Social Care Funding

Baroness Keeley Excerpts

Monday 12th December 2016 Commons Chamber

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

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the crisis in funding in social care, and the effect it is having on the NHS and on the care of vulnerable older people.

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

I thank the hon. Lady for raising today’s question. All Members of this House will agree that there are few areas of domestic policy that touch on so many lives and that are so important to so many of our constituents.

I wish to start by acknowledging the work of more than 1.4 million professional carers, the vast majority of whom provide excellent, compassionate care. I also wish to acknowledge the 6 million informal carers who also do so much.

Spending on long-term care in our country is more than the OECD average—in particular, it is more than comparable economies such as France and Germany. Nevertheless, I accept that our system is under strain, and that pressure has been building for some years now.

The Government response has been to ensure that councils have access to funding to increase social care spend by the end of this Parliament. We estimate that the increase could be around 5% in real terms. Additional funding comes from the better care fund, the additional better care fund and changes to the precept.

Another response has been to put into place and enforce a robust regulatory system. Between 2014 and early next year, all homes and domiciliary providers will have been re-inspected. Seventy-two per cent are classified by the Care Quality Commission as good or outstanding. Where homes are inadequate, powers now exist to ensure improvement or force closure. Those powers are being used.

Another Government response has been to work with local authorities to ensure that a continuing market exists. In the past six years, the total number of beds has remained constant, and there are 40% more domiciliary care agencies now than in 2010. Finally, the Government have responded by driving further and faster the integration of the care and health systems. We have seen that those councils that do that best demonstrate far fewer delayed transfers than those who adopt best practice more slowly.

Any system would benefit from higher budgets, and social care is no exception—but quality matters too. Today is not a budget statement or a local government settlement. I wish to end by commending again the many hundreds of thousands of carers who work hard to make the current system work for so many.

[Barbara Keeley]

That was a disappointment. Before the autumn statement, we debated the funding crisis in social care—it is not a strain but a crisis—and the serious concerns expressed by local government health and clinical leaders. We on the Labour Benches called on the Government urgently to bring forward promised funding to address that crisis. The Chancellor did not listen and did not bring forward any funding for social care—he did not even mention it. Will the Minister tell us in his response why Health Ministers do not stand up for vulnerable and older people in this country and fight harder to get extra vital funding for social care?

Over 1 million older people in this country have unmet care needs, 400,000 fewer people have publicly funded care than did so in 2010 and, as he recognises, a heavier burden now falls on unpaid family carers. The crisis in social care has been made by this Government as a result of £5 billion being cut from adult social care budgets. Can the Minister confirm what is reported by The Times—that the Government intend to dump this funding crisis on local councils and council tax payers by increasing the social care precept?

The King’s Fund has called that proposal “deeply flawed” because local councils in the least deprived areas would be able to raise more than twice as much as those in the most deprived areas. This year that means that the precept raises £15 per head of the adult population in Richmond, but only £5 per head in Newham and Manchester. That would widen inequality of access to social care across the country. Is it the care Minister’s intention to support a solution that widens inequality of access and denies social care to hundreds and thousands of vulnerable older people?

[David Mowat]

The hon. Lady fought the last election on a manifesto that said not one penny more for local government spending. She is against the change to the precept that we brought in in the spending review. She talked this morning about being against taxpayers and council tax payers having to meet the cost of increased social care. That raises the question who she thinks should be paying for it. Is it borrowing, or is it the magic money tree? She said that the precept increases inequalities because some councils are able to raise more than others from it. That would be true, if it were not for the fact that the additional better care fund is distributed in a way that balances that. That is precisely what we do.

Social Care

Baroness Keeley Excerpts

Wednesday 16th November 2016 Commons Chamber

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

I beg to move,

That this House notes the serious concerns expressed about the social care system, including by the Local Government Association, The Association of Directors of Adult Social Services and the Care Quality Commission; calls on the Government to urgently bring forward promised funding to address the current funding crisis and to put in place a longer-term settlement to ensure that the social care system is sustainable going forward; and further calls on the Government to ensure that the most vulnerable in society are guaranteed the adequate and sustainable care they deserve.

