6 Lord Lancaster of Kimbolton debates involving the Department for Education

Oral Answers to Questions

Lord Lancaster of Kimbolton Excerpts
Monday 16th April 2012

(12 years ago)

Commons Chamber
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John Hayes Portrait Mr Hayes
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One of the first things I did when I became a Minister was to insist that apprentices should be employed, in order to end programme-led apprenticeships. They were the hallmark of the previous Government’s approach, as was recently highlighted in the programme referred to a few moments ago.

The letter that I am holding was sent to me, and it says:

“We warmly welcome the Government’s focus on Apprenticeships and its efforts to guarantee”

apprenticeship “quality”. It is signed by some of Britain’s leading companies and by the TUC. So business, unions and the Government are coming together—only the Labour party is standing apart.

Lord Lancaster of Kimbolton Portrait Mark Lancaster (Milton Keynes North) (Con)
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17. What steps he is taking to speed up the adoption system.

Tim Loughton Portrait The Parliamentary Under-Secretary of State for Education (Tim Loughton)
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As I said earlier, the Government have published “An Action Plan for Adoption”, which aims to reduce delays in adoption by legislating to prevent local authorities from spending too much time seeking a perfect adoptive match; accelerating the assessment process for prospective adopters; and making it easier for children to be fostered by their likely eventual adopters in certain circumstances. We will also shortly introduce an adoption scorecard to focus attention on the issue of timeliness; this is linked to a tougher intervention regime.

Lord Lancaster of Kimbolton Portrait Mark Lancaster
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I commend the Government on the action they have taken to speed up the adoption process, but concerns remain about the level of support provided to families after that process. Will the Minister therefore expand on the action the Government will be taking to support families once they have actually adopted?

Tim Loughton Portrait Tim Loughton
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My hon. Friend raises a very important point, which was covered slightly in my earlier answer. I am concerned about getting good pre-adoption support, peri-adoption support and post-adoption support, because the worst thing that can happen is a breakdown in adoption. There is scant evidence about breakdown in adoptions, but some of the highest-performing adoption agencies in the country, be they local authority or independent, are those that invest in adoption support, which means that adoptions do not break down. That results in not only a financial saving for that authority, but, more importantly, a social gain for the child, who gets a safe, stable and loving home—permanently.

Oral Answers to Questions

Lord Lancaster of Kimbolton Excerpts
Thursday 8th December 2011

(12 years, 4 months ago)

Commons Chamber
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John Hayes Portrait Mr Hayes
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I take the view that Government have a role and that procurement has a role as well. For that reason I have established a ministerial champions group for apprenticeships involving 14 Departments, we have explored the development of kitemarking for good employers who use apprenticeships and supply the public sector, and we have provided streamlined informational skills for companies that want to supply Government.

My hon. Friend has been a great champion of apprenticeships, and has even taken on an apprentice himself. Let me again urge all Members to take on their own apprentices.

Lord Lancaster of Kimbolton Portrait Mark Lancaster (Milton Keynes North) (Con)
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16. What plans he has to encourage small and medium-sized businesses to offer apprenticeships.

John Hayes Portrait The Minister for Further Education, Skills and Lifelong Learning (Mr John Hayes)
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As you can see, Mr Speaker, I am irrepressible.

We have recently announced a new financial incentive of £1,500, which will help up to 40,000 small employers who have not previously engaged in the programme to take on a young apprentice. We are taking radical steps to speed up and simplify the process for employers, and to remove unnecessary paperwork and bureaucracy.

Lord Lancaster of Kimbolton Portrait Mark Lancaster
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While the Minister’s talents are obvious, some of us have hidden talents. I, for instance, am a pyrotechnician, and ran the family firework company for many years. We were always keen to take on apprentices, but it was hard to keep them in a long-term skilled job, and the paperwork involved in taking them on in the first place was very extensive. What can be done to help the situation?

