Defending Public Services

Norman Lamb Excerpts

Monday 23rd May 2016 Commons Chamber

[The Secretary of State for Health (Mr Jeremy Hunt)]

Today’s debate, chosen by the Opposition, is about defending public services, so I want to start by stating very simply that this Government do not believe in private wealth and public squalor; quite the opposite—we believe in prosperity with a purpose, and building high quality public services is perhaps the most important purpose of all. But there is a difference between the two sides of the House. Indeed, there is more than one difference. One is that we on this side are prepared to take the difficult decisions necessary to build the strong economy that will, in the end, fund those public services. A second difference is that we go further and say that securing funding from a strong economy is not enough, and that the battle for higher standards is as important as the battle for resources. Without high standards, we let down not just the taxpayers who fund our public services but the vulnerable citizens who depend on them.

So yes, we are proud to have protected schools funding since 2010, but we are even prouder that 1.4 million more children are in good or outstanding schools. Yes, we are proud to meet our 2% of GDP defence spending pledge, but we are even prouder of the professionalism of our armed forces operating in the Mediterranean today to help to find the wreckage of the tragically lost Egyptian airliner. Yes, we are proud to have protected science and research funding, but we are even prouder that this country continues to win more Nobel prizes than any other, apart from the United States. Yes, we are proud that, since 2010 and despite the deficit, we increased NHS funding by more than was promised by the Opposition at both elections. We are even prouder that failing hospitals are being turned around, that MRSA rates have halved and that cancer survival rates have never been higher.

With that, let me turn to the NHS and say up front that nowhere is the importance of the two challenges of proper funding and high standards more stark. I pay tribute to the 1.3 million staff who work in the NHS. Whatever they have thought over the years about the politicians running their service, their dedication to patients, their hard work, night and day, and their commitment to the values that the NHS stands for make up the invisible glue that has always held it together, whatever the challenge. I know that I speak for the whole House when I thank them for their service.

Let us look at what staff have achieved over the past six years. Compared with 2010, we treat 100 more people for cancer every single day. We treat 1,400 more mental health patients, 2,500 more people are seen within four hours in A&E departments, and we do 4,500 more operations. At the same time as all of that, hospital harm has fallen by a third and patients say that they have never been treated with more dignity and respect. In the wake of the tragedy of Mid Staffs, we should recognise the huge efforts of staff at the 27 trusts that have since been placed into special measures. Eleven have now come out, three of which are now officially rated as good. Neither Stafford nor Morecambe Bay nor Basildon—three of the hospitals of greatest concern—are now in special measures thanks to excellent local leadership and superb commitment from staff.

However, all NHS staff want to know about the funding of their service. The NHS’s own plan, published in October 2014, asked for a front-loaded £8 billion increase in funding not just to keep services running, but to transform them for the future. The then shadow Health Secretary, the right hon. Member for Leigh (Andy Burnham), said that the Conservative promise to deliver that funding was a cheque that would bounce, but we delivered that promise to the British people in last autumn’s spending review, and the increase was not £8 billion, but £10 billion. It was not back-loaded, as many had feared, but front-loaded with £6 billion of the £10 billion being delivered this year.

[Norman Lamb (North Norfolk) (LD)]

On the Secretary of State’s point about what the NHS asked for, is it not right that the forward view set out three different efficiency savings scenarios? It was not a case of the NHS asking for £8 billion. Does he really believe that the £8 billion— £10 billion including last year’s increase—will be sufficient to meet the NHS’s demands?

[Mr Hunt]

The right hon. Gentleman will have heard Simon Stevens being asked that question on “The Andrew Marr Show” yesterday. He was clear that £8 billion was the minimum of additional funding that he thought the NHS needed. In fact, we supplied £10 billion, which came with some important annual efficiency saving requirements. Indeed, for that £8 billion, the NHS recognises that £22 billion of annual efficiency savings are required by 2020, because even though funding is going up, demand for NHS services is increasing even faster. I will come on to talk about how we are going to make those efficiency savings. Some in this House have observed that without £70 billion of PFI debt, without £6 billion lost in an IT procurement fiasco, and without serious mistakes in the GP and consultant contracts a decade ago, the efficiency ask might have been smaller.