The Government amendment

“commends the work and dedication of those in the social care sector”.

I join the Government in that. It might be the only part of their amendment I support. It is right that we praise our care staff. Unison the union had a meeting here today with care staff from a London borough and from Leicestershire. They talked about the difficult financial situation facing care services. Some care providers are not paying a decent wage. I heard all about that from the care staff from the London borough. Care staff receive less than the national minimum wage. They are not paid for travel time and they are not paid the correct rate if they sleep over. We should value our care staff more highly, we should pay them properly, we should train them, and they should know that they do a valued job. I pay tribute to the care staff I met today. I hope that other hon. Members also attended that event and met the same care staff and that they read Unison’s report, which is called “Care in Crisis”.

Social care is “in crisis” owing to a lack of funding. So says the Conservative leader of the Local Government Association’s community wellbeing board, Councillor Izzi Seccombe, who says that

“it is no exaggeration to say that our care and support system is in crisis.”

Richard Humphries, of the King’s Fund, talks of

“a deeper existential crisis of care”.

The Care Quality Commission says that the sustainability of social care is seen as “approaching tipping point”. Ray James, of the Association of Directors of Adult Social Services, says that

“the Government must face up to the reality that social care is in crisis now and provide immediate funding to stabilise the sector.”

On the priority of providing extra funding for social care, NHS England chief executive, Simon Stevens, says that

“there is a strong argument that were extra funding to be available…we should be arguing that it should be going to social care.”

I could go on. Googling the words “social care funding crisis” returns 2 million results.

[Alex Cunningham (Stockton North) (Lab)]

It is stating the obvious to say there is insufficient money going into the system, yet we have private companies taking huge profits out of the system as well. Will my hon. Friend join me in commending Stockton-on-Tees Borough Council for setting up a not-for-profit organisation to ensure that the money goes into services instead of shareholders’ pockets?

[Barbara Keeley]

I certainly will join my hon. Friend in commending the council. It is one of the things we talked about to the care staff today. Why should people be paid vast profits from public money, when care staff are so badly paid?

The reasons for the social care funding crisis are clear: insufficient funding in the face of growing demand and a fragile market in the provision of social care. We know that people are living longer and that demand on social care services continues to increase. People aged 85 and over are the group most likely to need care, and their numbers are projected to rise sharply in the coming years. Moreover, the gap between need and funding has grown wider since 2010.

[Robert Flello (Stoke-on-Trent South) (Lab)]

The sustainability and transformation plan for Staffordshire, some of which has been leaked to me, NHS England and NHS Improvement having categorically refused to make it available to Members of Parliament, shows a deficit for Staffordshire over the coming years of more than £250 million. Is that not appalling?

[Barbara Keeley]

It is dreadful. The deficit in Greater Manchester is £1.75 billion, so the problem is the same up and down the country.

We have had six years of Government cuts to local authority budgets, and that has seen local authority spending on the care and support needs of older and disabled people fall by 11% in real terms. In fact, the number of people getting publicly funded support has plummeted: 400,000 fewer now than in 2009-10. Such facts are shocking, but behind the statistics are real issues: the impact that cuts to social care are having on the NHS, on people who need care and on unpaid family carers.

First, I will deal with the issues that the crisis in social care causes for the NHS. As the Nuffield Trust states:

“Hospitals have struggled to meet the needs of the older age group in a timely way, in both emergency departments and inpatient admissions”.

The most visible manifestation of the pressures caused by cuts to social care budgets is the rapid growth of delayed transfers of care from hospital. The September figure of over 196,000 delay days is another record—the highest figure for six years—and it comes not in winter but at the end of summer. That means for the NHS 6,700 patients stuck in hospital. The most common causes are waiting for a care home placement and waiting for a nursing home placement.

The funding that was supposed to help with these issues is the better care fund, but there is no extra funding for social care in the fund this year and only £100 million next year.

