Contaminated Blood

Baroness Keeley Excerpts

Tuesday 25th April 2017 Commons Chamber

[Andy Burnham]

That was the direct content of the Stanford letter. There was a worry that the NHS was using such products in a completely different context, not understanding the difference between the two systems. That was the Stanford letter.

I am not standing here claiming to be an expert on all the papers, because I am not; I am saying what I know, from the people I have spoken to, to be wrong, and linking that to the documents in order to say what I believe to be the case. I may not be right, but we need to find out whether I am right, and that is the point that I will be putting to the Government.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I was not going to intervene, but the hon. Member for Worthing West (Sir Peter Bottomley) made the point that generous treatment is needed. The victims of this NHS scandal are not receiving generous treatment. I have a constituent who was infected during the scandal as a child at the Royal Manchester children’s hospital. When he discovered that his cirrhosis, if it remained untreated, meant that he ran a 25% chance of developing liver cancer, he was told that he would be denied treatment by the NHS. The treatment he needed to clear the virus load from his system cost £100,000, and at that point he decided to use the ex gratia payment that he had been given—such a payment is supposed to be some compensation, although it is not enough—to try to do so. That is the situation that victims such as my constituent are in at the moment, and it is a disgrace: they should not be fighting this and having to use their own money for their own treatment.

[Andy Burnham]

It is a total disgrace. Absolutely there must be full, fair compensation now. I say to the Government, do not delay; do what Ireland and other countries have done. They should do that now. They raised expectations and they should do it. We would all support it.

Mrs Bullock, whom I mentioned, is reduced to sending begging letters. She has had to sell the family home and move away from everything. She is sending begging letters to the Skipton Fund for a stair-lift. She is not well herself now. How can that be right? We are making a woman who has lost everything send begging letters for a stair-lift, as she tries to cope on her own because her husband is no longer there. On the point about medical treatment, I understand that Mr Bullock may have been refused a liver transplant because his notes said that he was an alcoholic. There is injustice upon injustice here. It is absolutely scandalous. I hope the House now understands why, as I said at the beginning, I could not live with myself if I left this place without telling it directly what I know to be true.

[Andy Burnham]

Absolutely; I could not agree more. It is downright immoral to make these people carry on begging in the way they have been forced to do. The Government raised their hopes; they should deliver on the former Prime Minister’s promise and do what my right hon. Friend has just described.

The story is becoming clear, is it not? Warnings from the United States were ignored. There was a wish to drive on with these new products from the Oxford haemophilia centre: “We’ll just push them out there to find out the results before we really know whether there is infectivity.” Problems started to happen and perhaps there was the idea, “Oh no, the Government might be exposed to litigation. Let’s not have it in people’s notes so that a story does not build about how there has been negligence and people might have a compensation claim.” That is the story I have got; I do not know what anybody else thinks. Worse, for some people, they said, “Don’t just destroy their notes; falsify their notes.” That is the story. We need to find out whether it is true or not. In my view, these are criminal acts. They did not just happen by chance. A major injustice has happened here.

In making this speech tonight, I think of our late, great friend Paul Goggins, who I miss every single day. He did so much to advance the cause of justice for those who suffered. I also think of his constituents, Fred and Eleanor Bates, and of the promises I made to act for them in Paul’s name. In a 2013 debate like this one just before he died, Paul made an impassioned call for:

“A serious Government-backed inquiry…with access to all the remaining records and the power finally to get to the truth of what happened and why.”—[Official Report, 29 October 2013; Vol. 569, c. 201WH.]

His demand was as undeniable then as it is now, yet it pains me that, in the four years since then, this House has not moved it forward at all. If that continues to be the case after what I have said tonight, I am afraid that this Parliament will be complicit in the cover-up.

In reply to the demand of my hon. Friend the Member for Kingston upon Hull North for an inquiry in a letter she wrote in October 2016, the Prime Minister said:

“the relevant documents have been published on the Department of Health and the National Archives websites and it is unlikely that a public inquiry would provide further information.”

In my view, that is a highly debatable statement. I do not think that a Prime Minister who has a good track record in helping to secure justice for those to whom it has been denied should have put her name to such a letter, which was probably drafted by the Department of Health. I remember exactly the same thing being said to me by those who opposed the setting up of the Hillsborough independent panel. “Everything is out there, it’s already known,” is what they always say. If the Prime Minister is confident in her assertion—I say this to the Minister—then rather than just publishing the documents the Government have selected as relevant, why not publish all the Government-held documents so that we can all decide whether her claim is true? On the basis of the evidence I have presented tonight, I believe it would be quite wrong for this House to resist that call.

To be clear, I am not calling for a lengthy public inquiry; I am calling for a Hillsborough-style disclosure process, overseen by an independent panel, which can review all documents held by government, NHS and private bodies. Just as with Hillsborough, the panel process should be able to view documents withheld under secrecy protections and make the necessary connections between documents held locally and nationally. It should then produce a report on the extent to which the disclosure of those documents tells a new story about what has happened.

So tonight I issue a direct challenge not just to the Government but to all parties in this House, including to my own Labour Front Bench and the Scottish National party: do the right thing and put a commitment in your election manifestos to set up this Hillsborough-style inquiry into contaminated blood. That, in my view, would be the most effective way to get as quickly as possible to the full truth and the whole story, as it was, effectively and efficiently, with Hillsborough.

I want to be very clear tonight with the Minister and with the House. If the newly elected Government after the general election fail to set up the process I describe, I will refer my dossier of cases to the police and I will request a criminal investigation into these shameful acts of cover-up against innocent people. I say to the Minister that the choice is hers. People are asking me why I do not just go straight to the police with the evidence I have, and I owe them an explanation. It is my view that the individual crimes I have outlined tonight are part of a more systematic cover-up and can only be understood as a part of that. If we refer them piecemeal to the police, they may struggle to put together the bigger picture of what lies behind the falsified medical records. That, in turn, may delay truth and justice. If the Government will not act, however, I believe a police investigation is the correct next step and that is what I will request. I cannot keep this information in my possession and not do something with it.

As we know, time is not on the victims’ side, so I will set a deadline. If the Government do not set up a Hillsborough-style inquiry by the time the House rises for the summer recess, I will refer my evidence to the police and request that investigation.

[Barbara Keeley]

My right hon. Friend is making an incredibly powerful case in his final speech in this place. The shadow Health team discussed this matter earlier and entirely support his call.

[Andy Burnham]

I am very pleased to hear that. I hope that means a commitment in the election manifesto of the kind I have just called for.

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank you on behalf of my constituent, Madam Deputy Speaker. I want to speak further, briefly, about that case. The Minister has made certain assertions and I want to give the House some more information. The main part of the debate has been about the excellent revelations from my right hon. Friend the Member for Leigh (Andy Burnham), but we have also referred briefly to the situation of people who were in many cases infected as children as a result of this scandal in the NHS. We need to keep reflecting on the fact that many people were children when this happened. My constituent was a child receiving the treatment that he needed from the NHS. I have already talked about him having to pay for his own treatment, and for the drug that he needed to clear the hepatitis C virus from his body .

The Minister referred to the consultation recently conducted by Health Ministers on reforming the system. I would like this Minister to know how that has gone down with my constituent. He tells me that he received a letter summarising the proposals. He says:

“For me personally, as someone who has progressed to stage 2, I would be significantly worse off. In real terms, the proposals mean that financial support will decrease over time as the annual payment will no longer be index linked. I will even lose the £500 winter fuel payment, and I will no longer receive a pre-payment prescription certificate which I use for painkillers and anti-inflammatory medication.”

It is disgraceful that people who were infected as children by the NHS are being treated in this way. My constituent goes on:

“I believe the Government is being deliberately punitive and exceedingly cruel in using the affected community’s request to reform the various support schemes to actually make cuts to those people who were infected by contaminated blood given to them by the NHS through no fault of their own.”

I just wanted to add those observations to what has been a powerful debate. It has already been stated by other Members that our constituents have no time left. This is the situation that they find themselves in, and this miserly treatment beggars belief. It is time we did something better.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

I am happy to congratulate the Cellar Trust, and to pay a visit if I can find the time to do so. My hon. Friend is right to say that voluntary organisations play a vital role. Very often, they can see the whole picture and they treat the whole person, not just the specific NHS or specific housing issue, so he is right to commend its work.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Recent figures show that 18 mental health patients were placed more than 185 miles away from their home for treatment, including five from the northern region—Jess is one such example. Their families will have to travel the equivalent of Manchester to London, or further, to visit them. We have also learned that £800 million was taken out of CCG budgets, which could be funding services such as mental health in-patient beds, just to help NHS England balance the books. Will the Secretary of State tell those patients and families why they should be treated so far from home when their local CCG should be able to fund the in-patient beds they need?

[Mr Hunt]

With great respect to the hon. Lady, we are the first Government to count out-of-area placements, and to commit to eradicating them. What she does not tell the House is the context, which is the biggest expansion in mental health provision anywhere in Europe, with 1,400 more people being treated every single day, and an extra £342 million being spent this year on mental health compared with last year.

