trouble to go through problems and deal with them on the spot, whereas others are more inclined to say, “I haven’t got the time, so you had better go to A and E.” The statistics show that for some GP surgeries the ratio of patients attending A and E is almost twice that of others in the same area and with the same demographic.

Delayed discharges have often been referred to in this debate. The figure was relatively stable until the start of 2014-15, but since then the total number of delays has risen by 19%. The King’s Fund analysis suggests that delays attributable to NHS services have risen from 60% to 68%, whereas those attributable to social care have fallen from 35% to 26%. It states:

“This suggests that capacity and workforce issues, particularly in nursing homes and non-acute services”

—within the NHS—

“are becoming more important than social care funding”.

I find that very interesting. I do not know on what evidence it is based, but the King’s Fund is a respected institution and we must look at what it says. It implies that there is an issue with integration not just between the NHS and social care, but between acute NHS services and non-acute NHS services.

So what should we do? First, we have to recognise that there will be increasing demand for complex acute care and, hence, for accident and emergency services. A and E departments therefore need to remain open and to expand. I welcome the fact that the A and E in Stafford will double under the investment plans. Secondly, we need clear pathways for out-of-hours care, rather than complicated pathways that are difficult to understand. Thirdly, we need clear information relating to those pathways. Fourthly, we need to do much more work on access to GPs and must look much more closely at the results of GPs in avoiding A and E admissions among their patients. Finally, we need to make integration a reality, not just between health and social care, but within all NHS services and social care.

5.36 pm

Ian Austin (Dudley North) (Lab): It is always a pleasure to follow the hon. Member for Stafford (Jeremy Lefroy).

21 Jan 2015 : Column 301

I ask Ministers to look at the situation at Russells Hall hospital in my constituency. Like anyone who lives in Dudley, I queue up at Russells Hall when I am ill. I know how hard the doctors, nurses, midwives and all the other staff at the hospital work. Over Christmas, they battled heroically to tackle unprecedented demand in A and E. The chief executive herself pushed trolleys around as they fought off the crisis that has been seen in hospitals elsewhere. I place on the record my appreciation for all their hard work over these difficult weeks.

Last week, we had the shocking news that 400 of Russells Hall’s 4,200 staff—that is one in 10—will have to go, including 200 over the next couple of months. In common with other NHS trusts, the Dudley Group NHS Foundation Trust is required to make efficiency savings of 4% a year, which equates to £12 million each year. At the same time, the hospital is facing cost pressures that are caused by increasing demands on emergency services and the need to provide seven-day services. As a result, the hospital is predicted to face a deficit of more than £7 million by the end of March. I want Ministers to see what they can do to address that issue.

As a first step, the hospital is looking to make voluntary redundancies. Depending on how that goes, it might have to make compulsory redundancies. Like at any hospital, managers at Russells Hall have to ensure that every penny is spent wisely and that every possible efficiency is made before they cut staff and front-line services. People in Dudley agree with me: two-thirds of the hundreds of local people who responded to my survey this week think that front-line staff must be the priority. Community GP practices were their second priority.

Everyone agrees that savings should first be sought among management and back-office functions. However, even if every manager at Russells Hall was sacked—obviously, that cannot be done—it would not come close to the savings that the hospital needs to make. Instead, the redundancies that the hospital is making might include theatre staff, radiologists and staff who deal with things such as blood tests. Even some midwives will be able to apply for redundancy. The trust says that it will do everything it can to protect the service that patients receive, but no one can pretend that our hospital can lose almost one in 10 of its work force without it having an impact on front-line patient care. We just need to look at the pressures that they have faced over the past few weeks. How will they deal with a situation like that after losing so many staff?

Local people share my concerns. I asked thousands of them about this issue this week and 98% said that they thought care would get worse if the job cuts went ahead and eight out of 10 said that they were already noticing longer waits for treatment locally.

I have raised this issue in the House with Ministers before. I warned them last year that more resources were needed to deal with waiting times and with the deficit. I ask Ministers to look at this situation and to ensure that our hospital has the resources it needs to serve my constituents and not lose those members of staff.

My second point contrasts the current Government’s record with that of the previous Labour Government. The previous Government built a brand new £300 million hospital in Dudley, with more doctors and nurses treating

21 Jan 2015 : Column 302

more patients more quickly than ever before. Despite promising no top-down reorganisation, this Government squandered billions that should have been spent on front-line patient care—£20 million in Dudley alone—on a bureaucratic shake up. As a result, local people are facing longer waits at A and E, cancelled operations are at their highest level for decades and waits for vital tests and treatments are increasing. We need a Government who put patients in Dudley first. That is why I welcome our plans to tax homes worth more than £2 million to pay for 20,000 more nurses, 8,000 more GPs, 5,000 more home care workers who have time to look after the elderly and vulnerable people they care for, and 3,000 more midwives.

My third point—it is a shame the hon. Member for Rochester and Strood (Mark Reckless) has left the Chamber—contrasts our proposals with what UKIP has said about our NHS. Nigel Farage said:

“I think we are going to have to move to an insurance-based system of healthcare.”

His deputy, Paul Nuttall, said that he wanted to

“congratulate the coalition government for bringing a whiff of privatisation into the beleaguered National Health Service”

and that the

“very existence of the NHS stifles competition”.

That is what senior people in UKIP believe.

Just this week, Nigel Farage suggested that the NHS might have to be replaced by a system of private health insurance within 10 years and that his party will return to that idea after the general election in May. When I challenged the hon. Member for Rochester and Strood about that, he said that his parents met in an NHS hospital, as though that trumps what his leader and deputy leader have said about how the NHS should be organised. Utterly ludicrous. UKIP must be the only political party in history that, when asked about its policies, asks us to discount what the leader and deputy leader have said. It is completely nuts. The serious point is what it says about UKIP’s instincts and values that it wants to replace our NHS with a US-style insurance system in which the treatment and care someone gets depends on the cover they can afford, because that is what Nigel Farage’s plan would mean.