[Karin Smyth (Bristol South) (Lab)]

My hon. Friend is making an excellent speech. Does she agree that it would be useful to remind Conservative Members of the Conservative party manifesto? Page 65—I do not want anyone to struggle to find it—outlines the promise to the people concerned. It says that they would not have

“to sell their home to pay for care”,

and that there would be a cap on charges to give people “peace of mind” and protection. All that is in the Conservative party manifesto—“peace of mind” and protection “from unlimited costs”. It amounts to a cruel disservice to that generation that the Government went back on that promise just two months into this Session.

[Barbara Keeley]

It is, and I agree with my hon. Friend that care costs are just running away with themselves, making the situation much harder for people.

The bulk of the extra funding that the Government promised to social care from the better care fund comes in 2018-19 and 2019-20. We have had six years of cuts to local authority budgets, and the extra funding promised for social care is backloaded to those later years in this Parliament.

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

The hon. Lady mentioned the most common causes of delayed transfers of care. However, I know that in hospitals in Kent near my constituency, around 30% of the delayed transfers of care are attributable to delays in social care and the majority are for other reasons. Does she not agree that it is important for the NHS to take its own steps within its own organisations to improve people’s discharge from hospital?

[Barbara Keeley]

That is what we are debating. Of course the NHS should put its own house in order, too, but delays should not happen on account of social care. People should not be stuck for weeks or months in hospital, waiting for a care home placement or a nursing home placement. I shall go on to say why.

Returning to the issue of the backloading of funding, in view of what was happening to social care, the Local Government Association and the Association of Directors of Adult Social Services appealed before the last autumn statement for £700 million of the promised better care funding to be moved forward to this year and next year. That appeal was ignored. Reacting to that, Ray James of ADASS said:

“Ministers must know that their proposals do not deliver sufficient funding to meet the growing number of older and disabled people requiring increasingly complex care and support…The Council Tax precept will raise least money in areas of greatest need which risks heightening inequality. Councils in deprived areas will have greatest social care needs, yet they will raise less than a third of what more affluent areas do through this approach.”

He went on by clarifying that ADASS does

“not believe that the funding for the next couple of years will anywhere near meet the costs of the national living wage and the increasing demand for social care.”

[Diana Johnson (Kingston upon Hull North) (Lab)]

In my Hull constituency, not only have we seen massive cuts to the local government budget since 2010, but the precept that we can raise—2%—is much smaller than the gap in the budget for social care. By comparison, wealthier areas of Yorkshire such as East Riding are able to raise far more, so this is a double whammy for deprived areas.

--- Later in debate ---

[Barbara Keeley]

It is indeed. The gap in my Salford local authority area is £1.1 million. We can raise only £1.6 million from the social care precept, while just paying the national living wage in the care sector is costing us £2.7 million.

Let me return to the matter of where the promised funding sits. In our motion, we call on the Government once again

“to bring forward promised funding”

for 2019-20

“to address the current funding crisis”

in social care. I am sure that the Health Secretary hears plenty about the impacts on the NHS of the missing funding for social care, but let us also think about the impacts on the people who actually need that care.

The hon. Member for Faversham and Mid Kent (Helen Whately) mentioned the thousands of patients stuck in hospital. We should be aware that keeping them there longer than necessary can have a number of detrimental effects. Long stays can affect patient morale and patient mobility, and of course increase patients’ risk of catching hospital-acquired infections.

Effects on mobility can be particularly keenly felt by older patients. As Professor John Young said in the 2014 national audit of intermediary care:

“A wait of more than two days negates the additional benefit of intermediate care, and seven days is associated with a 10% decline in muscle strength.”

As my hon. Friend the Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, observed when the Committee published its own report on discharging older people from hospitals:

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

Cuts to the funding of social care also affect a larger group of older and vulnerable people, and those cuts are now having a major impact on family carers. Age UK estimates that more than a million older people in England are living with unmet social care needs. I was struck by what the Unison staff told me about the many people they see during their care visits who are lonely and isolated.

Social care services have clearly failed to keep pace with increasing demand. Carers UK tells us that the drop in social care support, in the context of the increasing needs of our ageing population, is having a profound impact on the unpaid family carers who are stepping in to provide more care than ever before. It also tells us that the increase in the number of people providing care, and the increased number of hours of care that they provide, are being delivered at a huge personal cost to those family carers if they are not well supported—as, in all too many cases, they are not.

