Health and Social Care

Andy Burnham Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

I will make some progress.

Even worse, when signs of how the targets policy was going wrong became clear, Labour’s response was to ignore or cover up the findings.

[Andy Burnham (Leigh) (Lab)]

Rubbish!

[Mr Hunt]

The right hon. Gentleman says “rubbish” from a sedentary position, but the Francis report—if he read it—mentioned 50 warning signs that were missed by his Government about Mid Staffs. He himself rejected 81 separate requests for a public inquiry into what happened. The Labour party created a lame duck Care Quality Commission, unable to speak out or force change, and an NHS where too often the system was more important than the individual.

[Andy Burnham]

At the outset, will the Secretary of State correct the record and remind the House that it was my decision, two months after being appointed Secretary of State in June 2009, to appoint Robert Francis to conduct an independent inquiry?

[Mr Hunt]

The right hon. Gentleman’s decision not to have a public inquiry that revealed extremely important information has meant that we are finally addressing the issue that his Government failed to address.

The Care Bill will include a vital element of our response to the Francis report, including regulatory clarity on who is responsible for identifying problems, driving up standards, and operating a single failure regime when urgent changes are not made.

--- Later in debate ---

[Mr Hunt]

I am going to make some progress.

Before I took the right hon. Lady’s intervention, I was talking about joined-up care. The truth is that Labour’s disastrous IT contract wasted billions and failed to deliver the single digital medical record that would transform the treatment received by so many vulnerable older people. Yes, it was a financial scandal, but it was also a care scandal. Last year, 42 people died because they received the wrong medicines. There were more than 20,000 medication errors that caused harm to patients, and 127,000 near misses. On top of that, structures such as payment by results were left unreformed for more than 13 years, making hospitals focus on the volume of treatment over and above the needs of individual patients. The Care Bill will help to address those issues by promoting integrated care. It creates a duty on local authorities and their partners to co-operate on the planning and delivery of care; it emphasises the importance of prevention and the reduction of people’s care needs; and, by making personal budgets the default and not the exception, it will significantly increase the control people feel over their care.

[Andy Burnham]

I am grateful to the Secretary of State for giving way, but the trouble with him is that, often, there is a huge gap between the rhetoric he comes out with at the Dispatch Box and the reality on the ground. He says he is promoting integrated care, but what does he say about the pioneers of integrated care in Torbay, who are threatening to take legal action because of the requirement for compulsory competitive tendering of services? Under this Government, are not the beacons of integration being demolished by his free market?

[Mr Hunt]

It is the right hon. Gentleman who has a problem with the difference between rhetoric and reality. Let me tell him about the reality of what happened to integrated care under Labour. Between 2001—[Interruption.] The right hon. Gentleman intervened, so perhaps he would like to hear the reply. We are talking about integrated care. On his watch, between 2001 and 2009—eight years during which Labour was in power—hospital admissions went up by 36%. In Sweden, where people started thinking about integrated care, such admissions went up by 1%. That is how badly Labour failed to do anything about integrated care when it had the chance. We are doing something about it. If the Opposition listen, I shall explain what.

--- Later in debate ---

[Andy Burnham (Leigh) (Lab)]

Like you, Mr Speaker, I am tempted to say, “Is that it?” I suggest to the Secretary of State that he starts reading the weekend newspapers. He began with complacent statements about how everything is marvellous and it is all going so well, but it will not feel like that to staff working in A and E. The Secretary of State’s statement will just confirm to them that he is completely out of touch.

Every day brings new signs of an NHS in distress: more ambulance queues outside A and E; more patients left waiting for a call-back by a 111 service ill-equipped to deal with their needs; more older people seeing social care support withdrawn, or struggling to pay spiralling care charges and ending up in A and E; more patients waiting hours in A and E on trolleys in corridors; and more hospitals running way beyond safe occupancy levels. This is the fragile state of the NHS today: battered and bruised by a reorganisation that nobody wanted and nobody voted for; an entire health and care system on the brink, facing huge challenges that require urgent answers. However, we will not find them in this Queen’s Speech. There is no answer to the collapse of social care, and no answer to the understaffing of hospitals or the growing chaos in A and E. On the preventable deaths and health harm caused by smoking and alcohol, there is silence.

