Cities and Local Government Devolution [Lords] Bill

Lord Mann Excerpts

Wednesday 21st October 2015 Commons Chamber

[Mr Kevan Jones]

Amendment 2, tabled by my hon. Friend the Member for Nottingham North (Mr Allen), calls for the creation of a constitutional convention, which I think is very important.

As we heard earlier from my hon. Friend the Member for Sheffield South East (Mr Betts), the Government’s proposals are likely to end up as a dog’s breakfast. The Bill does not represent a movement for devolution or an attempt to improve local government or governance; it represents a clear political agenda. It is about the Chancellor’s vision of a small state Britain that will make it easier for him to push through draconian cuts. Once he has pushed responsibilities down to local government or regional tiers, he will be able to top-slice the budgets, while the difficult decisions will have to be faced locally, by mayors and councils. Those individuals will get the blame for the tough decisions that will be taken. The Chancellor and this Government will step back and say, “I’m sorry, it’s not our fault; it’s your local decision-making process.”

This is a unique way of approaching the devolution debate in this country. There have been other approaches. There was the Crowther debate in the late 1960s and early 1970s, which stood back and looked at not only Scotland, Northern Ireland and Wales, but how to devolve power locally. The Redcliffe-Maud reorganisation of local government took time to look at future structures for local government. That was controversial at the time—some of the historical counties were abolished, for example— but at least there was an evidence base.

That is not what is on offer now, which is why amendment 2 is so important. We need a properly thought-out national debate on devolution and what the structures will be. What we have now in this so-called enabling legislation is legislation with a big stick attached to it. Local areas such as the north-east have been told they can have devolution but only if there is an elected mayor, even though the Minister keeps denying that. He said an interesting thing in response to the previous set of amendments; he said no area would be disadvantaged if it did not go down the devolution route. That is not what he has been saying in the region or what his supporters in the Conservative party have been arguing in the region. The argument there is that if these truculent local authorities do not agree to devolution, they will lose out on all this money. The Minister has changed his tune this afternoon and said that is not conditional. It will be welcome if there is still an option to get those extra resources without necessarily going down the route he wants.

This is about local decision making, but what is key in any organisation is who holds the purse-strings. The Chancellor still holds the purse-strings under what is being proposed, and when the tough decisions come down the line his fingerprints will not be on them.

My hon. Friend the Member for Harrow West (Mr Thomas) mentioned business rates. I take his point: allowing local councils and others to have the powers to regenerate areas and try to create extra revenue is welcome, but he will appreciate—as my hon. Friend the Member for Nottingham North noted earlier—that there is not a level playing field across the UK. Without any mechanism for redistribution in local business rates, areas such as the north-east—those that have already been hit disproportionately by this Government taking the need element out of grant formula, which rewards richer areas more than poorer areas—are going to lose out.

Westminster city council will benefit if it gets to retain 100% of its business rates and gains from any new development it can have. Its situation will be easy compared with that of the poor people of Redcar; Redcar council is going to find it very difficult to attract new development that plugs the hole left by the closure of the steelworks.

We need to ensure we put in place structures that not only will work and have the support of people, but are practical. If we have a Teesside mayor and a mayor for the north-east, both will have responsibility for transport in their area. Where that will leave the A19, the M1 or any of the other transport links that cross the area, no one seems to know. Will the mayor of Teesside be responsible for the section of the A19 as far as the border of the area? Will the mayor for the north-east assume responsibility for the road network beyond that point? Therein lies one of the issues.

The Government said that they were against regions, but they have now divided quite a small geographical area. Supporters of the proposals have not explained how all this will work in practice. They have been out there in the north-east vigorously putting forward their case. Many of them have been posing as business people while forgetting to tell everyone that they are actually Conservatives.

There is a similar problem with resource allocation. The Government are proposing to impose a new tier of regional government, but how will it relate to the existing local authority tiers? The Minister keeps saying that this will be different because it involves moving power down from Whitehall to the region, but I can envisage people starting to ask whether they really need the large numbers of councils that they have at the moment. That will certainly happen in Manchester, for example. I know that turkeys do not usually vote for Christmas, but some local authorities need to think about where the Government’s agenda will lead. The Conservative party has traditionally been quite passionate about local government—it has always been supportive of it—but I believe that the Bill represents a move to reduce those tiers of local representation.

We need to step back and look not only at how the new system will work in practice but at the levels of local support. The Government are refusing to allow the people of the north-east a say in whether they want an extra tier of local government. The Minister is adamant that he is not prepared to give those people a say over whether they want an elected mayor whose responsibilities would stretch from the Scottish border down to Barnard Castle. As I said earlier, when we proposed a regional assembly in 2004, we quite rightly put it to the people. The Conservatives and their supporters argued vigorously against the proposal, and I am sure that if the then Labour Government had imposed an assembly on the region without taking the proposal to the people, we would rightly have been criticised. There would have been an outcry. Those same advocates who argued against us then are keeping very quiet now, however.