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[Mr Hunt]

My hon. Friend speaks with great knowledge and as chairman of the all-party group on mental health. He is absolutely right to say that we need system change. The system change we need is to stop putting mental health in a silo, but instead to understand that it needs to be part of the whole picture of treatment when a person is in hospital or with their GP; it needs to be integrated with people’s physical health needs. We need to look at the whole person. We will not get all the way there in this Parliament, but I think the taskforce gives us a good and healthy ambition for this Parliament and I am confident we will realise it.

[Norman Lamb]

I am pleased to hear the Secretary of State acknowledge the importance of quality of care in mental health as well, but of course there are also problems in areas such as learning disability, where there are some highly vulnerable individuals. After the shocking Southern Health exposé, does he really not think that the leadership of that organisation, which presided over some dreadful events and so many unexpected deaths not being investigated, need to be held accountable and to move on?

[Mr Hunt]

As the right hon. Gentleman knows, the chair of that organisation has stepped down, but he is absolutely right about accountability. Accountability needs to be about not just individual organisations within the NHS, but the people commissioning mental health care and care for people with learning disabilities. That is why, from July, we will for the first time be publishing Ofsted ratings on the quality of mental health provision and of provision for people with learning disabilities by clinical commissioning groups, so that we can see where the weak areas are and sort them out.

I conclude on quality by saying that important though a seven-day NHS is, we need to go further if we really are to make NHS care the safest and highest quality in the world. According to the respected Hogan and Black analysis, we have 150 avoidable deaths in our NHS every week. That is 3.6% of all hospital deaths with a 50% or more chance that that death could have been avoided. In the United States, Johns Hopkins University said earlier this month that medical error was the third biggest killer after cancer and heart disease, causing 250,000 deaths in the United States alone every year. That is why this year England will become the first country in the world to lead a transparency revolution in which every major hospital will publish its own estimate of its avoidable deaths and its own plans to reduce them. This year, we will focus particularly on reducing maternal deaths, stillbirths and neonatal death and harm, with plans I hope to outline soon to the House.

If we are to do that, perhaps most difficult of all will be transforming a blame culture found in too many parts of the NHS that still makes it far too hard for doctors and nurses to speak openly about medical error. Among other measures, we have set up a new healthcare safety investigation branch to conduct no-blame investigations when we have tragedies. It is modelled on the highly successful air accidents investigation branch. As in the airline industry, our model for reducing avoidable death must be transparency, openness and a learning culture that supports rather than blames front-line professionals, who in the vast majority of cases are only trying to do their best. Part of that new culture of responsibility and accountability must be a return to proper continuity of care, which is why this Government have brought back named GPs for every patient, which had been abolished in 2004, and are introducing lead consultants for people who go to hospital with complex conditions.

In conclusion, for this Government defending the NHS involves higher standards of care, wise use of resources and secure funding from a strong economy. Because the challenges we face in England are the same as in Wales, Scotland and Northern Ireland— indeed, the same as in developed countries all over the world—we should exercise caution in politicising those pressures, or we simply invite scrutiny of the relative performance of the NHS in different parts of the UK, which often shows that those who complain loudest about NHS performance in England are themselves responsible for even worse performance elsewhere.

What this Government want is simple: a safer seven-day service, backed by funding from a strong economy. Already we have delivered more doctors, more nurses, more operations and better care than ever before in NHS history.

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[Keith Vaz (Leicester East) (Lab)]

It is always a pleasure to follow the right hon. Member for Wokingham (John Redwood). He speaks with huge passion about these matters, and of course he has always been consistent in his opposition to being a member of the European Union. He also speaks eloquently about why he feels the way that he does.

The European debate—I say this as a former Minister for Europe—has dominated the Government’s agenda to such an extent that this Queen’s Speech is a shadow of what it should be. There is no great ideological commitment in it, so it is difficult to attack too much of it. It is important that, when we get past 23 June, we can then settle down to an intelligent legislative programme that is not dominated by people banging on about Europe —I include myself in that. Although crime has gone down in England and Wales, blue-on-blue crime has increased as far as the EU debate is concerned.