This Queen’s Speech is the product of a dysfunctional Government who have lost any ability they once had to face up to the big challenges the country faces. It cements the impression of a failed coalition project now preparing the ground for the next election rather than governing in the national interest. What else could explain the pathetic spectacle this weekend of Government Members, spooked by UKIP, falling over themselves to say that they will be voting against their own legislative programme? Has this place ever seen something so ridiculous?

[James Duddridge (Rochford and Southend East) (Con)]

Will Labour give us a referendum?

[Andy Burnham]

I thought the new compassionate Conservative party was meant to have stopped “banging on about Europe”—that was the phrase, was it not?—but now its Members are all dancing to UKIP’s tune and reading out what Mr Crosby gives them. It will not wash. The country can see that this is a shambles of a Government who look ridiculous to the country they purport to govern. When Britain needed leadership, it got the farce of this coalition. There is no need to send in the clowns; they are already here.

[Toby Perkins]

Does my right hon. Friend think, like me, that perhaps the Government feel more comfortable exposing their divisions on Europe than facing up to their record on the NHS, which, as many people across the health service recognise, is an absolute disgrace?

[Andy Burnham]

I shall come to that point directly, because the Queen’s Speech is a diversion from the real issues, an attempt to say, “Look over here at this other issue” and divert people’s attention from the chaos the Government have visited on the NHS.

On health and care, our objection is not to the modest measures the Government are proposing. We will of course wait to see the detail, but it sounds as though we will be able to give our support to many of them. Our objection to the Gracious Speech is not to what is in it, but to what is not in it and to the unpleasant political strategy that lies behind it. As a response to the developing crisis in our health and care system, it is inadequate. Worse, however, it tries to disguise that fact by pointing the finger at others. Forget compassionate Conservatism; this is straight back to the dog-whistle tactics—failed tactics, I might add—of the 2005 general election. This is the coded message the Government want the Queen’s Speech to send: “You see all those problems with accident and emergency departments? Well it’s all down to immigration. It’s nothing to do with us.” It is a Crosby-fied Queen’s Speech that is more about positioning and politics than a serious programme for government.

[Mr Edward Leigh (Gainsborough) (Con)]

On a real issue that concerns people, there have been 1.1 million immigrants from eastern Europe since 2004, so I repeat the question very courteously put by my hon. Friend the Member for Rochford and Southend East (James Duddridge). The right hon. Gentleman talks about leadership, so will he show some and tell us whether the Labour party would grant the British people a referendum on Europe? Yes or no?

[Andy Burnham]

It is interesting, isn’t it? Here we are, in the middle of this Parliament, discussing the Queen’s Speech and health and social care, and what is the only issue Conservative Members can raise? Europe! We are talking about people waiting hours on end in A and E, about ambulances queuing outside, about a 111 service that does not ring anybody back, and about social care close to collapse, but they have nothing to say about those issues. Instead, they bang on about Europe. That is because they are preparing the ground for the 2015 election. The nasty party is back, scapegoating vulnerable people and stoking social division as a means of diverting attention from its own record, so get ready to hear how problems in the NHS are caused by health tourism and are nothing to do with the coalition’s toxic medicine of fragmentation, privatisation and budget cuts.

[Chris Bryant]

Is there not another side to the argument about immigration in relation to the NHS, which is that many of the people who keep the NHS functioning are from outside this country? One of the biggest problems facing accident and emergency departments around the country is that they cannot recruit enough consultants, yet the system that the Government have introduced on migration for those people is making it more difficult to recruit overseas. Would not a more enlightened attitude give us a more effective NHS?

--- Later in debate ---

[Andy Burnham]

As ever, my hon. Friend says it more eloquently than I can. The Government are playing politics rather than addressing the national interest. People will see that, but at least the Government have revealed their hand. We will work hard over the next two years to show who is really to blame and expose this Government’s failures on social care, the NHS and public health. Let me take each in turn.

At face value, the social care measures that the coalition is proposing sound like progress towards a fairer and simpler system. Indeed, the Care Bill builds on many of the recommendations of the Law Commission’s review of adult social care legislation, which was initiated by the last Government and included in the White Paper I published before the last election. National standards for eligibility could help to bring consistency to the care system, and stronger legal rights for carers are long overdue, as is improved access to information and advice. However, the question in the minds of many today, particularly councillors watching this debate, will be: how on earth will we be expected to pay for all that? That is when we realise again that there is a huge gap between the rhetoric we hear from the Dispatch Box and the reality on the ground across England. More than £1.3 billion has been cut from local council budgets for older people’s social care since this Government came to power.