I have some sympathy with the amendment tabled by the hon. Member for Carlisle (John Stevenson). He has raised various issues, and I agree that there is a problem. One question that some of the smaller district councils will face is whether they will have capacity as a result of the cuts that will be imposed in the autumn statement, on top of those that have already been imposed. The last Labour Government introduced unitary councils in the north-east, in Durham, and it was one of the best things that happened making decisions more straightforward. I hate to think what some of those smaller councils would do if they were still in existence now, given the cuts that this Government have imposed. I doubt that they would have the capacity to deliver their services.

I put it to the Minister that these larger areas will need an effective mechanism for ensuring that local people are engaged in the decision-making process. I used to work in Cumbria and I know it well. I understand some of the attitudes he has referred to. Having a veto over decisions on what is needed there could be a disadvantage for Cumbria rather than an advantage.

We need the measures that my hon. Friend the Member for Nottingham North is proposing. We should have had them in place before we embarked on this process, but the Government know exactly what they are doing. This is not about devolution. It is about the clear political agenda of the Conservatives and the Chancellor. They know what they are doing, and it has nothing at all to do with the proper devolution of decision making.

[John Mann (Bassetlaw) (Lab)]

I concur that a constitutional convention would be very sensible, as my hon. Friend the Member for Nottingham North (Mr Allen) said.

I hear the idea of a hotel tax in London—I hope it is not on my constituents coming down for a good overnight stay, but on those coming from abroad. I am not sure a hotel tax would work particularly well in Bassetlaw, although it is worth considering. I recall that until the last few years Welbeck Estates levied £3 on every tonne of coal produced for a century. If local government had been allowed to do that, Bassetlaw would be a very different place, because the infrastructure and so on would have been appropriately remunerated for the coal that we provided for the rest of the country in wartime and in peacetime, at great cost. That concept of local decision making is a very good one, so I would accord with the idea, but I hope there would be some exemptions to anything that is done in relation to the good people of Bassetlaw.

--- Later in debate ---

[Mr Betts]

My hon. Friend is reiterating the point that I was making earlier, and I entirely agree with him. Although Bassetlaw could not be forced into D2N2, could it not be prevented from joining the Sheffield city region as a full member? In other words, it could be left in limbo.

[John Mann]

I suppose Bassetlaw would have the option of declaring itself a unitary authority, of getting approval for that and of joining Sheffield city region. There may be routes around it, but the principle is fundamental. We need to have the ability to choose. If those two choices were put to the electorate, I suspect that I know which they would choose, and probably decisively. They may have a different view to me, but that is their prerogative—we have a word for that: democracy. What we do not want is “undemocracy”. Some people are very hostile to what the Government are doing and some are much more sympathetic. Either way, will these two options—is it the D2N2 model—lead to more councillors?

[Mr Kevan Jones]

I am very interested in what my hon. Friend is saying. He knows that I am very familiar with his constituency, having grown up there. Does he think that the fundamental weakness of this Bill is that there is nowhere for the people to have a say in what actually happens?

[John Mann]

The Minister will clarify whether, legally, people can have a say, but I am sure that there are ways in which a say can be created to ensure that there is popular consent. There are ways in which we could choose to do that. I am not talking about my own informal consultations, which are pretty huge. It would be interesting to get the Minister’s take on that. Those are key points.

Can we have some assurance that, over time, these measures will not lead to more elected representatives? If people are honest, they understand that if we have a two-tier scenario linked in with unitaries, either the districts or the counties will inevitably go at some stage, and probably sooner rather than later. That is bound to happen. Some may say that that is a good thing. As I have said, I have argued for unitaries before, but it is important that councillors understand that that is what is happening. Similarly, it must be clear that we will be able to choose, and the Derbyshire districts will be able to choose, where we will go. I am sure that the Government want that. They say that it is a brilliant idea, so they must want us to be part of it. It is really how we do that with guarantees. It would be useful to have that on the record.

[Peter Dowd (Bootle) (Lab)]

As a former leader of a council and a member of a combined authority and local enterprise partnership, I welcome the thrust of the Bill. There is no question about that. I said in a previous debate that the train is going out of the station—the cat is out of the bag, to mix metaphors. Whichever description we use, this is the reality.

I do not deny that the governance structure in local regions is important, but whatever that structure is we must move the debate on. Local government has changed over centuries. In the 19th century, it changed to reflect the industrial revolution. It changed at the beginning of the last century and at the end to reflect the patterns of population, demography, business and so on. It has changed over time. London changed in the early ’60s, we changed again in the 1970s and it is now time to change once more. People might have concerns, but that is life. It has to move on.

My hon. Friend the Member for Bassetlaw (John Mann) made a point about having too many councillors, but I am pretty agnostic on that. The United States have significantly more councillors proportionately than we do, and they get on okay, and the same applies to the French. It is part of the heart of a community that there might be lots of councillors. I am not arguing for that, but I do not think that it is a reason for not going ahead with changes.

I support the comments made by my hon. Friend the Member for Nottingham North (Mr Allen) about the principle. There will be changes to local government and devolution in the coming years, and we might as well recognise that while we are in this transition and get on board with the constitutional convention. That does not stop things happening now, but we really need to get on with it, and I ask the Government to consider that seriously.