[Maria Caulfield (Lewes) (Con)]

The hon. Lady is making a case for more funds for social care. May I ask how the Labour party would raise that money? Would it give more to local authorities, or would it increase council tax precepts further?

[Barbara Keeley]

Our motion asks for promised funding that is backloaded to 2019-20 to be moved forward. The LGA and ADASS wanted it to be moved last year, and that is what we keep asking for.

[Maria Caulfield]

I thank the hon. Lady for giving way again; she is being extremely generous. Will she tell me, however, whether she is committing her party to delivering that money to local authorities directly, or to allowing them to increase their precepts?

[Barbara Keeley]

We do not even know what the Chancellor is going to do next week. The hon. Lady has invited me to make a declaration today, and it was a nice try, but we did not hear a word from Ministers about their plans during Health questions yesterday. I will, however, make what I think is an important point to the hon. Lady and to any other Member who raises the same issue. Labour would not have put our councils in this position to start with. If the hon. Lady looks back at our spending plans, or looks at the analysis by the Institute for Fiscal Studies relating to the different parties, she will find that our plans meant that we did not have to make the cuts that her party has made. This Government’s cuts will take £5 billion out of social care. I will send her the link to the IFS analysis if she wants to read it.

[Toby Perkins (Chesterfield) (Lab)]

My hon. Friend is making a powerful case. The scale of the crisis in some areas is very serious, and it will become even worse following the increase in the minimum wage. Although that increase is welcome, if the local authorities do not have the budgets to cover it, the crisis will be exacerbated.

Is my hon. Friend aware that many providers in both the private and the charitable sectors are returning council contracts? They are saying, “We can no longer make this pay; in fact, we will go bankrupt if we carry on servicing the council.” That is adding to the current problems.

[Barbara Keeley]

My hon. Friend has made a key point. I have already mentioned the fragility of the care market. We shall not be able to explore that fully during my speech, but it is a serious factor. If we do not get the funding right, more and more care providers will simply walk away. At the Unison meeting, members of a Leicestershire rehabilitation team spoke of the problems that they experience when care providers walk away from a contract. When the staff are not there any more, they have to plug the gaps.

[Mr Clive Betts (Sheffield South East) (Lab)]

The Communities and Local Government Committee is conducting an inquiry into the funding of social care. We have learned that not only are care providers handing contracts back, but councils are terminating contracts because of the inadequacy of the care that is provided. Ultimately, that means that individuals do not receive the care that they should be receiving. Their appointments are cancelled, or there are flying visits from under-trained care workers who are paid less than the minimum wage.

[Barbara Keeley]

My hon. Friend is right, and I shall come to that point shortly.

Carers UK reports that insufficient support from health and social care services is leaving the carers who are doing all that extra work

“isolated, burnt-out and unable to look after their own health.”

The Richmond Group of Charities published the story of Susan. She cares for her husband Bruce, who has been diagnosed with both Parkinson’s and dementia. The struggle that Susan underwent to find quality care is one about which I have been hearing from carers for some time. She was provided with respite care from a care home which was of such low quality that her husband was unrecognisable when she returned for him:

“He hadn’t been shaved, he couldn’t walk, and his eyes were crusted…with blepharitis.”

When Susan managed to get home care for her husband, it was also poor quality. She said:

“They didn’t know what they were doing. It seemed like they’d never cared before. They turned up at five o’clock in the afternoon to put my husband to bed. Or they turned up at ten, once I’d already helped him to bed. Absolutely awful.”

It is also telling how carers like Susan feel when dealing with the challenges of negotiating complex and fragmented care systems. She “felt small” and she said:

“You go in there, and you’ve got no idea about anything, about care. It’s like going in on the first day at school.”

Susan is not a rare case of a carer battling to get respite care or home care of an acceptable quality. Carers UK tell us that three out of 10 carers in its survey have experienced a change in the amount of care and support services that they receive. Six out of 10 of those carers experiencing a change said the amount of care and support received had been reduced.