Just last week, the Association of Directors of Adult Social Services said that Government cuts to care and councils would mean a further raid of £800 million from care budgets in the next year. The Care and Support Alliance has said that the system is in deep crisis and that without

“appropriate funding for the social care system…the aspirations set out in the Care Bill will not be reached.”

The Care Bill does nothing for people who face a desperate daily struggle to get the support they need right now, with many paying spiralling charges for their care. That is the effect of this Government’s drive to cut councils to the bone. They are foisting huge care charges on the most vulnerable people in our society. These are the coalition’s dementia taxes.

[John Glen (Salisbury) (Con)]

Does the right hon. Gentleman not understand that the people of this country would have more confidence in what he says at the Dispatch Box had he not said in the last general election campaign that it would be irresponsible to safeguard the NHS budget, which is what this Government undertook to do?

[Andy Burnham]

I will come directly to that quotation in a moment, because the hon. Gentleman will remember that at the last election he stood on a manifesto promising real-terms increases for the NHS. I hope that when he speaks later—or if he wants to get up right now—he will tell me whether they have been delivered.

[John Glen]

I am grateful for the opportunity to acknowledge the great difference between England and Wales, where Labour is in power and where we are seeing real cuts in NHS spending.

[Andy Burnham]

Government Members are just embarrassing themselves. When they cannot answer a question, they try to raise another one or go on about Europe. It is just not good enough. The answer is—though the hon. Gentleman cannot admit it—that Andrew Dilnot said this Government had cut the NHS. It is there in black and white. That is what they have done, and they stood on a manifesto promising the opposite. I secured a budget to protect the NHS at the last election. I said that I could not give real-terms increases because that would be irresponsible; and as it turns out, nor can the hon. Gentleman. His party was writing cheques that it simply could not cash, and that is a fact.

The Care Bill does nothing for those hit by the coalition’s dementia taxes right now. Since this Government came to power, the average care user has paid £655 a year more for home care than when they came into office. Overall, that is around £6,800 a year. Dial-a-ride transport services have doubled in price over the same period, from an average of £1.92 to £4.12. Meals on wheels now cost an extra £235 a year, while people in Conservative areas pay more for each service on average than friends and family in Labour-controlled areas—on average, £15 a week or £780 a year more for home care. That is the record of this Government.

[Stephen Mosley (City of Chester) (Con)]

rose—

[Andy Burnham]

I will give way one last time.

[Stephen Mosley]

The right hon. Gentleman has been speaking for more than 10 minutes and he has not once said what Labour would do. Will he come to what the Opposition propose we should do?

[Andy Burnham]

I assure the hon. Gentleman that I will come on to that, but I have a job to do in holding this shambles to account and that is exactly what I am doing.

Under this Government, people are paying more out of mum or dad’s bank account for care, which often does not come up to the standards that they want, because their council has been cut to the bone. What are they meant to make of a promised, far-off cap of £72,000, or £144,000 for a couple? The Government are giving a little with one hand, while with the other they are grabbing a fortune from people’s bank accounts.

[Barbara Keeley]

Does my right hon. Friend acknowledge that this is not even a question of £72,000 or £144,000, because those caps will be metered at the level that the council would pay, and will take no account of top-ups or accommodation costs? I have seen examples that show that people might have to pay £250,000 before they get anywhere near the cap and any help from the state.

[Andy Burnham]

My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.

How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—

[Mr Jeremy Hunt]

indicated dissent.

[Andy Burnham]

That is what this Government are doing. A cap is ineffective without long-term funding for the future of social care, and the failure to face up to the crisis in adult social care budgets that Conservative councillors are talking about will leave people with the impression that this Health Secretary is fiddling while Rome burns. The social care system in England is close to collapse, and the reality behind the Government spin is that, under this Government, people’s savings are being washed away more quickly than ever before.

