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In the week when our right hon. Friend the Chancellor of the Exchequer has spoken of the importance to the Government of securing full employment, will the Prime Minister confirm that the record shows that no Labour Government in history left office with unemployment lower than when they came to office? Does that not illustrate in this area, as in all others, the importance of the principle that what matters is what works?
In the week when our right hon. Friend the Chancellor of the Exchequer has spoken of the importance to the Government of securing full employment, will the Prime Minister confirm that the record shows that no Labour Government in history left office with unemployment lower than when they came to office? Does that not illustrate in this area, as in all others, the importance of the principle that what matters is what works?
My right hon. Friend is factually correct: every Labour Government have left office with unemployment higher than when they came to office. In this Parliament what we have seen is 1.7 million more people employed in the private sector and 1.3 million more people employed as a whole—one of the highest rates of employment in our history. We must keep up the work to offer more hope and more security to more of our people.
Does the Minister agree that the steps that the Government are taking to reform the funding of care for the elderly represent long overdue action to deal with an issue that has bedevilled this world for more than 20 years? Tony Blair promised to the Labour conference in 1997 that he would deal with it, and he did precisely nothing about it.
Does the Minister agree that the steps that the Government are taking to reform the funding of care for the elderly represent long overdue action to deal with an issue that has bedevilled this world for more than 20 years? Tony Blair promised to the Labour conference in 1997 that he would deal with it, and he did precisely nothing about it.
I remember the quote from Tony Blair well—he did not want to live in a country where people have to sell their homes to pay for care. However, over 13 years of the last Labour Government nothing happened. There were lots of commitments—manifesto commitments and so on. However, I am proud of the fact that this coalition Government are implementing reform, and it is long overdue.
Does my right hon. Friend agree that the question asked by my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) is the most important single question facing the health and care system? Do not too many elderly people—the greatest single source of growing demand on the health and care system—experience our system not as a national health service but as a national illness service? Is not the challenge facing the system to ensure that, as people live longer, we enable them to get greater quality out of those extended life years?
Does my right hon. Friend agree that the question asked by my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) is the most important single question facing the health and care system? Do not too many elderly people—the greatest single source of growing demand on the health and care system—experience our system not as a national health service but as a national illness service? Is not the challenge facing the system to ensure that, as people live longer, we enable them to get greater quality out of those extended life years?
As so often, my right hon. Friend encourages us to raise our heads above the horizon and to look forward. He is absolutely right. There will be 1 million people with dementia by 2020 and, as he knows, most of those will have other long-term conditions alongside dementia. The name of the game will be looking after people so they can live healthily at home, which will be the focus of health policy.
Does my right hon. Friend agree that successive Governments over 30 years have talked about the importance of joining up the different bits of the health care system and joining that up with social care? Is not the difference between this Government and their predecessors that, through health and wellbeing boards, the integrated care fund, named GPs and the pioneers programme that he has announced, this Government are actually doing it, rather than just talking about it?
Does my right hon. Friend agree that successive Governments over 30 years have talked about the importance of joining up the different bits of the health care system and joining that up with social care? Is not the difference between this Government and their predecessors that, through health and wellbeing boards, the integrated care fund, named GPs and the pioneers programme that he has announced, this Government are actually doing it, rather than just talking about it?
I have to pay tribute to my right hon. Friend, because he has been talking about the integration of health and social care for a lot longer than I have, and he is absolutely right. I would add to his list one other really important thing we are doing: we are making sure that whatever part of the system someone is in, doctors can access their GP medical record—with their permission—because that information is vital in showing their allergies, medical history and previous admissions. Breaking down the barriers that prevent that from happening is one of the things that has not been picked up but is in the GP contract.
While I welcome the fact that the provider sector as a whole is in surplus, will my hon. Friend confirm that some trusts are indeed anticipating that they will be running deficits? Will he also confirm that the National Audit Office has estimated that up to 30% of acute hospital admissions would be avoidable if we had properly integrated services, and that that would allow us to deliver not only better financial management but, much more importantly, better quality care for patients?
While I welcome the fact that the provider sector as a whole is in surplus, will my hon. Friend confirm that some trusts are indeed anticipating that they will be running deficits? Will he also confirm that the National Audit Office has estimated that up to 30% of acute hospital admissions would be avoidable if we had properly integrated services, and that that would allow us to deliver not only better financial management but, much more importantly, better quality care for patients?