Schools Admissions Policies

Lord Lancaster of Kimbolton Excerpts
Monday 13th December 2010

(13 years, 4 months ago)

Commons Chamber
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Lord Lancaster of Kimbolton Portrait Mark Lancaster (Milton Keynes North) (Con)
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Tonight, I shall try to find the balance in schools admissions between the right of schools to set their admissions policy and the right of parents to get their children into a local school. In Milton Keynes, a growing city with many in-year admissions, that is no mean feat. Hopefully we can find a resolution tonight, but it is fair to say that for many, school admissions is a sore subject. It preoccupies parents, has the power to inflate house prices and has even been the stuff of TV drama.

In Milton Keynes, schools admissions has gained renewed controversy since changes were made to the allocation process. The previous Government said that those changes would ensure fairness, but combined with other factors, they have had the unintended consequence of leaving scores of children out of education or having to travel miles across the city to get to school. The delays and distances endured by many of my young constituents are simply not fair.

From September, local authorities were charged with co-ordinating all applications for foundation schools and academies for those applying outside the yearly round. Previously, these in-year applications, usually from people moving into the city, were submitted directly to schools. Now councils must match each child’s three preferences with the schools’ admissions criteria and capacity, and allocate a place. Nationally, councils have reported concerns to the Office of the Schools Adjudicator about this new role. Pressure group Parents Outloud even championed the previous system, and admissions staff at schools have bemoaned the new layer of bureaucracy. Locally, the impact of the change has been compounded by the fact that all our 12 state secondary schools are foundation schools, with one voluntary aided and one academy. Milton Keynes council only has a team of five to deal with its new responsibility.

Since September, I have been inundated with complaints from parents about delays in the process, as well as about what has been offered. Children are now sitting at home for weeks while the council finds them a place, and then further weeks for the school to induct them. When places are offered, many of them are on the other side of the city.

Iain Stewart Portrait Iain Stewart (Milton Keynes South) (Con)
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My hon. Friend is raising an important topic. Is he aware that on my side of Milton Keynes I have received a similar number of complaints, and that some of the complaints about admissions relate to primary schools as well as secondary schools?

Lord Lancaster of Kimbolton Portrait Mark Lancaster
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I am aware of the problem, because it is the same in Milton Keynes North. However, I am also aware of my hon. Friend’s sterling efforts in getting many of his constituents into school. I congratulate him on that.

This is a particularly timely debate. The Government are reviewing the school admissions framework and the school admissions code, with a view to making it simpler and fairer. A White Paper on “The Importance of Teaching” has just been published, putting the onus of fair access to schools on local authorities. Fairness is the driving force of the White Paper. I want therefore to outline the situation in Milton Keynes and consider how we can make admissions fairer for schools, authorities, parents and, most importantly, pupils.

As I have said, many of the complaints I have received relate to the delays in council allocation and school induction. This year, Milton Keynes council received 327 secondary school in-year applications. This influx is to be expected in our city, which is an area of rapid growth. The Department for Education—or the Department for Children, Schools and Families, as it was then—recommended that places be allocated within five school days. Milton Keynes council aims for a turnaround of 15 days. Owing to this year’s influx, however, parents have seen a reported six-week wait for their child’s three preferences to be processed. Then, once a place is allocated and accepted, there is a further delay as the school conducts its induction arrangements.

Jason McCartney Portrait Jason McCartney (Colne Valley) (Con)
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I congratulate my hon. Friend on securing this important debate. In September and October, I was inundated with problems from parents, particularly in the Holme Valley, Honley and Brockholes, with over-subscribed schools. Does my hon. Friend agree that consistency in admissions policy would be particularly helpful, especially when it comes to siblings being able to go to the same school?

Lord Lancaster of Kimbolton Portrait Mark Lancaster
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That is absolutely right. My hon. Friend makes a powerful point that I will come on to.