I also support what my hon. Friend the Member for Sheffield South East (Mr Betts) said. He referred to some of the specifics. It seems remarkable that a mayor would not have the borrowing powers he described. I hope that is just a mistake—a lacuna in the legislation—that will be put right. It is important that the detail is picked up.

There is a danger that this debate will get a bit too esoteric. Do I think that devolution will be good for my city region of Liverpool? Yes, it will. Why? This is not unique to us, but we have a thriving visitor economy. For many years, that has been our direction of travel and Liverpool is now the fourth most popular city in England for national and international visitors. That could link into the point made by my hon. Friend the Member for Bassetlaw about hotel taxes and the ability, if that many people are coming into the city from abroad, to use that revenue if we so wish. I am not saying that we should, but we should have that flexibility if we want it. The visitors are coming to my city, not to anybody else’s, and that is important.

At the moment, the visitor economy brings in £3.8 billion and 40,000 jobs, and it is a major growth sector. Do I think that the city region would manage that, grow it and progress it better? Yes, I do. There is no question about that. If we wait for Whitehall to help us, we will be waiting until the cows come home, and I mean no disrespect to Whitehall.

--- Later in debate ---

[John Mann]

Is there anything in the Government’s proposal that would impact on a district such as Bassetlaw —the hospital trust crosses the border into south Yorkshire, but the clinical commissioning group money remains entirely within the district—electing to join Sheffield city region, in another region, where other decisions will be needed? Are there any hidden nasties we should be aware of?

[Alistair Burt]

No, I do not think so. There are neither hidden nor unhidden nasties. Local decisions will still be made, and CCGs will still be monitored for quality, effectiveness and the like. I am just coming on to talk about the regulation.

Clause 19 provides that the regulatory functions of national bodies held in respect of health services will not be available for transfer to a combined or local authority. This makes it clear that local devolution settlements will not devolve the regulatory functions of Monitor, the Care Quality Commission or other health service national regulatory bodies as defined. This means that a transfer order may not change the way in which our national health service regulators operate to protect the interests and safety of patients. Amendment 38 inserts a provision clarifying that a “health service regulatory function” means a regulatory function within the meaning given by section 32 of the Legislative and Regulatory Reform Act 2006, in relation to the health service. Amendment 35 omits the word “supervisory” but clarifies that the supervisory functions of NHS England in relation to CCGs are also expressly protected from transfer.

The safeguards set out in clause 19 would support the Secretary of State in ensuring in a transfer order that where a combined authority or local authority was to exercise transferred health functions, using the Bill’s new powers, that authority could be held to account as to the exercise of its health service functions, just as NHS commissioners are currently held accountable. Amendment 36 amends clause 19 to require that in a transfer of functions to a combined authority or a local authority, provision must be made about standards and duties to be placed on the authority.

Amendment 38 provides further explanation of the national service standards to which the Secretary of State must have regard when making such provision. These include, for example, those in the standing rules set for NHS England and CCGs, recommendations and quality standards published by the National Institute for Health and Care Excellence, and of course the standards set out in the NHS constitution, which sets out pledges and codifies requirements, statutory duties and rights that NHS services in England must, as a minimum, meet. These include national access standards, including waiting times. Amendment 38 also provides definitions for “national information obligations” and “national accountability obligations”.

As amended, clause 19 provides further clarity about the role of the Secretary of State for Health and what will and will not be included in any future transfer order giving local organisations devolved responsibility for health services. This clear statement in legislation, making provision for the protection of the integrity of the NHS, is intended to provide further confidence for future devolution deals. In essence, they will be underpinned by the basic core duties of the NHS, and that cannot be shifted. Amendments 32 to 38 give further definition and clarity to support the valuable principles behind this clause.

New schedule 1, which inserts schedule 3A in the Bill, provides for amendments to the National Health Service Act 2006, and new clause 8 is a clause to introduce that schedule. These amendments concern the making of arrangements with combined or local authorities for the exercise of health commissioning functions under the 2006 Act, including provisions allowing greater flexibility over how partners to such arrangements may work together. This will enable greater integration of health and care services and support local leaders to take collective steps towards better health and care for their local population.

New schedule 1 also makes small amendments to the 2006 Act concerning the provision that may be made in regulations concerning local authorities’ social care information.



Places such as Greater Manchester and Cornwall are calling for the ability to design and deliver better health and care services, and the ability to make decisions at a level that works best for their communities—locally or, where it makes more sense, at a regional or sub-regional level. As we know, devolution deals will be tailored to the needs and circumstances of a local area. The Bill will already allow the Government to make orders to devolve to a combined authority or a local authority a range of powers and functions currently carried out by Whitehall Departments or bodies such as NHS England.

A and E Departments

Lord Mann Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I am listening. I have said that we have teething problems and that we want to sort them out. I am prepared to look at the whole of the 111 service to see whether it is delivering the service that the public need. However, I would say to the hon. Lady that the issues with 111 have focused public attention on the poor standard of out-of-hours care in many parts of the country. There is a particular issue of enabling people to speak out of hours to a GP who can, with their permission, look at their medical record, which is a pretty basic starting point. Until we sort that out, we will not be able to sort out the wider issue of confidence in 111.