In the US, insurance can cost families up to £10,000 a year. It can cost almost £20,000 to have a baby privately, and treatment for a knee operation can cost £11,000. Imagine the crippling impact that treatment for life-threatening diseases or emergency treatment could have on the finances of an ordinary family in Dudley. Local people are overwhelmingly against that kind of privatisation, and nine out of 10 people told me in this week’s survey that they are totally against any introduction of a US-style health insurance system.

When I asked the hon. Member for Rochester and Strood about that, he mentioned my constituency and the forthcoming election. If he were here now, I would tell him that I will be telling people in Dudley what UKIP’s policy for our NHS would mean for them every day between now and polling day. When people in Dudley compare our plans for more doctors, nurses and care workers, quicker GP appointments and faster cancer tests and results with the Government’s plans for increased savings, longer waiting lists and redundancies, or with an insurance-based system and more privatisation from UKIP, I am sure they will know who is on their side.

21 Jan 2015 : Column 303

5.43 pm

Chloe Smith (Norwich North) (Con): It is instructive, as always, to follow the hon. Member for Dudley North (Ian Austin), and I thank him for his exposition of the positions set out around the Chamber this afternoon. I also welcome the comments of my hon. Friend the Member for Wycombe (Steve Baker) in picking up on the needs of areas that might not normally be viewed as deprived, but that need attention none the less. Norwich is one such city, because it contains wards and areas of serious deprivation. I have argued on behalf of GP surgeries that serve those wards, and there is a genuine question about the way our national structures and funding serve those areas.

Steve Baker: Is it not odd how people who are obsessed with inequalities take levels of aggregation that hide the real suffering of individuals and families?

Chloe Smith: My hon. Friend makes a wise point.

Tomorrow, I am visiting a walk-in centre and the hospital that serves my constituents. When I am there, I shall be explaining, as I have several times in the House recently, my support for the NHS in Norwich and across Britain, my thanks for what the staff are doing and my understanding of what the patients, my constituents, need from the NHS.

I want to make three points in the debate. My first point is that, as many hon. Members have said this afternoon, the NHS is under unprecedented demand. It does it no disservice to acknowledge that and bring it into the debate. I for one welcome the decisions that allow for increased numbers of doctors and nurses in urgent care—that is true in the Norfolk and Norwich University Hospitals Trust; for an increased number of operations to be carried out each year—that is true everywhere in the country; and for increased hours at GP surgeries. I recently learned to my pleasure that Norwich doctors will apply for the next round of the access fund. They have not done that before and it is very welcome. The Government have made the fund available and it could be of great benefit to patients in my area.

I am also grateful to the Government for the decisions made early—earlier than ever before—that have allowed for winter pressures to be dealt with. Again, that directly benefits the area of Norfolk that contains the Norfolk and Norwich hospital. I am particularly pleased that the use of that funding will be planned jointly with local authorities through the system resilience group. That is incredibly important. I will turn to that kind of joined-up working in my final remarks.

Let me make a point about the motion. We have heard wise contributions from Back Benchers on both sides of the Chamber. For example, my hon. Friend the Member for Stafford (Jeremy Lefroy) rightly asked us not to use the name of his area as a shorthand. He is right that we ought to look much deeper. As a further example, the hon. Member for Wirral South (Alison McGovern) rightly spoke eloquently about mental health. Unfortunately she is not in the Chamber, but I am sure she will be back before the winding-up speeches. I intervened on her to ask why the motion does not refer in its own right to mental health; it is a great shame that it does not. The motion is 10 lines of overblown and

21 Jan 2015 : Column 304

fly-blown rhetoric. It asks for an NHS that is “fit for the future”, but makes no mention of mental health being equal to physical health, which I believe strongly. Mental health and physical health should be equal in word and deed, and in budgets. Indeed, I have been discussing that with the Minister recently through parliamentary questions.

The truth is that the motion is rather sad and inadequate. It betrays even the usual standards of political football that are played on Opposition days. The right hon. Member for Leigh (Andy Burnham) said in his opening speech that it is time for honesty. To that end, we would like to know whether his party leader believes in “weaponising” the NHS. To that end, we would like an end to the shabby leaflets on the NHS that go around the country.

I would have liked mental health, which is an important topic, to replace the waste of words in the motion. The motion is a pathetic reuse of the tired and crumbling money-making policy—the mansion tax—that not even all Opposition Members agree with.

Liz Kendall (Leicester West) (Lab): Will the hon. Lady give way?

Chloe Smith: Perhaps the hon. Lady will explain whether the mansion tax will be spent once or 20 times over, like Labour’s bonus tax.

Liz Kendall: Why is the NHS as a whole not one of the hon. Lady’s Government’s five priorities?

Chloe Smith: The hon. Lady will have heard the Secretary of State speak eloquently on the topic of the Government’s priorities. The point I was about to make is that economic competence allows us to run an NHS securely and strongly for the future. It is the Conservative party and this Government who are demonstrating such economic competence, thus allowing the NHS to be a priority for the future.

My final point is much more important than this political to-ing and fro-ing. My hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) made a sensible point about the good that can come from local commissioning and joined-up working. I would add a third point, to make a kind of trinity. The third important thing we all want to see in our local health services is the making of decisions in good time. For example, the walk-in centre in Norwich has recently had to move. As I mentioned, I will be there tomorrow discussing this further with staff and patients. There was no need for the decision to relocate to be made at the last minute. It is a source of great frustration to patients locally that the decision was not confronted earlier on. It was there in black and white in the centre’s rental lease contract, so it was not too hard to spot.

Patients look to health officials—both locally and, where it applies, nationally—to make sensible decisions on time, and for those decisions to be made locally, wherever possible, and in a joined-up way, as my hon. Friend the Member for Blackpool North and Cleveleys rightly said. I would like the walk-in centre to look to its future by assessing its relationship with accident and emergency, GPs, physical health, mental health and all types of provider, including the voluntary sector, which has not been mentioned in the debate so far. I would

21 Jan 2015 : Column 305

particularly like decisions about the walk-in centre to be made in good time. There can be no forgiving decisions taken right up to the wire, which fail to deal with the real world as it stands in terms of rental contracts and, most importantly, fail to serve patients best.