We can all agree that the last thing we want is children out of school. In fact, parents could be prosecuted for keeping their children at home for such lengths of time. However, according to a Mail on Sunday investigation in September, bureaucracy was barring up to 15,000 primary and secondary pupils from the classroom nationally. Each school calculates its own published admissions number—known as a PAN—every year. This determines the number of pupils that can be admitted to each year group. However, such is our shortage of places that 120 of this year’s 327 secondary school applicants did not get any of their three choices.

One school is bearing the brunt of the city’s scarcity of school places. The Radcliffe school in Wolverton does not fill its PAN, so when the council cannot give in-year applicants any of their three preferences, it allocates them to the Radcliffe, seemingly regardless of where the children live in our ever-expanding city. Head teacher John O’Donnell is currently dealing with an influx of 140 allocations. A staggering 119 are from children who are out of area, many of whom will have to be bussed or potentially taxied in from outside. Understandably for students who are out of catchment, Radcliffe was not one of their three preferences. The council is fulfilling its duty—every applicant is being offered a school place—but this is turning the Radcliffe into a de facto community school. Whereas 5% of its intake came from outside the catchment area previously, that has suddenly increased to 10%, and is set to rise further.

That volume of allocations has taken its toll. Mr O’Donnell is devoting two days a week to dealing with the backlog. His induction arrangements involve meeting the pupils and families to determine their requirements, be they special educational needs, academic courses or even language—after all, 37 mother tongues are spoken at the school. The induction process has been criticised, but it is understandable that Mr O’Donnell wants to get his pupils off to the best start. His school finally broke out of special measures in October 2009, after a well-deserved record round of GCSE results, but do we want him to put children straight into lessons that are not appropriate just to get them into school, or do we want him to continue raising standards? Such is the backlog that pupils are now being allocated places at the Radcliffe, where they will not be able to start for months. The result is scores of children sitting at home—not studying, just waiting.

Why has the Radcliffe seen such an influx? It can be partly explained by the creation of the Milton Keynes academy—a fantastic new facility, and the city’s first—which opened in September 2009. As I told the Secretary of State after he delivered his White Paper on 24 November, the academy’s PAN is lower than that of its predecessor, the Sir Frank Markham community school. That has displaced people from the academy’s catchment area, who are instead being given places at the Radcliffe. For example, Mr O’Donnell is for the first time seeing applicants from the Netherfield estate, which is 1 mile from the academy, but nearly 7 miles from the Radcliffe. In fact, many of the Radcliffe’s new intake of 119 are from the academy’s catchment area.

It is worth taking a moment to consider why it is so important for children to go to a school close to home. Once they are 18, many seem to pick a university that gets them as far away as possible—or a continent that takes them even further afield, on their gap year—but most school kids just want to walk to school with their mates. The national Walk to School campaign highlights why travelling on foot is good for morale and health, taking congestion off our roads and promoting a more cohesive society.

Lord Wharton of Yarm Portrait James Wharton (Stockton South) (Con)
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I congratulate my hon. Friend on securing this excellent debate and campaigning so vigorously on behalf of school pupils across Milton Keynes. I am sure that he will be aware that there is a problem right across the country. In Ingleby Barwick in my constituency, a local group called BO2SS—Barwick’s Own 2nd Secondary School—has come together to put forward a free school application specifically in order to allow local pupils to attend a school within walking distance in their community. It is important to put on record the fact that although the problem is significant in Milton Keynes, it needs to be addressed across the nation as a whole.

Lord Lancaster of Kimbolton Portrait Mark Lancaster
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I agree with my hon. Friend. Indeed, I would argue that a good basis for the big society is schooling children in their own communities.

With Mr O’Donnell’s out-of-catchment intake, he is seeing a massive decrease in those attending after-school activities. Engagement has already taken a hit because many pupils have to change buses in central Milton Keynes. There, they are drawn to shops and attractions, rather than continuing with their journeys, which sometimes involve catching two or three buses. We have to think about what sort of society we want to create. Do we want our children to become juvenile commuters, reading bus timetables rather than textbooks?