[John Mann (Bassetlaw) (Lab)]

Despite my warnings in the Chamber, this Government closed the Newark accident and emergency department, as a consequence of which there has been a 37% increase in deaths. I know that the Secretary of State is too much of a survivor ever to dare to mess with Bassetlaw A and E, but does he agree that the reconfiguration of services in London has absolutely nothing to do with the reconfiguration of services in north Nottinghamshire?

[Mr Hunt]

All decisions on reconfigurations have to be taken on a case-by-case basis. The really important thing is to ensure that, when we reconfigure services, we have a good alternative in place and we are able to give the public the confidence that it is in place. As the hon. Gentleman knows, we follow the four tests before any ministerial approval is given for a reconfiguration to go ahead.

Sudden Adult Death Syndrome

Lord Mann Excerpts

Monday 25th March 2013 Westminster Hall

[John Mann (Bassetlaw) (Lab)]

It is a pleasure to take part in this debate and I congratulate my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) on the fine way that he introduced it. I pay tribute to the campaigners who have given Parliament an appropriate kick in the pants to ensure that this issue is debated with proper time. This is a great opportunity for us to look at what can be done and the best way to do it. I will be giving the Minister some proposals on how this can be taken forward that will not cost her any money—there are ways that Governments can spend money, but some suggestions are cost-neutral.

By a remarkable coincidence, in Bassetlaw we are about to launch a campaign. When we agreed to launch it, I did not know that this debate would take place. After we had set our campaign dates, I got some e-mails and twitters telling me about it—[Interruption.] Tweets, apparently. Anyway, I got them, read them and responded. There was a good bit of pressure, but we had already decided, because we have a campaign group that has been battling. People power has brought this debate here, and we had our own people power in our ambulance campaign in the east midlands, which was resolved today—the Minister will want to know this, because I doubt whether she had anyone in the meeting this morning, but I did.

In our area, we put forward the idea that, rather than have all our ambulance stations closed, going down to none, we should have them kept open and have three. We have won. All three are being kept open, as a result of people power. The number of fully crewed ambulances with qualified staff will remain as is, rather than being cut. I asked for six guarantees—I put it in writing—and got the formal answers on the record this morning. We won that campaign.

I offered the ambulance service a bit of a deal when I met it. Our group, the “Save Our Services” campaign, which just so happens to include Councillor Adele Mumby and Mr Gavin Briers, community first responders, and various others, has campaigned with me and the local council on this matter. I said, “Look, I’ve seen some figures that say Bassetlaw has a less than 2% survival rate. However, in Lincolnshire, it is apparently 11%. Hang on a minute. I don’t know who’s not been informing me about this, and I’ve not seen these figures before, but if our survival rate is under 2%, and Lincolnshire’s is 11%, something’s wrong.” When I looked into it, the community first responders were clear about what is needed: they said we need defibrillators everywhere in our community and we need training.

We have therefore agreed the Bassetlaw defibrillator campaign, which we are launching on 11 April. It will be an unusual campaign, compared with some. I have heard a lot of medical jargon, but we will not be using any of that, because I cannot follow it, and I am the MP. Many of my constituents will have more medical knowledge than me, but some will not be able to follow that jargon, so we will keep the campaign really simple. It is going to be like this. Every school will have to have a defibrillator; those that do not will get a visit from me to hold their governors to account. I do not care who funds this: the council, the county council or the school governors. The Lions are also raising money. What I do care about, though, is that the defibrillator is registered with the ambulance service, which can then do the training to make sure the defibrillator is properly used.

I have been to have a look at a defibrillator, and I was photographed trying one out. Like my hon. Friend the Member for Liverpool, Walton, I know how simple they are; us simple guys, we can get it. It is easy to use one, and I can do it. However, I want to make sure the systems are good, and I want people to think them through. That is important for the kids. When I was 11, a lad in my class at school died suddenly, so I am very aware of the problem. However, I also want to make sure the community can use these defibrillators, so we are not stopping just at schools, although if a school does not want to have a defibrillator, I will name and shame them. I am sure they all want one, and some have them already, but they should all want to participate fully.

To help, the Minister could have a word with the Secretary of State for Education, as others have said. I could suggest bits of the national curriculum that could be dropped. We could lose a king or queen who is long dead, and put in a bit about defibrillators. If the Minister or the Education Secretary wants to come up with other bits of the national curriculum we could lose, I do not mind, but they should get these issues on the curriculum, so that everyone in school learns about it. In areas such as mine, the children will then go back home and teach the old folk such as me—the grandparents and all the rest of them—the skills they have; they will tell them what to do. That knowledge will spread through the community like wildfire; that is what I want.

However, there is more than that. My neighbour, the hon. Member for Brigg and Goole (Andrew Percy), is well trained, and I am glad that he is, because I do not live too far from him. However, nursing homes are provided by the health service, county councils and others, and they are licensed by the CSQ—

[Anna Soubry]

The Care Quality Commission.

[John Mann]

The Minister knows them. She could have a word with these bodies and insist that homes have a defibrillator. What are they doing employing staff who have not been trained? We should insist they train them; we should make it part of the licensing process. It costs the Government nothing; it is also good business practice for the private homes and good public practice for the publicly run homes.

