Health and Social Care

Debbie Abrahams Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is an honour to follow my hon. Friend the Member for Neath (Christina Rees), and I congratulate everybody who has made their maiden speech today; they have certainly put the rest of us under pressure.

My right hon. and hon. Friends have talked about cuts in social care. I will start by giving an example of what those cuts mean in practice. I called at a house one afternoon during the election campaign and an elderly woman in her 70s answered the door. She was dishevelled, distressed and clearly confused. She had an empty bubble-wrap pack of medication in her hands and she said to me, “I don’t know what I have to do”. I called the pharmacist, and she came straight out, but this was clearly a very vulnerable woman on her own. What if I had not called? We saw £3.5 billion cut from social care in the last Parliament, while 87% of local authorities provide care only for people with substantial needs, and, as we know from the Institute for Fiscal Studies, the Office for Budget Responsibility and the International Monetary Fund, the pressure on public services and funding for local authorities is going to get much worse over the next three years. Some 450,000 fewer people are being supported, and the number of cases like that of the woman I called on is only going to increase.

We have also heard from right hon. and hon. Friends about the crisis in the NHS, which we can land firmly at the door of the Conservative party and the Health and Social Care Act 2012. In addition, this top-down reorganisation, which is wasting billions, is underpinned by an agenda to privatise the NHS. The Secretary of State refused to acknowledge that section 75 of the Act was entirely about compelling all health services to be put out to tender and that four out of every 10 health services put out to tender have been awarded to private healthcare companies.

At the time, the Government argued—I know because I was on two health Bill Committees—that increasing competition would improve service quality, but there is no evidence for that; in fact, international evidence shows exactly the opposite. In addition to not improving quality, we know—again from international evidence—that it will actually reduce health equity, in terms of access to care and health outcomes. Other effects of the Act have already been mentioned: hospital A&Es not meeting their four-hour targets for 97 weeks on the trot; an increase in the number of urgent operations being cancelled—up 40% on last year—and one in four people not able to see a GP within a week, or two in three in my constituency, according to a survey that I undertook. I think also of the shocking care that our children and young people have to face if they are suffering from a mental health condition—being kept in police cells or shipped hundreds of miles from their families, if they have an acute episode. And, of course, all of that is underpinned by the appalling state of the finances. Unfortunately, these trends will only increase over the course of this Parliament. The pace of the privatisation agenda will increase, and the principles of the NHS as a universal, comprehensive and free service will be under threat.

We heard the Secretary of State refer to the party mantra: “We have a strong economy, and we will have a secure NHS”. But do we really have a strong economy? We have had a flatlining economy for the past three years, with only a tiny spurt of growth in the last year, while the Government have borrowed £219 billion more than they said they would in 2010. They did not clear the deficit; instead, they broke their own law. The debt to GDP ratio is 81%. Even after a global crisis, it was only 60%. They have increased that ratio. Our productivity is the second lowest in the G7, and the 19th lowest in terms of average productivity—the worst since 1992. Where are we going to get all the money needed to invest in our health service, social care and child care?

The Government do not get it. As any successful business will say, its most important asset is its people. Our people should be valued, but instead of supporting, enabling and investing in people—in our skills, our health and our care—the Government’s approach is reminiscent of a Victorian workhouse. Amanda Story is a case in point. In her late 50s, she came to me saying she had always worked as a teacher, but that 18 months before she had been diagnosed with breast cancer. As she went through her treatment, she became more and more poorly and had to take time off work. Eventually, she was made redundant. She applied for and was granted employment and support allowance. Months later, she was also able to take her teacher’s pension. Imagine her horror when she received a letter from the DWP last December informing her that she was being investigated for fraud, because she had not notified DWP that she was now receiving a pension. In the physical and emotional rollercoaster that she was going through—cancer, treatment, redundancy—she had not realised that although ESA is a non-means-tested benefit, she was meant to inform the DWP about changes to financial circumstances. Although she explained this in her interview under caution, she was told by the authorities that she was still going to be pursued. This is beyond sense.

One thing I recognise that the Government have done very skilfully—and other parties have done the same—is to demonise certain groups of people. Using language such as “shirker” or “scrounger”, they try to point the finger at others, making us angry and likely to blame others for our lot. They have successfully created the perception that all people in receipt of social security are on the take, lazy or not worthy of support. The facts are against them. Whenever people hear this language, I urge them to think of Amanda and the thousands of honourable people like her—because tomorrow, “it could be you”.

G8 Summit on Dementia

Debbie Abrahams Excerpts

Thursday 28th November 2013 Commons Chamber

[Hazel Blears]

I am delighted that the hon. Gentleman has mentioned Plymouth, because it is one of the pioneers in this area. Plymouth, Torquay, Bradford and other towns all over the country want to ensure that dementia is not something shocking that we do not know how to deal with, and that everyone is dementia-friendly and aware. They are tackling the stigma, which is a huge issue. People do not like to talk about the fact that their families and friends are afflicted with this disease.

The search for a cure is essential. No one wants to have dementia, and everyone wants to be able to cure it. However, at the G8 I want just as much importance to be ascribed to research on the quality of care. The Evington initiative, which is backed by a number of business leaders including Terry Leahy—who used to chair Tesco—and Sir Marc Bolland are putting their weight behind that initiative. They are asking two questions. First, how can we change the system so that it is driven by users and carers rather than simply by clinicians and producers? Secondly, how can we establish a good, rigorous evidence base in relation to therapeutic interventions, quality and consistency of care and tackling stigma, so that clinical commissioning groups can be confident that the services they are commissioning actually work?

I think that the research is very exciting, but we are not likely to find a cure for 10, 15 or 20 years, and in the meantime 800,000 people are living with dementia. At present, there is virtually no evidence base relating to the quality of care. “Singing for the brain” is fantastic, but does it work, and if so, why does it work? Then there are the arts, the drama, and all the memory work that goes on. We need that rigorous evidence base, so that the commissioners can take the right packages off the shelf.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will my hon. Friend give way?

[Hazel Blears]

I am afraid that I do not have enough time.

We also need research on prevention. The Alzheimer’s Society is working on a system that helps care home staff to reduce the use of anti-psychotic drugs by intervening in other ways to deal with people’s behaviour. That system is being rolled out in 150 care homes, and has reduced the use of anti-psychotic drugs by 50%. It is saving money, and it is making a huge difference. The G8 presents us with a fabulous opportunity to press for further research. I do not want it to be a one-off: I hope that there will be another summit of this kind next year. I also hope that work will continue between now and the next summit. This issue is not going away—it will be with us for a long, long time—and it would be fabulous if we could secure that international collaboration.

I invite the Minister to visit our university institute after we have launched it tomorrow, so that he can observe the fabulous work that is being done there and, perhaps, meet some of the people in Salford who are taking a whole systems approach that I think will prove helpful.

Let me end by saying that we owe a duty to every single one of the people who have dementia or are caring for people with the condition. It is the worst thing in the world to lose the person with whom you once had a connection. We have an absolute duty to do whatever we can, here in the House and in our communities, to give those people support and help.

[Richard Graham (Gloucester) (Con)]

It is a pleasure to follow the right hon. Member for Salford and Eccles (Hazel Blears), who has spoken so well and done so much work on this subject along with her colleagues, my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Sutton and Cheam (Paul Burstow). All three major parties now have at least one significant dementia champion to raise this important issue. I know that the Minister will enjoy responding to the debate, because he has covered a number of debates on the subject before. Much has been said on dementia, and much action has been taken. The right hon. Lady was right to mention the Prime Minister’s initiative and his championing of this issue. Many people are suffering as a result of dementia, not only those suffering directly from the disease, and there is still no cure, so it remains a significant challenge for science and society.