The problem is not confined to the two aforementioned schools. For example, the Mumford family moved to a house in Newport Pagnell that overlooks a secondary school, Ousedale. Two of their daughters were offered places at the school, but not in a classroom yards from their home—rather, at the campus in the next town, Olney, which is more than 8 miles away and not on a bus route. They were alternatively offered places at the Radcliffe school, 6.5 miles away, but told that they would not be able to start until November. After weeks out of education, they face a daily commute when there is already a school on their doorstep. Likewise, a mother and her son moved to Olney, very near the town’s Ousedale campus. The son was instead offered a place at the Radcliffe school, 11 miles away. As there is no bus service that would get him to school, he was offered a council-funded taxi to take him there and back every day. Fortunately, after an intervention from my caseworker and persistence from his mother, his appeal was successful and he has happily started at his local school, without having to use a taxi, that would have cost the council £2,875 a year.

We are talking about fairness, but what is happening is unfair on children whose parents are not able, for whatever reason, to fight their case and push for appeals. It is unfair on the children whose parents cannot provide them with transport if they have to travel several miles to school or support them if they are stuck out of education for a period of time. Indeed, schools can admit above their PAN in exceptional circumstances if children fall into the categories stipulated by the fair access protocol. This protocol also applies to those who have been out of school for more than one term or those whose parents have been unable to find them a place after moving to the area. However, Milton Keynes council resorted to this protocol on only four occasions last year and not at all this year.

After my prolonged campaign for “I before E”—infrastructure before expansion—and the coalition Government’s commitment to it, I am confident that our rate of school building will keep up with our population growth. After all, Milton Keynes is the fifth fastest-growing city in the UK, but I am concerned that, as new schools appear, they will fill up with pupils from across the city before nearby houses are built. Head teachers have wanted to hold places, but the incentive is to fill places to secure maximum funding.

Martin Horwood Portrait Martin Horwood (Cheltenham) (LD)
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Does the hon. Gentleman accept that the problem is not limited to growing towns? We have a strikingly parallel situation in Cheltenham, where two neighbouring schools were both over-subscribed, which left an admissions gap between them. Again, pupils were referred a long distance away. That was resolved in the end by the good will of the governors of both schools, but with the assistance of the local authority. Does he share my slight concern that the more independence we give schools over admissions, the less incentive they will have to co-ordinate and resolve these problems?

Lord Lancaster of Kimbolton Portrait Mark Lancaster
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The hon. Gentleman comes to the nub of the problem—how we square that circle between the rights of schools to set their own admissions and the rights of families to get their children into their local school. In Milton Keynes, the consequence is that new families moving in cannot get a place at their local school.

Network Rail’s new headquarters is set to bring 2,000 new staff to the city. Yes, there will be school places for the children who move here, but will these be anywhere near their houses and how long will they have to wait to start? This situation also spells trouble as we see the creation of more academies. In Milton Keynes, two schools have applied for academy status, which I wholeheartedly support. I am delighted about it, but will they, as in the previous case, have reduced PANs and will we see yet more displacement within the city?

Meanwhile, the Secretary of State has mooted the idea of allowing schools to prioritise children from disadvantaged backgrounds in the oversubscription criteria. While this is laudable in principle, it has been suggested that allocation will favour a child’s means over their proximity to a school. Will we end up with a city where students are crossing each other’s paths as they travel to school? Indeed, this situation has posed more questions than answers. Of course there is no dispute that fairness should underpin whatever we do, but there remain two problems with the current set up: delays and distance.

Various recommendations have been made. One that head teachers say would make a big difference is allowing schools in high-growth areas to be able to hold places for people moving in at a later date. This could be made possible by “ghost funding” those places, which is the approach taken by armed forces schools. Again, I am all for infrastructure before expansion, but it has to be done in a strategic way, because at the moment people are moving next to these new schools, but are not able to get a place there.