5.52 pm

Kevin Barron (Rother Valley) (Lab): It is a pleasure to speak in the debate, and to follow the hon. Member for Norwich North (Chloe Smith).

My hon. Friend the Member for Dudley North (Ian Austin) mentioned private health insurance. In America, 80% of the population have great health care through private health insurance, but for the many people who cannot afford any private health insurance and rely on charity, it degrades very steeply. My parents used to have to rely on charity in the 1930s in this country. If any so-called political party is talking about returning to health insurance, I have to say that people will get what they can afford and the bulk of people will get very little. What Nigel Farage said the other day was completely consistent with UKIP’s 2010 manifesto— I have a copy of it.

I want to talk briefly about the pressures on accident and emergency. It is no coincidence that when the economy is being run more “efficiently”, as I think the hon. Member for Norwich North put it, through cuts and austerity, there will be an effect on services. Figures from an Age UK report that came out this week show that despite rising demand from growing numbers of people in need of support, the amount spent on social care services for older people has fallen nationally by £1.1 billion, or 14.4%, since 2011, even accounting for additional funding from the NHS, and by a total of £1.4 billion, or 17.7%, since 2005-06. That is quite a large cut.

According to the Health and Social Care Information Centre, between 2010-11 and 2013, the number of older people receiving home care fell by 31%, from 542,000 to 370,000; the number of day care places plummeted by 66.9%, from 178,000 to 59,000; and the number of older people receiving vital equipment and adaptations to help them remain safely at home dropped by 41.6%. This is the austerity that the people on the Government Benches say our economy needs.

Sarah Newton rose

Kevin Barron: In a few minutes—let me get to my third page, and I will gladly give way.

Spending on home care has dropped since 2011 by 19.4%, from £2.2 billion to £1.8 billion, while the amount spent on day care has fallen even more dramatically, by 30%, from £378 million to £264 million.

Sarah Newton: I read the Age UK report with great interest, but the data, which the hon. Gentleman has cited, is aggregated information from across England. Not all local authorities are cutting social care. Some really good local authorities are coping with the reductions in funding from central Government, prioritising the needs of the most vulnerable people in their communities and finding innovative ways of working with the NHS and the voluntary sector to improve the self-reported well-being of the people they serve. It is not the blanket situation across the UK that he describes.

21 Jan 2015 : Column 306

Kevin Barron: That is not a denial that the figures are true. They are true. These are the facts and figures of what austerity under this Government has introduced to local government and social care.

The cuts have happened at the same time as the number of people aged 65 and over has increased by 1.2 million. Caroline Abrahams, charity director at Age UK, said:

“This devastating scorecard speaks for itself and it lays bare the fact that our state funded social care system is in calamitous, quite rapid decline. Today, many hospitals are finding it hard to discharge older people and commentators are asking why this challenge seems to be growing, year on year. A big part of the explanation is revealed by this scorecard: the marked decline in central government funding for social care and the resultant reduction in support for older people to live independently at home - this at the same time as their numbers are rising.”

She continued:

“Until recently the impact of the decline in social care has been relatively hidden, but social care is a crucial pressure valve for the NHS and the evidence of what happens when it is too weak to fulfil that function is clear for us all to see.”

She maps that out pretty well.

Councillor Izzi Seccombe, of the Local Government Association, said the system was “chronically underfunded”. She said:

“Councils have protected our most vulnerable people as far as possible, often at the expense of other services, and we will continue to prioritise those most in need.”

She continued:

“However, the combined pressures of insufficient funding, growing demand, escalating costs and a 40% cut to local government budgets across this parliament mean that despite councils’ best efforts they are having to make tough decisions about the care services they can provide.”

This councillor is the Conservative leader of Warwickshire county council—not somebody from an urban area but a Conservative who knows exactly what austerity is creating in Warwickshire, and probably elsewhere as well.

On 7 January, following an urgent question on A and E and major incidents, I raised in the House an issue about an elderly member of my family. In response to my right hon. Friend the Member for Leigh (Andy Burnham) and me, the Secretary of State mentioned the better care programme but said little else about the problems facing people in hospital. That member of my family was actually my mother, who was in Rotherham hospital, having been admitted to A and E on 9 December. Two days later, she was told she could go home, as there was no medical need for her to be there. She spent her 93rd birthday in Rotherham hospital on 24 December and was discharged on 5 January—with no medical reason to be in that hospital all the time from 11 December until then.

I have since checked the reductions in my local authority’s adult services budget. This year thus far, the reduction has been over 6%. Over the last full financial year, the reduction was over 8% and previously 4% and 3%. That has a cumulative effect on people’s ability to be looked after in the community. People stand at that Dispatch Box or anywhere else talking about “the need for austerity”, well that shows the price of that austerity. My mum is good; she is back at home with a good care package, and she is fine. She wants to continue on her own as much as she can, but many people cannot do that. If we want austerity, we will have such problems.

21 Jan 2015 : Column 307

On 7 January, no mention whatever was made on the Front Benches about the situation. Yesterday, the Government acknowledged the impact of social care cuts and announced £25 million-worth of emergency funding for 65 council areas experiencing the most severe delays in discharging elderly patients from hospital. No mention at all was made by the Secretary of State when he opened the debate today. It was hidden away, but it is in the national press if anyone wants to look for it. The Government know the situation: they know what problems have been created in A and E in hospitals up and down the land by these cuts, yet no mention was made, even though the motion specifically mentions A and E problems.

I shall finish now, but I must say that if people want austerity and if they want to fight a general election on the basis of being better at the economy than the other side, they need to realise the price paid for it. My mum survived it, but many people in this land are not surviving it. In my view, it is not a price worth paying. We need serious change—and I say that not only to the Government Front-Bench team, but to the Opposition Front-Bench team. We need to make serious changes in this country to look after our most needy people. We are not getting that under this Government.