As I mentioned earlier, last Thursday the Minister for Employment was in my constituency with a very big red bus parked outside the biggest temple telling everyone that if we remained in the European Union, there would be a curry crisis and people would not be able to eat curry any more. It is important that we get the European debate into perspective.

As a fellow east midlands MP, you would expect me to say this, Madam Deputy Speaker, but I was surprised that there was no mention in the Gracious Speech of Leicester City winning the Premier league, but perhaps that will come next year.

I agree with the Government’s proposals regarding the revolution in the Ministry of Justice and our prisons. I and members of the Select Committee on Home Affairs have been very concerned about, for example, the number of people who go into prison with no interest in drugs and come out addicted to drugs. We are concerned that our prison system is not doing what it was intended to do: to punish, but also to rehabilitate. Although we expected the right hon. and learned Member for Rushcliffe (Mr Clarke), when he was Lord Chancellor, to talk about changing the way we look at prisons, we did not expect this from the current Lord Chancellor, and we are delighted that he has embraced the reform agenda. Ensuring that when people go to prison they are first punished, then rehabilitated and they do not pick up bad habits, so that when they come out of prison they do not reoffend and go back again, is one of the big issues that has confronted this Parliament for all the 29 years that I and the right hon. Member for Wokingham have been Members of it. How do we break the cycle?

I remember on a visit to a prison in the south of England speaking to a young man who was there because he had committed murder. He told me that his father had had a life sentence and he had a life sentence; he just hoped that his young son, who was then a year old, would not end up in prison. How do we break the cycle? I think we should work with the Government to make sure that our prison system does what it is intended to do.

The second issue I am interested in and concerned about is extremism. Although the Government are proposing legislation on extremism, I do not think they have gone far enough on the counter-narrative. The Select Committee is about to conclude its year-long inquiry into counter-terrorism. I am concerned, as is the rest of the House, about the number of young British citizens who decide to give up their life in this country and go and fight abroad. The current figure for those who have done so is 800, and 400 have returned so far. I cannot understand why we are not doing enough while they are still here to prevent them from going in the first place. Also, although there are programmes to detoxify those who return to this country, there is always the risk that having gone abroad to fight, whether in Syria or elsewhere, on their return they will retain the poison that was drilled into them abroad. It is important that we treat the counter-narrative seriously. We need to support our police and intelligence services in working out who is going, and work with families so that we can try to persuade people not to go.

[Norman Lamb]

Does the right hon. Gentleman agree that our prisons are a breeding ground for extremism and radicalisation, and that until we address that the flow of new extremists will continue?

[Keith Vaz]

The right hon. Gentleman is absolutely right. It is not just about preventing people without a drugs habit going to prison and coming out with one. We have been sending people to places like Belmarsh, which has been described as a place where jihadists seem to be able to influence young people. Knowing his great passion for mental health issues, the right hon. Gentleman reminds me that Simon Cole, the chief constable of Leicestershire, who is the lead on counter-terrorism in the Prevent programme, has talked about the number of jihadists who have mental health problems. These are all issues that we need to confront. We cannot necessarily do it by legislation, but we need to make sure that we have the framework in legislation to provide the resources, the time and the effort to work with people.

My final point concerns the sugar tax. I was delighted when the Chancellor of the Exchequer introduced it. We should acknowledge the fact that today is his 45th birthday. I hope he is having a sugarless cake because, as we know, a spoonful of sugar may help the medicine go down, but it is also one of the steps on the way to diabetes. As someone who suffers from type 2 diabetes and chairs the all-party parliamentary diabetes group, I believe the proposed sugar tax will send a clear message out to the retail companies. However, the manufacturers of drinks such as Coca Cola and Red Bull do not have to wait until the sugar tax comes into effect; they can start promoting sugarless drinks now.

I got into a lot of trouble because I did not want the Coca Cola van to come to Leicester at Christmas. I was accused by some people of robbing them of their Christmas. They had decided that the Coca Cola van was so strongly associated with the Christmas spirit—forget about Christianity, the birth of Christ and so on; it was the Coca Cola van that gave them Christmas—that I was severely criticised. I will make a deal with Coca Cola from the Floor of this House: if the company sends its van to promote non-sugar drinks, I will be happy to welcome it, but promoting a drink containing seven to 10 teaspoons of sugar, cannot be good for the health of our nation.