[Norman Lamb (North Norfolk) (LD)]

The hon. Lady argues for bringing forward funding, and I agree. Does she agree, however, that that is not enough in itself and that all of us on both sides of the House must confront the chronic underfunding of the health and care system, and we need to find ways to raise significantly more resources to ensure we have a modern and efficient health and care system?

[Barbara Keeley]

I agree, and our motion talks about the need for

“a longer-term settlement to ensure that the social care system is sustainable going forward”.

We absolutely do need that.

On quality of care, I was talking about Susan finding a care home and it giving inadequate care. There are too many such care homes. In its 2016 “State of Care” report, the Care Quality Commission said that when it makes a return visit to a service originally rated as “inadequate”, one quarter of those services were not able to improve their ratings. Susan found poor-quality home care, and last week the ombudsman reported that the number of complaints about homecare is rising and that the number of complaints upheld by the ombudsman is also rising.

[Dr Sarah Wollaston (Totnes) (Con)]

I agree with the right hon. Member for North Norfolk (Norman Lamb) on the need for cross-party working to achieve sustainable funding for both health and social care. As the hon. Lady will know, I have set out my concerns about the underfunding of social care in a letter to the Chancellor. Does she agree that it is not just about funding, however, but also about how we support and train our social care staff? Would she like to see further progress made on the recommendations of Camilla Cavendish about how we train and support our care staff to help to retain them as well as recruit them?

--- Later in debate ---

[Barbara Keeley]

I agree, and that is why I started my speech by saying we should value the job our care staff do and we should train them properly; it should be a proper job with a proper career path. The care staff I met today were reduced to worrying about what they were being paid, however, simply because they were paid less than the minimum wage.

This is what six years of funding cuts to social care actually mean for people who need care and their carers: unmet needs for care; patients stuck in hospital, increasingly because they have to wait for a care home or a nursing home place; poor care in care homes, with one quarter of “inadequate” services unable to improve; poor home care, with more complaints being upheld by the ombudsman; more unpaid family carers having to step in to care; more unpaid family carers having to provide increased levels of care; and, without the right support, those family carers becoming isolated, burnt-out and unable to look after their own health. That is a disturbing deterioration in the state of social care. I want the Secretary of State to tell us whether he recognises the scale and seriousness of the issues I have outlined.

[Mrs Madeleine Moon (Bridgend) (Lab)]

As chair of the all-party group on Parkinson’s—and motor neurone disease—I have had repeated complaints about the 15-minute calls that local authorities are being forced to introduce because of cuts in their social care allowance. They mean that people are neglected: carers literally run in, and, if the person cannot communicate or has poor mobility, the quality of their care is appalling.

[Barbara Keeley]

It is indeed. There are many examples of that, and we have debated them here many times. The funding crisis is at the base of all this.

I repeat what I said at the start of my speech: social care is in crisis due to a lack of funding. It is notable how many leading doctors, health experts and organisations involved with the NHS are now expressing their concerns and fears about social care and the lack of funding for it. Here are some of those people: Simon Stevens, chief executive of NHS England; Miss Clare Marx, president of the Royal College of Surgeons of England; Professor Dame Sue Bailey, chairwoman of the Academy of Medical Royal Colleges; Dr Suzy Lishman, president of the Royal College of Pathologists; Professor Carrie MacEwen, president of the Royal College of Ophthalmologists; Professor Neena Modi, president of the Royal College of Paediatrics and Child Health; Professor David Oliver, president of the British Geriatrics Society; Dr David Richmond, president of the Royal College of Obstetricians and Gynaecologists; Professor Sir Simon Wessely, president of the Royal College of Psychiatrists; Dr Anna Batchelor, dean of the Faculty of Intensive Care Medicine; Dr Liam Brennan, president of the Royal College of Anaesthetists; and Professor Jane Dacre, president of the Royal College of Physicians. All those people have expressed their fears and concerns about social care and the lack of funding for it.