I have just a few points to add to what has already been said. The Minister will recall that I led a debate recently in Westminster Hall on what was being done about dementia in Gloucestershire and on the ways in which I believed we had adopted best practice. However, a critical question is: do we really know what best practice is? How do we measure the quality of what is being done in our local hospitals and care services? How do we measure the contribution of organisations such as the Barnwood Trust, a mental health charity specialising in these conditions which we are lucky enough to have in our area?

As the right hon. Lady said, it would be useful if the Minister could share his thoughts on a guide to best practice, not only for commissioners—although I agree that that is important—but for MPs. Representatives of the Gloucestershire family of NHS services recently told me in a meeting that they had received an award for the care and services they provided for old people in general and for dementia sufferers in particular. That was terrific news—I am always delighted when people win an award—but it would be useful to know what we are doing best, and what is being done better in different areas, so that we can have a nice, easy frame of reference. People could then see whether their area offered a four-star or a five-star dementia service, for example, and we could assess how we might attain a higher standard if we did certain things differently.

[Debbie Abrahams]

Is the hon. Gentleman suggesting that, in addition to building up the evidence base through randomised controlled trials that establish a causal relationship between therapies and outcomes, some kind of action-based research would be appropriate? Such research could be carried out and interventions could be offered and evaluated while providing the service at the same time. It would be a case of learning as we went along. Does he agree that we need different approaches because of the scale of the issue that we are facing?

[Richard Graham]

I think I agree with the hon. Lady. Different things need to be tried. Singing and music were mentioned earlier. In my mother’s case, they were the last things she was able to relate to and enjoy before Alzheimer’s closed over her. So I agree that different things are always worth trying, and that is where the charities can play a role as well.

My first question to the Minister is: could we have star ratings for dementia services and, if so, how would we identify and measure best practice? My second point relates to how we are using the Prime Minister’s initiative to get dementia on to the G8 summit agenda for the first time. We should work with other countries on this. A number of us have received briefings suggesting that the United States and France, among others, are also doing great things in dementia research. Should we not all be able to share our findings? Perhaps we could have what is known as a global inter-operative data sharing base, so that all the work being done by organisations such as Alzheimer’s Research UK could be shared, rather than being duplicated. Effort could then be spent on taking research forward, rather than replicating it.

The aim of trying to join up what organisations around the world are doing is a key reason for the Prime Minister getting this topic on to the G8 summit agenda, and I hope that the result will be an international plan involving more pooling of thinking, research and ideas. I sense that science is beginning to feel more confident about finding solutions to this ghastly disease, and if the G8 summit can give an enormous turbo-boost to pooling research and getting closer to finding solutions, the actions of the Prime Minister and the Government will have been worth while, not only for the 800,000 people in this country who have dementia today but for the many millions who will suffer in the future.

Carers

Debbie Abrahams Excerpts

Thursday 20th June 2013 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), the hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on organising this debate. I am grateful for the opportunity to speak after such thoughtful contributions. I want to focus on unpaid carers; I will leave others to talk about the care system as a whole.

As we have heard, carers play a vital role, not just for their family members and friends but for the country. In the past decade, the number of carers has grown from just under 5 million to nearer 7 million. By 2037, it is estimated that the number will have increased to nearly 9 million. In my constituency, there are 11,076 unpaid carers, nearly a quarter of whom provide care for more than 50 hours a week. As has been said, we know that this is an underestimate of the actual number who provide care. My hon. Friend the Member for Worsley and Eccles South talked about the lack of information and advice, which has certainly been identified in my constituency. Age UK in Oldham recently opened an information and advice centre, and I hope that people will avail themselves of that. Like other Members, I, too, have had the plight of carers increasingly brought to my attention in my surgeries. Their situation is a growing problem.

In today’s terms, the role played by carers saves the economy £119 billion a year. That is more than the total NHS budget and nearly six times the adult social care budget. The country could not survive without the work that carers do, and that is even more so today, with the crisis that social care is facing. We are facing the double whammy of an ageing society—it is great that we are, on the whole, living longer, although austerity is certainly having an impact on life expectancy—and a meltdown in social care in local authorities, with cuts to their budgets having an impact on social care budgets. Unfortunately, carers are picking up the tab. A recent Carers UK survey showed that a third of those caring for more than 35 hours a week have no support at all. Although 3 million carers juggle work with caring responsibilities, one in five has been forced to give up work.

In addition to the lack of support for caring, carers across the UK are starting to see the impact of the Welfare Reform Act 2012. Changes to financial support with housing and council tax in some areas mean that many families are experiencing reduced financial support from more than one of the changes. The discretionary funding set aside by councils to support people affected by the bedroom tax is enough to help only one in 10 disabled people. Carers who require an additional room because they cannot share with partners who sleep in hospital beds, or parents of disabled children who need the space for care workers to provide overnight care are being seriously let down. More than 5,000 families with care needs are faced with either moving or finding an extra £700 a year.

The cumulative effects of the economic downturn, a squeeze on wages and the increasing costs of essentials such as food and fuel, along with the cuts in social security support, are making it more difficult for carers to manage. More than four in 10 carers in the Carers UK survey said they had been in debt as a result of caring. This year will see other changes to the benefits system, as the transfer of disability living allowance to the personal independence payment and the universal credit are introduced, which is also of considerable concern to many carers. DLA was the gatekeeper to carer’s allowance. The changes mean that 10,000 fewer carers will not be entitled to carer’s allowance. Many of us have already called on the Government to review these changes and undertake a cumulative impact assessment of the effects of these welfare reforms. For many, they will be the tipping point.

In addition to that, and as a consequence of debt and a lack of support, there are significant effects on the health of carers. Eight out of 10 carers report that their caring role affects their physical health and nine out of 10 say that their mental health has suffered. This is not only a human tragedy; we are storing up problems for the future by not caring for our carers.

I know about that from my personal experience of caring for my mum—I have spoken about her before—who died of Alzheimer’s last September. She had Alzheimer’s for 10 years, and for the last three years was unable to communicate or to feed or toilet herself. Although my mum lived in the States, I provided respite care during leave, so I can personally attest to the physical and emotional toll that it had on me. In the last few months of her life she was bedridden. I am little, but I am fairly fit and strong, yet physically trying to lift her to bathe her or change her continence pads was something I found really difficult to manage. The worst thing was the emotional toll, however, as I worried how everyone was coping.

I want to spend the last few minutes talking about young carers. One of the last research projects I worked on before I was elected to this place concerned the effect on young carers’ health of their caring role. Many people will be surprised to learn that, according to recent census figures, there are more than 178,000 young carers in England and Wales. Those are the official figures, but we know that they are an underestimate. Children as young as five are looking after family members who are physically or mentally ill or disabled, their roles ranging from doing household chores to providing nursing or personal care.

The effects on those children and young people are immense and lifelong. Because of their caring responsibilities, nearly a quarter of young carers often miss school or have educational difficulties. Young carers are also more likely to grow up in poverty, to be socially excluded, to have low aspirations and achievement and to have relationship issues. Those problems can follow them throughout their lives. There is also evidence of significant effects on their physical and mental health, with anxiety, depression and self-esteem issues being particularly prevalent. It has been shown that, after a year of caring, morbidities fail to return to pre-caring levels.