--- Later in debate ---

[David Mowat]

Much of the money will go through the better care fund and there is conditionality on that. We expect councils to spend this money, as they have requested it, on social care and we believe that that will be the case. We understand the pressures and have acted.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

But 1.2 million older people are living with unmet care needs. The £1 billion that was announced in the Budget for this year is not enough to prop up the failing care sector, when many councils are suffering contracts being handed back. Given that 1 million people over the age of 65 do not have adult children, will the Minister explain how all those people living with unmet care needs are meant to manage?

[David Mowat]

The figure on unmet care needs comes from an Age UK analysis. I am meeting Age UK to go through its recent report, but we do not accept that analysis because the Care Act 2014, which had cross-party support, set statutory consistent definitions for what care councils have to provide. It is illegal for that not to be met, and our follow-up work with the Local Government Association has indicated that it is being met. Furthermore, we have put in a 17% increase over the next three years.

Health Committee

Baroness Keeley Excerpts

Thursday 16th March 2017 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

(Select Committee Statement): The scale of the avoidable loss of life from suicide is unacceptable. In 2015, 4,820 people in England took their own lives, and across the UK 6,122 people did so in 2014. But those official figures underestimate the true scale of the devastating loss from suicide, which remains the leading cause of death in young people between the ages of 15 and 24, and it is the leading cause of death in men under 50. It is strongly linked to deprivation and is a major contributor to health inequality. However, the key message our Committee heard throughout its inquiry is that suicide is preventable, and we can and should be doing far more to make sure we reduce it. That was the key focus of our suicide prevention inquiry.

First, let me thank all those who contributed to the inquiry, particularly families bereaved by suicide, and those who had experienced suicidal ideation and been users of mental health services. Their evidence was courageous and compelling. I also thank all the voluntary groups and volunteers who are working to provide support for people in crisis, and all our front-line staff. Finally, I thank my fellow Committee members and our Committee staff, particularly Laura Daniels, Katya Cassidy and Huw Yardley.

I shall now move on to what we found in our inquiry. First, let me say to the Government that we welcome their suicide prevention strategy, but as with any strategy the key is implementation. We therefore call on them to go far further in implementing and resourcing it, and to give greater attention to the workforce in order to make the important improvements come forward. We also make further recommendations and we are disappointed that the Government have not gone further in a number of areas. We know that we can take actions to reduce suicide and we highlight a number of these in our report. For example, we know that half of those who take their own lives have previously self-harmed, and we feel it is really disappointing that the experience of so many of those who have self-harmed when they go to casualty departments is that they are made to feel that they are wasting people’s time. We know that liaison psychiatry makes an enormous difference, but there are resourcing issues on that.



We also know that those who have been in-patients in mental health settings should receive a visit within three days of leaving in-patient services, but there simply are not the resources available for that to be put in place. We call on the Government to go further in looking at the workforce and resourcing needed for that to happen. We know of other serious issues, for example, the fact that about a third of people who take their own lives are not in contact with either primary care or specialist health services in the year before their death. We feel that suicide is everyone’s business and we all have a responsibility to reduce the stigma attached to mental health so that it is easier for people to seek help. Again, I pay tribute to all those who are working in this field, reaching out to people in non-health settings and making a real difference. However, many of those voluntary groups are coming under great financial pressure. It is welcome that the Government have announced that there will be £5 million for suicide prevention, although that does not come in until next year, with £10 million in each of the subsequent two years. However, we feel that that is too little, too late, particularly given the cuts to public health grants and across local authorities to those services that can reach out to people who are vulnerable to suicide.

We would like the Government to put a greater focus on adequately resourcing the measures they set out in their suicide prevention strategy. We would particularly like them to look at how those plans are being implemented. It is very welcome that 95% of local authorities have a suicide prevention plan either in place or in development, but there does not seem to be sufficient quality assurance for those plans. We would therefore like a national implementation board to look at how we can move those plans forward, because any strategy, however good, cannot be effective if it is sitting on the shelf and not being implemented. That was one of the key messages we heard from our witnesses, and I know that the Minister will have heard it from the National Suicide Prevention Strategy Advisory Group loud and clear.

We also know that there are things that need to happen when people are in contact with services. It is disappointing that greater focus has not been put on the consensus statement for information sharing. On too many occasions, when someone hears that a loved one has taken their life it is the first time they have heard that their loved one had been in contact with services—nobody had let them know. Understandably, health professionals are concerned about issues of confidentiality and consent, but what the consensus statement makes clear is that if we ask people in the right way, they are much more likely to give that consent to information sharing. We would like to have seen the Government put a greater focus on how we can increase awareness of how health professionals go about sharing information with people’s loved ones, because we believe that will save lives.

We think that measures can be taken across the board both out in the community and within health care settings and specialist settings, but the Minister will know that our inquiry also examines the role of the media. Irresponsible reporting of suicide increases suicide rates, as we know, and far more can be done within the broadcast media, the mainstream media, on social media and on the internet to make sure that we save lives. I was very pleased that during today’s Culture, Media and Sport questions the Culture Secretary agreed to a meeting with me, but I hope that the Under-Secretary of State for Health, my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood), will assure me that she will be liaising with colleagues in the Government to make sure we can save lives in that way.

Finally, I wish to touch on the issue of data. We know that there is an issue relating to the increasing use of narrative verdicts which are hard to code. That results in the official data we have on suicide under-representing the true scale of the avoidable loss of life, and with the huge variation we have around the country this makes it much more difficult to understand what works best in preventing suicide. We would like the Minister to revisit the recommendations in our report on how to provide better training to coroners and how we review the evidential standard and move from using “beyond reasonable doubt” to the “balance of probability” in recording suicide. Only in that way can we ensure that we are doing absolutely everything possible to protect families and individuals in future. I commend the report on suicide prevention to the House and call on the Government to go further in implementation.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Labour welcomes the recommendations in the report, and I join the hon. Lady in thanking Select Committee members and staff for their work.

The Committee visited the award-winning Salford mental health liaison team, which offers 24/7 mental health support at Salford Royal hospital and has been able to halve the admission rates for people with mental health problems. The Royal College of Psychiatrists reminds us that only 7% of emergency departments provide 24/7 liaison psychiatry services, and said it would be difficult to recruit enough psychiatrists and other staff to provide such a service in every hospital—the hon. Lady touched on that in her statement. What does she think the Government must do to ensure that there are enough trained staff to establish and sustain liaison psychiatry services in every acute hospital to help to deliver the suicide prevention strategy?

[Dr Wollaston]

We need to start right back at medical school recruitment and what happens in medical schools and beyond, to encourage more health professionals—not just doctors, but nurses as well—to consider psychiatry and mental health services as a career. One of the key issues is the lack of a workforce. I know the Government are working with Health Education England to improve the situation, but we would like to see them go further. Also, we need to ensure that resources get to the frontline.

Health and Social Care Budgets

Baroness Keeley Excerpts

Tuesday 14th March 2017 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve with you in the Chair, Mr Bailey. I congratulate my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier) on securing the debate and the excellent way in which she opened it.

Last week, in the spring Budget statement, the Chancellor announced that the Government would provide £2 billion in funding for social care over the next three years. We have heard a variety of comments about that in the debate. It is welcome that Ministers have finally heard the warnings from the Opposition, a wide range of health and care leaders and the three Select Committees represented in the Chamber today about the fragile and underfunded state of social care, but the extra funding has to be seen against the cuts to local council budgets, leading to the loss of about £5 billion from adult social care budgets since 2010. Clearly, the announced funding is not enough.

The cuts have already had an impact on the lives of many people. Older, vulnerable and disabled people have had support that they relied on taken away. Others have been turned away by local authorities and left to rely on friends and family for help. Last week, in this Chamber, we debated social care in Liverpool, when we heard that the cuts there meant that care could be funded for only 9,000 people, not the 14,000 people who had previously received care packages, as my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) reminded us today. In one city alone, that is 5,000 care packages lost and, nationally, 400,000 fewer older people than in 2010 receive publicly funded care.

We should remember that, as Age UK tells us, 1.2 million older people have to live with unmet needs for care—older people who do not have help they need to feed themselves, wash or get dressed. Apart from coping with future demographic change, we have to look at that unacceptable level of unmet need, because that is part of the serious state of social care and it is having a knock-on effect on the NHS. As Mark Porter from the British Medical Association said:

“When social care is on its knees, patients suffer delayed transfers, and the personal and financial cost is vast.”

In January we saw a record high in the number of delayed discharges from the NHS. The King’s Fund recently described social care as

“little more than a threadbare safety net for the poorest and most needy older and disabled people”—

it is a threadbare safety net that many people are now falling through, with the NHS left to pick up the pieces.

Given the damage done over the past seven years and the crisis that the Government have caused in social care, the £1 billion announced in the Budget for this year is simply not enough. As we have heard in the debate, the King’s Fund, the Nuffield Trust and the Health Foundation warned the Government about a £1.9 billion funding gap in social care, which means that the Government are funding only half of what is needed now. As for comments outside this place, the Care and Support Alliance has said that the extra funding

“keeps the wolf from the door”,

but no more, while the Academy of Medical Royal Colleges said that

“we’ve now got to get real and recognise that short term measures of the kind we’ve seen today won’t help in the longer term.”