My right hon. Friend is absolutely right to highlight the fact that a very small minority—20%—of trusts across the health care provider sector, including trusts and foundation trusts, are anticipating a deficit. Many of those trusts have a direct legacy of debt from the private finance initiative arrangements that the previous Government put in place. That is one of the direct legacies of the poor PFI deals that were arranged. He is absolutely right to highlight the importance of integrated and joined-up health care. That is exactly what the £500 million we are providing for winter pressures is designed to do by focusing on better preventive care to keep people out of hospital.
Does my hon. Friend agree that there is no solution to the economic challenges facing the health and care system—still less any solution to the quality challenges that are increasingly coming to light—that does not involve proper integration of health and care? Is not the decision announced by the Chancellor a couple of weeks ago the first tangible step of a Government delivering a policy that Governments have talked about for a generation?
Does my hon. Friend agree that there is no solution to the economic challenges facing the health and care system—still less any solution to the quality challenges that are increasingly coming to light—that does not involve proper integration of health and care? Is not the decision announced by the Chancellor a couple of weeks ago the first tangible step of a Government delivering a policy that Governments have talked about for a generation?
My right hon. Friend is absolutely right, as always. He is a tremendous advocate—and has been since his time in office—of integrated health and social care, and of the transformation in the delivery of care that we need to make if we are to better look after patients with long-term conditions and the frail elderly. This Government are the first Government who are committed to doing that. Compare that with the real-terms cut in funding for social care that happened under the last Government, according to the Dilnot report.
Main estimates 2013-14. First estimates day (part one). Motion made, and Question proposed, that, for the year ending with 31 March 2014, for expenditure by the Department of Health: (1) further resources, not exceeding £50,475,001,000, be authorised for use for current purposes as set out in HC 1074 of Session 2012-13, (2) further resources, not exceeding £2,414,054,000, be authorised for use for capital purposes as so set out, and (3) a further sum, not exceeding £50,292,107,000, be granted to Her Majesty to be issued by the Treasury out of the Consolidated Fund and applied for expenditure on the use of resources authorised by Parliament. Question deferred. Resolved.
Main estimates 2013-14. First estimates day (part one). Motion made, and Question proposed, that, for the year ending with 31 March 2014, for expenditure by the Department of Health: (1) further resources, not exceeding £50,475,001,000, be authorised for use for current purposes as set out in HC 1074 of Session...
Does my right hon. Friend agree that the introduction of health and wellbeing boards represents a very welcome introduction of democratic accountability into the management of the health and care system? Does he further agree that the acid test of health and wellbeing boards will be their ability to increase the pace of integration between health and care so that the service we deliver is more closely matched to the needs of patients?
Does my right hon. Friend agree that the introduction of health and wellbeing boards represents a very welcome introduction of democratic accountability into the management of the health and care system? Does he further agree that the acid test of health and wellbeing boards will be their ability to increase the pace of integration between health and care so that the service we deliver is more closely matched to the needs of patients?
As is so often the case, my right hon. Friend speaks extremely wisely on this issue. Integrated services will be the big thing that transforms the service we offer vulnerable older people, which the right hon. Member for Leigh (Andy Burnham) mentioned earlier. Health and wellbeing boards will have an extremely important role to play in bringing together local authorities and clinical commissioning groups so that we have joint commissioning of services for those very vulnerable people.
My right hon. Friend said in his answer to my hon. Friend the Member for Fylde (Mark Menzies) that certain aspects of the treatment of dementia patients had to change. Does he agree that that should include the services that are delivered to them becoming more integrated, not only between hospitals and community health care services but between social care services and social housing support, in order to provide a proper joined-up package of care for people who receive such diagnoses?
My right hon. Friend said in his answer to my hon. Friend the Member for Fylde (Mark Menzies) that certain aspects of the treatment of dementia patients had to change. Does he agree that that should include the services that are delivered to them becoming more integrated, not only between hospitals and community health care services but between social care services and social housing support, in order to provide a proper joined-up package of care for people who receive such diagnoses?
I wholeheartedly agree with my right hon. Friend. I was in the accident and emergency unit at Watford hospital last week when a lady with advanced dementia was admitted. She had bruises all over her face after having had a fall. The shocking reality was that that A and E department knew nothing about that lady. It did not know her medical history, and it did not know whether that was her normal condition. There was no proper joined-up link between the social care system and the NHS. Tackling that issue is probably the single biggest long-term and strategic challenge that we have to address in the NHS.
There is currently much talk about the importance of integrated services. Can my hon. Friend assure us that when commissioning primary care, the NHS Commissioning Board will emphasise the importance of integrating it with the other community health services supplied by the NHS, and that social care will be included in that fully integrated service?
