NHS Long-term Plan

Liz Kendall Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

Yes, I would be very happy to meet my hon. Friend to discuss the legislative changes. These changes have been proposed by the NHS. The NHS wants the changes set out at a high level in the plan. Of course there is a lot of consequential work to do to turn them into a full legislative proposal. The NHS is working on that. If it does that alongside and working with the Select Committee, I would be very happy to meet with her to discuss how that might happen. This is very much the NHS’s proposed legislation and I look forward to discussing it with her.

[Liz Kendall (Leicester West) (Lab)]

I am glad that the Secretary of State says that he will listen to clinicians if they want to change primary legislation. I just think that many of those clinicians and many Labour Members wish that he and his colleagues had listened to us when we warned about the problems with the Lansley legislation six years ago. But let us put that to one side. The biggest challenge facing the NHS is indeed the increase in the number of older people with two, three or more long-term chronic conditions. They need more joined-up services in the community and at home. The local NHS has been asked to put forward its plans for these new services by April. It cannot do so without proper long-term funding for social care. So will we hear about that in the Green Paper before April—yes or no?

[Matt Hancock]

When I answered a previous question on the timing of the social care Green Paper, I said it would be provided “soon.” I certainly intend that to happen before April. My previous commitment was to do it before Christmas, so it is well advanced. But the hon. Lady is right on the legislative proposals. There is a broad consensus on the need for more integration, as my hon. Friend the Chair of the Select Committee said. The proposals that are made by the NHS in the paper are what it thinks is needed in order to deliver this integration, which I very strongly support.

Social Care Funding

Liz Kendall Excerpts

Wednesday 17th October 2018 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

This year is the 70th anniversary of the NHS. It is also the 70th anniversary of our social care system, but that has received far too little attention to date. It is not getting any of the national celebrations—the birthday cakes and cards—and certainly none of the £20 billion birthday present that the NHS received from the Prime Minister.

Yet social care is more important than ever before. A quarter of older people now need help with daily living—getting up, washed, dressed and fed. More adults with physical and learning disabilities need substantial packages of support. There are 1 million paid care workers and 6.5 million unpaid carers. Yet despite the fact that this touches so many people’s lives and that there is an increasing demand, we have no sense from the Government of the reality of the situation. There has been a 10% cut in real terms in social care spending, with 400,000 fewer people getting any kind of help and support. A third of carers have to give up their job or reduce their hours to look after their loved ones, and a quarter of the paid care workforce leaves every single year. There is nothing from Government Front Benchers—no sense of the urgency of the challenge we are facing.

We cannot solve this problem without substantial extra funding. The Health Foundation says that we need £6 billion just to maintain the current inadequate system. It is not good enough.

Over the last 20 years, we have had 12 Green and White Papers and five independent commissions, but we have not solved this problem, and we need to understand why. Most people think that they are not going to end up needing this support. When they end up needing it, they do not realise that many of them will have to pay. They think the current system is unfair, but when radical proposals have been put forward for how to fund the system, they believe that those are unfair too.

This issue has been a political football. Labour was accused of imposing a death tax, and the Tories were accused of imposing a dementia tax—but it is not the politicians who suffer; it is the people who use the services and their carers. We cannot go on like this any longer.

I believe that one of the reasons this issue has not been solved is that much of it is about low-paid women who work in people’s homes and care homes invisibly. Caring is not valued, and we have to change that.

[Karin Smyth (Bristol South) (Lab)]

My hon. Friend is making an excellent speech and she is an expert in this area. She is right; the language we have heard today is all about the challenges and the costs. This is an infrastructure issue, and it needs to be treated as such. Because women lead this workforce, it is not considered an infrastructure issue, and if we did that and changed the language around this, we would have a completely different debate. Does she agree?

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[Liz Kendall]

I absolutely agree. If a third of parents had to give up work or reduce their hours because they could not get childcare, it would be a national scandal. We need to make social care as much a part of our economic infrastructure as childcare, and we have to wake up to that.