Is it not time to examine the true gap in social funding? Will the Minister acknowledge that £2 billion in funding is needed now, rather than spread over the next three years?

We also heard about the intention to produce a Green Paper on the long-term funding options for social care. The Chancellor said that those options do not include what he described as “Labour’s hated death tax”. As my hon. Friend the Member for Sheffield South East (Mr Betts), the Chair of the Communities and Local Government Committee, said, the Government should not reject options proposed in the past by other parties, and the Chancellor should not label one such option as a “death tax”, because to describe it in that pejorative way is not helpful in securing cross-party support for a sustainable solution to funding social care. That was done back in 2010 for political reasons, and it is being done now for political reasons. Inheritance tax is not called a “death tax”, although it is a tax levied after death. It has been known in the past as probate duty, estate duty and capital transfer tax. The Labour party has not played such political games with the Government’s highly unpopular increase in probate fees, which will affect people in the coming months.

I also challenge what Ministers have said about previous work on a sustainable and long-term funding option for social care. We need to deal with the issue now. In the Budget debate, the Financial Secretary to the Treasury denied that the Government might kick it into the long grass, instead talking about previous reviews. Let us be clear about that, however. In 2010, the Labour Government produced a White Paper called “Building the National Care Service”, a copy of which I have with me. Before that, in 2009, we had a Green Paper and the “Big Care Debate”, involving 68,000 people. Members are right that we need that big conversation with the public, but we have already had it once—we held it in 2009. We had firm plans to build a national care service. In seven years, this Government abandoned those proposals, established the Dilnot commission on the future funding of adult social care, adapted Dilnot’s proposals for their 2015 manifesto and then abandoned them. I call those seven wasted years. We appear to be back where we were in 2009.

As we have heard, it is clear that the demographic pressures in social care have a real impact on the NHS. In a typical hospital at any one time, two thirds of in-patients are over 65 and more than a quarter have a diagnosis of dementia. On top of rising demand, the Government have simultaneously sought to pass on what I see as unachievable savings. As we have heard, hospitals already have record deficits. NHS providers ended last year with a £2.5 billion deficit, although the Nuffield Trust suggests that the real underlying deficit was closer to £3.7 billion. The Public Accounts Committee identified that the NHS is resorting to

“repeated raids on investment funds in order to meet day-to-day spending”.

We have heard those issues covered in this debate.

The decision to provide just £100 million in the Budget for capital investment looks odd, given that the NHS had to resort to raiding £1.2 billion from capital funding this year just for day-to-day running costs and faces a £5 billion repairs backlog. It has become increasingly clear that a £22 billion savings target for the NHS is simply not realistic. The Public Accounts Committee said:

“we remain concerned about whether plans are really achievable”.

Not one independent expert I have seen believes that such savings can be achieved with services maintained at current levels, and I am worried that efficiency savings on that scale will increasingly affect the quality of care that patients receive. We know that the number of trolley waits rose by 58% last year and the four-hour target has not been met since July 2015, and we have now heard about the rationing of hip replacements.

Importantly, the King’s Fund told us this week that the financial pressures on mental health services have been

“a major factor driving large-scale changes to services, which may have had a detrimental impact on patient care”.

Its report states that patients who are able to access treatment get fewer contacts with adult secondary mental health services. That suggests that there is rationing of support in England. It is also clear that the shortage of specialist mental health beds is resulting in a significant increase in the number of patients being sent for treatment away from their home area. In the four months to January this year alone, more than 2,000 vulnerable people in England with serious conditions such as schizophrenia, psychosis and anorexia were sent for out-of-area treatment. Almost half those placements were more than 60 miles from the patient’s home, and one in five of those patients were admitted to a psychiatric intensive care unit.

The Public Accounts Committee said that

“the financial performance of NHS bodies has worsened considerably and this trend is not sustainable.”

In social care, mental health and the NHS, it is evident that the most vulnerable people in our society are bearing the brunt of financial pressures. We have heard a strong consensus in this debate that that has to change.

--- Later in debate ---

[Mr Dunne]

In the sustainability and transformation plans there is the opportunity for commissioners of care and health services to look holistically at the demands of the residents in their area, which to a degree includes palliative care and respite care. As we move towards an STP, there is a greater opportunity for those things to be considered as well.

[Barbara Keeley]

I agree with the hon. Member for Portsmouth South (Mrs Drummond). There is a real dearth now and respite care for carers has got lost. With £120 million, 40,000 carers could be helped with a respite care break. The Minister should look at that.

[Mr Dunne]

As I just said, the STPs provide an opportunity for areas to place greater focus on respite care if they consider that to be required.

I would like to touch on the adequacy of the social care funding package. The announcement means that in the next three years councils will have access to some £9.25 billion of more dedicated funding. That includes extra money going to local authorities through the combination of the improved better care fund and the social care precept, which, for those councils introducing it with effect from next month, will raise some £1 billion extra. The £1 billion provided in the Budget and the £1 billion from the precept amount to the £2 billion called for by external sources for the coming year. That funding will allow councils to expand the numbers of people they are able to support and, in turn, address issues at the interface with the NHS such as delayed discharges from hospital, which as we know cause problems with patient flow through the system.

Questions were raised about how the social care funding is to be allocated. I inform colleagues that 90% will be allocated using the improved better care fund formula to local authorities that have responsibility for adult social care. That distribution takes account of the ability to raise money through the council tax precept for social care and means that it is well targeted at areas of greater need and market fragility. However, in recognition of the social care pressures faced by all councils, 10% of the funding will be allocated using the relative needs formula.

The response to the measures from external audiences reflects comments made by hon. Members today: they have been broadly welcomed. Of course, several hon. Members said that it is not enough, but that is a traditional response to any increase in money—it is always easier to say that it is not enough. Hon. Members have generally recognised that the Government have listened to concerns about social funding. Those of us with responsibility for the health service recognise that there has been a particular problem in dealing with delayed discharges from hospital. Through closer working in the sustainability and transformation plans as they are rolled out across the country, with local authorities working more closely with health service providers, we think that the money will provide a lifeline to help to remove some of those pressures and to improve patient flow through our hospitals.

I would like to touch on the medium-term challenge and how in the coming months we can try to use the development of a social care Green Paper to address the longer-term concerns. The Government are committed to establishing a fair and more sustainable basis for funding adult social care in the light of the future demographic challenges that the country faces. We will therefore bring forward proposals to put the state-funded system on a more secure and sustainable long-term footing, setting out plans in a Green Paper. Some hon. Members asked when the Green Paper will be published. If I was in charge of Government timetabling, I would be in a better position to answer. They will not be surprised to hear that I cannot give a definitive answer, but, to use traditional parliamentary language, it would be fair to say that it is expected to be published in the summer.

Social Care (Liverpool)

Baroness Keeley Excerpts

Tuesday 7th March 2017 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) on securing the debate and on the excellent way in which she opened it. We have heard about the real pressures on social care in Liverpool from my right hon. Friend the Member for Knowsley (Mr Howarth) and my hon. Friends the Members for Garston and Halewood (Maria Eagle), for Liverpool, Wavertree (Luciana Berger) and for Liverpool, Walton (Steve Rotheram). We have heard about the 5,000 people who have lost care packages, about cancelled surgeries and about patients stuck in hospital.

To be clear, the funding crisis in social care is, in my view, one of the Government’s own making. The Chancellor failed to recognise the crisis and provided no extra social care funding from central Government at the autumn statement. Indeed, Ministers continued what they had already started in shifting the burden on to councils and council tax payers through increases in the social care precept. I will say more about that, but we have heard very well in the debate how that is not a sustainable solution.

As my hon. Friend the Member for Liverpool, Riverside said, Liverpool still has to make a further £19 million of cuts by 2020, taking the cuts to its Government funding to a staggering £420 million—the equivalent of a 68% reduction since 2010. The cuts to grants and the increased reliance on council tax have hit cities such as Liverpool very hard; we have heard about some of the impacts. As my hon. Friend the Member for Liverpool, Walton said, a serious weakness of using council tax to fund social care is that both demand for social care and the relative value of the council tax base vary so much across the country.

[Mr Philip Hollobone (in the Chair)]

Order. I am sorry to interrupt the hon. Lady when she is in full flow, but there is a Division in the House. We will come back in 15 minutes and carry on where we left off.

--- Later in debate ---

[Mr Philip Hollobone (in the Chair)]

Welcome back. The revised finish time is now 6.18 pm.

[Barbara Keeley]

As I said, a weakness of using council tax to fund social care is that both the demand for social care and the relative value of the council tax base vary across the country. Census data show that in Surrey 40% of over-65s have a long-term condition that limits their day-to-day activity, but in Liverpool that figure is much higher, at 62%, and there is a strong link between long-term conditions that limit day-to-day activity and care needs. A 1% increase in council tax would raise £6.2 million in Surrey, whereas an equivalent rise for the same size population in Liverpool would raise only about half that sum—£3.4 million. Therein lies the problem.