However, we can do more than that. The Retford, Gainsborough and Worksop Times has agreed to back and publicise the campaign, and it is going to do a sticker. Every building—say, a shop—that has a defibrillator will get good publicity. It will not need me to go there for a photograph to launch it, although I am available, if any shop wants me; they would regard that as good publicity. They can have the Minister if they really want. The sticker will tell people the defibrillator is in the shop. To me, that is a really obvious step.

However, I want more than that. We give a lot of money to sport. Another mate of mine got taken ill playing football. I pulled my hamstring, and he thought he had pulled his, but it was far worse. Luckily, we got him to hospital, because he had a heart attack just outside it. He lived, and he is perfectly fine now. However, that made me think, and it is part of the motive behind the campaign. Where are the defibrillators and trained people in all these community sports facilities? We give these facilities money. There is the Football Foundation, which my right hon. Friend the Member for Leigh (Andy Burnham) knows well. I think it spends £30 million a year. It should be built into the small print that people should get defibrillators when they get the money for their fancy new facilities. It does not matter whether it is public money, football money or lottery money. The Minister could be raising this issue with these bodies. The Government are also rightly putting money into school sports. We could use the leverage provided by money going into sport to say that defibrillators should be part of the deal. If we do that, we will get them without the Government having to put in lots of money; indeed, if they follow my suggestions, they will not have to put in any money.

I have two other suggestions that are also cost-free. On the planning system, people are always asking for planning permission. We have heard how the system can work against what we are trying to do, but, used sensibly, it can work for us. If someone wants to get planning permission to set up a new shop, a new factory or a new community centre, having a defibrillator should be built into the planning conditions; that is really simply, and it does not cost the state anything. Yes, it will take some time to make that happen, but we can establish the principle in council policy, and that is what we want to achieve with our campaign in Bassetlaw. People will retrofit. They will jump the gun.

Like me, the Minister is a good friend of the unions, and it would be great if the shop steward and the health and safety rep negotiated to ensure that every workplace with such a representative—it will tend to be the bigger workplaces—has a defibrillator. Indeed, it might be more than one if we are talking about some of the big workplaces in my area, which employ 1,000 to 2,000 people. There might be plenty of trained people throughout the work force who know what to do. That is an easy win; it is good publicity. Those suggestions are all cost-free for the Government.

[Mr Gary Streeter in the Chair]

I have a final suggestion. The Minister will like this, because it suits her area, just as it suits mine. I have about 80 parish councils in my area, and they are elected—well, allegedly, because there is never an election in most of them. However, through the democratic process, they are anointed as the village representatives. I shall contact them and go to those who are reticent. Every parish councillor should be trained up. Every parish, every village and every estate should know where the defibrillators are and publicise them so that everybody else knows.

If we get our act together, we can do something significant, without it costing the Government money. It is pure coincidence that Bassetlaw’s campaign is happening now. We waited until we had won our ambulance campaign. I did not want people going round saying, “You’re only doing this because you lost your ambulance stations.” No, the proposals are additional to the professional staff at the ambulance stations and all their brilliance. Now that my area has won its ambulance station campaign, we can deal with our defibrillator campaign properly and efficiently. We will name and shame.

I invite the Minister to come up to be photographed with a business or a parish council, or with councillors and county councillors who have donated a bit of money to assist the process. She can be photographed with me and them; it will be a great photo. However, I hope she will take these proposals forward, which are cost-neutral to the Government, and use leverage to get them moving.

East Midlands Ambulance Service

Lord Mann Excerpts

Monday 21st January 2013 Commons Chamber

[John Mann (Bassetlaw) (Lab)]

I rise to highlight the problems of the reorganisation and funding of the East Midlands ambulance service. The problem has been covered up because, over the last 18 months, the service has lost the contract for non-emergency transfers of patients to Arriva trains and buses. Regardless of the question of service, the impact on the East Midlands ambulance service is £5 million a year. That was told to me, in advance of the loss of the contract, by the senior officials who ran the service. That £5 million a year has not been put back in additionally by the Government. Therefore, £5 million of cuts are required in the service.

To make those cuts, the service is attempting to reconfigure, which has a detrimental impact on my constituency and elsewhere, as I shall outline. Before doing so, I wish to highlight another problem for the Minister to respond to: targets and how they are set. There is currently an in-built pressure for ambulance services to meet specific targets. The reconfiguration is happening in the context of meeting those targets, but there are perverse incentives within many of them.

I shall highlight that with one example, but there could be many. A mother sadly lost her child last year. The mother went into premature labour at 29 weeks and the child, Jessica Day, died at birth. When the mother went into premature labour, she had a midwife with her and an ambulance was called, but none was available. A response vehicle with a single paramedic came, but Jessica Day’s mother needed—medically—an immediate transfer to an intensive care unit within a hospital to give the baby, Jessica, a chance of survival. Had that immediate transfer happened, on the balance of probabilities, Jessica would be alive. It did not happen because no ambulance was available. In fact, the nearest ambulance was on its way back from Sheffield on the M1 in Yorkshire.