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[Norman Lamb (North Norfolk) (LD)]

I am one of many speakers in this debate who feel that in significant ways this Queen’s Speech falls short of addressing some of the big challenges of our time in this country. I want to address two of those.

The NHS and the social care system face an existential challenge. I agree with the right hon. and learned Member for Rushcliffe (Mr Clarke), who says that it is not just about money. The system often seems to be completely dysfunctional as a result of the inappropriate divide between health and social care, between physical health and mental health, and between primary care and secondary care. This must be addressed so that we can shape care around the needs of patients.

There is no escaping the fact that there is a financial issue. It makes no sense that between now and 2020 we are projected to spend a decreasing percentage of our national income on the health and care system, at a time when demand is rising rapidly. There are consequences from that trend. I believe the Secretary of State for Health when he says that he cares passionately about patient safety, but as the hon. Member for Dulwich and West Norwood (Helen Hayes) pointed out so effectively, the underfunding of mental health services in our country has massive consequences. As we heard last week, there has been an increase in the past year in the number of people who are shunted around the country in search of a bed. That is a scandalous practice. We know that it is associated with an increased risk of suicide, yet it continues to happen in increasing numbers.

When the pressure increases, crisis management takes over. We cut preventive services in order to prop up acute hospitals, and the services that we cut are the very services that prevent people from going into hospital in the first place. It makes no sense and it needs to change. I have two proposals which the Government need to consider.

I repeat again that I think this is the time for a 21st-century Beveridge report, bringing the parties together to come up with a new long-term settlement for the NHS and, critically, for the social care system. Also, we should consider the case for a dedicated health and social care tax. That has been proposed by people from across the political spectrum. It is the only area of public policy where there is an inexorable rise in demand, yet by protecting the NHS we disproportionately cut other areas of public service. It therefore seems to me that there is a very strong case for carving health and social care out and introducing a dedicated tax. Lord Patten on “Any Questions?” last week made the case for it. Lord Finkelstein for the Conservative side has also argued for it, as has the right hon. Member for Birkenhead (Frank Field).

We are losing pace with other European countries in our spend on health and social care, and there are consequences from that. I know, as I have said, that the Secretary of State cares about patient safety, but the safety of patients is being put at risk by the financial pressure that the NHS faces.

Finally, I want to address the prison reform Bill. I welcome the reforms in it, but something much more fundamental is needed. I encourage the Secretary of State for Justice, with his reforming instincts, to go further. A fundamental failure of public policy is reflected in the number of people in our prisons with mental ill health, learning disability and autism, and the number of people in prison in connection with drug addiction or offences relating to the criminal market in drugs. We are seeing a spike in the number of suicides in our prisons, which should horrify all of us. We need to do something about that.

The Secretary of State needs to go beyond the civilising proposals that he has for our prisons and look at radically reducing the number of people who end up inappropriately in our prisons. Germany and Finland imprison about half the number of people that we do. Those are not lawless countries, yet they manage to adopt a much more civilised approach. There should be a presumption against short sentences. We know that people leave prison and reoffend in vast numbers. That does not protect the public. There should be a much greater use of mental health treatment orders as an alternative to putting people in prison, and a renewed focus on restorative justice to address the causes of crime.

There needs to be the long overdue declaration of an end to the war on drugs, which has failed so fundamentally internationally. It criminalises vast numbers of our fellow citizens. Every year in our country, it puts billions of pounds—about £7 billion—into the hands of organised crime. It is associated with extreme violence in our communities. This makes no sense, and too many people end up in our prisons as a result of this misplaced policy. Just as many states in the United States are now moving towards a much more rational policy, and just as Canada has now committed to legislating to regulate the market for cannabis rather than leaving it in the hands of organised crime, I believe that in this country we should follow the same route, with a rational, evidence-based policy that does not criminalise people inappropriately for doing exactly the same as many members of this Government will have done in their youth. Instead, we need to take money away from criminals and collect tax revenue to spend on our essential and vital public services. It is time for a more rational approach. I hope that at some point this Government recognise that if they are to address the problems of crime in our society, ending this futile war on drugs is one of the steps that they must take.