I want to turn now to our accident and emergency services. The crisis in social care is the predominant driver of what we are now seeing in our accident and emergency departments. If people’s services are withdrawn, or if they cannot afford to pay for them, they are more likely to struggle and fall ill at home and to end up in hospital. That is bad for them, and it costs the NHS more. Also, NHS staff are finding that people who are ready to leave hospital cannot be discharged because the necessary support cannot be put in place. Beds are not being freed up on the wards, and A and E therefore cannot admit people to the wards because there is no space. A and E then becomes full, which results in ambulances queuing up outside because they cannot hand over patients. The system is now backing up right through A and E.

[Mr Hunt]

indicated assent.

[Andy Burnham]

The Secretary of State is nodding; he should do something about it. This is happening on his watch. Across the country, hospitals are operating at levels way beyond safe bed occupancy—[Interruption.] He nods, but I am saying, “Do something. Don’t just nod!” We need action from the Secretary of State.

Let me return to the quote that I mentioned earlier. People love to say that I would have cut the NHS. For the record, I have never said that I would cut the NHS. At the last election, I promised real-terms protection for the NHS. The Conservatives promised real-terms increases, which have never been delivered. Let me read that quote in full:

“It is irresponsible to increase NHS spending if the effect is that it is damaging, in a serious way, the ability of other services to cope…that are intimately linked to the NHS. The health service needs functioning day care, and housing”

and meals on wheels.

That warning has now come true.

[Mr Hunt]

rose—

[Andy Burnham]

I will give way to the Secretary of State, but I ask him to address this point. He has paid for the so-called ring fence on the NHS by ransacking local government funding, and that makes no sense whatever.

[Mr Hunt]

If the right hon. Gentleman looks at the figures, he will see that real-terms spending on the NHS has gone up since Labour was in power. Given that he thinks it irresponsible to increase the NHS budget, does he agree that if he were to follow his own policy, he would now need to cut that budget from its current level? That is Labour policy.

[Andy Burnham]

I do not think the right hon. Gentleman is listening. I said that if there were to be any increase, it should go into supporting social care. I now hear that Government Members are proposing emergency transfers from the NHS budget to social care because of the crisis that the Secretary of State has created.

[Hugh Bayley (York Central) (Lab)]

Surely the Secretary of State has forgotten that he received a letter in December from Andrew Dilnot, the chair of the UK Statistics Authority, which said that

“we…conclude that expenditure on the NHS in real terms was lower in 2011-12 than it was in 2009-10…In light of this, I should be grateful if the Department of Health could clarify the statements made.”

[Andy Burnham]

I am very grateful to my hon. Friend. He has now embarrassed the Secretary of State who, just a moment ago from the Dispatch Box, claimed the opposite. Similarly, the Work and Pensions Secretary was pulled up last week for doing exactly the same thing. They think they can stand there and say whatever they like, and they think they can get away with it, but they cannot, because people have seen through them. They have cut the NHS; they have broken the central promise on which this Government came to office. Now they are saying that the pressure on A and E has nothing to do with social care funding or NHS funding, but is all to do with the GP contract in 2004. That is what they have been saying on the radio for the last three weeks.

Let the Government answer this. In 2009—five years after the GP contract came into force—98% of people were seen within four hours at A and E departments across England. What we have seen recently is that, week after week, major A and E units are missing their lowered target. That is the reality right now, and the Secretary of State had better start facing up to it.

[Dame Joan Ruddock]

My right hon. Friend will have heard me refer to the situation in Newark, when intervening on the Secretary of State. Does my right hon. Friend agree that when a promise is made that closing or downgrading an A and E will save lives, that is what one logically expects to happen? The fact that the death rate subsequently went up is an indictment of what the Secretary of State has done. Does my right hon. Friend agree that when we cannot meet the four-hour target for A and E throughout the country, it is ludicrous to close existing, well-functioning A and E units?

[Andy Burnham]

I could not agree more with my right hon. Friend. All over the country, we hear that A and E is under intense pressure. Such is the importance of these services to every community that changes should be made only if there is a compelling clinical case to support them. If clinicians can demonstrate that more lives will be saved and disability will be reduced by changing A and E services, I think every Member should have a moral obligation to support them, but when the changes are financially driven—my right hon. Friend knows this better than anybody, as the Secretary of State has downgraded a successful A and E in Lewisham to deal with problems in another trust—that simply will not do. A and E units in west London, for example, are being closed one after another. That is not good enough, and neither is it good enough in Greater Manchester, where huge changes are planned. These changes must be clinically driven, not driven by finance, which is what we are seeing under this Government.