The school admissions code needs to recognise the importance of schools admitting children from the catchment area. Councils do not seem to have a problem sending children 10 miles away; parents and head teachers do. If we want to improve attainment and children’s quality of life, we must recognise that proximity of schooling is very important. A school’s duty should be to serve its local area. John Prescott famously warned of the dangers of setting up good schools, because

“everyone wants to go there”.

Well, our schools in Milton Keynes are all good. The only danger is that many children will continue to wait too long and travel too far before they actually get to go there.

Schools White Paper

Lord Lancaster of Kimbolton Excerpts
Wednesday 24th November 2010

(13 years, 5 months ago)

Commons Chamber
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Michael Gove Portrait Michael Gove
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I am grateful to the right hon. Gentleman. I know that he is a reasonable man as well. I am sure that we can work together in future to ensure that the additional resources that we are investing in education, and the additional emphasis on competitive team sport, provide every school with the support that it needs to give all children the physical education that they deserve.

Lord Lancaster of Kimbolton Portrait Mark Lancaster (Milton Keynes North) (Con)
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The new academy in Milton Keynes is a fantastic facility, but the fact that it has fewer places than the school that it replaced has had the unintended consequence of forcing another school in my constituency to become the de facto community school. How can we ensure a balance between the rights of schools to set their own admissions policies and the rights of parents to send their children to a local school?

Michael Gove Portrait Michael Gove
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My hon. Friend has asked an important question, to which I can give two answers. First, we are encouraging collaboration to enable more schools to join trusts or federations involving an outstanding school that is sponsored by an academy, so that excellence can be more evenly spread. Secondly, we are going to simplify the admissions code and give local authorities a clear role in policing it, in order to ensure that admissions are fair to all.

Building a High-Skilled Economy

Lord Lancaster of Kimbolton Excerpts
Thursday 17th June 2010

(13 years, 10 months ago)

Commons Chamber
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John Hayes Portrait The Minister of State, Department for Business, Innovation and Skills (Mr John Hayes)
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I beg to move,

That this House has considered the matter of building a high- skilled economy.

It is a delight, having spent so many years in the shadows, to come into the light and be able to speak in this House as the new Minister. Some hon. Members will have read today in the press of my endorsement for floristry and dance. I am wearing this perfectly coloured co-ordinated buttonhole to illustrate the first, but the House, and you in particular, Mr Deputy Speaker, will be relieved to know that I shall not be illustrating the second, at least not by example.

The performance in office of the shadow Minister, the hon. Member for Cardiff West (Kevin Brennan), once the man who called the tune, was rather more of a conga than a quickstep. You know the conga, I have no doubt, Mr Deputy Speaker. It comprises a group of hapless individuals linked by routine, hopelessly following one another on a journey to nowhere.

Adult learning is a subject that inspires in those hon. Members present—I know this is true of hon. Members across the Chamber—emotional attachment and personal commitment. At the same time, it is not a subject in which anyone or any party can claim a monopoly of wisdom, which is why I am interested to hear views from across the Chamber. However, a new Government offer a new chance of a fresh start, the opportunity to bring change and hope to adult learners. However, not everyone realises that there has been a change. Sitting in my office the other day in my new Department, I was surprised to receive an out-of-the-blue phone call from someone asking for Mandy. I had to break the news to him that Mandy had moved on. To paraphrase Barry Manilow, “Oh Mandy, well you came and you took without giving…but I sent you away.”

Lord Mandelson was right in at least one important respect. He made the economic case for skills. The economic case for skills was by far the strongest case made by the previous Government. It is significant, of course—indeed it is vital—but it is not the only case for skills. The economic case, which I shall deal with first, has been thrown into sharp relief by the economic turbulence, by the rising levels of unemployment and falling levels of hope, especially among young people, and by the growing numbers of employers finding it difficult to stay in business. It will continue to occupy a prominent place in public discourse as we move out of recession and towards the renewed growth about which my right hon. Friend the Secretary of State spoke recently at the Cass business school.