The reality is that we face a choice: either we leave individuals to pay for care, through no fault of their own, with only the wealthy able to afford to put aside extra money—the idea that a “care ISA” will solve the huge challenge of social care is, quite frankly, ridiculous—or we pool the costs and share the risks for a fairer and more equitable and efficient system. My view is that we have to look at the contribution of wealthier older people, not just the working-age population who are already struggling with so much of the cost of daily living.

Alongside extra money, we need real reform. We have to change and improve the way we offer care and support, to give people more choice, say and control and to ensure that care is personalised and flexible around the needs of individuals and families, not just one size fits all. We have to shift the focus towards prevention, early intervention and promoting genuine wellbeing. We have to put people who use care and have lived experience at the heart of the system, in terms of both policy and delivery. That is what has to be in the Green Paper. I cannot believe we are still without it. The Government need to get a move on and take action.

Dangerous Waste and Body Parts Disposal: NHS

Liz Kendall Excerpts

Tuesday 9th October 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend makes a valid point about the lessons to be learned from this. Part of what I would expect to look at as we move forward are questions about when the NHS was first made aware of this and what powers are available to enforce at an earlier stage. As I have mentioned, enforcement notices cover a spectrum of risk. Some of those risks are more technical in nature than others, so while there have been 13 notices, their enforcement encompasses a range of severity.

[Liz Kendall (Leicester West) (Lab)]

According to its most recent accounts, HES made a gross profit of over £15 million last year. What financial penalty will it suffer because of its gross incompetence?

[Stephen Barclay]

The first financial penalty it has suffered is the prompt action we took over the weekend, with 15 NHS trusts cancelling those contracts and moving across. There is a clear financial penalty in that loss of business. As for fines, that is a matter of legal process, through the Environment Agency, in the normal way. That is not an NHS matter. The focus for the NHS is on maintaining continuity of service.

NHS Long-Term Plan

Liz Kendall Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for hosting me at his local hospital, which was very informative. He is absolutely right: it is an enormous cause of frustration to staff throughout the NHS that so many of our hospital systems are, frankly, antediluvian. We must put that right, because so many nurses could spend so much more time with patients if they were not having to fill out forms, and the same is true for doctors.

[Liz Kendall (Leicester West) (Lab)]

We cannot put the NHS on a steady financial footing without a proper funding settlement for social care, yet the Secretary of State now says that that will not happen until the spending review, which in reality means no substantial extra money for social care until 2020 at the earliest. We cannot transform care for older people or reduce pressure on the NHS until we look at the two together. Why are the Government still ducking this vital issue?

[Mr Hunt]

I always listen to the hon. Lady very carefully when she talks about the social care sector. I would say to her that while we are not announcing a new long-term plan for social care today, we are making some very important commitments to the NHS and the social care system, including the commitment that we will not allow the pressure from the social care system on the NHS to increase further. That means that, even before the date she mentioned, we are going to have to look very carefully at the settlement for social care.

Learning Disabilities Mortality Review

Liz Kendall Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

My right hon. Friend is a fantastic champion for equality issues in her role as Chair of the Women and Equalities Committee. I take on board everything that she has said, and I will certainly look more closely at the issue that she has raised.

[Liz Kendall (Leicester West) (Lab)]

The true disgrace is that none of this is new and we have been here before. Five years ago the Government set out their promises to tackle this appalling death by indifference, yet we have seen no progress. Can the Minister tell me how many hospitals regularly ask the four questions on treatment of people with learning disabilities set out by Sir Mike Richards, how many clinical commissioning groups check and monitor how many health checks and health plans people have in place, and what Health Education England has done to put the training in place to try to start turning the tide on this appalling situation?

[Caroline Dinenage]

The hon. Lady is right that this issue was identified a few years ago. The report was commissioned in 2015 and has been in the making since then. There was a Care Quality Commission report in 2016 which concluded that bereaved families do not often experience openness and transparency. Everything we have done up until this point—the mortality review, the learning from deaths programme and all the other things we have put in place with regard to the transforming care programme and annual health checks—is geared towards addressing this very issue.