[Mr Watts]

rose—

[Andy Burnham]

I will give way one last time, before making some progress.

[Mr Watts]

I am grateful to my right hon. Friend, who is rightly concentrating on A and E units and social care. Does he agree with me that many hospitals around the country are facing a financial crisis, too, where the Government are refusing to fund anything other than consultancies? In my area, that has meant spending hundreds of thousands of pounds to tell us what we already knew—namely, that my hospital is underfunded.

[Andy Burnham]

That is what happens when a market is set up in the NHS, pitting one hospital against another in open competition. That is what is beginning to take hold in the NHS, where the Government waste money on consultants and all the other things that come from bidding for contracts. That is a direct effect of the legislation they pushed through. This reorganisation and the budget cuts I mentioned a few moments ago are providing a toxic mix. This is why for 32 weeks running, the NHS in England has missed the Government’s own lowered A and E target for major units. It really is time that the Health Secretary got a grip on the issue. We hear that last week he was trying to hatch a panic plan to deal with the A and E crisis. That is the reality of what was going on behind this threadbare Queen’s Speech: the Health Secretary was trying to cobble together a plan to deal with the A and E problems, weeks after we had first raised the issue in the House.

We hear of an e-mail leaked by an NHS finance officer which said:

“The SoS would like to announce tomorrow that £300m-400m is being invested to solve the A&E problem. We have spent most of the day trying to hold him off doing this.”

The Health Secretary seems to have forgotten that his powers to intervene were given away by his predecessor. He no longer has the power to mandate the NHS to do what he wants; the NHS can now “hold him off”. I am afraid that he looks weak. He has no response to what is happening to A and E departments. And where is the “£300 to £400 million” plan? It has not materialised. That is proof that when the Government surrendered their powers of control over the NHS, the Health Secretary surrendered his ability to do anything about the problems that we now face.

It is just as bad when it comes to staffing. We hear that nurses’ posts continue to be lost. Nearly 5,000 have been lost since the Government came to power, and according to the findings of a survey published yesterday, nurses fear that further tragedies could happen as a result of staff losses. That should set alarm bells ringing throughout the Department of Health. The Care Quality Commission has said that one in 10 hospitals in England does not have adequate staffing levels. The Health Secretary nods. I am glad that he accepts that, but, again, what is he going to do about it?

I welcome the fact that the Care Bill will contain measures relating to the Francis report, and I will work with the Health Secretary on that, but let us get to the crux of the issue of safe staffing levels, because that is the most urgent problem facing the NHS. The Health Secretary nods again. Let me make him an offer. If he introduces a benchmark—if he specifies minimum staff to patient ratios—we will support him, and the measure will go straight through the House. I shall wait for him to respond to that offer, and to ensure that the recommendations of the Francis report are properly implemented.

I give a cautious welcome to some of the Health Secretary’s measures to deal with health tourism, but let me issue two caveats. First, it is important not to overstate the nature of the problem, and secondly, it is essential for health practitioners not to be turned into immigration officers. In March, when asked how much health tourism was costing the NHS, the Health Secretary said:

“I don’t want to speculate… but… we have heard… it’s £200 million.”

On the same day, the Prime Minister’s spokesman said he believed that the figure was more like £20 million. Perhaps the Health Secretary could account for the difference—or did he just add a zero?

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

Would it not be helpful if the Health Secretary could tell us exactly how much he thinks is being lost and what it will cost to try to recover the money? At present the only figure that he has is the one on the invoices, rather than one relating to the money that is actually recovered.

[Andy Burnham]

We must wait to see what the Government produce, but we need to be sure that they are attacking the real problem rather than playing politics with an issue and creating the impression that all the A and E problems are caused by immigration. If that is their real intention, they will have no support from the Opposition.

[Chris Bryant]

Did my right hon. Friend have an opportunity to hear what the Conservative right hon. Member for Haltemprice and Howden (Mr Davis) said during the debate on the Queen’s Speech last week? It was very intelligent and nuanced. He said that it was necessary to ensure that not just life-threatening diseases but notifiable diseases and mental health conditions would not be covered by the proposed measures. The position is not quite as straightforward as some newspapers might like to suggest.

[Andy Burnham]

Nuance, care and caution are precisely what we need in this debate; we do not need press statements written by Lynton Crosby which then turn up in the House as Bills. We want responsible government, ensuring that the NHS is not abused. We will support the Government as long as that is their intention, but if they are doing something more sinister and playing politics with these issues, they will not have our support.