Lord Lancaster of Kimbolton Portrait Mark Lancaster (Milton Keynes North) (Con)
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Will my hon. Friend give way?

John Hayes Portrait Mr Hayes
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I happily give way to my hon. Friend, who has been such a resolute champion of the Open university in his constituency, which does so much to foster learning.

Lord Lancaster of Kimbolton Portrait Mark Lancaster
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I am grateful to my hon. Friend. I should like to invite him to join me in paying tribute to the Open university. The one thing that has not changed in recent times is the contribution that that institution has made to lifelong learning.

Education and Health

Lord Lancaster of Kimbolton Excerpts
Wednesday 2nd June 2010

(13 years, 11 months ago)

Commons Chamber
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Lord Lancaster of Kimbolton Portrait Mark Lancaster (Milton Keynes North) (Con)
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It is a pleasure to be able to contribute to this debate. I am certainly seeing the benefits of the election, as I think that this is the first time that I have been called to speak before 9 pm in the five years that I have been here. It is also a pleasure to follow the right hon. Member for Rother Valley (Mr Barron), who was an excellent Chair of the Health Committee in the last Parliament. I regard him as a friend and he did a sterling job.

I wish to thank my right hon. Friend the Secretary of State for Health for coming to visit Milton Keynes hospital yesterday. I said during my election campaign that I would make health my priority and, in the past two years, we have had some particular problems in Milton Keynes at the maternity unit. It was very reassuring to have my right hon. Friend visit yesterday and to see that the hospital, which is desperately trying to do the right things to put matters right, will have the full support of the Department of Health in trying to deliver the positive change that we all want to see.

I shall address three issues—the funding formula, targets and waste. NHS funds are allocated to primary care trusts on the basis of a complex weighted capitation formula. The allocation is based mainly on the number and age distribution of a PCT’s population and then adjusted for a large variety of other factors, including the type of population; deprivation; mortality rates; and, controversially, the difference between previous allocation and formula results.

The formula leads to a marked difference in per capita allocation by PCT across the country. For example, in the current year the PCT with the lowest funding was Leicestershire with £1,330 per head, and the highest was Liverpool with £2,140 per head. This year, Milton Keynes PCT received £1,410 per head, the 12th lowest in the country. In other words, if Milton Keynes, with a crude population of approximately 240,000, had received average national capitation, it would have an extra £51 million more than the £349 million it actually received, and had it been funded at the average rate of a northern PCT, it would have received £74 million pounds more. Just to underline this point at a regional level, South Central strategic health authority received £5.8 billion for its 4.1 million people. Had it received a typical northern per capita allocation, it would have received an extra £1.2 billion.

Given those numbers, perhaps it is not surprising that the NHS in the south of England struggles to make ends meet.

Caroline Flint Portrait Caroline Flint (Don Valley) (Lab)
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What are deprivation levels like in the hon. Gentleman’s constituency? How much longer do people in his constituency live compared with men in Doncaster, Liverpool, Newcastle and other northern areas? We recognise that there are health inequalities and we have to fund the necessary measures to ensure equality in living as long as possible.

Lord Lancaster of Kimbolton Portrait Mark Lancaster
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The right hon. Lady makes a valid point. The whole point is that we have the health formula to take those factors into account, but despite that the last Government artificially adjusted the funding to upgrade certain PCTs. If she listens to my speech, she will understand what I am trying to say.