That in itself is a major issue, but perhaps equally major is the fact that the target was met. Despite the fact that the mother with the baby needed to be in hospital immediately but did not get there for an hour and two minutes, the target was met, because a car arrived with a paramedic within 19 minutes. The mother and baby needed to be in an ambulance, and it was the right medical decision not to transfer them in their own car, which was available, as that would have endangered the mother as well. That is a graphic illustration of the problem.

As we see repeatedly, not least in respect of elderly people, if the target is not met, the ambulance does not come for many hours. For example, one 80-year-old pensioner was laying in a garden for more than an hour with a broken hip. Because the immediate response target could not be met, the emergency was de-prioritised, and the ambulance was sent somewhere else to meet another target—the second incident may or may not be as urgent. The longest wait I know of for an emergency response is 10 hours, but it is often three or four hours—with “often” not meaning daily, but certainly weekly. That needs to be looked at.

I also see a problem emerging with improvements. How could improvements be a problem? Over the last 11 years as an MP, I have called for a vast increase in the number of community defibrillators. I would like to see them in every community building, every significant employer, most small employers, every school and every parish council, with trained responders to use them. That would be wonderful, and a wise expenditure. All those defibrillators would be maintained by the East Midlands ambulance service, and every time one was used, it would be deemed to be an eight-minute response. Therefore there is a perverse incentive not to have community defibrillators in areas such as mine, because it would mean fewer ambulances. The community first-responder with the defibrillator would meet the response time, but the ambulance would not come in that minority of cases in which the patient needed to get to hospital. That is no good for my constituents.

It is similar for strokes. I would like to see localised thrombolysing done immediately in the way it is done in Iceland, for example. The brain image is scanned and sent to the consultant, wherever they are. They analyse it instantly and the decision on thrombolysing is made. That is done without having to take people to hospital, but we are light-years away from that simple system. The reconfiguration of the ambulance service now under way will worsen that situation.

There are bigger problems for people who do not live in a city. I want to go through some mathematics with the House to show the problems. The problem of averaging to meet targets means that, by definition, high-density cities will always be prioritised over low-density rural areas. I have a theoretical example, but it could be real in the east midlands. Suppose we have a city of 900,000 people and a rural constituency of 100,000 people. The average time for an ambulance to get to a job is much shorter in the city because of the density of population. In other words, the propensity of any square kilometre to have an incident is much higher simply because of the density of population. Therefore there will be a much higher level of vehicle cover in the city. But a 95% response time in the city and a 60% response time in the rural area—with the population figures I have given—results in a 91.5% response time overall. If those figures are reversed, with a 60% response time in the city and a 95% response time in the rural area—the exact opposite—the overall response time falls from 91.5% to 63.5%. Therefore, by definition, setting response times as they are means that ambulance services will disproportionately put their resources in the high-density cities rather than in rural areas. That is bound to happen, and the problem when the service faces a shortage of money is that when it reconfigures to meet response times, it has to downgrade the rural areas. It is not possible to do otherwise if response times alone are taken into account. The Minister needs to look at how the response times are set.

These are major issues for the Government, and I do not make those points in a hostile, partisan way. These are issues that successive Governments have looked at, but no solution has been found. Those things have to be changed. As well as Bassetlaw hospital, we use Doncaster royal infirmary—we are part of the same trust. We use Sheffield hospitals for heart attacks and cancer. However, the East Midlands ambulance service plans have been reconfigured to take us to King’s Mill in Ashfield, which is an entirely different area.

[Gloria De Piero (Ashfield) (Lab)]

The loss of ambulance stations in semi-rural areas is a particular concern. The town of Eastwood in my constituency faces the loss of its ambulance station. Does my hon. Friend agree that closing an ambulance station cannot help already poor response times?

[John Mann]

The figures I have presented to the House show this in-built bias against rural and semi-rural areas, and, not least, former mining communities. We have the proposals to close Worksop and Retford ambulance stations and to have one hub in Ashfield’s King’s Mill hospital to serve my population. The population of Bassetlaw will have a parking lot with a potential portakabin under the original proposals.

[Toby Perkins (Chesterfield) (Lab)]

Was my hon. Friend as surprised as I was to hear that the initial consultation has been replaced by a subsequent one which is suggesting doubling the number of hubs? I welcome the fact that there was some element of listening, but it suggests that the original plans were miles away from what was safe for the people in the east midlands.

[John Mann]

As you might imagine Mr Deputy Speaker, in Bassetlaw we had the biggest response to the consultation, with more than 19,000 people involved directly in the consultation, and we had the largest public meetings. We found one person—I will not name his political party, but he was the campaign organiser for a small party—in favour. All the other 19,000 who signed up were against it—every single person in the public meetings was against it. All the staff were against it—every single one of them. They were all against it because, if the ambulances and the base are shifted out of the area and we have just a parking lot with a portakabin, we will have an even worse second-rate, service in Bassetlaw. The averages will be maintained as the cities get our ambulances and we will not have them, and we will become the bit of the response time that is not met. My constituents will continue to die unnecessarily.