I should like to add to that list some of the organisations working in the NHS and social care that are now expressing their serious concerns about the funding of social care. They include: the King’s Fund, the Nuffield Trust, the Health Foundation, the Local Government Association, the Association of Directors of Adult Social Services, the County Councils Network, the BMA, Care England, Unison, Age UK, the Alzheimer’s Society, the British Red Cross, Carers UK, Independent Age, United for all Ages, the Learning Disability Coalition, the Motor Neurone Disease Association, and the Care and Support Alliance. Those people and those organisations share a belief that the Government must act now on social care funding, and I urge hon. Members on both sides of the House to support our motion and vote to save social care tonight.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 15th November 2016 Commons Chamber

[David Mowat]

My hon. Friend is right that there was an inadequate CQC rating for that care home. It is therefore right that the care home must either improve or go out of business. That is what the CQC regulatory environment will ensure. She makes a point about the issue with the hospital in Paignton; that is out for consultation at the moment, and I would expect the local care situation to be part of that consultation.

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

The National Audit Office report “Discharging older patients from hospital” said that

“there are…far too many older people in hospitals who do not need to be there”.

Delayed discharges reached a record level in September. The Minister says that this is complex, but I can tell him that the main drivers for that increase were patients waiting for home care or for a nursing home place; those issues are both related to the underfunding of social care. Does he agree with NHS England chief executive Simon Stevens that any extra funding from Government should go into social care?

[David Mowat]

As I said earlier, we accept that the system is under pressure, but we also make the point that there is a massive disparity between different councils. Some 13% of local authorities cause 50% of the delayed transfers of care—DTOCs. The real point is that those local authorities that go furthest and fastest in integration, with trusted assessors, early discharge planning and discharge to assess, have the most success.

Social Media and Young People's Mental Health

Baroness Keeley Excerpts

Wednesday 2nd November 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for Cheltenham (Alex Chalk) on securing this important debate. I draw attention to the contributions made by my hon. Friends the Members for Neath (Christina Rees) and for Ogmore (Chris Elmore). There is not enough time for me to mention everybody who spoke because, as usual at the end of these short debates, we are tight for time, but I particularly thank the hon. Member for West Aberdeenshire and Kincardine (Stuart Blair Donaldson). He spoke of a painful experience, which is always so difficult to do.

Young people are growing up in an age in which online culture and social media are so central to everyday life. That is particularly true of social networking sites, to which more than 85% of children now belong. We have heard some interesting statistics relating to that throughout the debate. Commenting on social media and mental health, the Children’s Commissioner said:

“Excessive use of social media has been linked to poor mental health…When combined with bullying it can have a terrible effect.”

Consultant child and adolescent psychiatrist Dr Sebastian Kraemer gave evidence to the Health Committee as part of the inquiry into young people’s mental health mentioned by the hon. Member for Cheltenham. On the impact that digital culture can have, he said:

“It makes intimidation more alarming and more chronic. You can be teased in the playground and it has gone with the wind, but if you have got your photograph on Facebook then it stays there forever…The medium is not the cause, but it certainly facilitates different ways of harming each other, of abusing each other, and that is what young children do.”

Parents are seeing the link. In a survey of more than 1,000 parents with children under 18, four fifths blamed social media for making their children more vulnerable to mental health problems. It seems that the excessive use of social media can be linked to depression and can play a role in heightening underlying anxieties and lowering self-esteem—we have heard about some interesting cases.

These days, there is much concern about body image and appearance, which is another potential cause of anxiety and low self-esteem. It is clear that social media can intensify such feelings. A small study in the United States found that teenagers were affected by the “like” culture, with photos with more likes being more attractive to them. This like culture was found to affect self-esteem, as the hon. Member for Cheltenham and my hon. Friend the Member for Ogmore both said.

The damaging impact of social media has been seen as one of the causes leading to the increase in the number of children and young people self-harming in the past 10 years. ChildLine has seen a 35% increase in the number of contacts from young people with anxiety. That increase has been linked to the rise of social media, which has increased the pressure to attain a so-called perfect life. With increasing numbers of young people self-harming or being diagnosed with depression or anxiety, will the Minister tell us what action is being taken to understand the possible links between social media and depression, anxiety and other mental health issues? I agree with the hon. Member for Cheltenham that we need a robust strategy and some research that proves the links.