Social Care

Liz Kendall Excerpts

Wednesday 25th April 2018 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I will make three brief points. The cuts we have seen to social care because of the huge reductions in local council funding are not just morally questionable but economically illiterate. Hundreds of thousands fewer people are now getting publicly funded social care, which is there to help frail, vulnerable people just to get out of bed and dressed, fed and washed—things we all take for granted. Those who still get publicly funded support are seeing it reduced, with shorter visits than they desperately need. The result is increasing numbers of elderly people going into hospital and getting stuck when they do not need to be there, which is terrible for them and costs the taxpayer far more.

As the shadow Care Minister said, this has a huge impact on unpaid family carers. One in four unpaid carers has not had a single day off caring for five years. Not a single day in five years! Think of the strain that puts on their physical and mental health. One in three unpaid family carers in work has had to give up their job or reduce their hours, so their income goes down, they end up claiming more in benefits and their employer loses their skills. There would be an outcry if that happened in any other area of the workforce.

I am afraid that the Government still do not get it. They are still failing to look properly at the NHS and social care together. It is astonishing that we have a separate Green Paper on social care, and doubly astonishing that the Green Paper focuses only on older people and not the hundreds of thousands of disabled people. We have to look at them together, and I urge the Minister to think again about the Government’s approach.

That leads me to my third point, which is about the solution. We need an urgent and immediate injection of cash into social care and the NHS. We simply cannot put the services, patients, carers and families through this all again next winter. We also need a bold 10-year strategy for investment and reform.

The NHS and social care will always be political issues, and rightly so—they are things we deeply care about—but we need a cross-party approach on future funding, especially of social care, not just because any party that comes up with a bold proposal risks being obliterated by its political opponents, but because we desperately need a system that will last for the long term, not for the politicians but for the people who use and work in those services.

I urge the Government to heed the calls from more than 100 MPs on both sides of the House for a short parliamentary commission on a long-term strategy, which would report within a year. I also hope the Government will consider the 10 principles of long-term funding for the NHS and social care put forward by myself, the right hon. Member for North Norfolk (Norman Lamb) and the hon. Member for Grantham and Stamford (Nick Boles). We agree that the NHS must remain a universal tax-funded service, available free at the point of delivery, based on need, not ability to pay. We agree that spending on the NHS and social care must increase by substantially more than inflation over the next 20 years because of our ageing population, new treatments and technologies, and the need to achieve genuine equality of access to treatment for people with mental ill health. We believe that people are more likely to be willing to pay more for the NHS and social care if they can be certain that additional resources are dedicated to that end and cannot be diverted into other Government programmes—in other words, there should be hypo- thecation. We believe that increases in funding must be progressive and fair between the generations, with higher earners, the self-employed and better-off pensioners making a fair contribution to future funding. We also believe that every five years there should be an independent assessment, carried out by the Office for Budget Responsibility or a separate health-focused body, to look at the resources needed to run the NHS and social care in future, which Parliament will then debate and decide on.

These are tough issues, no one is denying it, but we have to join up the services, and we need in this year, the 70th anniversary of the NHS, to get a future funding settlement. If we were creating the NHS today, it would be a national health and care service. It must be fair, it must be progressive and it must last for future generations. I urge the Government to act.

 Orkambi and Cystic Fibrosis

Liz Kendall Excerpts

Monday 19th March 2018 Westminster Hall

[Liz Kendall (Leicester West) (Lab)]

The hon. Gentleman is being very generous with his time. One hundred and eighteen of my constituents signed the petition, so I am very grateful for the debate. He speaks with great passion about the huge challenges facing people living with cystic fibrosis. I agree that NHS England and the drug company need to get together to resolve this issue as quickly as possible. However, does he agree that the bigger issue is about ensuring that NICE has the proper processes in place to make sure that new drugs are agreed as quickly as possible? Does he also agree that the Government should review that, to make sure, not only with this issue but with others, that people have confidence in the process and that that follows the right principles and guidelines?

[Paul Scully]

I thank the hon. Lady for that intervention, and I totally agree with her.