What I want from the East Midlands ambulance service, therefore, is a proper rethink. It is clearly rethinking, but I want to ensure that Worksop and Retford ambulance stations stay open. If they want to juggle the minutiae of where the management is based, I am not worried about that and neither are my constituents, but we want two proper bases. We want the Gainsborough ambulance service maintained to keep accessibility in the north-east part, the rural part, over the border in Lincolnshire. That is what we need if we are to maintain the kind of service that my constituents expect. They pay their taxes. We have our illnesses like everybody else. What is unacceptable to all of my constituents and to me is that former mining areas and rural areas have a worse ambulance provision than the rest of the country. We are not prepared to accept that. East Midlands ambulance service must come back with a proper proposal. In that proposal, Worksop and Retford ambulance stations will need to stay open so that there is a proper base to allow the staff to continue to do their excellent job. I thank the people of Bassetlaw for the way they have responded. They will continue to do so to ensure that we get the service that they deserve.

--- Later in debate ---

[Anna Soubry]

That is a very good point. My hon. Friend has summed it up—we are having an outbreak of cross-party unity. As he says, the key point is the positioning of the hub. One of the attractions of the hub approach is that the mechanics would be in place to ensure that the vehicles were ready at the beginning of a shift. At the moment, paramedics are responsible for that, which does not seem to be a very good use of their time. There is therefore much merit in establishing 27 hubs in the right areas to ensure that we have a service that is fit for purpose.

There is something else that needs to be, not so much explored, perhaps, as exposed. The hon. Member for Bassetlaw has quite properly commented on the difficulty of having targets, and I could not agree with him more. This debate is a good example of where top-down, Government-led targets have blighted an ambulance service—no doubt there are many other examples in the NHS. That is why, when this Government were elected, for many of us it was on the basis that these targets, far from freeing up services and making them better, were strangling them and making them worse. This debate is an example of targets doing all the things they were designed not to do, constricting a service and making it worse. It is worth bearing it in mind that it was in 1997, I believe, that the ambulance service suffered from such targets. I hope that there will be more cross-party agreement and moving forward, so that although there are laudable aims that all services should have, we should not necessarily set rigid targets, which then create exactly the sort of horribly sad cases that the hon. Gentleman told us about.

[John Mann]

Is the Minister saying that she is going to get rid of them?

[Anna Soubry]

No, the Minister is not saying that she is going to get rid of them; what I am saying is that I take the view—as the hon. Gentleman does—that targets are not particularly improving services. I think there is a case for re-examining targets, and I hope he would join me in saying to the ambulance service, “Let’s look again at these targets in the NHS to see whether they’re doing the job we want them to do,” because it is precisely because of these targets that elderly people in my constituency have been lying on floors for up to four hours while ambulances have to go to meet a target.

--- Later in debate ---

[Anna Soubry]

My hon. Friend’s intervention raises a point that I hope I can help him with. There is absolutely nothing to prevent an ambulance in Daventry from going to whichever hospital offers the best treatment for that particular patient. Exactly the same applies in Bassetlaw. Under the new rule, there will be nothing to prevent a patient from going to Doncaster royal infirmary, or up to Sheffield, or indeed down to the Queen’s medical centre in Nottingham. The changes will not affect the ultimate decision of which is the best hospital for that particular patient—[Interruption.] The hon. Member for Bassetlaw is chuntering at me. Does he wish to intervene on me?

[John Mann]

I was saying that we need the ambulance to be there in the first place in order for it to take people to those hospitals. That is the whole point.

[Anna Soubry]

With great respect to the hon. Gentleman, he misses the more important and indeed more valid point that just because there is an ambulance station in a particular town or village, that does not mean to say that there is always an ambulance sitting there waiting to serve that town or village. What is important is—

Oral Answers to Questions

Lord Mann Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Burns]

If my hon. Friend would be kind enough to write to me with specifics on the situation in Newark, I would be more than happy to look into it in detail and respond to him.

[John Mann (Bassetlaw) (Lab)]

14. How many (a) accident and emergency departments and (b) maternity units he expects will be (i) downgraded and (ii) closed between May 2010 and May 2015.

[The Minister of State, Department of Health (Mr Simon Burns)]

The reconfiguration of local health services, including A and E and maternity services, is and will remain a fundamentally local process. What matters is that decisions about service changes are clinically driven, and that patients and the public are involved in those changes to ensure that they get the highest quality care.

[John Mann]

I refer to the answer that the Minister just gave to the hon. Member for Newark (Patrick Mercer). The buck stops with the Minister. Would he like to congratulate the SOS Save Our Services group in Bassetlaw, which in the past two months has overturned the proposals to downgrade A and E and maternity services at Bassetlaw hospital? Is that not a good example of the real big society?

[Mr Burns]

As the hon. Gentleman knows, on 20 May 2010 my right hon. Friend the Secretary of State brought in the four conditions that had to be met for reconfiguration, which included paying attention to the views of local stakeholders and the medical profession. So, as the hon. Gentleman rightly says, the decision has been taken not to proceed with the changes at Bassetlaw hospital. No doubt he also welcomes the £900,000 that is being invested to expand and improve Bassetlaw hospital’s A and E facility.

Oral Answers to Questions

Lord Mann Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

I have to say to the hon. Lady that it was this Government who, through the spending review, gave priority to social care. More than £7 billion was added to the social care budget as a consequence of the steps taken by my right hon. Friend the Secretary of State for Communities and Local Government and by the NHS. This year the NHS is providing an additional £648 million specifically to support adult social care. In addition, I have announced our Warm Homes Healthy People funding for this winter, which will provide additional support for those most urgently in need.