Services do not always respect young carers and the role that they play. My research indicated that many young people felt excluded from discussions about their family member’s care, even though they were providing much of it. Some of the responses to questions on whether the young carers should be allowed to see their parents in hospital, for example, were quite heartbreaking. Similarly, many young carers felt that there was a lack of understanding and support from their teachers and schools. I echo what my hon. Friend the Member for Worsley and Eccles South said about this. We must ensure that schools take seriously their role in supporting young carers.

[Barbara Keeley]

I have mentioned the fact that we have a young carers project in Salford that is doing great work. It was interesting, however, that one of the schools involved came back to the project and said, “We have no young carers at all”, when the project knew that it did. The perception among some head teachers is that they do not have any. Is my hon. Friend worried about that as well?

[Debbie Abrahams]

I totally agree with my hon. Friend; that is very worrying, and we must try to do better by those young people.

I am encouraged by what the Minister has said today about the discussions, but I reiterate my hon. Friend the Member for Worsley and Eccles South’s sentiment that warm words are not enough. Will he tell us when we can expect to have the amendments included in the Children and Families Bill? The rights of parent carers of disabled children are also still in limbo, and the Government must bring forward changes to the Bill to ensure that the rights of that group of carers are not left behind. I recognise the Government’s commitment to carers’ rights, but I reiterate my earlier remarks: no matter how much we legislate for assessing carers’ needs, it is meaningless without the means to implement it. Local authority budgets have been pared to the bone, and that is having an impact on social care budgets. How are we going to deliver those assessments? A further £800 million of cuts are planned for this year alone. I would be grateful if the Minister would address that point as well.

Dementia

Debbie Abrahams Excerpts

Thursday 10th January 2013 Commons Chamber

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I congratulate right hon. and hon. Members on securing this important debate. The speeches have been moving and thoughtful. Today has demonstrated the best of Parliament, with MPs coming together and contributing to how we can resolve the dreadful issues around dementia. I am grateful to have the opportunity to speak today as, in addition to representing a constituency in Oldham where, in 2010, 2,318 people were diagnosed with Alzheimer’s, the most common form of dementia, I have personal experience of being the daughter and carer of someone with Alzheimer’s. I would like to bring that personal experience to the debate.

In September last year, my mother died of Alzheimer’s. She was only 74. In 1992, she remarried and moved to the US, and it was there, 10 years later, that she was diagnosed with the disease.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Does the hon. Lady agree that those who have experienced these sorts of incidences first hand can bring to debates a remarkable amount of insight to, and understanding of, these conditions? Does she also agree that it is important for us all, especially Government, to listen to those experiences, so that we might be able to learn from them?

[Debbie Abrahams]

I am very grateful to the hon. Lady for her intervention. I totally agree.

My mother was 64 when she was diagnosed and was still working. She told me that she stood in the middle of the office where she worked and could not remember why she was there. Not only did she find it abhorrent to be diagnosed with this devastating degenerative disease, but the financial consequences of having to give up her job were a severe blow too.

To watch her decline was nothing short of heartbreaking. Two years after she was diagnosed, the penny dropped for me when we went to a restaurant and she was given a menu. As my hon. Friend the Member for Bridgend (Mrs Moon) said, it is so important to make sure that people with dementia still have as much control over their lives as possible. She looked at the menu, and kept on looking at it again and again. She did not understand what she had to do with the menu—one of the practical consequences of the disease. She became a different person—not a better or a worse person, just different. As much as I loved my old Mum, I loved my new Mum too. I will remember until the day I die the first time she did not recognise me, which was about four years after she was diagnosed. She was very distressed, because she knew that I was someone of importance to her, but she did not know her relationship to me. Needless to say, the pain I felt was—well, I cannot explain.

My mother went from being a brilliant, vivacious, caring woman—a woman who invented the term social justice before it entered the lexicon—to a woman who gradually lost her ability to communicate, feed or toilet herself. In the last year of her life, she became wheelchair-bound and in her final month completely bedridden. She was unable even to lift her head and the end came shortly after she lost her ability to swallow.

In many ways we were very lucky because my mother remained physically well for so long, but also because up until the last year of her life she seemed relatively content, smiling and laughing, particularly around animals and children, as she had always been. I agree with my hon. Friend the Member for Bridgend that people with dementia understand far more and we have to find ways of communicating with them. My hon. Friend the Member for Liverpool, Walton (Steve Rotheram) also talked about different ways of engaging with people with dementia.

Unfortunately, the care arrangements in the final year of Mum’s life, and ultimately the circumstances around her death, can only be described as shameful. She was in the US at this stage. After much consideration, I have decided to talk about this now because dementia has such consequences for everybody in this country and across the world. Up until 2011, my stepfather, who is 81, had been Mum’s main carer, although he paid for a carer to help Mum get up in the morning in their New York home. I used to provide respite for him during my leave, but the physical and emotional toil and strain was taking its toll and he began looking for caring support.

That support was offered by an acquaintance of his who offered to provide care for my mum for an agreed fee. Over a few months, unbeknown to me or my family, the new carer moved into the house, got access to their finances, sold their home and drove them more than 800 miles away from my stepfather’s family in New York to South Carolina, where they knew nobody. Within a week of the move, my mum was admitted to hospital and we were told that she had days to live. When I arrived, I was shocked to see their circumstances: they had moved from a comfortable family home to what can only be described as a hovel, and the female carer had gained almost complete control over their lives. I alerted Adult Protective Services in South Carolina to my concerns for my mum’s and stepdad’s welfare on 24 August. After week’s of chasing it, including through the Governor’s office, I got a reply on 19 October saying that it deemed my father, whom it had never even met, to be competent and would not be taking it any further. Unfortunately, my mum had died by then.

My mum’s story is not unique. The stages in her decline and her and my family’s experiences are being replicated in this country and across the world. My story happened in the US and, based on my discussions with adult protection teams in this country, I am confident that the casual response from Adult Protective Services in South Carolina would not be reflected here, but there are still lessons to learn. We must ensure that the regime we set up around carers protects people with dementia from exploitation. I fear that, as has happened in other areas of the world where personal health budgets and individual social budgets have been introduced, some of the moves towards personal budgets here will lead to fraud and exploitation.

I could speak for hours about what I believe we need to do, but I would like to raise just a few points. First, as individuals, families and communities, we need to be more aware of the disease, as has already been mentioned. The odds are that most people will be affected by this disease. It might not be themselves or their family, but it might be their friends or neighbours, and we need to do more to protect ourselves against the disease. The Alzheimer’s Society is a wonderful resource, as we just heard, for information and support. We need to keep active and healthy, not smoke and so on—all the messages we know so well.

We need to do more on research. I fully support and recognise what the Government are doing in increasing research funding—it is such an important area—but the moneys being dedicated are paltry next to the scale of the problem. We need to address that. I was pleased to hear what my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said about the Wellcome Trust funding, and I hope that we can pursue that more.