6.2 pm

Dr Julian Huppert (Cambridge) (LD): It is a pleasure to follow the right hon. Member for Rother Valley (Kevin Barron). We have heard references to Nye Bevan and his amazing work in setting up the NHS. We should talk about Beveridge and his report, too. He was a good Liberal and he did that work during a coalition, albeit a somewhat different coalition that had come about for different reasons.

Let me start by looking at some issues that have arisen in my area of Cambridgeshire over the last month or so. There has been a number of winter challenges to be faced. Among them, I could talk about the ongoing problems with the ambulance service. The real problem that struck us was, I suspect, when the East Anglian ambulance service changed to the East of England ambulance service—and it has never recovered from that.

What has hit people most, I think, has been the problems at Addenbrooke’s hospital—a major incident took place, and a large number of operations had to be cancelled. I have spoken to the managers there and to many of the doctors and nurses. It seemed that there were two main reasons for the big problems. One was that Addenbrooke’s has been implementing the new e-hospital system—an exciting electronic records system that is the largest NHS IT project ever to be implemented. It is not as big as the one that was scrapped, but it was implemented. Although it will be a good thing when it is finally working, there have been many teething problems along the way and lessons that have to be learned. I suspect that other hospitals will want to learn from this: they should look carefully at the bad things, as well as the good things.

The other problem is the shortage of care wards, with delayed transfers of care. That has been a problem for a long time. Addenbrooke’s opened some new wards, but more are needed. I have been campaigning for some

21 Jan 2015 : Column 308

time to reopen some wards at Brookfields hospital, also in Cambridge, and I spoke about that in this place last year. I am delighted that, as of 9 February, these wards will be opened at Brookfields hospital. That is very encouraging. It is interesting to note that, in 2007, there were proposals to close down the entire hospital; I am delighted that we are opening up more wards instead.

We are trying to solve the problem for the long term through a new older people’s contract. This is the second-largest tender ever put out for the NHS, as it includes all the older people’s services in the county. I am delighted that the contract was won by the NHS—unlike the largest contract. The acute hospitals, the mental health services and the community work sector will all be working together to solve the problems we are having with things such as delayed transfers of care. That is the long-term fix for older people’s services in Cambridgeshire, and I hope it will be a model for other parts of the country to have a look at.

We have seen the news about Circle pulling out of the Hinchingbrooke hospital. This has been discussed in this place, and it is a shame that the shadow Secretary of State is not in his place, as it is always fascinating to hear him argue that he was in favour of the NHS bid led by Serco. I do not count Serco as part of the NHS, and I do not think that any Opposition Member would wish to do so.

Andrew Gwynne: Will the hon. Gentleman give way?

Dr Huppert: I will give way once on this issue.

Andrew Gwynne: I fear that the hon. Gentleman is, yet again, seeking to rewrite history. He will know that when my right hon. Friend the Member for Leigh (Andy Burnham) became Secretary of State, he changed the “any willing provider” policy to “NHS preferred provider”. That allowed Cambridge University Hospitals NHS Foundation Trust to become a partner of one of the three bidders. It was, of course, the Government whom the hon. Gentleman supports who signed the contract 18 months after the general election.

Dr Huppert: The hon. Gentleman ought to get his facts right. The Cambridge university trust put in a bid—it was the sixth last to do so—but then withdrew because the cost of the tendering process under the right hon. Member for Leigh was far too high. It did not have a partnership with Serco. The hon. Gentleman should check the facts and check the record. The trust was driven out by the tendering. The hon. Gentleman should also know that the bid to which I suspect he was referring was led by Serco. What he is saying, in essence, is that the current shadow Secretary of State had to undo the damage that had been done by previous Secretaries of State. That is a bit of Labour misery that I imagine Labour Members can sort out between them.

We know the history, and we know the problems that led to it: the Government had to decide between three private sector-led bids for Hinchingbrooke. What we must do now is work out what to do next, and I think we need to ensure that Hinchingbrooke stays in the public sector. Trying to remove it from the public sector in order to deal with the PFI problems, which was the original idea, simply has not worked. It must stay fully within the NHS.

21 Jan 2015 : Column 309

Last year, before any of this happened, I led a debate about health in Cambridgeshire. I dealt with a number of issues, and I will not go into all the details now, but I spoke about health funding and, in particular, about mental health. I gave a number of detailed examples of some of the many challenges that we have faced and still face. For instance, huge cuts were made five or six years ago. During that debate, I called for a substantial amount of extra money, not just for Cambridgeshire—although I shall say something about that shortly—but for mental health throughout the country. Members in all parts of the House have made some excellent speeches about mental health, but it is not talked about enough. I find it regrettable that the motion does not mention it, and I suspect that a number of Members on both sides of the House do as well. Let us hope that we receive that extra money for mental health.

Cambridgeshire, however, suffers from a number of specific problems. We have been a test bed for experimentation for many years. We had the Hinchingbrooke experiment— the largest tender that the NHS has ever seen. We saw huge numbers of PFI projects not just at Hinchingbrooke, but at Peterborough. Paying off the NHS costs is still taking 18% of Peterborough hospital’s budget. That is only a small proportion of the 138 PFI projects that we saw under the last Government, the costs of which will amount to £11.7 billion over the next Parliament. That money could be used far more productively.

We have been hit hard by that, but we also receive very low funding. We inherited a formula from the last Government, and the process of changing it has been too slow under the present Government.

Sir Hugh Bayley rose—

Dr Huppert: The hon. Gentleman can intervene if he wants to talk about why PFI is a great thing, but otherwise I will move on.