We have had no answers on the NHS. Let me finally turn to public health. There was not much on which I agreed with the last Health Secretary, but he had my strong support when he spoke about tackling smoking. He said that he wanted tobacco companies to have “no business” in this country, and that introducing standardised packaging was an essential next step to ensure that young smokers were not recruited by the tobacco industry. [Interruption.] The Under-Secretary of State for Health, the hon. Member for Broxtowe (Anna Soubry), looks confused, but I think she advanced the same argument on the radio a couple of weeks ago, saying she was an advocate of standardised packaging. Then, we read in advance in our newspapers that the measure had been dropped—one of the “barnacles” on “the boat”, we were told, by the said Mr Crosby. This is the same Mr Crosby who has represented “big tobacco” since the 1980s, who masterminded the campaign against standardised packaging in Australia, and who was federal director of the Liberal party of Australia when it accepted millions of pounds in donations from the tobacco industry.

The Secretary of State said last week that a decision has not been made yet because the consultation has only just finished. It ended nine months ago. He can make a decision. I say to him again today, here is another positive offer from the Opposition: if he brings forward these proposals, they will have our full support and we will get them on the statute book.

[Ian Mearns (Gateshead) (Lab)]

My right hon. Friend may be interested to learn that the Prime Minister wrote to me about plain packaging before the Queen’s Speech was delivered to both Houses. He said in that letter that there were currently no proposals to introduce plain packaging.

[Andy Burnham]

The former Secretary of State said that it was full steam ahead and that is what they would do. This Secretary of State comes in and says nothing about the issue. Then, a right-wing Australian lobbyist arrives, and all of a sudden no one mentions it at all. Has the Secretary of State ever met Lynton Crosby and discussed this issue with him? I think we have a right to know. [Interruption.] He nods; I should be interested to know the substance—[Interruption.] He has not met him to discuss the issue. He looks very uncomfortable all of a sudden.

[Mr Jeremy Hunt]

Just to put the right hon. Gentleman out of his misery, I have not discussed this matter on any occasion with Lynton Crosby.

[Andy Burnham]

We are going to have to get to the bottom of this—not just the Secretary of State, but all his Ministers and advisers and all the No. 10 advisers—because it looks to us as though this Government have raised the white flag on having any semblance of a progressive public health policy. I cannot believe that the Liberal Democrats put their name to such reactionary stuff. Where is minimum alcohol pricing? Where is public health in this Queen’s Speech? They are totally absent.

[Jackie Doyle-Price (Thurrock) (Con)]

I appreciate that the right hon. Gentleman has very clear convictions and a desire to tackle smoking as a public health issue. However, a third of cigarettes smoked in London are contraband. How would standardised packaging deal with that problem?

[Andy Burnham]

I agree that we need to do something about that, and we did bring forward measures in government, but standardised packaging is not plain packaging: it is about having designs on the pack that could be used to ensure there is no counterfeit tobacco. Surely some things are more important—the young smokers in the hon. Lady’s constituency and mine who are targeted by the tobacco industry. Surely we in this House can unite on issues such as this and take steps to improve the long-term health of the country. It seems to us that the Government have given up on the health of the nation.

I said I would set clearly out for the House what I would do had I been standing at the Government Dispatch Box today. For a start, I would have introduced a Bill to repeal the disastrous Health and Social Care Act 2012, which has placed our NHS on a fast track to fragmentation and privatisation. That Bill would have restored the powers and responsibilities that the Secretary of State’s predecessor gave away, and which he found out last week he no longer has. I would legislate for the full integration of health and social care as the only realistic answer to the challenges brought by the century of the ageing society.

People can see that increasingly it is the Opposition who have the courage and the answers to deal with the big challenges the country faces, not a failed coalition that is now playing out time. Its toxic medicine of cuts and reorganisation has laid the NHS low, and now it has no answers to the chaos it created. That is because the Secretary of State only discovered last week that his own reorganisation had stripped him of his powers to intervene, leaving him looking weak—in office, but not in power. Having done that, the Government’s answer is to try to scapegoat others for problems of their making. It will not work—we will remind people that it was a right-wing reorganisation that has left the NHS destabilised and demoralised. We will never tire of reminding the Prime Minister that the British people never gave him their permission to put the NHS up for sale, and we will restore the right values to the heart of our NHS—compassion before competition, integration over fragmentation, people before profits. The NHS and the country deserve better than a Government who are out of touch and out of ideas.