Finally, we need to do far more at health and care service levels. As I said, 2,318 people in Oldham were diagnosed with Alzheimer’s in 2010 and more than 800,000 across the country. By 2020, it is estimated that this number will have increased to 1 million. Most worryingly, however, as we have already heard, that is an underestimate and is probably half the actual scale of the disease. Apart from the human cost, £23 billion is spent treating and caring for Alzheimer’s patients every year. This will rise to £27 billion by 2018 and will continue to increase. There is already a care crisis in this country, with cuts to adult care services in the NHS, and this will only get worse, not better. Care services are already at breaking point. How will families cope with Alzheimer’s? It is a ticking time bomb. I urge the Government and the Opposition to work together to reach a cross-party consensus on how we fund and deliver a national care service, and that must include the Treasury teams. We cannot afford to kick this issue into the long grass any longer.

Induced Abortion

Debbie Abrahams Excerpts

Wednesday 31st October 2012 Westminster Hall

[Mr Laurence Robertson (Tewkesbury) (Con)]

I congratulate my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) on raising the issue again, and I encourage her to continue doing so.

My motivation for speaking—although I am basically against abortion in principle—is that I want to touch on one or two aspects of the issue, one of which is late abortions. I remember doing a fundraising project for a special care baby unit in 1992 in Derbyshire. Even as long ago as that, babies were starting to survive after 24 weeks’ gestation. I saw those babies, their fight for life, and the care and attention that they were given. The entire unit was there to help preserve life, and it struck me as very wrong, especially as time has gone on and as medical science has advanced, that we should be aborting babies who are capable of life.

We have heard it said today that babies cannot survive at 20 or 21 weeks. I shall not argue with that position, but it is fairly well established that they can survive from anything above 22 weeks, and certainly at 23 or 24 weeks. It is not fit for a civilised society to take, live from the womb, babies who are capable of life, leave them to struggle for life, and let them die. In any other circumstances, allowing a baby to die like that, through omission, would certainly be manslaughter, at least. That cannot be right. I can understand why some people might be in favour of abortion up to 12 weeks or so, but I simply cannot understand how anybody in this House would want this practice to continue.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

What does the hon. Gentleman think the balance should be between scientific and anecdotal evidence in the development of policy? He suggests that we should use anecdotal rather than scientific evidence to produce policy.

[Mr Robertson]

I find that intervention rather confusing, because if the babies are surviving, surely that is proof of the science. If the hon. Lady will forgive me, I cannot understand the point of the intervention.

The hon. Member for Sunderland Central (Julie Elliott) asked why we were having the debate now, when we considered the issue four years ago. I have to say that Parliament does not always get things right. On very many issues, public opinion and the evidence are way ahead of where Parliament is. Examples include welfare reform, immigration and the European Union. Parliament has not caught up with what everyone else in the country is saying on those issues. This is one such issue that certainly needs to be revisited. My hon. Friend the Member for Mid Bedfordshire is right: we should not shy away from this subject or any other, because if we—

NHS (Rationing of Care)

Debbie Abrahams Excerpts

Monday 16th July 2012 Commons Chamber

[Mr Burns]

I am extremely grateful. I take that as a compliment, because I would hate to reduce the hon. Gentleman to tears.

As the hon. Lady and other hon. Members well know, cost-based rationing of the sort that she has described is not permitted and not condoned.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Will the Minister give way?

[Mr Burns]

No, I will not; I am going to make some progress. This is not the hon. Lady’s debate and I have only just started.

If the hon. Member for North Tyneside or any other member of her party or of the public brought forth genuine evidence of cost-based rationing—blanket bans on treatment—this Government would act decisively to stamp it out, but the fact is that so far we have been brought no such convincing evidence of that.

The core principle underpinning the NHS is that it is a comprehensive health service, available to all, free at the point of use and based on need and not ability to pay. That principle is enshrined in the NHS constitution and reaffirmed in the Health and Social Care Act 2012.

EU Working Time Directive (NHS)

Debbie Abrahams Excerpts

Thursday 26th April 2012 Westminster Hall

[Andrea Leadsom]

Thank you, Mr Howarth. Occasionally it is difficult to remember that we are not having a conversation.

The point about the opt-out is that, under the working time directive, individuals can opt out of the maximum 48 hours per week if they choose to do so—they cannot be compelled to do so.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Is the hon. Lady suggesting that we opt out of, for example, co-ordination on public health strategy or communicable diseases? Co-ordinating at an international level on bird flu and other pandemics is hugely important.

[Andrea Leadsom]

All I am saying is that, under the Lisbon treaty, member states that do not like certain legislation have the opportunity to club together and to propose that the European Commission look at it for possible deletion or significant amendment. That happened with the working time directive at two points in the past, in 2004 and 2010, but the attempts to amend it came to naught. The great tragedy is that with 27 member states there is simply a Chinese whispers effect. Someone says, “This is ridiculous, it is harming our national health service”; everyone agrees, “Yes, it’s ridiculous”, and therefore an amendment is proposed; but by the time it has gone around 27 member states, it is completely lost and gets nowhere. That is the fundamental problem with negotiating amendments.

My original point was about the importance of the time line of the working time directive. In 1990, the European Commission tabled the proposal for the working time directive as a health and safety measure. In November 1993 the UK was outvoted 11 to one at the European Council negotiations. The European Commission stated that the working time directive was

“a practical contribution towards creating the social dimension of the internal market”—

it was all about health and safety for employees, and employees in the real economy overworking; it was not intended to have the profound impact it has had on the national health service. David Hunt, who was Employment Secretary under the then Conservative Government, said that he would fight the legislation and not accept it. He tried hard, by going to the European Court of Justice to challenge the legal basis of the directive as health and safety legislation, but the UK was outvoted.

In 1996 the ECJ ruled against the UK, and Labour implemented the working time directive in 1998. The directive requires a maximum working week of 48 hours, a rest period of 11 consecutive hours a day, a rest break when the day is longer than six hours and a minimum of one rest day per week, as well as the statutory right to four weeks’ holiday. Such a list of requirements highlights the directive’s complete inflexibility; it clearly cannot be applied to absolutely every type of worker in our economy. In the end, the European Union had to admit that there were certain exceptions, which is why in some countries trainee doctors are treated as autonomous—in other words, self-employed. That is used as a means to get round the rules, because it is never going to be possible to enforce that kind of rigidity on people who are self-employed. There are all sorts of unintended consequences from a prescriptive and damaging set of rules.

In his response, will the Minister confirm whether the NHS has caused some of those problems—not necessarily deliberately—by offering contracts to doctors and junior doctors that are subject to a maximum of 48 hours? We should remember that the NHS is not allowed to invite new employees to opt out of the 48-hour working week at the same time as they sign their contract, because of fears of coercion. Does the Minister have a view about whether the NHS has created part of the problem by telling junior doctors and other health workers in their contracts that they will be paid for a 48-hour week, and then inviting them to opt out at a later date? There is a wealth of evidence to suggest that many doctors are working hours that are unpaid because their contract allows them to be paid for only 48 hours a week. Perhaps the Minister will comment on that in his response.

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[Andrea Leadsom]

I am grateful to my right hon. Friend. As my hon. Friend the Member for Bristol North West pointed out, representatives of doctors and NHS staff do not agree among themselves about whether they support the European working time directive. Certainly, the Royal College of Physicians, NHS Employers and the Royal College of Surgeons are concerned not only that the working time directive causes a problem for doctors and patients, but that it does not do what it sets out to do, which is to deal with the exhaustion of doctors themselves. The Royal College of Surgeons says:

“We know from our members that working in a full shift pattern is more tiring when compared to working using an ‘on-call’ system, and creates a working environment that is impairing to patient safety.”

The British Medical Association believes that the European working time directive is entirely right in all of its manifestations. Patient and doctor representatives need to resolve the question of where they stand, as representatives of health service workers, on the implications of the working time directive.