The Government have been too slow to move to the new formula, which properly takes account of ageing populations. We know that the elderly cost more in terms of health care. Cambridgeshire receives £961 per head, whereas West Norfolk, for example, receives £1,255. That is a huge difference. I asked for extra money during the debate that I mentioned, and I am delighted that we have managed to secure an extra £20 million as a result of the recent allocation. That will provide much more funding for mental health, on top of the extra £1.5 million that has been provided this year and the extra £2.2 million that will be provided for IAPT—improving access to psychological therapies—next year. That will make a big difference, and will reverse some of the challenges that we face.

We need that extra cash, but we still need more in Cambridgeshire and throughout the country. Simon Stevens called for an extra £8 billion by 2020, after savings and efficiencies had been taken into account. He said that an extra £8 billion, in real terms, was needed if the NHS was to keep going. I think that that is important, and we as a party think that it is the right thing to do. One of the problems with the motion is that it does not deliver what Simon Stevens has said is needed for the NHS. I am not all that keen to support the provision of less than a third of what is needed to keep the NHS going, especially after hearing from the shadow Secretary of State that, despite what the motion

21 Jan 2015 : Column 310

says, the money is not all for the NHS but constitutes the entire offer for the NHS and social care, which also needs its own funding. We need that £8 billion.

I voted against the Health and Social Care Act 2012 as I did not agree with much of it. There are some issues, such as parity of esteem, that are very good and that I hope will never be repealed. I also disagree, however, with many of the things that the Labour party did to bring in the private sector in some damaging ways, with people being paid for things that never happened.

The fact is, as was mentioned by the hon. Member for Brighton, Pavilion (Caroline Lucas), under the previous Government medical spending on private provision went from £1.1 billion a year in 1997 to £7.5 billion in 2009-10. That is a vast increase. I have no problem with people who say that they support that and that it was the right thing to do, but to suggest that that large increase was excellent for the NHS while the fact that it has continued at essentially the same rate under this Government is a disaster for the NHS strikes me as a rather bizarre claim.

I have criticisms of this Government, the previous Government and the one before that. I want the NHS to spend more of its time focusing on patients or, even better, avoiding the need for people to be patients in the first place. That needs a trained, motivated and well-paid staff—I think they should get the money from the independent review. It needs a focus on prevention and public health and proper funding—that is, the £8 billion by 2020.

Paul Burstow: On that point, does my hon. Friend agree that the better care fund, which is now being launched in April, is a key way in which we can deliver the joined-up care that he is talking about and that we need to have an ambition that by 2018 all CCG budgets, primary care budgets and social care budgets are in that pot?

Dr Huppert: My right hon. Friend is right, of course, and I pay tribute to him for the work he has done on this and on many other health measures. We must ensure that that integration happens so things work together and that is why token amounts such as a couple of billion pounds from the Conservatives, who need to go a lot further, and the £2.5 billion across health and social care from Labour—and by the way, please correct me if I am wrong, but according to The Guardian that is from 2017 onwards —will not go far enough. We need integration through the better care fund and we need that £8 billion. That is the proper funding that is needed.

Finally, we in this House ought to have a proper debate about how to fix problems and cut back on the amount of partisan bickering that happens in this place. That does not do us proud. We are all prone to it, including me. It is much better to talk about what we can do to promote health, whether it is physical or mental.

Several hon. Members rose

Madam Deputy Speaker (Mrs Eleanor Laing): Order. I am afraid that I shall have to reduce the time limit to seven minutes and that it will have to be further reduced if people take more than just over six and a half minutes.

21 Jan 2015 : Column 311

6.12 pm

Sir Hugh Bayley (York Central) (Lab): NHS services in the vale of York are provided by well-qualified and hard-working staff and this year they received £367 million to provide their services. Nevertheless, services in my city of York are in crisis as a direct result of coalition Government policy.

The A and E service at York hospital has broken down over the past two months. In December, 71 operations were cancelled at the last minute so the beds could be freed up for emergency admissions from A and E. Between 1 and 11 January this year—11 days—84 operations were cancelled for the same reason. When my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) was Secretary of State for Health, he created the walk-in centre in York, which he visited with me, and it reduced pressure on A and E. He created NHS Direct, which reduced pressure on A and E. The walk-in centre was closed two or three years ago and NHS Direct has now been closed, so it is not surprising that we face these extra pressures with hundreds of thousands of extra presentations at A and E each year.

The pressures in A and E mean that when ambulances arrive with acutely ill patients they often have to wait a long time before they can pass the patient over to the A and E service. That inevitably has a knock-on effect on ambulance response times. A freedom of information request made last week by the trade union Unite found out that Yorkshire ambulance service failed to meet its national target of responding to 75% of emergencies within eight minutes in 11 of the 12 months leading up to October of last year.

The problems within mental health services are even worse. Last year, the Care Quality Commission highlighted major failings and, following an especially serious incident at Bootham Park hospital, the acute mental health hospital in York, in which a patient died, I wrote to the Secretary of State in April 2014 in support of the local clinical commissioning group and Leeds and York Partnership NHS Foundation Trust, the provider of mental health services in York, to press for urgent plans to replace the 250-year-old Bootham Park hospital. It is a fine grade I listed building, but because of its listed status English Heritage prevents the health trust from removing ligature points or installing anti-barricade doors and makes it impossible to provide clear lines of sight from nursing stations to the patients’ bedrooms.

The CQC’s concerns are not just about adult mental health services. The child and adolescent mental health unit in York, Lime Trees, was constructed more recently. It is a mixed unit for girls and boys, but it does not have sufficient bathrooms to preserve dignity with two genders within the unit. It also has inadequate space for clinical meetings, therapy sessions and family visits, and it only has limited space for the young people themselves to relax and, because of its deficiencies the more acutely ill young people have to be sent away, often to the other side of the Pennines, in order to get treatment. That does not make sense. We have heard from my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and others today about the pressures on families when acutely mentally ill young people are moved away.

I got a letter back from the Minister of State saying that NHS Property Services was working with local commissioners

21 Jan 2015 : Column 312

“to look at a comprehensive estate strategy for York.”