As we heard in the debate, this year the 2% social care precept raised £2.8 million in Liverpool. That is not enough to cover the £9 million that Liverpool reports is needed in the care sector just for increases in the national living wage. Liverpool’s Mayor did some months ago suggest a 10% council tax increase to pay for social care, which would have needed a referendum. That proposal was similar to the one for a 15% increase from Surrey County Council. As we know, Surrey appears to have got a sweetheart deal from the Government when it suggested that increase in council tax, so I would like the Minister, when he responds, to tell us where Liverpool’s deal is.

As we heard, last month Liverpool’s director of adult social care resigned, stating that councils are in danger of failing to meet their statutory requirements. He said:

“People are struggling, people are suffering, and we’re really only seeing the tip of the iceberg.”

Only those with the highest needs are getting help. I worry that financial pressures in social care are now leading to failures and serious reductions in the quality of care that people receive. That was underlined by the Care Quality Commission bringing prosecutions against the owners of Mossley Manor, in the constituency of my hon. Friend the Member for Liverpool, Riverside. The neglect and poor care of residents at that care home was shocking. The CQC said that there was

“a continued and serious risk”

to the lives, health and wellbeing of residents. It is welcome that the owners have been prosecuted by the CQC, but I am worried that failures such as that are now a symptom of a wider problem.

The number of care home providers forced to cease operations because of deregistration has increased from 34 two years ago to 54 this year. A recent BBC “File on 4” programme reported that 23,000 allegations of abuse had been made against care staff working in people’s homes. In the programme, the new local government ombudsman, Michael King, said that there is a growing problem with standards of home care. The CQC says that more than one quarter of care homes require improvement or are inadequate, and that figure rises to 41% for nursing homes. The King’s Fund has said that adult social care is rapidly becoming a “threadbare safety net” for the poorest and most needy older and disabled people.

Falls in the quality or availability of social care are clearly having a knock-on effect on the NHS. We heard, rightly, about examples of that from Liverpool. My hon. Friend the Member for Garston and Halewood talked about sustainability and transformation plans and the need for STPs to make savings, which is the ridiculous position we seem to be in, but as the Health Foundation has said:

“The vision contained in many STPs…on preventing ill health and deterioration of illness, of care delivered closer to people’s homes…will be impossible without a vibrant social care sector.”

As we heard in the debate, it is impossible to have a vibrant social care sector with the funding issues in Liverpool. The Government have tried to shift the burden of funding social care on to councils. In the Budget tomorrow, I hope that the Chancellor of the Exchequer takes responsibility and both makes available the £2 billion needed immediately and suggests a longer-term plan, which is needed to put social care on a more stable footing.

Those who lose out are the thousands of people who need social care in cities such as Liverpool, but are now living with unmet care needs. That also hits their families, particularly the unpaid family carers, and the thousands of people in the care workforce, who are now working under very poor terms and conditions. A very large proportion of them are on zero-hours contracts; often, they are not even paid the minimum wage, are not paid for their travel time and have very poor prospects or no pension.

My hon. Friend the Member for Liverpool, Walton has offered to convene, if he is elected Mayor—I wish him all the best in the forthcoming election—a health and care summit to look at the issues and explore solutions. I hope that he is able to do that, but I know that my hon. Friends and I are not happy to accept a threadbare safety net. We want a decent and fair social care system, and we want it to be funded.

[Mr Philip Hollobone (in the Chair)]

If the Minister would be kind enough to conclude his remarks no later than 6.15 pm, that would allow Mrs Louise Ellman three minutes to sum up the debate.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

I thank all those who have spoken in the debate. This is a serious subject, and we have had a number of serious contributions. I will answer some of the points that have been made, before talking more generally about the Government’s approach to adult social care, both now and for the remainder of this Parliament.

I congratulate the hon. Member for Liverpool, Riverside (Mrs Ellman) on bringing this debate to the Chamber, because this subject matters. If there is one thing on which we can all agree, on both sides of the political divide, it is that the whole care agenda is very important to very large numbers of people. The care industry employs more people than the NHS: it employs 1.5 million people. As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, many of them are not well paid. I think she said that some of them do not get the minimum wage. If she has evidence of that, she needs to come forward with it and we need to prosecute, because that is illegal.

However, it is right to say that 1.5 million people work in social care—more than in the NHS—and that number will grow over the next decade or two decades. Depending on how he gets on in the forthcoming election, the hon. Member for Liverpool, Walton (Steve Rotheram) may find that his responsibility in that regard is increased greatly. As well as those 1.5 million people, to whom we should all be grateful—I do not think I could do that work very well—6 million people across our country give informal care. Of those, some 300,000 are aged under 18. It is estimated that one in 30 people in schools are giving informal care to an adult or sibling. We should all reflect on that, because that number will also increase over the next decade or so.

A number of Members have made the point that the precept raises less in Liverpool than it does in Surrey. The hon. Gentleman said that many more houses are in council tax bands A or B, and the consequence is that the precept will raise less. That is self-evidently true, and the Government accept that. That is why the way in which the improved better care fund is and will be allocated to councils takes into account the moneys that are available from the precept, so that the total is in accordance with the relative needs formula.

There is one thing I want to get absolutely straight. I do not want to spend the next 18 minutes bandying numbers around, and I am happy to write to all the Members here about the numbers that I am about to give. The hon. Member for Liverpool, Riverside correctly said that the Liverpool spend on social care was £154 million in 2015, and she said that it is budgeted to be £130 million by 2020. I think those were the numbers she used. The number that we have in cash terms—I will write to Members with this—is £194 million by 2020. That is a real-terms increase of 18% between now and 2020. I have spent quite a long time with officials today to make sure that those numbers are correct. The amount that Liverpool City Council will receive from the improved better care fund in 2019-20 is £26 million. That dwarfs the amount that the precept will raise.

[Barbara Keeley]

The Minister said that he does not want to keep on bandying figures about, but as we all know, the difficulty is that the funding that he and the Government keep talking about is back-loaded. The problem is happening now—5,000 people have lost their care packages now, and the problem has been happening since 2010. It is not helpful, in this totally stressed situation, to talk about money in 2019-20.

[David Mowat]

I was just making the point that the figure the hon. Member for Liverpool, Riverside used was £130 million and the figure I have is £194 million. I accept that that number is not for today, and I also accept, as I have said many times in the Chamber, that the social care system is under pressure throughout the country, and Liverpool is part of that.

--- Later in debate ---

[David Mowat]

That is a fair challenge. We have a plan, and we are implementing it in that process. Winterbourne View was about seven years ago now. I have met a number of parents of the children affected and there has been a lot of pressure from them to go as far and as fast as we can. I make the point that every one of those facilities is a project of its own in terms of finding other accommodation and putting in place care—sometimes round-the-clock care. To answer the hon. Lady’s question directly, I would like us to go faster, but I think that we are doing as well as could be expected given the starting point. However, it is a fair challenge.

[Barbara Keeley]

I do not know whether the Minister watched last week’s Channel 4 “Dispatches”, “Under Lock and Key”, which showed some serious cases of young people who were not better off in their institution, a private hospital. It seemed very difficult to get them moved out into the community. I know that it was a different part of the country, but there were young people in that institution from across the country. It is great to have a plan, but we see programmes week in and week out showing failures, as I have highlighted.

[Mr Philip Hollobone (in the Chair)]

In responding to the intervention, the Minister needs to make his last point.

Health and Social Care

Baroness Keeley Excerpts

Monday 27th February 2017 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Chairs, members and staff of both the Health Committee and the Public Accounts Committee for their work on the reports under discussion. I also thank the two Chairs for their excellent opening speeches.

The Health Committee noted a tight financial situation for health and the fact that deficits were growing and widespread. The King’s Fund and the Nuffield Trust reported in November 2016 that there was a net deficit of £2.5 billion for NHS trusts in 2015-16. Furthermore, they said that the 1.3% funding increase for the NHS in 2017-18 would largely be absorbed by deficits. We have heard many useful contributions on the issues with trust deficits. NHS funding increases will be 0% in 2018-19 and 0.3% in 2019-20. Those are seen as “inadequate” and not enough

“to maintain standards of care, meet rising demand from patients and deliver the transformation in services outlined in the NHS five year forward view.”

I take the point made by the hon. Member for Central Ayrshire (Dr Whitford) that we are now halfway through the five year forward view, so in fact we have only a two and a half year forward view. If the opinion is now that the view is inadequate, we have got some issues.

On social care, the Health Committee has said that increasing numbers of people with genuine social care needs are no longer receiving the care they need because of a lack of resource, and we have had very many contributions about that. The Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), talked about increases in demand for social care. The King’s Fund and the Nuffield Trust have said that six years of “unprecedented” budget reductions have led to a 26% fall in the number of people aged over 65 accessing publicly funded social care, which is

“imposing significant human and financial costs on older people, their families and carers and”—

as we know—

“exacerbating pressures on the NHS.”

They also estimate that the publicly funded social care system faces the prospect of a £1.9 billion funding gap next year, and one of at least £2.3 billion by 2020.