We have heard much about cyber-bullying, which is a growing problem, with more than one in 10 young people admitting they have been affected by it. We heard about Declan; I am very glad to hear that he has moved past the bullying phase that was so affecting him. Bullying UK found that 43% of young people aged between 11 and 16 had been bullied via social networks. Bullying has been found to be a factor associated with children’s mental health issues. One study reported by the Office for National Statistics found that children who had been bullied at 13 were more than twice as likely to have depression at age 18.

Stress and anxiety have also been linked to cyber-bullying. Will the Minister outline what action the Government are taking to tackle cyber-bullying and what measures will be put in place to help young people who are affected? Following the debate on young people’s mental health in the main Chamber last week, my concern is that help is not getting through to children before mental health problems escalate. Indeed, in 2015 the Children’s Commissioner found that one in four young people experiencing serious emotional or psychological problems were being turned away from specialist mental health treatment.

Early intervention can help. Lorraine Khan of the Centre for Mental Health said:

“There is good evidence for a range of interventions to boost children’s mental health, and the sooner effective help is offered the more likely it is to work.”

However, Government cuts to local authority budgets have meant the loss of services for children and young people. Cuts have been made to the numbers of social work staff and educational psychologists, and to mental health services in schools, leading to a reduction in care and support for young people. In the face of such cuts to early intervention and prevention services, will the Minister outline what steps are being taken to develop better early intervention?

From pressures about body image to cyber-bulling and the pressures caused by social networking sites, it is clear that we need to do more research on the impact that social media are having on young people’s mental health. Although Ministers have pledged extra funding for mental health services, we know it is not reaching the front-line services that children and young people need. Schools and colleges must be supported to help their students to cope with the challenges of online culture that we have heard about in this debate. The internet and social media are clearly here to stay, so it is vital that the Government ensure that young people receive the help, support and guidance that they need in this digital age.

[Sir Alan Meale (in the Chair)]

Before you begin, Minister, may I ask you to be so kind as to consider leaving up to a minute at the end of your speech for Mr Chalk to sum up?

Young People’s Mental Health

Baroness Keeley Excerpts

Thursday 27th October 2016 Commons Chamber

[Tim Loughton]

The hon. Gentleman is right; he pre-empts a couple of my comments. From my experience as a former Minister—and, I am sure, from his—the term “joined-up government” is a complete illusion. Joined-up government does not happen in practice. On becoming a Minister, one is cocooned in a Department, and instead of having a dialogue with colleagues in the Division Lobby or wherever, a huge wall suddenly comes between you. Trying to get interdepartmental action becomes really frustrating.

I remember setting up something called the youth action group, which consisted of Ministers from nine or 10 Departments and representatives of six major children’s charities. It was co-chaired by the Prince’s Trust and Barnardo’s. The charities came to us with problems—often complex ones—affecting young people. One example related to housing benefit and accommodation for children in care. I cannot remember what the specific problem was, but it involved housing, which was the remit of the Department for Communities and Local Government, and benefits, which were the remit of the Department for Work and Pensions, as well as children in care, who came under the remit of the Department for Education. Normally there was a vicious circle that involved people being pushed from pillar to post. Alas, that committee has not met for the past 15 months or so, but our meetings used to consist of at least six actual Ministers—not just civil servants—from the relevant Departments as well as their officials. We would get Ministers together and ask them to go away and solve the problem.

Mental illness falls into that category, in that it is not simply the remit of the Department of Health or the Department for Education. There are many other implications and knock-on effects that can relate to the underlying cause of somebody’s mental illness problems. The hon. Gentleman is absolutely right that the structure of government needs to be much better. We need taskforces that genuinely cut across Government Departments, but in my experience they will flourish only if they have the buy-in and direct engagement of Ministers at the top. One welcome initiative from the hon. Gentleman’s party was the appointment of a Cabinet-level Minister for mental health. I think that that appointment has slightly gone by the wayside now, but the principle behind it was absolutely right, in that it tried to join up all the relevant Departments at the top table.

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

May I remind the hon. Gentleman that I am the shadow Cabinet Minister for mental health? That post has not gone away on this side of the House.