--- Later in debate ---

[Paul Burstow (Sutton and Cheam) (LD)]

I want to concentrate my remarks on social care, because all too often in debates entitled “Health and Social Care” we tend to spend most of our time debating health, and yet our social care system is absolutely vital in regulating health care costs and delivering a better-quality health service. The Bill announced in the Queen’s Speech—it was indeed published on Friday—goes a long way towards laying some important foundations for a better social care system.

The Care Bill attempts to address a number of long-standing flaws in the system that have developed over the past 60 years through a series of piecemeal measures enacted by successive Governments. It is essential that in considering this over the next few months we make sure that we get it right, because legislation in the social care sphere comes to the House very infrequently. Our care and support system is of key importance because the rapid age shift that is taking place in our population is profoundly changing the nature of the demands on the system. It is important to note that this is not just about ageing; it is about the complex co-morbidities of long-term health conditions, both physical and mental, that are at the heart of the serious pressures on our whole system.

Our social care system has a number of features that need to change. It is too oriented around crisis and stutters into life when things have already gone wrong. It does not enable people to plan successfully for future care needs or, indeed, to prevent and postpone them. It does not provide adequate signposting, information, advice and advocacy for people to secure what they need from it, making it feel too much like a fight to get what is necessary. There is a lack of recognition of, and support for, family carers. Quality is variable around the country. We have heard announcements today about co-ordination of care and continuity, which is clearly a problem too. The costs of care are a lottery, and that needs to be addressed.

The Bill is taking all this forward. It focuses on early intervention and prevention, with a new responsibility for that to be up front in the way that local authorities plan their services. There are new duties on information and advice. I welcome the fact that the Government have agreed that the Bill should specifically refer to financial advice as being part of the legal obligations. There are new rights for adult carers—I will talk about young carers in a moment—with a lower threshold of eligibility for services. That is very welcome. A new rating system is being established to assist with quality of care and to help providers themselves to benchmark their performance.

[Andy Burnham]

I know that the right hon. Gentleman is very knowledgeable on this subject, but does he believe that councils have sufficient resources to consider new rights, given that we hear that care is collapsing all over the country and the Local Government Association says that if nothing else happens councils will be overwhelmed by the costs of care in less than 10 years?

[Paul Burstow]

I am grateful to the right hon. Gentleman for intervening. If he looks at last year’s Government impact assessment of the draft Bill, he will see that it gave a commitment to directing an additional £150 million specifically towards the rights of carers. The White Paper also gave a commitment to an additional £300 million over this and next year to support the system during this spending review period. I will address the funding questions for the future in a moment.

The right hon. Gentleman was a little harsh in his comments on the Bill laying the foundations for the implementation of the Dilnot cap on care costs. To understand this properly, we need to consider the relationship between the Government’s generous change to the means test—the threshold is being raised to £118,000—and the cap itself. Of course, we do not want people to reach the cap. We want steps to be taken to enable them to avoid having to pay catastrophic lifetime costs in the first place. The biggest gain of implementing the Dilnot proposals is a public health gain. It is about having conversations about care needs earlier, so that steps can be taken to minimise the risks of heavy-end care costs later in life. The Bill also commits the Government to national eligibility for the first time, which is hugely welcome.

I want to touch on three issues in the time remaining. First, some serious questions remain about how the Bill, which we will scrutinise over the coming months, will deal with the issue of young carers, which has already been raised. It is possible that young carers will fall into a gap between the Children and Families Bill, which is currently before the House, and the Care Bill, which will soon be before us. The Care Bill needs to address situations in which an adult does not qualify for local authority support and their children end up taking on caring responsibilities that become overly burdensome and inappropriate. In such circumstances the adult should be entitled to some sort of service so that their child does not lose their childhood to caring responsibilities. That requires action in the adult-related Care Bill; it should not be pushed away to be dealt with in the Children and Families Bill.