I will finish on the issue of living with cystic fibrosis by saying that in addition to having physio and nebulisers, sufferers often have to take a huge cocktail of drugs, as the hon. Member for South Antrim said. The cupboard that I saw for Grace was bigger than one of my kitchen cupboards and it was just full of medicines. There have to be savings in that respect. To return to the hon. Lady’s point, it is really important that we have a system that is fit for purpose. We can sit there and put sticking plasters, as it were, on all these things, but that is what we need. When we are talking about the health service as a whole, it is not always about the big headlines that we argue about across the Chamber. It is about efficiency and ensuring that things work in the modern age. For modern diseases, there need to be modern treatments and so on.

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[James Frith (Bury North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Evans. My constituent Graham Little got in touch with me. His wife Claire has cystic fibrosis. Until that moment, I was not aware of the potential life-changing drug available to sufferers of cystic fibrosis. Graham and his father-in-law Brad raised with me the status of the precision medicine Orkambi. The result of today’s debate could make the difference and give them decades more with their wife and daughter, Claire, and give her decades more with her children. I cannot imagine how that must feel.

We can either observe the steady death caused by cystic fibrosis—it has been compared to drowning—or reach for the life jacket, which is primed, ready for use and in all sizes. Our country has the largest number of cystic fibrosis patients anywhere in the world, so we ask the Government what they are going to do for our cystic fibrosis sufferers. If they will not make Orkambi available, what are they going to do? The transformative, life-prolonging impact of the drug is tantamount to life-saving. Used early enough, it can ensure that people fulfil their potential. It can prolong life and lung capacity, enabling those with the disease to contribute to the economy and wider society, as well as providing extra decades with family and loved ones.

The Government should consider the case for a commissioning body for rare diseases. It is not right that the judgment criteria used to determine funding on globally common diseases are universally applied when the uncommon traits of a rare disease bring untypical symptoms and a different economic argument. We risk overlooking the incredible efficacy of the drugs now available.

The power in numbers is not much solace to a cancer sufferer, but such is the profile of cancer treatment that we are all assured of the progress being made there. The same cannot be said for the rare diseases argument, however. We have a job to do in making the case for rare diseases. I hope the Minister will listen to the case being made for a medicine and treatment decision-making body for rare diseases, as well as consider how we bring NICE into the modern age, 20 years after it was established.

[Liz Kendall]

My hon. Friend will know that the Government review NICE once every three years. Does he agree that the next review, which will start in July this year, must look seriously at how NICE makes its decisions? Does he also agree that the results of that review should come out quickly? Last time, it took about a year and a half.

[James Frith]

I completely agree with my hon. Friend. We need to see far more nimble-footed decision making by the decision-making body, as per my call for a specific dedicated body for rare diseases. Parents in my constituency make the case about the plight of those with rare diseases. There is a constant sense of those enduring rare diseases being overlooked.

We come to the remaining agents at the table. Just this weekend, NHS England has refused to agree to the deal that Vertex proposed last month. I do not think the wording of the refusal was constructive, but I am not surprised that the NHS was unwilling to sign up in principle to the deal, which amounts to a futures prospectus from Vertex off the back of a sure thing with Orkambi. Patient groups are at the table, and I commend the work that the Cystic Fibrosis Trust is doing on behalf of CF sufferers.

We need compromise and urgency from all. Nobody should expect Vertex to surrender its drugs, but neither should we accept a failure to reach an agreed price. I say to Vertex that the pipeline might need to be for another time. When I met Vertex, I cautioned that its “portfolio of drugs” approach may be cost-prohibitive to a decision, and that appears to have been the case. We need Orkambi for patients today. It is not the time to test the innovative decision making of NHS England. Vertex should take in good faith that a fair price to the world’s largest population of cystic fibrosis sufferers will set it up well for future developments. A price somewhere between what it was offering in its recent pipeline deal and a single purchase deal is where we are now. I ask Vertex to please stay at the table. We keep in mind its proposal of having Orkambi readily available, swiftly and easily, for all. We urge focus on enabling that. The rest will surely follow.