That was eight months ago, and I say to the Minister—I hope his Parliamentary Private Secretary will tap him on the shoulder now—that I would like him in his response today to say what progress has been made in those eight months in providing a capital package to replace Bootham Park hospital in York. It is urgently needed and he has had a long time to consider it.

Just last week the CQC, in a new report, made further criticism of the Leeds and York mental health trust. Most worryingly of all, it revealed that York receives much poorer services than Leeds, despite the same trust providing services to both places. The local paper in York had a headline story describing it as “A Tale of Two Cities.” The trust chief executive Chris Butler has told me that the reason for the disparity in services is simply because the CCG in Leeds is better resourced than the CCG in the Vale of York and therefore it receives more money per capita for the population served from Leeds than for that served from York. It is simply unacceptable for access to care to depend on a postcode lottery.

Two things have brought about this crisis. First, there has been a squeeze in funding in the NHS. As I pointed out when the Secretary of State was speaking, the NHS budget has fallen from 8.2% of our GDP in 2009-10 to 7.9% in 2013-14, and the situation is getting worse as we will see when the figures for this year are revealed. To put that fall in perspective, the difference between 8.2% and 7.9% of GDP is some £5 billion a year. That is the amount by which this coalition Government have cut the NHS budget.

The Government must address not only the overall level of funding, but the way the funding is split between different health authorities. Within the former North Yorkshire primary care trust area, where all patients used to get the same level of treatment, funding in the Vale of York is just £1,062 per person as against £1,270 in Scarborough and Ryedale. I went with colleagues from neighbouring constituencies to see the Secretary of State to say that parity of funding should be restored, but nothing has happened. This is a Government who talk the talk but do not walk the walk on the NHS.

Several hon. Members rose

Madam Deputy Speaker (Mrs Eleanor Laing): Order. I must reduce the time limit to five minutes if everyone who wants to speak is to have an opportunity so to do.

6.19 pm

Liz McInnes (Heywood and Middleton) (Lab): The pressure that the NHS faces in my constituency under this Government is all too apparent. I have a constituent, Mr Stephen Corfield, who asked me to call on him last weekend. Stephen has been housebound for the past year with severe back, hip and neck pain that results in severely restricted mobility. He lives in his upstairs bedroom and is cared for by his wife. He has not been able to go downstairs for a year. Stephen is in dire need of X-rays to diagnose his condition, yet he cannot get to hospital because the privatised ambulance service in Greater Manchester, run by Arriva Transport, will not come out to take him. Arriva says that all Stephen has to do is to get to his front door, at which point its passenger transport system will do the rest. This completely

21 Jan 2015 : Column 313

overlooks the fact that Stephen is totally incapable of getting to his own front door. Is it any coincidence that Stephen’s problems are being exacerbated by the inaction of a privatised ambulance service? Stephen has to sit at home, his health deteriorating day by day, all for the want of an appropriate, decent response to his problems from that privatised service.

Other constituents have been to see me to complain about the withdrawal of the diabetic retinopathy screening service from Heywood. This has resulted in diabetics living in Heywood being asked to travel to Rochdale for an essential screening test. The test leaves them with impaired vision, and therefore unable to drive. They have to use public transport, and often have extreme difficulty in doing so. If ever there was an argument for keeping health services local, the diabetic retinopathy screening test is it. As a result of this cut to the service, diabetics in Heywood are not keeping their appointments because they do not feel confident that they will be able to return home safely after their test. The result of the cut is that patients are missing out on an essential test that helps them to maintain their eye health and keep them out of hospital. This is a false economy if ever there was one.

Sadly, those two examples are all too typical of the patient experience in today’s NHS. Services are being cut and privatised, with an inevitable reduction in quality of care for the patient, and this is all the result of the Health and Social Care Act 2012. The Act was introduced by a coalition Government with no mandate to do so; it was mentioned in neither the Tory nor the Lib Dem manifesto.

I should like to move on to talk about NHS staff. Not long ago, I was one of them. I worked as a health care scientist and I saw at first hand how demoralised NHS staff had become under this Government. NHS staff are not against change. We have spent our careers working with a background of constant change, but what has happened since 2010 has been unprecedented. Services have been cut and privatised, and staff have been made redundant or TUPE-transferred to private providers. I have seen hard-working colleagues burn out, and many people have taken early retirement if they can afford to do so. They were unable to take the pressure of working in today’s NHS.

In a spirit of consensus, I should like to suggest to the Secretary of State—were he here—that one easily achievable thing he could do would be to stop ignoring the recommendations of the pay review body that were made last year, and to pay all NHS staff the 1% pay rise they so richly deserve. I cannot understand why this Government have chosen to pick a fight with NHS staff over a 1% pay rise. They cannot possibly be proud of the fact that they have presided over strikes in the NHS. Any Government who can get the not-normally-militant Royal College of Midwives out on strike must surely admit they are doing something wrong.

NHS staff will strike again next week, simply because the Secretary of State refuses to meet the trade unions to discuss and negotiate the issues. The Secretary of State constantly heaps praise on hard-working NHS staff, yet he refuses to do this one simple thing. If he were to remunerate the staff in this way, it would improve morale, which would have a positive effect on patient care. The NHS is one of this country’s greatest achievements, yet under this Government we have witnessed

21 Jan 2015 : Column 314

a decline in the quality of care, growing health inequalities and stressed, demoralised staff. The Secretary of State is presiding over strike action in the NHS, yet the simple solution to the strikes lies in his own hands.

6.24 pm

Mr Andy Slaughter (Hammersmith) (Lab): It has been a dispiriting afternoon, listening to the Secretary of State and Government Back Benchers saying that they do not play politics with the NHS while doing exactly that by blaming a previous Labour Government. They say they respect and care about NHS staff but they are not even prepared to pay them the 1% increase that has been recommended. Most of all, they say that they care about individual incidents but ignore statistics, whereas those statistics are simply the aggregate of so many individual tragedies that are going on at the moment.