As we have heard in this debate—it has rightly focused on this—the cuts mean that 400,000 fewer older people now receive publicly funded care packages than in 2010. An Age UK report shows that nearly 1.2 million people do not now receive the care and support they need with essential daily living activities. It is worth breaking that down further: nearly 700,000 older people do not receive enough help for their daily care needs; and 500,000 people receive no help, not even from family and friends. Taking into account tasks such as shopping and taking medication—the hon. Member for Lewes (Maria Caulfield) mentioned the important factor that older people need to be reminded to take their medication—Age UK says that 1.5 million people are not getting the help they need day to day.

It is shocking that nearly one in eight of the entire older population now lives with some level of unmet need. Of course the impact on the NHS of the crisis in social care funding is important—I will come on to delayed discharges—but the real impact, which we must never forget, is on all those older and vulnerable people living without care. Cuts to social care budgets also hit the 6.5 million unpaid family carers and the 1.4 million people in the care workforce who provide care. The impacts on those groups are often overlooked. The hon. Member for South West Bedfordshire (Andrew Selous) talked about the terms and conditions for the care workforce, and he was right to raise that point, but cuts hit those 1.4 million people as well. There have been dreadful cuts in terms and conditions; providing care is an important job and that should not happen.

The Government responses to the social care funding issues in the Select Committee reports are inadequate. The responses talk about the social care precept and the additional funding in the better care fund, but most of that funding is proving to be a problem because it is back-loaded to 2019-20. The King’s Fund has described using the social care precept as an

“inadequate response that just passes the problem to local government”.

That is a key factor. There is also the question of whether the precept is adequate or otherwise. The precept raised £382 million in 2016-17, and it will raise £543 million in 2017-18. In both cases, that is less than the cost of the national living wage to be paid by care providers.

Sadly, this Government’s inadequate funding of social care was made worse by measures in the local government finance settlement. Having passed the problem of extra funding for social care on to the council tax payer, Ministers went on to make the problem worse by announcing the creation of the £240 million adult social care grant, with funding recycled from the new homes bonus. One third of councils providing social care will be worse off next year as a result of this inept settlement. My own local authority, Salford, will have £2.3 million less in its budgets for social care, and Tower Hamlets Council is set to lose £3.3 million. Where does the Minister think we, with such notice, can find £2.3 million in one local authority budget? Sadly, the answer will be rationing, which is not where we should be.

The Public Accounts Committee has published a report on discharging older people from acute hospitals, but the situation has got worse since the Committee’s report was published. In 2016, a record number of hospital bed days was lost as a result of problems with social care. The number of days lost has increased by over 400,000 in the past year. Over a third of those days were lost as a result of social care problems, and we must take into account the fact that the proportion attributable to social care problems has been increasing. Given the funding cuts, we should not of course by surprised by that. My hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, said:

“Delayed discharge is damaging the health of patients and that of the public purse.”

Unnecessarily long stays in hospital can affect patient morale and mobility, as well as increase their risk of catching hospital-acquired infections. In 2014, Professor John Young said of the mobility effects of long hospital stays:

“A wait of…seven days is associated with a 10 per cent decline in muscle strength”,

which is clearly not desirable.

The funding crisis in social care is a theme in many of the reports we are debating. The Public Accounts Committee report on personal care budgets expresses concerns that

“funding cuts and wage pressures will make it hard”

for local authorities

“to fulfil their Care Act obligations”.

That is serious. The legislation was passed only in 2014, but councils now find it hard to fulfil their obligations. On underfunding, the Local Government Association said in its recent Budget submission:

“Without bolder action the Government will need to re-evaluate its offer to residents and consider whether the set of legal rights and responsibilities contained within the Care Act are appropriate and achievable.”

The Chair of the Communities and Local Government Committee mentioned that.

The Public Accounts Committee report on improving access to mental health services described the ambition to improve services as “laudable”, but, given the current pressures on the NHS budget, it said that it is

“sceptical about whether this is affordable, or achievable”.

The Committee rightly said that achieving parity of esteem between mental and physical health is a task

“for the whole of government”.

I trust that that includes the hon. Member for Mid Norfolk (George Freeman), who heads the No. 10 policy unit, and who said that disability benefits should go to “really disabled people” rather than those

“taking pills at home, who suffer from anxiety”.

I should say that that has been mentioned already today, and that I have informed the hon. Gentleman of my intention to mention it this evening. Comments such as those reinforce stigma about mental health rather than reduce it. They are profoundly disappointing coming from someone who was until recently a Health Minister. They show just how far hon. Members and the Government have to go on parity of esteem.

Underfunding of mental health services by commissioners has dominated many debates in the House. The Government have failed to deal with the problem that funds intended for mental health services have been used by the NHS for other priorities. In their response to the Committee’s report, the Government say they accept all the recommendations and have implemented them, but I question that. The Government response says that the mental health five year forward view dashboard published in October 2016 monitors key performance and outcomes data. In December, the Royal College of Psychiatrists released compiled figures on spending by CCGs on child and adolescent mental health services, which are vital and which we often discuss in debates in the House.

A number of hon. Members have mentioned the scale of variation that came out of the Royal College of Psychiatrists figures, because the range was from £2 per child per annum to £135 per child per annum, which is a disturbing variation. They have been told only that the CCGs were reporting the data on their spending differently. I say to the Minister that it hardly helps transparency for CCGs to report on their mental health spending differently.

I wrote to the Under-Secretary of State for Health, the hon. Member for Oxford West and Abingdon (Nicola Blackwood). From her response, I understand that further guidance has been issued to CCGs. I would be grateful if, in the Minister’s response, he told the House whether we can expect that the actual spend and planned spend on mental health services reported will be accurate and comparable. Hon. Members have mentioned in the debate their local CCGs decreasing spending on mental health. We hear that that is not the Government’s intention, but we cannot track what is happening if CCGs do not report accurately. We know that one in four young people who need mental health services are being turned away. The Government should therefore do all they can to ensure that young people can get that access. Extra funding prioritising mental health should be spent as intended and not spent on other NHS priorities.

In its report on NHS specialised services, the Public Accounts Committee said:

“Accountability, to both patients and taxpayers, is undermined by the lack of transparency over NHS England’s decision-making”.

The Committee recommended that NHS England should

“improve the transparency of its decision-making”.

I note that 30 charities from the Specialised Healthcare Alliance wrote to the Prime Minister recently to raise the issue of NHS England restricting and rationing treatment because of underfunding, especially for patients with rare and complex conditions. The charities say that this has taken place without sufficient public scrutiny. Lack of transparency in decision making is a serious issue and I ask the Minister to address it in his response.

There are many issues raised in the Committee reports relating to funding for the NHS and social care. Media reports say that the Chancellor is considering a short-term, ring-fenced cash injection for social care worth hundreds of millions of pounds for councils, but I hope the Minister will convey to the Chancellor that adult social services directors say they need an immediate injection of £1 billion for social care to prevent the weakening and collapse of some parts of the sector. As I have said, the funding gap in social care will be between £1.9 billion to £2.3 billion by 2020. I hope the Government are not going to try a quick fix in the Budget that is too little. The hundreds of thousands of vulnerable people who need social care certainly deserve better.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The hon. Member for Central Ayrshire (Dr Whitford), who speaks for the Scottish National party, described this as a great debate. I agree that it has been a very good debate. Members on both sides of the House have spoken with a great deal of passion and, in general, with a great deal of knowledge. A number of clinicians, as well as three Select Committee Chairs, have spoken. I join the shadow Minister in thanking the Select Committees for the reports we are discussing today. An awful lot of comments have been made by Members and I will do my best to respond to the majority of them.

The Government accept that these are challenging times for both the NHS and social care. My hon. Friend the Member for Totnes (Dr Wollaston), the Health Committee Chair, talked about this at length. The demographics—both the number of people and their age—are uncompromising. I was at a Health Check conference recently and one of the speakers described the process we have been through. We have been very successful at elongating quantity of life. Until now, however, quality of life has not kept up. Increasingly, older people are living with multiple long-term conditions. Having one long-term condition is becoming unusual, whether it is diabetes, chronic obstructive pulmonary disease or heart disease. This is a fact we all have to face. One reason why we are so keen for the STPs to address this issue is that 70% of total expenditure on the NHS is spent on long-term conditions. Frankly, if we were starting with a blank piece of paper, we would not start with the NHS we have now. Instead, it would be organised around those long-term conditions, meaning more work in the community and all that goes with that. I will come on to talk about the STP process and how we are trying to achieve that.

We know, therefore, that there is an issue with demography. I think it was a Public Accounts Committee report that said that, in 1948, 50% of people lived to be over the age of 65. In 2017, only 14% die before they are 65. That is a massive demographic change and we all need to step up to the mark to meet it. We will try to do that. Drugs and treatment are becoming more expensive. They can do a lot more, but we have all heard the discussions around the cancer drugs fund. The third driver is that patients’ expectations are, rightly, higher than they were decades ago.