Northern SHAs have surpluses approximately three times the size of South Central. Yorkshire and Humberside enjoys a surplus of £49 per head. However, putting the inequality of this to one side, it means that the weaknesses of the current NHS structures are likely to appear first in the south rather than in the north of England. But given that the allocation formula attempts to fund broadly according to need, why have the funding formula at all if we are going to ignore it? The answer, in part, appears to lie in an extract from the Health Committee’s report, “Health Inequalities”, published in March 2009. Paragraph 96 says that

“not all areas currently receive what they should receive according to the resource allocation formula. This is because historically many areas have received less funding than they need, but rather than taking away large amounts of funding from some over-funded areas to compensate more needy areas, the Government has adopted a more gradual approach to shifting resources over a number of years, meaning that some PCTs are still receiving funding below their ‘target’ amounts.”

The development of the weighted capitation formula is continuously overseen by the independent Advisory Committee on Resource Allocation, or ACRA. Given the inequalities in funding that currently exist, I would like to suggest some minor changes of my own. First, the allocation formula should adequately address the costs of providing health care to the elderly, especially in areas with high life expectancy. Secondly, the allocation formula should adequately reflect the fact that the majority of an individual’s lifetime costs of health care are incurred in the last two years of life, whatever the age of death, and—crucially—regardless of the local level of deprivation. Finally, the key area in which the formula could be improved—I make no apologies for the fact that as a very diverse community Milton Keynes would benefit from this change—is by basing allocations on individuals’ health, rather than the blunt tool of populations being aggregated at the PCT level. However, I accept that the principal problem with that is getting sufficient data.

Process targets sometimes yield perverse incentives when coupled with the inappropriately named “payments by results” scheme, which actually seems to reward activity rather than results. I shall give just two brief examples. The first is the four-hour waiting time in accident and emergency. Say that after three hours 55 minutes a patient is waiting for a blood test result. The hospital will take them in as an in-patient—perhaps only for 10 minutes until the result arrives—so that it does not miss the target. That means that rather than being charged £70 for out-patient treatment, the PCT will be charged £700 for in-patient treatment. Is that really the best use of scarce financial resources?

Hospitals have no incentive to discharge people from out-patients as they are paid for activity. Indeed, in Milton Keynes, less than half of first out-patient appointments are the result of GP referrals. For example, lots of patients attending accident and emergency or the assessment unit will be given a hospital-initiated out-patient appointment rather than being discharged back to their GP. If a hospital can see a patient several times, generating a bill on each occasion, where is the incentive to organise care so that everything can be done at one visit if it can then only bill for that care once? I support limited targets, providing that they are based on clinical need and are not process driven—and do not lead, like the examples that I have just given, to scarce financial resources being squandered.

It is widely recognised that the NHS, in common with health care systems in every developed country, wastes possibly 20% or more of its resources on overuse, misuse and underuse of health care. Many feel that the current configuration of hospitals and community services in England does not readily allow clinicians to offer the highest quality of care at lowest unit costs.

There is an argument that the rigid demarcation between primary and secondary services and the role of the district general hospital needs to be allowed to evolve to meet the needs of the 21st century. That is particularly true where administrative boundaries and top-down planning have stifled local developments. For example, the Milton Keynes and south midlands growth area has a rapidly growing population. The growth area straddles three strategic health authorities and government regions. It has a population of nearly 2 million, but is served by several small hospitals close together, each of which is struggling both financially and to provide the quality and range of services that the population needs and expects. The challenge in and around Milton Keynes is to allow local communities and hospitals to think beyond and across artificial bureaucratic boundaries to find new ways of improving value for money and quality of care.

Taken together, if health services were held to account for the outcomes that they produce, rather than the numbers of patients treated, the services of the future, and particularly hospitals, might need to look very different from those of today. However, if we allow changes to be led by clinicians in consultation with the public—a bottom-up approach rather than the top-down approach advocated by the last Government—we can be confident that, most importantly, the services will be of a higher quality. I believe that the measures outlined in the Gracious Speech are a step in the right direction, and that we can achieve those aims.

In the final 20 seconds left to me, I simply want to wish all those about to give their maiden speeches the best of luck.