At the table, there is a ministerial chair that needs filling by a Minister who is willing to lean in to the debate and signal their support for prescribing Orkambi on the NHS; willing to lead and lean in to the deal-making part of the job to transform lives; willing to look at the costs and to help with the price; and willing to align the political will to the possibility of life for those with cystic fibrosis. Treatment for cystic fibrosis has moved from science fiction to science fact, so the Minister is required to act and step in. The Government have a choice to make. They can ignore our arguments, or, having heard them, choose to change their mind. In changing their mind, they can change lives and lifetimes. I urge the Minister to do that and make real-life change for cystic fibrosis sufferers a reality. He would have support from Members across the House, as has been demonstrated by the magnificent strength of feeling in the contributions and arguments made today.

NHS Winter Crisis

Liz Kendall Excerpts

Wednesday 10th January 2018 Commons Chamber

[Liz Kendall (Leicester West) (Lab)]

I am afraid that too much of what we have heard from Ministers and some Government Members has tried to pass off the pressures that we are seeing in the NHS as just what happens every year. I have worked with the NHS for around 20 years, and let me tell Members that those pressures are not what we see every year. Cancelling operations for a whole month is extremely serious. In one week alone, 300 operations were cancelled in Leicester, including for patients such as 80-year-old Kenneth Roberts, who was due to have his hip operation tomorrow. He is in so much pain that he is on liquid morphine and has to use crutches or a wheelchair to get about, and his wife, Jenny, is physically and mentally exhausted, too.

One of the real problems is the absence of any acknowledgement from Ministers of the huge knock-on effect that rescheduling a whole month’s operations will have. It will simply mean that existing patients who are already on the waiting list will have to wait even longer, too, and it will be very, very difficult to bring that list back down. As my hon. Friend the Member for Stockton South (Dr Williams) said, a number of Labour Members have a terrible sense of déjà vu. We remember the 1990s, with ambulances queuing up outside A&E and millions of patients left languishing on waiting lists. I also remember the predictable cries from some right-wing commentators that the NHS’s time was up and that it could no longer survive as a service free at the point of use. I am afraid that we will see that coming back again all too soon.

The truth is that we are not dealing with the long-term underlying demands on health and care services—our ageing population, and more people living with one, two or more chronic conditions who desperately need more preventive services in the community—and huge technical advances. Yes, the Government talk about that, but they do not understand the scale of the challenges or the response that is required. The truth is that, since 2010, the NHS has had an average annual real-terms increase of 1%. That figure compares with 3.5% historically and 5.5% under the previous Labour Government. On top of that, we have had huge cuts to social care, and the dreadful, wasteful, pointless Lansley reorganisation, which has given reform a bad name. Unless the Government change course, we will see increased rationing as patients are waiting in the NHS, leaving thousands in pain and distress, and increased rationing as a result of eligibility criteria in social care, leaving millions of older and disabled people without any support at all. That is not what the people of this country want.

The Government need to put in place a bold 10-year strategy of investment and reform for both the NHS and social care. They should drop the idea of a separate social care Green Paper—we cannot look at the two separately—and they should heed calls from 90 Back Benchers for a cross-party convention. I am worried about the idea of a royal commission, as that would take too long. We know the options for investment and reform, so we need to get on with the job. I suggest a shorter process of six to eight months to try to get cross-party agreement, particularly on funding for social care, because any party that comes up with a substantial proposal risks being obliterated by its opponents, and we need a proposal for funding that will last whichever Government are in power. In the 70th anniversary of the NHS, I urge the Government to act.

NHS Winter Crisis

Liz Kendall Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

I do not think my hon. Friend will be surprised if I say no, I do not agree that the system is broken. I do accept that it requires more funding, and that is why more funding was provided. It also requires local authorities to work more closely alongside the NHS to try to share these problems and find solutions together.

[Liz Kendall (Leicester West) (Lab)]

The Minister said earlier that he did not know how many operations had been cancelled—maybe a few. Let me tell him that in one week alone 300 operations were cancelled in Leicester. I find myself unusually agreeing with the hon. Member for Wellingborough (Mr Bone)—social care is broken. Will the new Cabinet Office Minister be leading on the social care Green Paper, as the previous one did, and if not him, who?

[Mr Dunne]

I am glad that the hon. Lady has referred to the social care Green Paper, because that will be published this year, providing an opportunity for all Members to participate in it. It does not sit within my set of responsibilities, so I will come back to the hon. Lady on exactly who will be leading on it.