The second issue is poor commissioning practice, which was highlighted by an Equality and Human Rights Commission report on home care more than 18 months ago. It identified that contracting by the minute, or time-and-task contracting of home care, denigrated people and that they were being dealt with in an undignified way as a consequence of how services were being commissioned. Just a few weeks ago the Low Pay Commission’s most recent report highlighted, yet again, too many circumstances in which home care is being delivered by people who are paid below the national minimum wage. That is unacceptable and the Government need to deal with it.

--- Later in debate ---

[Mr Gary Streeter (South West Devon) (Con)]

It is a real joy to follow the hon. Member for Plymouth, Moor View (Alison Seabeck), my next-door neighbour—you are being extremely skilful in your selection of speakers today, Mr Deputy Speaker. I very much enjoyed her contribution; she spoke in her usual trenchant and passionate style. I also enjoyed hearing about the work that her late father was involved in, and I can say with some confidence that he would be extremely proud of her and all that she has done in her time as a Member of Parliament.

I liked the Queen’s Speech, but it was a little long for my liking. I was looking forward to the Queen sitting on the throne and saying, “My Government have decided to introduce no new laws this year, but to concentrate on implementing and overseeing well the policies that we have already passed and the laws that we have already put in place.” As we all know, coming to the House and taking legislation through involves a huge time commitment for Ministers, and there is a huge case to be made for Ministers to focus on implementing well the things that we have already decided. We have been radical in the past three years in this Parliament, so let us make sure that the policies now work in practice on the ground—let us set our Ministers free to do that. Interestingly, the key areas our constituents are most concerned about—getting the deficit down, getting the economy moving and cracking down on immigration—do not require any legislation at all. They simply require us to do well the things we have already decided.

I welcome the Queen’s Speech and, despite having said what I just said, the increased attention on immigration, which is what our constituents want. The reaction of my constituents to some of the tough measures we have introduced so far on immigration and on welfare changes is, “It’s about time. We have been waiting for this for many years.” So I support the broad direction of travel of the Government, and I have full confidence in the Health Secretary.

I want to make two points in a brief contribution about health issues, the first of which is about the challenge of urgent care. Our parliamentary system has many strengths, but one weakness is that every Government Member is inclined to say that everything we are doing is wonderful, while the Opposition are inclined to say that everything we are doing is rubbish. We all know that the truth lies somewhere in between. I support and pay tribute to the fact that we continue to pump fresh money into the health system year after year. The shadow Health Secretary is convinced that we are not meeting our commitment to increase health spending above inflation every year—I think we are, but of course there is a debate to be had. I do know that there are pressure points in the health system that need to be tackled, and urgent care is one of them.

[Andy Burnham]

The hon. Gentleman’s association with the detail seemed to be loose there; Andrew Dilnot wrote to the Government to say that health spending was lower in real terms in 2010-11 than it was when Labour left government. It is important to point out that the promise the hon. Gentleman stood on was for real-terms increases in every year of this Parliament and that that has not been honoured.

[Mr Streeter]

That is Andrew Dilnot’s opinion, but it is not mine—that is the point I am seeking to make. [Interruption.] The right hon. Gentleman’s speech was riddled with references to spending—more spending on health and on local councils—but is he not aware that this year the deficit in this country will still be, even after three years of austerity, £110 billion? If he comes to the Dispatch Box to make speeches about extra spending for health and local councils, he is obliged to tell us where that money will come from. At the moment, I can see no signs of it whatever.

[Andy Burnham]

rose—

[Mr Streeter]

I will not take any further interventions, but let us not hear any further speeches calling for extra spending unless we know where the money is coming from.

As I was saying, before I was so rudely interrupted, there are pressure points in the health system, and urgent care is one of them. This is about not only accident and emergency departments, but GP and out-of-hours services, community nursing, social care, ambulance services and hospital beds—there is pressure on all those points.

The hon. Member for Plymouth, Moor View and I are fortunate to go to Derriford hospital in Plymouth for briefings. I have been going slightly longer than she has—21 years—and I can tell the House that in good times and in bad times Derriford hospital is under pressure. It has a running capacity of about 95%, which means that when there are spikes, as there have been this winter, it can be running at 103% capacity, which puts the hard-working staff under enormous pressure. Even when the Labour Government were spending money as though it were going out of fashion, I have never gone to Derriford hospital and had the staff tell me, “It’s fine. There are no pressure points. Everything is working in our health service. It’s all working well and waiting lists are coming down.” That has not happened once in 21 years.