There is currently much talk about the importance of integrated services. Can my hon. Friend assure us that when commissioning primary care, the NHS Commissioning Board will emphasise the importance of integrating it with the other community health services supplied by the NHS, and that social care will be included in that fully integrated service?
I am happy to give my right hon. Friend an absolute assurance to that effect. The Department and I are working closely and collaboratively with both the Commissioning Board and the Local Government Association to ensure that we deliver integrated care, which is much the best way of keeping patients out of hospital and maintaining their condition.
Does my right hon. Friend agree that one of the most effective things we can do to improve the patient experience of health and care is to improve the co-ordination, not just between the hospital service and community-based health services, but between the NHS and social care, and to put in place the infrastructure, including the IT infrastructure, to make that real?
Does my right hon. Friend agree that one of the most effective things we can do to improve the patient experience of health and care is to improve the co-ordination, not just between the hospital service and community-based health services, but between the NHS and social care, and to put in place the infrastructure, including the IT infrastructure, to make that real?
My right hon. Friend makes an extremely important point—in fact, I will be giving a speech on this tomorrow—because, in the end, if it is not possible to see a full medical record of some of these frail elderly or heaviest users of the NHS going in and out of the system throughout the year, it is not possible to give them the integrated, joined-up care that they desperately need. This will be a very big priority for us.
Does my hon. Friend agree that the best way to ensure that high-quality care continues to be available to all patients, as and when they need it, is to ensure that the health and care systems are brought together into a single joined-up system so that, in the words of Mike Farrar of the NHS Confederation, we operate a care system with a health adjunct rather than a health system with care support?
Does my hon. Friend agree that the best way to ensure that high-quality care continues to be available to all patients, as and when they need it, is to ensure that the health and care systems are brought together into a single joined-up system so that, in the words of Mike Farrar of the NHS Confederation, we operate a care system with a health adjunct rather than a health system with care support?
My right hon. Friend has, over many years, been a very strong advocate—probably the strongest advocate in this House—for integrated care, which this Government are determined to make a reality. He is absolutely right that we need properly joined-up care that we properly deliver when we face up to the big health care challenges of how we better look after people with long-term conditions and older people. The only way to do that is to deliver more care in the community, and that has to be achieved through more joined-up and integrated care.
Does my right hon. Friend agree that the effective delivery of care to people with long-term conditions relies on breaking down the silos within the health service, and between the health service, social care and social housing? Will he encourage the new health and wellbeing boards to follow through that agenda with a serious purpose?
Does my right hon. Friend agree that the effective delivery of care to people with long-term conditions relies on breaking down the silos within the health service, and between the health service, social care and social housing? Will he encourage the new health and wellbeing boards to follow through that agenda with a serious purpose?
My right hon. Friend is absolutely right. By 2018, nearly 3 million people will have not one but three long-term conditions. All too often, the system treats them on a disease or condition basis, and not as a human being who needs an integrated care plan. That is the route to lower costs, but it is also the route to transformed care.
I welcome my hon. Friend’s statement today and the announcements last week about the future structure and the commitment to introduce legislation later in this Parliament in line with the draft Bill. Will he confirm that it is the Government’s intention to pursue the cross-party talks on funding options for the Dilnot package, and that if solutions can be found, they can be included in the legislation that is introduced?
I welcome my hon. Friend’s statement today and the announcements last week about the future structure and the commitment to introduce legislation later in this Parliament in line with the draft Bill. Will he confirm that it is the Government’s intention to pursue the cross-party talks on funding options for the Dilnot package, and that if solutions can be found, they can be included in the legislation that is introduced?
Notwithstanding some of the perhaps intemperate exchanges we have in this place, my colleagues and I are still determined, if those on the Opposition Front Bench are, to engage in talks on how we reform the funding system. Indeed, the debate we had in the Chamber last night confirmed that both sides of the House wish to support the principles of the Dilnot reforms, so I hope that we can have such talks and that they can be reflected in the Bill.
I welcome the successful development of clinical commissioning groups, but does my right hon. Friend agree that their success in refashioning care throughout the whole of the health and social care system will depend on close relationships not just in the health service but across into social care and the world of social housing, too?
I welcome the successful development of clinical commissioning groups, but does my right hon. Friend agree that their success in refashioning care throughout the whole of the health and social care system will depend on close relationships not just in the health service but across into social care and the world of social housing, too?
I do believe that and the legislation requires it of clinical commissioning groups and health and wellbeing boards. The relationship being built up between clinical leadership in the NHS and democratic leadership through health and wellbeing boards is an instrumental part of delivering that integrated care.