Turning to the options for change, the Fresh Start project has done a great deal of work on this. Certainly, there are things Britain could do in isolation to try to improve the situation, and we have heard about some of them today. Some doctors in other European Union countries have two contracts, which has been used as a way of getting round the working time directive. We have heard about all sorts of workarounds that Britain does not tend to use, and the Government might want to consider what other countries have done. Certainly, MEPs in Europe have told me that some doctors will take on two 48-hour contracts, which seems to be going back to dangerous practice. Nevertheless, if an impossible situation is created, we end up with people just trying to defeat the problems.

A far more likely scenario is that we negotiate for change with other members that are unhappy with the consequences of the working time directive. We should get together with the 16 other member states that are determined to see change and that have negotiated an opt-out, so that we can get the directive changed specifically in relation to the NHS and make our economy more flexible.

What we are proposing is a concrete option for change. At the time of the European members’ attempt to get their recent fiscal consolidation agreement into the main treaties, there will be an opportunity for Britain to go to the EU Council with its own proposal for change. This is a clear opportunity, which has arisen from the need for fiscal consolidation in other EU countries, for Britain to prepare a list of changes to various elements of the treaties that it would like to see, and to go all out to negotiate those changes when the time comes, in three or four years. In line with the proposal put forward at the all-party parliamentary group for European reform, I recommend a triple lock whereby Britain arranges to opt out.

[Debbie Abrahams]

This is an interesting and useful debate. Is the hon. Lady aware of the recent systematic review—the highest level of evidence we have—that was inconclusive on the impact of the working time directive? I think there has been only one UK study undertaken since 2009, and one recommendation in the systematic review is that there should be more research. Is that not one of the outcomes we should be pressing for here, so that we have a full, evidence-based understanding that will enable us to ensure that policy is adhered to correctly?

[Andrea Leadsom]

I thank the hon. Lady again, but a mistake that many Opposition Members fall into is to think that only the European Union can legislate to protect the British NHS. Of course, that is simply not the case. Britain is perfectly able to legislate for its own NHS needs without the support of the European Union.

[Debbie Abrahams]

Will the hon. Lady give way?

[Andrea Leadsom]

I would like to finish now. I have given way to the hon. Lady twice.

The first lock would be for the UK to argue that it should opt out completely from the social policy section of the EU treaties. The second lock should be for the UK to have the ability to opt out of any future EU proposal that it believed would impact intolerably on its social and employment law. The third lock would be for Britain to negotiate that the ECJ should not be allowed to have jurisdiction over ruling whether the UK was right to opt out of that legislation. That is the only way, once and for all, to enable Britain again to have control over its own working time hours—not only for the NHS, but for the future of the whole of our British economy.

[Amber Rudd (Hastings and Rye) (Con)]

It is a pleasure to follow my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) who, as always, speaks with such authority on the relationship between this country and Europe. I was particularly interested to hear the relevant experience of my hon. Friend the Member for Totnes (Dr Wollaston). Most hon. Members have said that we do not want to go back to 100 hour weeks; her rather shocking and frightening examples remind us all why that is so. What we want is flexibility—F for flexibility, as the hon. Member for North Antrim (Ian Paisley) so helpfully put it—so that we can try to get a better outcome for everybody.

So much has already been said and covered, particularly by my hon. Friend the Member for Bristol North West (Charlotte Leslie), who did so well to secure the debate. As she made her remarks, I was concerned that she was going to cover absolutely everything. She pretty much did, so I will just concentrate on one area—surgery—where the effect of the working time directive has been particularly damaging.

Although, as some hon. Members have pointed out, the British Medical Association has said that all training can fit into 48 hours, surgeons I have spoken to are concerned. The body that represents trainee surgeons, the Association of Surgeons in Training, has stressed that surgery is very different from all other aspects of the medical profession. It has clearly taken on the BMA in trying to make that point. As the hon. Member for Vauxhall (Kate Hoey) said, surgery is a craft specialty like chefs, for example—a lot can be learnt from books, but in the end there is nothing like hands on practical experience. Operative and procedural skills define the surgical craft and they are finite in number, with the majority to be gained during working hours. By limiting those hours, we are working against their training and therefore their competency as future consultant surgeons. As the ASIT survey confirmed, the majority of surgical trainees would welcome the opportunity to work in excess of the hours permitted—we are not doing them any favours by restricting their hours.

The Royal College of Surgeons estimates that 400,000 hours of surgical time are lost every month. ASIT believes that the restrictions imposed by the directive will be detrimental to the quality of training for junior surgeons and, therefore, to the quality of surgical service and provision in the future. Ultimately, as said by many of my colleagues today, the restrictions will be harmful to patient care. We also risk deterring junior doctors from specialising in surgery, as they are only too aware of the consequences of the restrictions. The royal college and ASIT both call for flexibility to enable UK surgeons to work up to a maximum of 65 hours per week, including time spent on call.

In addition to the effect of the working time directive on doctors’ training, the legislation is impacting on the continuity and quality of patient care in our hospitals. According to a survey by the Royal College of Surgeons, 80% of consultant surgeons and 66% of surgical trainees said that patient care had deteriorated as a result of the directive. Those consequences are worrying, and we need to focus on them.

[Debbie Abrahams]

In an earlier intervention, I referred to the systematic review. I appreciate that surveys give a certain amount of one-off evidence, but systematic reviews are the strongest form of evidence, and there were no conclusive results regarding an impact on patient outcomes. Whatever action we take, it surely should be based on the strongest evidence and not on evidence of lesser quality.

[Amber Rudd]

I am talking about evidence, and every Member present has been talking about their own evidence—

[Debbie Abrahams]

But not the strongest form of evidence.

[Amber Rudd]

Anecdotal evidence is absolutely relevant. We get such evidence from talking in our hospitals to consultants, patients and surgeons. That is much more relevant sometimes than the box-ticking consequences from a more desk-driven survey.

Our 24-hour health service has had to make dramatic changes to how hospitals are staffed. The effects of the reduction in hours have been further compounded by the Jaeger and SiMAP rulings of the European Court of Justice, referred to by my hon. Friend the Member for Bristol North West. Those decree that all time spent in the workplace should be regarded as work, whether at rest or not, which is a dramatic change from previous arrangements. As a result, hospitals have had to scrap all on-call arrangements in favour of full shift rotas, which is creating a multitude of problems. Consultants at the Conquest hospital in Hastings told me that, in order to staff a full shift rota in one department, they now need eight people instead of the six they used to have on the old on-call system. Sometimes there is not even enough work. Indeed, the exposure of each doctor to training opportunities in the day is diluted, and the extra doctors are employed purely to service a working time-compliant rota.

The rota and the system are driving health arrangements, which is surely wrong. It is an inefficient and costly way to manage doctors, and it is damaging to the quality of their training. It is particularly harmful for district general hospitals such as my own, the Conquest, which find that they are no longer able to support certain specialties, such as the neurology department in my example, which has now largely moved to the nearby Eastbourne general hospital. Unfortunately, as we have heard from other Members, the same impact on certain specialties is being experienced in their district hospitals. The doctors at the Conquest do a fantastic job, and I am extremely grateful for the hard work and commitment that they put in; but, from my conversations with the consultants, I know that those doctors are being stretched too thin.