Let me explain what I mean by that last point. This week, the Evening Standard has been running a series on the London ambulance service, and yesterday it was revealed that the head of the service had resigned after producing the worst results in the country—in only two thirds of the greatest emergency cases did the ambulances arrive within the target time. On Monday, it was reported that there had been a two thirds increase between November and December in stacking—ambulances waiting more than 30 minutes outside hospitals—across London. What those statistics, bad as they are, hide is shown in the e-mails I get every week from my constituents.

One such e-mail was about an incident where someone on a pizza delivery bike was hit by a car, with the rider badly injured. The police arrived rapidly and administered first aid. They were

“overheard to say that the victim was bleeding from the ear and his injuries may be ‘life-changing’”,

but that the fact they had arrived might itself delay an ambulance arriving. In this case, it took an hour and a half for that to happen. Another e-mail was about an elderly man who fell, cut his head and was lying in blood. The neighbours came out to help, but after an hour, during which time no ambulance had arrived, he was helped back into his home. Another e-mail relates to the case of a constituent who came to the aid of somebody who had come off their bicycle and broken their nose on Shepherd’s Bush road. My constituent was told by a paramedic, who was phoning back, that it would be at least two hours before an ambulance arrived, and they managed to get a police officer to take the injured person by minicab to Chelsea and Westminster A and E. I am sorry to say that I get those e-mails every week.

That is about the ambulance service, but what is happening to A and E? The A and E departments of the Imperial College Healthcare NHS Trust are performing at a level where about one in four people wait more than four hours, but at Christmas it was one in three. In neighbouring hospitals, performance has been as low as having half the people wait more than four hours—for example, at Northwick Park before Christmas. Let me read out what one constituent has written. He is the son of a 94-year-old woman and the following words say it all:

“She was seen by her GP…and he arranged for her to go to Charing Cross A & E department by ambulance and we arrived there at 6 pm. The department was extremely busy with people waiting in corridors due to a lack of beds.

21 Jan 2015 : Column 315

Although it was not ideal I agreed with the doctor to start her treatment while she was sitting in the corridor. I say treatment but it was only preliminary things such as taking blood and inserting a line feed in her arm in order to administer antibiotics.

My mother is incontinent and needs help with going to the toilet. Because the staff were rushed off their feet she could not receive the help she needed in a timely manner.

It is obvious that the closure of the other A & E departments in West London has had an adverse effect on those that remain open.

It was not until about midnight”—

six hours later—

“that she was given a bed and a room of her own…where finally she was given an examination by another doctor.

At 1 am I left the hospital and returned the next morning to be told she was being transferred to Hammersmith Hospital because there were no beds available at Charing Cross.

I think you will agree that this level of care is unacceptable. While I cannot fault the staff at Charing Cross the whole Conservative policy of closures in West London is the worst political decision they have ever made.”

The point is that I could have been talking about anywhere in England, although in reality the situation in west London is much, much worse. Two of our A and E departments closed last September, and A and E figures plummeted after that. At last night’s meeting of the council committee that scrutinises Imperial College Healthcare NHS Trust managers, I asked whether they would now review—not cancel but simply review–their decision to close the A and E department at Charing Cross hospital, demolish that hospital, lose 93% of the in-patient beds and lose the best hyper-acute stroke unit in the country. Still they would not answer. They would not say yes and they would not say no. They are frozen; they cannot do anything but continue. Perhaps that is why the CQC said that all that trust’s hospitals requirement improvement, why the trust’s foundation status bid is on hold at the moment and why I and several of my west London colleagues have written to the Secretary of State to ask him to intervene. I am not holding my breath. Even though we represent more than 1 million people between us, he has done nothing and has not been willing to meet us for the past two years. That is a disgrace.

6.29 pm

Jim Shannon (Strangford) (DUP): It is a pleasure to contribute to the debate. I thank the Opposition for bringing the matter to the House for consideration. The one thing that unites the whole House is a love of our health service. We have different opinions on either side of the House, but we are united by the need for an NHS that delivers services for our constituents.

It is important to look at the regional issues affecting our devolved Administrations, but a nationwide strategy for the overarching issues facing the whole of the UK is of paramount importance. My concerns relate to barriers to accessibility and the quality of NHS provision. I shall focus on the availability of vaccinations and the issue of nationwide strategies. Sometimes we should not be parochial about the NHS, but rather consider nationwide strategies that can be put into practice across the entire United Kingdom of Great Britain and Northern Ireland.

21 Jan 2015 : Column 316

With the undeniable strain on NHS resources and their ability to provide services efficiently, quickly and to the high standard that we strive to meet, in the past few days the Northern Ireland Assembly announced an extra £203 million for the Department of Health, Social Services and Public Safety. That will alleviate some of the pressure, but there are continuing financial demands to provide the new drugs and new technologies that are vital for the provision of essential services. It is a great pity that as a result of Sinn Fein’s delay in agreeing welfare reform measures, fines were imposed, impacting upon the moneys available.

As other hon. Members have mentioned, mental health services are struggling to deliver urgent care, particularly for younger people. Some 17% of young people have been sectioned under mental health legislation since 2010. That is an indication of the issues that permeate our whole society. For those of us of a certain vintage and those of us who are younger, the issues of mental health are clear.

Cancer care is a subject close to my heart. One in every two of us is expected to have cancer. The devolved Administration in Northern Ireland have been maintaining funding for clinical trials that will benefit the whole of the United Kingdom, but it is a challenge to find the money for that. The statistics from Cancer Research UK emphasise the prevalence of the disease: every two minutes someone in the UK is diagnosed with cancer. The NHS must deliver the necessary care.

The Northern Ireland Budget has made promising provision for health. The demand for health care is greater in Northern Ireland than in the rest of the United Kingdom. How we deliver that care, how we manage our services, and what preventive strategies are in place are all crucial aspects. The problems affecting A and E departments in Northern Ireland are as acute as those in some parts of the mainland. Education campaigns in GP surgeries and on television and radio could encourage people to use A and E departments appropriately and to consider using the other systems that are in place.