The Government response in the spending review was a front-loaded £10 billion injection into the NHS budget, representing an 8% or 9% increase, depending on how it is counted. I agree with the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, that we should not bicker about these amounts. We can argue about whether it is enough, but the facts are that this is a real increase over the course of this Parliament. There is a discussion to be had on whether that real increase is enough—I accept that. What I do not accept is what we have heard about cuts from some of those on the Opposition Benches. There is a valid discussion to be had about whether an 8% or 9% real-terms increase is enough—I gently remind the Opposition that at the last election they said they would not be in a position to fund more than that—but it is not right to talk about it in the context of cuts, as some Opposition Members have done.

[Barbara Keeley]

We get into this repeatedly. The Opposition have no plans to cut £5 billion from social care or to cut the budgets of local councils. That is the difference between us and the Government. Given that we have talked mainly about social care and cuts to social care, the Minister ought to take that into account.

[David Mowat]

I will come on to social care. We have covered the NHS, which this Parliament will get a real-terms increase of 8% or 9%. Let us accept that and move on. On social care, a 5% or 6% real-terms increase has already been made available—that is not the Budget; I do not know what is in the Budget. Again, we can argue about whether that is enough, given the demographics, but we cannot argue whether it is true.

I want to spend a little time on the international comparisons, about which we heard some discussion earlier. According to the OECD, in 2014 this country spent 9.9% of its GDP on health. The OECD average is 9%, so that is 1% more, but it is true that the OECD average includes countries such as Mexico with which we would not necessarily wish to compare ourselves. The average for the EU15, which by and large does not include the newer states in the east, is 9.8%. So in 2014 we spent more than the EU average. It is true that we spend less than some of our comparator countries—we spend less than France and Germany—but it is completely wrong to say that there is a massive gap between us and the EU.

--- Later in debate ---

[David Mowat]

There are assumptions in that—to do with our GDP growth, their GDP growth and everything else—so it is a difficult question to answer. I would just refer again to the latest OECD figures, for 2014. Those figures are accurate. There is a valid debate to be had about whether they are enough, given the demographics and all the rest of it—that is fair—but it is not fair to imply that there is a massive disparity between us and our EU neighbours.

[Barbara Keeley]

rose—

[David Mowat]

I have given way to the hon. Lady once already, and I need to make some progress.

--- Later in debate ---

[David Mowat]

He is right about that. NHS England is evaluating the STPs at the moment and during March and April, and it will decide which STPs are high priority, which will be invested in and which will be taken forward at speed. We heard the phrase “accountable care organisations” used earlier, and it is the Government’s intention to ensure that those high-performing STPs that we proceed with—it will not be all of them; frankly, the standards are variable and locally driven—will in time become accountable care organisations.

The shadow Minister asked me to talk about social care, and I will do so. During the present Parliament, accessible funding for social care has risen by 6% in real terms; it fell during the last Parliament. Last year 42% of councils increased their social care budgets in real terms, and in December £900 million was provided in new homes bonus payments.

[Barbara Keeley]

Will the Minister give way?

[David Mowat]

No, I will not.

[Barbara Keeley]

rose—

[Mr Speaker]

Order. The Minister is not giving way at the moment.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

This is a very important issue because, as the hon. Gentleman knows, half of all mental health conditions are diagnosed before or become established before people are 14, and the sooner we catch them, the better the chance of giving someone a full cure. We therefore need to find a way whereby there is some mental health expertise in every primary school, so we can head off some of these terrible problems.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

As my hon. Friends the Members for Bermondsey and Old Southwark (Neil Coyle) and for Liverpool, Wavertree (Luciana Berger) have already said, last night’s “Panorama” showed that mental health services are not funded properly. At the Norfolk and Suffolk mental health trust funding cuts led to community teams being disbanded, a loss of staff and the loss of in-patient psychiatry beds. Most disturbing of all is to hear parents talk of what happens to their children when they are denied support in a crisis—when they are self-harming or suicidal but there are no in-patient beds. One parent called it a “living nightmare”. We do not need any more warm words from this Secretary of State—we need action to make sure that mental health services are properly funded and properly staffed.

[Mr Hunt]

Let me tell the hon. Lady what action is happening this year. The proportion of CCG budgets being assigned to mental health is increasing from 12.5% to 13.1%, which is an increase of £342 million. That is action happening today because this Government are funding our NHS.

--- Later in debate ---

[David Mowat]

My hon. Friend is correct in so far as two thirds of all delayed transfers of care are a consequence of internal NHS issues, not issues between the NHS and councils. The issue regarding Blackburn and Burnley is part of that.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Recent figures on delayed transfers of care ranked Salford 105th out of 154, with 533 delayed days in November 2016. Sir David Dalton has said that overcrowding at Salford Royal hospital is due to its

“inability to transfer patients safely to an alternative care setting”,

and that changes to social care funding are “urgently required”. Salford Council’s budget has been cut by 40% since 2010, leading to the loss of £18 million from social care budgets. Salford royal hospital, rather than the council, is now providing social care. I know that the Health Secretary respects Sir David. Does Minister accept Sir David’s view about the need for funding changes, or will he continue to find people to blame for cuts inflicted by his Government?

[David Mowat]

Conservative Members very much respect Sir David Dalton. I remind the hon. Lady that she stood for election on a slogan of not a penny more for local government, so it is entirely inappropriate for her to say different things now. There is now an opportunity in Manchester, through the devolution deal, to integrate care and the NHS more effectively, and I expect that to happen.

NHS and Social Care Funding

Baroness Keeley Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Wollaston]

Absolutely. It was extraordinarily encouraging to hear the Prime Minister say that she was prepared to consider that and to meet Members from across the House. I urge colleagues who feel that this is a better way forward to sign up to it, speak to their party Whips and make it clear that it has widespread support.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I wonder, on this vital issue, whether the hon. Lady wants to say something about what her own party did on the two previous times we tried to get important cross-party working on health and social care: it made it an election issue, producing posters about a “death tax”; and on the second occasion the Secretary of State just walked away from the talks.

[Dr Wollaston]

I am afraid that that intervention is exactly not the kind of debate we want to be having. Let us look to the future. We are in a different part of the electoral cycle. I accept the hon. Lady’s comments—I was still an NHS clinician when that happened and, like many of those working in health or social care, I looked at the yah-boo debate in this place and thought that surely there had to be a better way—but I ask her to put them aside and to look to the future rather than backwards, otherwise we will not get anywhere. I think our constituents want us, as politicians, to recognise the scale of the challenge and to get to grips with it.

--- Later in debate ---

[Helen Whately (Faversham and Mid Kent) (Con)]

It is a pleasure to speak in this debate and to follow hon. Members who have made very thoughtful contributions. The hon. Member for Bristol West (Thangam Debbonaire) spoke about loneliness, which is a problem across the country, and the very important work that is being done on that. It is also a pleasure to follow colleagues who have spoken about their personal and family experiences. My hon. Friend the Member for Wells (James Heappey), the hon. Member for Chesterfield (Toby Perkins), who is no longer in his place, and the hon. Member for Workington (Sue Hayman) spoke about their experiences, both good and bad, of the national health service.

I, too, have personal experiences both good and bad. Three years ago, I spent Christmas night in A&E with my son, who was five at the time, and who had his appendix taken out first thing in the morning on Boxing day. He had absolutely exemplary care and was home within two days, eagerly making up for the quantity of sausages that he had omitted to eat on Christmas day because of his tummy ache. Last Christmas, my grandmother, then aged 100, was in hospital—she was there for several months—and she had a much, much worse experience; it was not the NHS at its best. We all have good and bad experiences to draw on. We hear from our constituents, as well, about these good and bad experiences. It is important to recognise what the NHS does well, and is doing well, but also where the system is failing, and to focus on supporting the good and tackling the bad.

I very much understand why this debate has been called, because there is no question but that the NHS is under extraordinary pressure this winter. We have heard that last week it had the busiest week ever. However, I am quite disappointed by the tone of some of the contributions and more significantly by the lack of proposals from those who just said that that there is no money and made no suggestions as to where the money will come from. That is fundamentally unhelpful.

[Barbara Keeley]

It is very clear where the money is to come from—we are asking for £700 million to be brought forward from the better care fund from 2019. It is already allocated.

[Helen Whately]

I appreciate the hon. Lady’s point, but bringing money forward still requires it to be found. This is set against a backdrop of Labour, in 2015—less than two years ago—not committing to fund the NHS with the money that it was asking for, as this Conservative Government are now doing. Labour is in rather a shocking position.

I want to seize this opportunity to say a very heartfelt thank you to all members of NHS staff—nurses, doctors, allied health professionals, porters, care assistants—and those in social services, particularly those in and around my constituency in Kent, who I know are working extremely hard to deal with the pressure on the frontline. I also thank patients and their families who are being thoughtful and taking care to make the best use of the NHS.

We know that there is great variation in how the NHS is coping. I have just been told that the waiting time in Maidstone A&E is—as we speak—only 37 minutes, so Maidstone is coping pretty well right now, but at the nearby William Harvey hospital in Ashford it is over four hours, so there is variation. I do not say that so that people listening can divert from where they are going; there may be a case for that and for greater transparency, but that is for another day.