Social Care

Liz Kendall Excerpts

Wednesday 25th October 2017 Commons Chamber

[Jackie Doyle-Price]

I need to make progress. I apologise to my right hon. Friend.

On delayed transfers of care, the Government are clear that no one should stay in a hospital bed for longer than is necessary. Doing so removes people’s dignity and reduces their quality of life. It leads to poorer health and care outcomes, and it is more expensive for the taxpayer. I will set out in more detail the work we are doing to reduce delayed transfers of care. That is critical, because a well-functioning social care system enables the NHS to provide the best possible service.

We are clear that we must make much faster and more significant progress well in advance of winter to help to free up hospital beds for the sickest patients and reduce pressures on overcrowded A&E departments. Last year, there were 2.25 million delayed discharges, up 24.5% from the 1.81 million in the previous year. Just over a third of those delays were attributable to social care. The proportion of delays attributable to social care increased over the last year by four percentage points to 37% in August 2017.

We have put in place an agile and supportive improvement infrastructure, and I have been very clear about priorities. First, in this year’s mandate to NHS England we set out a clear expectation that delayed transfers of care should equate to no more than 3.5% of all hospital beds by September. Those in the system have worked extremely hard to agree spending plans and put in place actions to make use of the additional funding, and they deserve real congratulation for their efforts. Since February, there have been significant improvements in the health and care system where local government and the NHS have worked together to tackle the challenge of delayed transfers of care, with a record decrease in month-on-month delayed discharges in April 2017.

[Liz Kendall (Leicester West) (Lab)]

Will the Minister give way?

[Jackie Doyle-Price]

I must make progress. Secondly, we put in place a comprehensive sector-led support offer. In early July, NHS England, NHS Improvement, the Local Government Association and the Association of Directors of Adult Social Services published a definitive national offer to support the NHS and local government to reduce delays. This package supports all organisations to make improvements and includes the integration of better care fund planning requirements to clarify how this and other aspects of the better care fund planning process will operate.

[Liz Kendall]

Will the Minister give way?

[Jackie Doyle-Price]

I have limited time, and I really must get this improvement on the record.

The package also includes joint NHS England, NHS Improvement, LGA and ADASS guidance on implementing trusted assessors; the introduction of greater transparency through the publication of a dashboard showing how local areas in England are performing against metrics; and plans for local government to deliver an equal share to the NHS of the expectation to free up 2,500 hospital beds. The package sets out clear expectations for each local area, reflecting the fact that reducing such delays in transfers of care must be a shared endeavour across the NHS and social care. Those expectations are stretching, but they are vital for people’s welfare, particularly over the winter period.

Thirdly, we have asked the chief executive of the Care Quality Commission to undertake 20 reviews of the most challenged areas to consider how well they are working at the health and social care boundary. Twelve of the reviews are under way and a further eight will be announced in November, based on the performance dashboard and informed by returns from July. Those reviews commenced in the summer, and the majority of them are due to be completed by the end of November. They are identifying issues and driving rapid improvement.

Fourthly, we have provided guidance on best practice, including how to put in place “trusted assessor” arrangements, which can allow more efficient discharge from hospital by avoiding duplicative patient assessments by different organisations. All areas have now submitted their better care fund plans, which include their trajectories for reducing delays.

Finally, in October we asked NHS England to extend the GP and pharmacy influenza vaccination service to include all paid careworkers in the nursing and residential care sector. They will be able to access the service via local GPs and pharmacies free of charge.

I know that the hon. Member for Worsley and Eccles South is concerned about the provisions for those that fail to improve, and I want to tackle head-on the suggestion that there will be fines. We are not talking about fines at all. The money that has been earmarked will continue to be retained by local authorities.

[Liz Kendall]

Leicestershire County Council fears that it could have £22 million removed from its budget because of fines for delayed discharges, when the Government have cut its funds. The Conservative deputy leader, Byron Rhodes, says:

“I can’t think of anything more stupid.”

The Conservative leader, Nick Rushton, says:

“How long can we put up with the Secretary of State?”

That is the reality of the policy. What is the Minister going to do about it?