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[Debbie Abrahams]

Is that not the point? This is about ensuring that we have quality data to inform policy development. It may not be working as it should be—I will accept that—but we cannot use incomplete, poor data to propose solutions. We need to ensure that we have quality data to inform that process. What if I made a statement now and that was regarded as evidence? Surely we are not going to base policy on just one person or on poor data.

[Chris Skidmore]

I agree. I am sure that all hon. Members would echo such a call. We should have complete data. The complete data, if we had them, would show that the situation is far worse and that, instead of the £1 billion a year cost, the hidden cost is, according to the data that I have, perhaps £2 billion. We do not know.

My hon. Friend the Member for Bristol North West, almost like a Cassandra, warned that this would be a problem back in 2010, and started the campaign with no data at all. Two years down the line, we find what she said to be true, in respect of data from individual trusts. We will know more, probably, by the end of this year and there will be more stories in the Sunday papers and it will become an ever bigger issue. That is why it is so important to have this debate now, because when the public and patients who use the NHS ask, “What were you doing about this, as MPs?”, we can say, “We’ve had this debate. Okay, it’s not come up with all the solutions just yet”—we are interested to hear what the Minister says about possible solutions—“but we are on the case.” That is important, because an avalanche of cases will come forward in the near future. It is important to recognise that.

There is a challenge from Nicholson and we need to make those savings. The problem is that this matter is standing in the way of the Nicholson challenge being effectively delivered. Either we have to push harder to gain those efficiency savings—the problem now is that we have inefficiencies of the worst kind and are essentially having to make more efficiencies elsewhere to reinvest in front-line care—or the money will not be reinvested back into front-line care. Working time directive costs are classed as front-line care, when clearly they are not, so money is being removed that could be spent on nurses or on alternative equipment for the NHS that would have benefited patients.

Health Inequalities (North-East)

Debbie Abrahams Excerpts

Tuesday 24th January 2012 Westminster Hall

[Ian Swales]

I absolutely agree with that and will go on to say more about it. The Department of Health has an important role in being the umbrella Department for monitoring action in this area, however. The report went on to say that the Department recognised its failings, admitting that it had been

“slow to put in place the key mechanisms to deliver the target it had used for other national priorities”

and

“slow to mobilise the NHS to take effective action.”

However, I agree with the hon. Gentleman that there is much more to this than simply the NHS.

There certainly has not been a shortage of reports on this subject. The Department of Health issued 15 major publications on the issue, starting in 1998 and rising to a crescendo in 2010. In fact, 2007 was the only year in which the previous Government did not issue a publication.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I wonder whether the hon. Gentleman could catalogue the action that was taken after the publication in 1980 of the Black report, which first demonstrated a causal link between ill health and poverty. In addition, “The Health Divide” was published towards the end of the ’80s. As I recall, because I was working in this field, there was absolutely nothing.

[Ian Swales]

I bow to the hon. Lady’s knowledge in this area. She certainly has a great deal more than I do. I do not know the answer to her question.

In 2003, the Government identified 12 cross-Government headline indicators and 82 cross-Government commitments, but sadly overall it was effective action that was the problem. In 2005, the Government identified 70 spearhead local authority areas for special attention, and credit to them for that. One third of those areas were in the north-east. However, only in London did those spearhead areas see a narrowing of health inequalities.

I know that this issue is complex, but some things are basic. The NAO report showed that more deprived areas had fewer GPs. Some had significantly fewer. They were also paid less. I was shown barely believable figures showing that Redcar and Cleveland had only half the average GP resource of the most deprived 20%. Clearly, that is not a good position to be in.

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[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I congratulate the hon. Member for Newcastle upon Tyne Central (Chi Onwurah) on securing this debate on a matter of considerable importance, and not only for the UK. Non-communicable diseases are a problem around the world, and inequalities also exist in Tanzania. I welcome Tanzanian MPs’ interest, as I do my new daughter-in-law, Maureen Rachel Mwasha, who married my son in Dar es Salaam at Christmas.

However, I will return to inequalities, if you will forgive me, Mrs Riordan. It cannot be right that people in one part of the country are likely to live about 11 years longer than people elsewhere, or that the likelihood of developing heart disease or cancer is determined to a significant degree by postcode. I stress that some of the detail of inequality is missed, and that it is necessary to consider large, significant but often hidden populations of inequality in otherwise affluent areas.

As the hon. Lady mentioned, inequalities in the north-east are particularly poignant and generally worse than in England as a whole, but although I recognise that spending on health increased under the past Government, so did health inequalities. As the hon. Member for Hartlepool (Mr Wright) stated, links between education, employment and health are well recognised, but we inherited a dreadful budget deficit, a terrible economic climate and worsening health inequalities.

[Debbie Abrahams]

Will the Minister give way?

[Anne Milton]

I am afraid that time does not allow me to.

Health in the north-east has historically been poor due to a legacy of heavy industries such as coal mining and shipbuilding, lifestyle choices and a complex web of factors. Levels of deprivation are high and life expectancy for both men and women is lower than the national average. Members might be interested to know that the Hartlepool shadow health and wellbeing board is already having a detailed debate about tackling the issues mentioned by the hon. Gentleman, including child immunisation. The proposed health reforms are enabling the people of Hartlepool to address the issues through local solutions instead of a top-down approach.

Even within local health authorities, wide and unacceptable health inequalities remain. Life expectancy can vary by as much as 18 years within a relatively small geographical area. On the plus side, although previously falling rates of early death from cancer have started to level off, death rates from all causes among males have fallen faster than the national average in recent years.

I reassure the hon. Member for Newcastle upon Tyne Central that I do not pretend about anything. She must look to her own party for the answers to her concerns. They were in Government for 13 years.

[Debbie Abrahams]

Will the Minister give way?

[Anne Milton]

I have only six minutes, and I have numerous questions to answer. The north-east has made commendable efforts to tackle its problems, acknowledging some of the things that happened under the last Government. At the core of Better Health, Fairer Health is a drive to tackle inequalities through multi-agency partnerships.

The north-east has its own tobacco control office, the first of its kind in the UK; Fresh began life in 2005. I am sure that the local authorities will recognise the work that has been done. It will be down to them to decide how the money is spent in local areas to improve their stubborn smoking rates. In the north-east, Fresh has managed to reduce the number of smokers by 137,000, and local NHS stop smoking services continue to provide support to the highest number of people in England. We in Government have introduced a tobacco control plan, and I assure the hon. Member for Newcastle upon Tyne Central that we will be consulting on plain packaging and continuing progress, as detailed in the plan, which I am sure she has seen.

However, the major part of poor health in the area will be remedied only by widespread changes in behaviour. It is this Government’s policy to encourage people to change how they live—[Interruption.] Hon. Members might gain slightly more from this debate if they listened to the answers rather than shouting at me from across the Chamber. We cannot frog-march people out of the off-licence, compel them to stop smoking or force them to practise safe sex. Our challenge is to make the case that freedom without responsibility is not sustainable, so for the first time, allowing for the progress of the Health and Social Care Bill through the House, the Secretary of State will have a specific responsibility to tackle health inequalities, whatever their cause, and will be backed up by similar duties— [Interruption.]