[John Mann (Bassetlaw) (Lab)]

16. How many accident and emergency departments have reduced their on-site service provision in the last 12 months.

[The Minister of State, Department of Health (Mr Simon Burns)]

This information is not collected centrally. It is for NHS commissioners to secure high-quality services for their communities. Where a substantial service change is proposed, decisions should be made against the Secretary of State’s four tests, including support from GP commissioners and clear evidence of patient and public engagement.

[John Mann]

Broadening the definition of major trauma would have disastrous consequences for many A and E departments, not least those in Bassetlaw and the surrounding towns in south Yorkshire and the north midlands. Can the Minister give an absolute guarantee that the definition of major trauma is not being broadened, so that those hospitals and their A and E departments are not put in jeopardy?

[Mr Burns]

The assurance I can give the hon. Gentleman is that the siting of A and E departments will be a matter of clinical judgment. I can also assure him that £900,000 will be invested in the A and E department at Bassetlaw hospital for improvements, including the creation of a three-bay resuscitation room, a larger waiting area for patients and other improvements to enhance the quality of care for his constituents.

Oral Answers to Questions

Lord Mann Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Lansley]

Yes, it was absolutely clear that the public wanted choice of treatment. That is one of the reasons that we have published some of the patient decision aids for the first time, and we will continue to do more. People want a choice in the consultant-led team that will provide their treatment, and in the hospital where that will happen. In the past few weeks, we have set out the details of how we are going to give patients the choice that they seek.

[John Mann (Bassetlaw) (Lab)]

T7. I have noticed a growing creeping privatisation of cleaning contracts in the NHS this year. Does this signify a return to the old Tory days of longer waiting lists and dirty hospitals?

[The Minister of State, Department of Health (Mr Simon Burns)]

The hon. Gentleman seems to be somewhat confused. This is not about privatisation in a derogatory sense, as he is trying to suggest. For many years, including the 13 years of the Labour Government, hospital cleaning services in NHS hospitals were put out to tender, and many private companies provided the service. That is simply continuing.

Southern Cross Care Homes

Lord Mann Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

I am keen not to start leaping to lots of conclusions. About 77% of all social care provision in England is already in the private sector. This is not an experiment, but a fact of life that has evolved over the last 20 and 30 years and has been overseen by Administrations of all colours. What we do need to do is ensure that we have effective, proportionate regulation that safeguards the interests of residents who see these homes as their homes, along with robust arrangements on the ground to safeguard good quality.

[John Mann (Bassetlaw) (Lab)]

Can the Minister confirm that elderly people could now be forced out of the homes in which they have lived for years and be stuck in homes that are inferior, or are situated many miles from where they live?

[Paul Burstow]

I believe that the hon. Gentleman has been in the House for a considerable time. He will know that the secret that he appears to be sharing with the House, and with others who are following our proceedings, is not something totally new. He knows that care homes close already, and he knows that, as a consequence, people do face such terrible circumstances. That is why the Government, working with ADASS, have ensured that the necessary arrangements and good practice advice are in place, which is something that his party did not do.

Southern Cross Healthcare

Lord Mann Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

I am entirely focused on ensuring, through the facilities and offices of the Government, that all the parties involved are clear about their responsibilities, which they are, and that they understand the reputational damage to them if they do not do what they must, which is to ensure a timely, thorough and effective restructuring of the business that secures the continuity of care for residents.

[John Mann (Bassetlaw) (Lab)]

In opposing the proposed sell-off of care homes by Nottinghamshire county council, I have been warning the council for 18 months about the crisis in Southern Cross, but that is not the only big care home provider with problems. As Mimosa, another major provider in my constituency, is also now in crisis and threatening to throw people out of Forest Hill care home, is the Minister prepared to meet families from my constituency so that he is ahead of the game on the next occasion rather than behind it?

[Paul Burstow]

rose—

Oral Answers to Questions

Lord Mann Excerpts

Tuesday 26th April 2011 Commons Chamber

[The Minister of State, Department of Health (Paul Burstow)]

I am grateful to the hon. Gentleman for his question. The listening exercise is a genuine one, and we intend to bring forward appropriate changes as a result. I can certainly give the commitment that we will want to take on board such representations. We are, and consistently have been, committed to such clinical networks for the valuable contribution they make.

[John Mann (Bassetlaw) (Lab)]

T7. If Bassetlaw council refers the reconfiguration of accident and emergency, paediatric and maternity services at Bassetlaw district general hospital to the Secretary of State, what criteria will he use to make a decision?

[Mr Lansley]

Under those circumstances, if a referral is made to me, I will wish to apply the kind of criteria that I set out last year for reconfigurations across the country for the first time: that they must meet the tests of being consistent with the result of any public consultation and with the public’s view, with the views of prospective future commissioners—such as the commissioning consortia that are coming together as a pathfinder in the hon. Gentleman’s constituency—and with the future choices made by patients about where and how they want services to be provided to them, and that they must meet clinical criteria for safety and quality.