In Northern Ireland we seek to increase the number of patients participating in clinical trials, but we need to maintain the funding for that and meet the costs involved, among the many other demands on the NHS budget.

I know that the Minister is usually responsive on the issue of cancer drugs, so in his summing up perhaps he will explain why six cancer drugs have been reduced, restricted or withdrawn and how that fits in with the strategy across the whole United Kingdom.

I want to put on record my thanks to our medical practitioners and nurses for the hard work that they do. Will the Minister consider increasing the number of agency staff on a contract basis to assist in alleviating the pressures on NHS services, or will he consider some sort of scheme whereby graduates are brought in to help them gain experience and training? This would not only benefit young people who need experience, but would put more staff on hospital wards and in A and Es, and could be financed from the existing budget.

6.34 pm

Yasmin Qureshi (Bolton South East) (Lab): I wish to start by thanking NHS staff. I agree with the Secretary of State that they should be recognised for all their

21 Jan 2015 : Column 317

work, so I ask him to consider giving them the 1% pay rise that has been recommended by an independent body. That would be a real way of recognising all their hard work.

I wish to talk about the Royal Bolton hospital in my constituency; it is the third largest accident and emergency department in the north-west. Last year, it saw 114,510 people. A and E admissions numbered 26,267 and in 2013-14, elective operations stood at 14,865 and non-elective at 1,407. The staff—porters, cleaners, care assistants and clinical staff—do an excellent job in a very difficult situation. My hospital needs more resources.

As I attend regular meetings with the chief executive officer and the chair of the Royal Bolton hospital, I also often visit the A and E department to see the situation at first hand. Recently, the hospital declared a major incident when it could not take in 76 patients. By cancelling non-emergency elective operations, it managed to free 40 beds. However, as a consequence of cancelling those operations, it lost £600,000.

As the hospital will now no longer be able to meet the target of the clinical commissioning group, it will end up getting penalised as well. To meet that target, the hospital may have to resort to using private companies, which may cost it even more. Whichever way we look at it, the hospital stands to lose quite a lot of money. Over the past two years, it has had to make £40 million of cost savings, and it will have to carry on cutting in light of the demands that it is facing.

The main reason for the long waits in A and E was that many people could not get GP appointments or go to walk-in centres, so they had to go to A and E as a first port of call rather than as a last one. Secondly, many elderly and frail people could not be discharged, which then led to bed blocking. There were 94,046 acute delayed days last November, which then created even bigger blockages. The hospital is caught bang in the middle of the problem—there are problems at the start, before people go to hospital, and there are problems at the end, because people are not being transferred or discharged. That situation must change. One reason for the delays in transfers and discharges is the cut in the budget for social services and adult care. More than 300,000 people no longer receive state funding for social care.

In 2009-2010, the Labour Government spent 8.2% of GDP on the NHS, whereas in 2013-14, the figure was 7.9%. It is quite clear, therefore, that less money is going into the sector. It has been recognised in this Chamber that, with more people living longer and with growing health needs, that money has to go up. To say that nothing further can be done with regards to putting more finance into hospitals is completely wrong.

In Bolton, the local authority, the hospital and the clinical commissioning group are trying to work together. When I recently visited my local A and E, 17 cubicles were in full use and two people were on trolleys. The situation is not good enough, because Bolton is an incredibly large area, serving about 300,000 people. People from Wigan and other surrounding areas also use the hospital.

Another problem is the shortage of GPs and the fact that walk-in centres have been closed down. We know that we need at least another 400 GPs and more walk-in centres. If we had an increase in those areas, the problem

21 Jan 2015 : Column 318

would not be so acute. Finally, not enough nurses are being trained, which will lead to a big shortage. That is another tsunami waiting to happen.

Mr Speaker: I am immensely grateful to the hon. Lady.

6.40 pm

Liz Kendall (Leicester West) (Lab): It is a privilege to speak in this debate, which has seen some passionate and thoughtful contributions about the NHS. Many hon. Members spoke about the pressures on their local ambulance services and A and E departments, including the hon. Member for Strangford (Jim Shannon) and my hon. Friends the Members for Barrow and Furness (John Woodcock), for Penistone and Stocksbridge (Angela Smith), for Heywood and Middleton (Liz McInnes), for Hammersmith (Mr Slaughter) and for Bolton South East (Yasmin Qureshi). The hon. Member for Stafford (Jeremy Lefroy) and my hon. Friends the Members for Jarrow (Mr Hepburn) and for Wirral South (Alison McGovern) spoke about the closure of walk-in centres, and difficulties in getting a GP appointment, which are piling pressure on their local hospitals.

My right hon. Friends the Members for Holborn and St Pancras (Frank Dobson) and for Rother Valley (Kevin Barron) described the terrible impact that this Government’s cuts to social care are having on elderly and disabled people, piling further pressure on the NHS, as Age UK’s excellent report showed yet again today. My hon. Friends the Members for York Central (Sir Hugh Bayley) and for Kingston upon Hull West and Hessle (Alan Johnson) spoke about the problems with child and adolescent mental health services, which have seen their constituents, like mine, sent thousands of miles away from family and friends to get treatment, which is terrible for them, terrible for their families and costs the taxpayer far more.

We have heard time and again during the debate how many of the long, hard fought-for gains achieved under the previous Government are being squandered before our eyes. When we left office, 98% of patients were seen within four hours in hospital A and E departments. Now that is down to 84%, with 180,000 patients having waited for more than four hours in the last month alone. In 2010, 80% of people could get a GP appointment within 48 hours; now one in four waits a week or more or cannot get an appointment at all.

The maximum 18-week wait for treatment has been missed for the last six months. Cancelled operations and delayed discharges from hospital have reached record highs in recent months. The vital cancer waiting target has been missed for the last nine months, meaning that 15,000 people have had to wait more than 62 days to start their cancer treatment. Anyone who has had a family member or friend wait for that treatment to start knows just how frightening that can be.