[Jackie Doyle-Price]

I reject the suggestion that there will be any kind of fine. The £22 million that the hon. Lady talks about will be retained for spending within Leicestershire. That funding has been allocated for a specific purpose, and where local authorities are not showing the improvement that we expect, we will work collaboratively with them and advise them how best to use that money.

Let me put on record exactly what we are going to do. There is significant variation in performance across local areas. We know that 41 health and wellbeing boards are collectively responsible for 56.4% of adult social care delayed transfers of care. That cannot be right, when other local authority areas have none. In particular, Newcastle has no adult social care delayed transfers of care, and if it can do that, other areas can as well, provided we have good partnerships and good leadership. I trust that I have demonstrated the extent to which the Government are supportive of the best performing systems where local government and the NHS are working together to tackle this challenge. However, we are clear that we must make much faster and more significant progress in advance of winter to help to free up hospital beds for the sickest patients and to reduce pressures on our A&E departments.

It is right that there should be consequences for those who fail to improve. Earlier this month, we wrote to all local authority areas informing them that if their performance did not improve, the Government may direct the spending of the poorest performers—it is not a fine—and we reserve the right to review allocations. It is important to note that the allocations will remain with local government to be spent on adult social care. It is not a fine; this is about making sure that public money delivers the intended outcomes.

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[Liz Kendall (Leicester West) (Lab)]

It is a privilege to follow the Chair of the Health Committee, and I shall pick up on some of the themes she raised.

During the election, Conservative Members were no doubt dismayed that their manifesto proposals were dubbed a “dementia tax”, conveniently forgetting their “death tax” assault on Labour in 2010. While some of us could be forgiven for experiencing more than a little schadenfreude, the truth is we face a fundamental problem. Our population is ageing, more people need help and support and our care services desperately need more money to cope, yet any party that comes up with a significant proposal for funding social care risks their political opponents destroying them.

We could carry on like this for yet another Parliament, and yet another election, or we could face up to reality: we will only get lasting change if we secure a cross-party approach. That is why I have joined the hon. Member for Totnes (Dr Wollaston), the right hon. Member for North Norfolk (Norman Lamb) and other Select Committee Chairs in calling on the Prime Minister to establish a cross-party commission on the future funding of health and social care. We cannot allow this issue to be kicked into the long grass any longer. More than a million people are not getting the help and care they need. Many end up in hospital, and are getting stuck in hospital for longer. That is not good for them, and it costs the taxpayer far more.

It is not just the people who need care who face a daily struggle. Six and a half million people in this country now care for an older or disabled relative; 40% of them have not had a break for a year, and a quarter have not had a single day away from caring in five years. What is the result? A third of unpaid carers have to give up work or reduce their hours, so their incomes are reduced, the cost of benefits increases and the economy is denied their talents and skills. The failure to deal with the funding problem has not just created a care crisis—it has created a crisis for families and our economy.

Alongside a significant and immediate injection of cash, which we must see in next month’s Budget, three long-term questions must now be addressed. First, what is the right balance between the contribution made by individuals and the state? Do we leave all the extra costs of care to individuals who are unlucky enough to need it, and who might end up seeing all their savings wiped out as a result, or do we pool our resources, share the costs and risks and create a fairer system for all?

Secondly, what is the right balance of funding across the generations? The Conservative manifesto proposals were deeply flawed, but with the longest period of wage stagnation for 150 years and rising personal debt, I do not believe the working-age population can pay for all the additional costs of caring for our ageing population. Wealthier older people will need to make a contribution, too.

Thirdly, how do we get rid of the inequities between the NHS and social care, and make the fundamental reforms we need to provide a single joined-up service and shift the focus of care and support towards prevention? The Barker review for the King’s Fund rightly calls for a single budget for the NHS and social care, and a single body to commission services locally. It also says that we must face up to the deep unfairness that while cancer care is provided free at the point of need on the NHS, if you suffer from dementia, you may have to pay for all your care yourself.

These are inevitably difficult and controversial questions, but the Prime Minister’s experience during the general election campaign and Labour’s experience in 2010 simply reinforces the argument that we need a cross-party approach. The Government must now act.