National Health Service

Debbie Abrahams Excerpts

Wednesday 26th October 2011 Commons Chamber

[Mr Lansley]

No, because I have already given way to the right hon. Gentleman many times. Let me tell him this. If he was going to offer to try to work with others on GP commissioning, he ought at least to have demonstrated before the election that he was going to do something about it; and using a transparent political ploy to try and interfere with the passage of the legislation in another place carries no credibility with me or with anyone else. Labour’s tabling of a motion in the other place in an attempt to block the Bill completely showed no willingness to work together, and the fact that it was defeated by 134 votes ought to have given the right hon. Gentleman a reason—and sufficient humility—not to try to return to the subject by tabling today’s motion.

As I said earlier, I find it regrettable that neither the right hon. Gentleman’s motion nor his speech made any attempt to deal with what has happened in the NHS over the past year. Let me tell him, and the House—for I know my right hon. and hon. Friends will be interested as well—what has, in truth, happened during that time.

At the end of the last Labour Government, the average in-patient wait was 8.4 weeks. According to the latest available figures, that has fallen to 8.1 weeks. The average waiting time for out-patients was 4.3 weeks at the time of the last election; it is now 4.1 weeks. Over the last year, the number of MRSA bloodstream infections in hospitals has fallen by a third, and the number of clostridium difficile infections by 16%. Nearly three quarters of a million more people have access to NHS dentistry. Nearly 2 million people have access to the new 111 urgent care service, and the whole country will be covered within the next 18 months. When we came to office, I discovered that there had been talk about a 111 telephone system, but nothing had been done. It is now happening.

More than 75% of stroke patients now spend 90% or more of their hospital stay in a stroke unit. That is a 20% increase in two years. The Cancer Drugs Fund has given more than 5,000 patients access to the drugs that they desperately need, and which under the last Government’s regime would not have been available to them. We have embarked on an £800 million investment in translational research, increasing our financial support for it by 30%, to help to secure the United Kingdom as a world leader in health research.

The NHS is leading the way in the prevention of venous thromboembolism, with 86% of patients receiving an assessment for the condition. I believe that that constitutes an increase of some 30% in the last year. The bowel cancer screening programme is enabling many more patients and members of the public to be screened, there is more screening for diabetic retinopathy than ever before, and there were 188,000 more diagnostic tests in the three months to August than there were last year. Pathfinder clinical commissioning groups have been established virtually through England, and there are 138 health and wellbeing boards in local authorities, meeting and putting together their strategies to deliver population health gain across their areas.

In a single year, the year preceding the election, the right hon. Member for Leigh presided over a 32% increase in NHS management costs. That was the year after the banks had gone bust. It was the year when it was obvious that Government deficits were out of control. It was the year when the debt crisis was just about to crash over the whole public sector. What happened on the right hon. Gentleman’s watch? There was a 23% increase in management costs in a single year, to £350 million. In the year that followed, we reduced those costs to £329 million.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

Can the Secretary of State tell us what the percentage of senior managers is, and how that compares with the percentage in the private sector?

[Mr Lansley]

Does the hon. Lady act as parliamentary private secretary to the shadow Secretary of State? Ah, she does. Well, she has the merit of consistency. I am reminded that in June 2006, when for a short period she was chair—I think—of Rochdale primary care trust, she resigned. She said that she resigned because the radical changes happening under the then Labour Government in 2006 would

“destroy the NHS as we know it.”

The hon. Lady has the merit of being consistent: she is against every Government and every change. She does not think that any steps will make the NHS into what it ought to be. I will not take any lectures from her, therefore.

I was explaining to the hon. Lady and the House what has been achieved. We have stripped out pointless bureaucracy. The number of managers more than doubled under Labour, but we have cut their number by more than 5,000, and we have increased the number of doctors in the NHS by more than 1,500. The Bill includes measures to abolish primary care trusts and strategic health authorities, but in the meantime we have clustered PCTs and SHAs together.

We are reducing the cost of bureaucracy in the NHS not only because it is necessary to do so. The transfer to clinically led commissioning in the NHS, for which there is a very good case of course, also involves reducing such costs. As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), has frequently made clear, as part of the transfer process we will deliver £4.5 billion in savings in administration costs this year across the national health service. The transition itself involves costs of course, but they will be recovered by the end of 2012-13, and by the end of the Parliament we will have gone on to save more than £4.5 billion in total.

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[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

It is always a pleasure to follow the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). I do not want to impugn his integrity, or to suggest that what he wants for the NHS is not exactly what I want. The issue is how we do that. Unfortunately, some unhelpful remarks were made in the run-up to the general election. At the least, they were disingenuous; at worst they were duplicitous. This debate is about trust, and there are serious questions about whether we can trust the Government with our NHS.

My right hon. Friend the Member for Leigh (Andy Burnham) has argued that pre-election pledges have been broken, and I want to speak specifically about how that relates to NHS funding. The first broken promise came within months of the general election. We have heard about the posters that we all saw as we went round our constituencies, showing a congenial right hon. Member for Witney (Mr Cameron), now the Prime Minister, promising to

“cut the deficit, not the NHS”.

Last October’s spending review seemed to support that position, with a 1.3% increase in NHS resource spending and real-terms growth of what seemed to be 0.4%. The Secretary of State, who is just returning to his place, was unable to answer my question on that. I want to talk abut management costs, because the Department is focusing on that spending. It is important to be clear about management costs in the NHS budget. In 1999, they were less than 3%; in 2010, they were just over 3%. Independent research has shown that, if anything, the NHS is under-managed rather than over-managed. [Interruption.] I can certainly provide evidence for hon. Members.

[Dr Thérèse Coffey]

Will the hon. Lady give way?

[Debbie Abrahams]

No, I am sorry; I am not going to give way.

We should compare our health care management costs with those in the United States, where they run at over 20%. We need to be very careful about what we are talking about.

[Mr Steve Brine (Winchester) (Con)]

rose—

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[Debbie Abrahams]

I am not going to give way—I am sorry.

In this year’s Budget, the Office for Budget Responsibility’s higher inflation forecast meant that NHS spending is now falling in real terms. House of Commons Library calculations show that it will fall by about 1% in real terms over the next four years—a loss in spending power of more than £1 billion by 2015. In the light of the recent inflation figures—[Interruption.] To help hon. Members out, last year’s figure was 5.6% based on the retail prices index. As inflation is at a three-year high, the loss in spending power is likely to be even greater. To keep his election promise, the Prime Minister would have to spend at least £1 billion more than he is doing.

This month’s King’s Fund report on NHS performance shows the effects of these financial pressures on the NHS, with the majority of finance directors saying that they are very or fairly pessimistic about the financial future of their local health economy. The Health and Social Care Bill, which is being debated in the other place, very conveniently sets out ways to help struggling foundation trusts. First, they can borrow money from the City to invest. Secondly, because foundation trusts will have to repay the money they have borrowed by treating more NHS patients and more private patients, they have been helped by the abolition of the cap on private patients’ income. However, as my right hon. Friend the Member for Leigh said, by raising income in this way they become economic enterprises and open themselves up to part B of EU competition law, so that they have to compete for every tender with private sector companies such as Capita, United Health, and so on. Incidentally, seven trusts, including in the Secretary of State’s constituency, have already said that they will be increasing the private bed cap. There is a private hospital in the Cambridgeshire University hospitals foundation trust area. Finally, when—not if—a foundation trust still ends up in financial meltdown, the Bill’s new failure regime means that they will be able to sell off NHS publicly owned assets to private equity companies. There are direct parallels with Southern Cross.