We talked earlier about money. There is no question but that this issue is partly about the need for more funding and more staff, but the Government are doing exactly that: they are giving the NHS more money and investing in significant increases in the workforce. However, money is not the whole answer. If the NHS just continued doing all it does in the way that it does without any change, we would find ourselves with a system that was unaffordable and that used a proportion of GDP for which there would not be public support. We know that we have an ageing population—people are living longer and have multiple complex conditions—and that high-cost treatments are becoming available that people want, so the NHS itself recognises that this is not just about more money but about changing the way in which services are delivered.

Such changes are being worked on and are actually happening at the moment. Earlier today, I spoke to the hospital trust chief executive who is the lead for the Kent and Medway sustainability and transformation plan. STPs have come up several times today. As I have seen, under him and the group around him, there has been a coming together across Kent and Medway of NHS organisations that have not tended to work closely together. The coming together of the NHS and social services is so important, so necessary and so right if we are to work out how to provide a better health service in a more sustainable way. We need to break down the barriers between organisations, as it just does not make sense to have a split between the NHS and social care in who provides what. We should look at how we can genuinely move care out of acute hospitals and closer to home, which we know is good for patients. It is exactly what the hon. Member for Workington hoped for her father and what we wanted for my grandmother as she neared the end of her life.

We need to enable people to be looked after closer to home or preferably at home, and to improve prevention and—I feel particularly strongly about this—mental health care. The Prime Minister has taken a personal lead on mental healthcare with her announcements on Monday. In the light of the pressure on A&E, I particularly value the commitment to psychiatric liaison in A&E departments, which we know is helpful in the prevention of suicide, is good for people who go to A&E with mental health problems and helps A&Es look after the people who need to be seen for physical health problems. I welcome the fact that my area of Kent is looking at bringing that forward and having psychiatric liaison in all A&Es by 2018. Really important work is therefore going on at local level.

I encourage Labour Members not to make the knee-jerk or even tear-jerk speeches that some have made, but to take a longer view of the situation. That would help us to have a more mature conversation about what the NHS needs and to talk about policies and concrete proposals, rather than just about having more money, to solve the problems. It would also enable us to get behind what the NHS is doing at local level, where the NHS and local authorities are coming together to draw up plans across their areas for better care for patients in an affordable and sustainable way.

--- Later in debate ---

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I want to start by paying tribute to our hard-working staff in the NHS and those in the care sector. The best way to thank those staff would be by giving them the resources they need to do the job we want them to do.

I welcome the contributions made by hon. Members today, particularly the moving contribution from my hon. Friend the Member for Chesterfield (Toby Perkins), who bravely told us about the personal catastrophe for him and his family when his father was sent home from a pressured A&E, sadly to die from an aneurysm. My hon. Friend the Member for Workington (Sue Hayman) was able to tell us about the happy death her father had with the end-of-life care at the local community hospital.

The hon. Members for Central Ayrshire (Dr Whitford) and for Totnes (Dr Wollaston) both emphasised the complexity and frailty of patients needing care in the winter months. We should remember that in terms of the scale of pressures facing the NHS. Both those Members supported the four-hour target for A&E as a barometer of the wider system pressures in the NHS: a measure of how the system is managing to process those frail and complex patients. My right hon. Friend the Member for Doncaster Central (Dame Rosie Winterton), as a former Minister for emergency care, urged the Government not to give the NHS the impression of giving up on the four-hour target, as that sends the wrong message. At our NHS leaders’ summit yesterday, we heard a real concern that, for instance, parents might be discouraged from taking their children to A&E.

Conservative Members have cited both Simon Stevens and Chris Hopson in support of their claims on NHS funding, but I would like to update them, because in the House this afternoon Simon Stevens said that

“we got less than we asked for”

and that the Government are

“stretching it to say the NHS…got more”.

He also said that it does not help anybody to pretend there are not financial gaps. Chris Hopson, of NHS Providers, said:

“No, we don’t believe the NHS has got all the money it needs”

and that the NHS is not sustainable on current funding.

I turn now to the pressures on the NHS caused by social care. The crisis in our hospitals has been made much worse by the Government’s continued failure to fund social care properly. The care crisis is caused by insufficient funding in the face of growing demand, and Ministers have ignored warnings from a wide group of doctors and from leaders and professionals in the health and care sectors. The Government failed to produce a single penny of extra funding for social care in the autumn settlement. Then they told us that extra funding was being made available for social care in the local government funding settlement, but this was not the extra funding so desperately needed from central Government—what Ministers did was to shift the burden on to council tax payers. That was made worse by the fact that the £240 million adult social care grant was actually money recycled within local government budgets, from the new homes bonus. One third of councils will be worse off as a result of this settlement; my own local authority, Salford, will have £2.3 million less in its budgets. This is not a boost to social care.

What health and social care leaders had pleaded for was for Ministers to bring forward funding promised for 2019 to address the current crisis in social care, and that is what today’s motion proposes. That would provide some breathing space, which is needed because the lack of social care means that thousands of older people are stuck in hospital waiting for a care package in their own home. That was the most common cause of delayed discharges caused by social care. More than a third of the record 200,000 delayed days most recently reported were due to lack of social care. Being stuck in hospital not only affects patient morale and mobility; it increases the risk of the patient getting hospital-acquired infections. The major impact, though, is the knock-on effect on people in A&E who are waiting for a bed for an emergency admission.

Health Ministers like to blame local authorities for the lack of social care, but there are problems with that. When NHS chief executive, Simon Stevens, gave evidence to the Communities and Local Government Committee’s recent inquiry into social care, he was asked by the Chair, my hon. Friend the Member for Sheffield South East (Mr Betts), what extra resources would be needed if every local authority performed as well on delayed discharge as the best local authority. He said:

“Even having sorted that out, if we have a widening gap between the availability of social care and the rising number of frail old people, that is going to show up as extra pressure on them, their families, carers and of course the NHS.”

Of course we want to reach a position where the best practice in tackling delays is spread throughout the country, but Ministers have to start to reflect on what their Government have done through the cuts they have inflicted on local authority budgets. Figures from the Local Government Association show that the hardest hit local authority has had cuts to its budget of 53% over the past five years; the average cut is 39%.

The budget cut for Surrey was at the lower end of the scale, at 29%. Even so, the cabinet member for social care in Surrey, Councillor Mel Few, wrote a letter to The Guardian about the issues faced by his local authority. He said:

“The Care Quality Commission is not the only organisation with worries about inadequate adult social care funding and the impact on already clogged-up hospitals.”

He went on to say that although the social care precept was

“a welcome move, it falls many millions of pounds short of what is needed now—let alone in two decades.”

I suggest that the Health Secretary and the Chancellor talk to social care leaders such as Councillor Few to understand the needs that they see in local communities and the impact of the lack of social care on NHS hospitals. Ministers have been warned and warned about the impact of cuts on social care, but they have ignored those warnings. The Royal College of Emergency Medicine has said that emergency care is

“on its knees…mainly due to a lack of investment in both social and acute health care beds”.

[Sir Nicholas Soames (Mid Sussex) (Con)]

Will the hon. Lady give way on that point?

[Barbara Keeley]

No, I will not.

The BBC has reported that last week there were 18,000 trolley waits—that is, people waiting on a trolley in a hospital corridor—of more than four hours, and there were 485 cases of patients waiting more than 12 hours. My hon. Friend the Member for Preston (Mr Hendrick) rightly said that we do not even know the figures for patients waiting in corridors, or being treated and waiting on a chair because of a lack of trolleys.

The figures do not tell us about the misery for patients and their family members waiting with them. Last night, a senior A&E consultant said on “ITV News” that patients can be left with absolutely no dignity during these waits. He said:

“We have got patients with severe illnesses on chairs receiving drips, antibiotics, medications, and patients with cardiac problems on chairs because there are no trolleys for them to go on to.”

The senior doctor talked about patients who were left unable to move off their trolleys or who were stuck on chairs and about a lack of shutters and blinds, meaning that patients can be left in full view of others while they are being treated. He also reported that some patients were incontinent in front of relatives and strangers because hospital staff could not reach them in time. He said:

“Patients have absolutely no dignity left.”

That is what the lack of social care and acute beds can lead to. How would any of us feel if that was our relative?

The situation may get worse with the expected cold weather, when more major incidents may be declared and more hospitals are put on black alert—the most severe warning level, which means that they cannot cope with the number of patients.

Downgrading the four-hour waiting time target for A&E misses the point that the problems in emergency departments are a symptom of a much wider problem. As has been discussed in the debate, that four-hour target is a proxy for patient safety. It is miserable for a sick patient to lose their dignity through being incontinent during a trolley wait in a hospital corridor. It is also miserable and frightening for a vulnerable patient to be discharged in the middle of the night to a cold home with no care package. That is why we repeat in the motion our call for the Government to bring forward £700 million of the funding promised to social care in 2019 to help the NHS and social care systems to cope with the extra pressures this winter. We are also calling for a new, improved settlement for the NHS and social care to be included in the Budget in March, so that we avoid this sort of crisis in future.

Staff in emergency departments are at the sharp end of saving lives. Many other NHS staff save lives, too, but A&E staff are so directly on the frontline. Whether they are working in people’s homes or in care or nursing homes, care staff make a huge difference to the lives of millions of older and vulnerable people, people with disabilities and people with mental health conditions. Those should be the best jobs in the UK, but without the right investment in the funding they need, the people doing them feel undervalued and overstretched. I urge Members to vote for the motion tonight.

Children’s Wellbeing and Mental Health: Schools

Baroness Keeley Excerpts

Tuesday 10th January 2017 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this debate with you in the Chair, Mr Nuttall. I, too, congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing this debate.

We have heard from Members of all parties: my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), who was here for a short while; my hon. Friend the Member for Bridgend (Mrs Moon); and the hon. Members for Taunton Deane (Rebecca Pow), for Bury St Edmunds (Jo Churchill), for Dwyfor Meirionnydd (Liz Saville Roberts), for Macclesfield (David Rutley), and for North Ayrshire and Arran (Patricia Gibson). We have heard much today much about the state of mental health services for children and young people, which was the focus yesterday, and about some of the causes and challenges. I, too, welcomed the Prime Minister’s intervention on children’s mental health yesterday. It was a step in the right direction, but inadequate without work on existing resources, which I will come on to. If mental health treatment is a burning injustice, it needs more than what I have seen summarised as teacher training, a review and a Green Paper.

Providing mental health first aid training in secondary schools will help some young people, but given that 50% of mental health problems start by the age of 14, why is that training not being extended to primary schools? A further commitment could fund a counsellor in every school, as we have heard in this debate when it was discussed by the right hon. Member for North Norfolk. We have also heard about the excellent results of school counselling in Wales.

The Children’s Society has stated that school-based counselling is seen as accessible, non-stigmatising and effective by children and pastoral care staff. As we have heard, it estimates that the additional cost of ensuring a counsellor in every school would be around £36 million; that is an overall £90 million cost when we include the current use of counselling by schools. That is not a great sum and it could make a great difference.

Personal, social, health and economic education should be statutory in our schools. That already has the support of the House. The Chairs of four Select Committees, including the Health and Education Committees, supported that as a

“crucial part of preparing young people for life.”

Importantly, the most recent Ofsted report on PSHE provision found that in two fifths of schools where learning was weak, pupils have gaps in their knowledge

“in the serious safeguarding areas of personal safety in relation to sex and relationships, mental health, and alcohol misuse.”

Does the Minister agree that if the Government are serious about tackling the stigma around mental health, making high-quality PSHE lessons statutory would be a good place to start?

Clearly, schools can play an important role in identifying vulnerable young people who may be living with mental ill health, such as those in care or those who have experienced abuse and neglect. Schools need to be supported to identify and respond to the safeguarding and emotional needs of young people affected by abuse and neglect, yet according to the Children’s Society, less than half of mental health trusts have clear pathways set up for referrals of children who have experienced sexual exploitation. If we think of the number of places in this country where that has been an issue, that is a serious gap.

Given the emphasis on the role of schools, it is deeply worrying that the National Union of Teachers’ analysis of Government figures for the national funding formula consultation found that funding would be cut from a very large percentage—98%—of England’s schools. My hon. Friend the Member for Liverpool, Wavertree, referred to the impact of cuts on schools’ budgets and their ability to fund counsellors. Some Conservative Members feel that their budgets will improve, but for many schools, they will not. Does the Minister agree that putting greater financial pressure on schools will, as we have heard, damage their ability to employ counsellors and take on other vital work to link schools with mental health services?

If schools and teachers take on a role in mental health, they need to be able to make a referral to mental health services quickly. On average, nearly one in four young people are turned away due to high thresholds for accessing services. It is unacceptable that vulnerable young people are turned away from the services they need. When young people do get access to services, they can still experience wide variations in waiting times across the country; average waiting times for treatment range from two weeks in Cheshire to 19 weeks in north Staffordshire. Such disparities must be addressed.

I turn briefly to the issue of young people in crisis waiting long periods for a bed, or being admitted to units hundreds of miles from home; as we know, that includes young people with eating disorders being sent to Scotland for treatment. It is clear that the stress and sense of isolation that that causes can damage a young person’s chances of recovery.

The Prime Minister said yesterday:

“By 2021, no child will be sent away from their local area to be treated for a general mental health condition.”

That is simply not soon enough. Will the Minister tell us whether that target of 2021 for out-of-area bed placements can be brought forward?

I turn now to CAMHS funding and the £1.4 billion of extra funding promised from 2015 to 2020. YoungMinds found, through freedom of information requests, that in 2015-16, only just over a third of clinical commissioning groups had increased their CAMHS spending by the full amount allocated to them, and this year only 50% of the CCGs had increased their spending to reflect the additional funds. As we have heard in this debate, it is totally wrong for such funding to be used for other NHS priorities. We have also heard that it is important that we know what commissioners are spending the CAMHS funding on. The hon. Member for Bury St Edmunds was right to talk about Members of Parliament being able to drill down into CAMHS spending.

There has been an issue with the way that CCGs have reported their CAMHS spending to NHS England. The Royal College of Psychiatrists reported that CAMHS funding ranges from £2 per child per year in NHS Luton to more than £135 per child per year in NHS Birmingham South and Central. When pressed, the CCGs with the lowest expenditure levels said that they had reported only the figure for the additional spending allocated to them, rather than their total CAMHS spending.

In our debate on children’s mental health in October, the Minister talked about delivering “accountability through transparency” on spending. I wrote to her on 7 December about the confusion among CCGs on the figures that they should be reporting on their CAMHS spending. I asked her to investigate and, if necessary, issue guidance so that we have the accurate figures on CAMHS spending that we need if we are to monitor that important area. I have yet to receive a response, so perhaps the Minister will respond on that issue.

Given that one in four young people are being turned away from services, we should be prioritising practical and measurable solutions to make sure that young people who need to access mental health services can do so. The Government can start the improvements, as a springboard from what the Prime Minister covered yesterday, by ensuring that the entire £250 million that was promised in each year of this Parliament is spent as intended. This spending should be ring-fenced for CAMHS and not used elsewhere in the NHS. If the social care precept can be ring-fenced, why not funding for children’s mental health?

Some schools in some parts of the country are doing excellent work on the “Future in mind” programme. In Salford, we have an emotionally friendly schools programme to support our teaching staff. We have approved registers for schools counselling. We have established school champions and young ambassadors for peer support. We are doing a review of transitions from primary to secondary school. We have developed an emotional health directory of services for children and young people, which sets out the services available and resources on websites. We are establishing a rapid response advice line for frontline professionals in schools to give them advice and guidance in times of crisis or if they lack understanding.

So much is going on, but as the right hon. Member for North Norfolk said, things are not even across the country. The Government should make it a priority to ensure that young people have timely access to clinically effective mental health support when they need it. “Future in mind” set out

“A five year programme to develop a comprehensive set of access and waiting times standards”

to bring rigour to mental health. I feel that a five-year programme is too long. It does not seem fair to spend so long developing access and waiting time standards when young people are not receiving the treatment that they need. Does the Minister agree?

Yesterday’s announcement could have been of a counsellor in every school, statutory PSHE and the ring-fencing of funding for children’s mental health. The things that we have discussed in this debate and to which I have just referred would have more impact on the burning injustice of mental health treatment than what has been summarised as teacher training, a review and a Green Paper.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

That is an excellent question. We are doing a number of things. First, we have the Stay Well this Winter campaign, which has a lot of advice to go out to his constituents and all our constituents about how to avoid things that can lead to their having to go to A&E. However, we also urge the public to remember that accident and emergency departments are for precisely that.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

There was no new money from the Government for social care in the local government settlement—just a recycling of money from the new homes bonus to social care, and that is for 2017-18 only. Fifty-seven councils will actually lose funding owing to this recycling. Salford, which was recently praised by the Prime Minister for its integration of social care, will lose £2.3 million due to this inept settlement. Is it not time for the Secretary of State to accept that social care is in crisis and that his Government cannot just dump the issue of funding it on councils and council tax payers?

[Mr Hunt]

I do listen carefully to what the hon. Lady says, because she has campaigned long and hard for social care. However, with respect, I would say to her that she is ignoring one simple fact: there is more money going into social care now than would have been the case if we had followed her advice at the last election. What the Communities Secretary announced was £900 million of additional help over the next two years.

[Barbara Keeley]

The Government’s plans for funding social care look inept because they have tied care funding, which is related to need, to council tax and to deductions from the new homes bonus. Last week’s settlement was a pathetic attempt to deal with a funding gap of £2 billion for social care by recycling £240 million within budgets. The chief executive of the British Red Cross has described the social care crisis as

“a humanitarian crisis that needs urgent action.”

When is the Secretary of State going to take that crisis seriously?

[Mr Hunt]

The hon. Lady talks about council tax, but she does not call out Labour councils like Hillingdon, Hounslow, Merton and Stoke which complain about pressures in the social care system and then refuse to introduce the social care precept that could make a difference to their residents. We are taking the situation seriously. More was done this week and more will be done in future.