The impact of that is already being felt in patient care. In addition to what is said by constituents attending my and many of my hon. Friends’ surgeries, the King’s Fund report showed that the proportion of patients waiting more than 18 weeks for treatment has increased nationally. Over a quarter of NHS trusts admitted fewer than 90% of their patients within 18 weeks. In my constituency, Pennine acute hospitals trust is able to treat only 70% of patients within its 18-week targets. That is more than double the number of trusts failing to meet the 18-week target in 2010.

I am afraid, however, that an increase in waiting lists is what the Government want; it is one of the intended consequences of the Bill. This increase in demand is feeding the growing private health care and insurance market. We know from the US that as people on low incomes will be less likely to be able to afford these products, there will be a direct impact on the inequalities that the Secretary of State says that he wants to reduce.

[Barbara Keeley]

My hon. Friend is concerned about health inequalities. Is she as worried as I am about changing the weighting of health inequalities in allocations of funding? In Salford, our experience is that that can push GP practices in deprived areas into the red in their indicative budgets, so they will be cutting down referrals and reconsidering treatments—another way of denigrating and cutting the benefits of services to patients.

[Debbie Abrahams]

My hon. Friend is absolutely right. I will come to that in a minute.

In fact, that is broken promise No. 2. Last week in Health questions, I asked the Secretary of State why, in December last year, he made a political decision, against the advice of the Advisory Committee on Resource Allocation to maintain the health inequalities component of PCTs’ funding allocation at 15%, and instead reduced it to 10%. He replied that he had made no decision against the advice of that Committee. However, it is quite clear from last September’s letter to him from the chair of the Committee that that is exactly what he did:

“I would like to draw your attention to ACRA’s position in relation to the health inequalities adjustment. We recommend that the current form of the adjustment is retained”.

The

“current form of the adjustment”

was 15%, and the Secretary of State made a political decision to reduce that. He should be apologising to the House for misleading us in his response to my question. The effect of that reduction is to shift funding from poor health areas to good health areas. The Secretary of State owes an apology to the people in those areas, as well.

I turn to broken promise No. 3. Although the move of public health to local authorities is welcome in principle, the timing could not be worse. Already, we are seeing plans that jeopardise the public health function as they move into local authorities besieged with cuts. As Labour has consistently argued, our health and social care system needs to balance the treatment and care of people who are poorly with creating supportive environments that enable all our citizens to live as healthily as possible for as long as possible—focusing upstream on stopping people falling in rather than on pulling them out further downstream, to use a familiar metaphor. That is absolutely key, but unfortunately the current approach means that it is not going to happen. For example, public health budgets, said to be ring-fenced, are not being ring-fenced. The shadow budgets that were being provided to public health departments for 2012 were supposed to increase from 3.7% to just over 4%, but further analysis showed that that increase was due to merging the public health and drug action team budgets, and not to any new moneys. There was, in effect, no real increase in public health funding.

I anticipate a future broken promise in relation to what the Secretary of State has said about privatisation: I think it will be a case of “Watch this space.”

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[Stephen Pound]

Trafford. I beg your pardon. However, the year before I was born, my parents had a son who died at the age of seven months. The year before that, they had another son who died at the age of eight months. I was born on 5 July 1948, two days after the health service, and I have my five brothers and sisters alive to this day. It is that important.

When I worked as a porter for 10 years at the Middlesex hospital, where my sister and wife were nurses and one of my brothers was an ambulance driver—half the family seemed to be employed there—we realised the consequences of the pragmatic approach to the health service. We had a private patients wing where people like myself, paid by the national health service, did work for people who paid money to a difference source, and where doctors trained under the NHS got personal recompense. One of the single most important aspects of our lives has been political from day one.

Each of the Health Ministers will remember, as I do, that we have sat in the same House as an hon. Member who lost his seat over a hospital closure. Let us never forget Wyre Forest and Kidderminster hospital. It is almost impossible to be objective about this issue. When the Turnberg report was published, it proposed an entirely sensible reconfiguration of London’s acute general hospitals, but it was opposed by almost everyone because of parochial and local issues. When polyclinics were proposed under the previous Government—one of the most logical, sensible, rational and helpful ways of providing primary health care—they were violently opposed by the Conservative party.

The situation now is that there is no consensus. However, I have not often seen anything quite so consensual, positive and forward-looking as the reference in today’s motion to an offer made by the Leader of the Opposition and the shadow Health Secretary of

“cross-party talks on reforming NHS commissioning.”

What could be better for the country, and for the reputation of this House, than our recognising that the NHS is not a political football or an issue on which we can strike postures? Yes, there are ideological differences between us, and Opposition Members may wish to see a greater infusion of finance-led choice, more and more commercialisation and an end to the Whitley system, which has survived for so many years. They may wish to see local pay bargaining setting hospital against hospital, clinic against clinic and clinician against clinician, with a constant stream of industrial disputes as localised pay bargaining bursts out all over the place in some industrial conflagration that attracts even more attention. At the moment we have one of the lowest numbers of hospital managers anywhere in Europe, and we will inevitably have to spend more and more on a greater and greater number of managers to deal with all that localised bargaining.

[Debbie Abrahams]

Will my hon. Friend give way?

[Stephen Pound]

I will give way to my hon. Friend, who knows far more about the subject than I do.

[Debbie Abrahams]

I thank my hon. Friend, and I am greatly enjoying his speech. Does he agree that the opening up of competition under the Health and Social Care Bill as it stands will be a real threat to the NHS as we know it?

[Stephen Pound]

I am grateful to my hon. Friend, and may I place it on record that, as I am sure virtually everybody in the House would agree, she has brought enormous expertise in this area to the House, for which we are extremely grateful?

The NHS cannot be disaggregated. It has to be a national health service, not a notional health service, a postcode health service, a better-in-some-parts-than-others health service or a good-for-Kensington-bad-for-Kidderminster health service. It has to be for the nation, and why? Because Beveridge did not just produce a one-point proposal for the NHS. There were actually five evils that he wished to slay. It was an integrated proposal that addressed want, hunger, ambition and other issues.

The NHS is not just an agency to patch people up; it is part of providing a healthy, productive nation and increasing the good and the good life within this country. At so many levels, we have to look beyond the bottom line and beyond, as the hon. Member for Southport said, the bean-counting philosophy. The NHS should not be about the click of the abacus in some cobwebbed recess, or about constantly seeking whether things can be bought cheaper here or commissioned for a lower price there. It should not be about container-loads of cheap goods being shipped in from Shanghai because some GP commissioning group somewhere has discovered it can get a discount on Tubigrip. It should be about the recognition that the health of a nation is utterly crucial, basic and intrinsic to that nation’s hope and future. Without health, we have no future.

Oral Answers to Questions

Debbie Abrahams Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Lansley]

I am sure that we all share my hon. Friend’s view of the great importance of this matter. The Department of Health leads on ensuring that health care is available to people who have been rescued by the police from human trafficking. We also lead on promoting an awareness that local government has multi-agency safeguarding processes to assist in supporting people who have been abused and harmed. There is more to say, but I will write to my hon. Friend on the subject.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

T5. In the evidence session on the Health and Social Care Bill, the Secretary of State told me that he was committed to reducing health inequalities. We also heard from the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton) on that subject a few moments ago. Will the right hon. Gentleman therefore explain why he made a political decision last December, against the advice of the Advisory Committee on Resource Allocation, to reduce the health inequalities component of primary care trusts’ target funding from 15% to 20%, in effect shifting funding from poor health areas such as my constituency to richer health areas such as his own? The Government are saying one thing—

[Mr Speaker]

Order. We have got the question.