[Tim Loughton]

I am delighted to hear that; I did not in any way mean to underestimate the hon. Lady’s contribution. However, when the hon. Member for Liverpool, Wavertree (Luciana Berger) held the position, she sat at the Cabinet table. I hope that that is still the case, and I would very much like to see my own party replicate that position in government, because this is such an important cross-cutting issue.

Mental health remains the Cinderella service of the NHS. Indeed, the report describes child and adolescent mental health services—CAMHS—as the Cinderella service of a Cinderella service. The whole question of parity of esteem and funding is important. We can have arguments about how much the NHS budget has increased and kept up with inflation, but in every year in which the funding for mental health remains static or, worse still, declines as a portion of the overall NHS budget, we are sending out a clear message that it is a secondary priority within the NHS, and therein lies part of the problem.

I do not want to be too negative, however. We are making progress, as are other countries. For example, when you go in through the main entrance of a hospital in Copenhagen, in Denmark, you turn left if you have diabetes and you turn right if you have a mental illness. And nobody cares whether you turn left or right; there is no stigma attached to mental illness. People are treated on exactly the same basis, and that is how we need to treat mental illness here. Despite the best intentions of many Ministers, that is just not happening in practice at the sharp end where our young constituents are trying to access the mental health support that they desperately need. It is certainly not happening in a uniform way across the whole country. As a result, at least one in four people in this country is still suffering from a mental health problem.

I have a particular interest in perinatal mental health, and I declare an interest in that I chair the all-party parliamentary group for conception to age two—the first 1,001 days. I am also chairman of the trustees of the Parent and Infant Partnership Projects charity. We now have seven parent infant partnerships—PIPs—across the country providing direct support and specialist perinatal psychological help to mums and dads with newborn babies. About half of all cases of perinatal depression and anxiety go undetected, and many of those that are detected fail to receive evidence-based forms of treatment. Alarmingly, at the time of the publication of the all-party group’s report, “Building Great Britons”, in February last year, just 3% of clinical commissioning groups in England had a strategy for commissioning perinatal mental health services. The upshot of all that, as the Maternal Mental Health Alliance has calculated, is a cost to the NHS of £8.1 billion for each one-year cohort of births in the United Kingdom. That is the equivalent of almost £10,000 for every single birth in this country, and it is a cost that the NHS can ill afford.

Why is this relevant to young people? Nearly three quarters of that cost relates to the adverse impacts on the child rather than the mother. Followers of attachment theory, which the hon. Member for West Ham (Lyn Brown) mentioned, will appreciate the strong link between achieving a strong attachment between the child and the primary carer and good nurturing from the earliest age—that is, from conception to the age of two, as our report puts it—when the synapses in the brain are developing at a rate of some 40,000 a second and the child’s brain, character and development are being formed. The earliest experiences shape a baby’s brain development and have a lifelong impact on that person’s mental and emotional health.

Research shows a direct link between what happens to a mum during the perinatal period and her child in later life. If a teenager aged 15 or 16 is suffering from some form of depression, there is something like a 90% chance that his or her mum suffered from perinatal depression. The link is that clear, so it is absolutely a false economy not to help mum out at that early stage. And let us not forget dad, who also plays a crucial role. Getting it right with parents and children early on is crucial to the good mental health of children and young people. This is not rocket science—technically it is neuroscience—and we should be doing it better, sooner.

Certain other factors have been flagged up in the report. My hon. Friend the Member for High Peak (Andrew Bingham) spoke about many of them, including the peer group pressure that our children and young people experience. In fact, I have no children any more. My youngest is now over the age of 18, but we went through the teenage years together and I have seen these things at first hand. No one can go out in the morning without the latest iPhone, without checking Facebook and without tweeting what they are having for breakfast and Instagramming a photograph of it. And that all happens just after they have got up. The pressure to succeed in school and the hothouse of exams and testing are not conducive to the best mental health, and young people need support to help them through the challenges. We never had those challenges in my day, which I guess was even earlier than that of my hon. Friend the Member for High Peak. Social media is a huge influence on young people, and it was just not around in my day. I would hazard a guess that it was not around in your day either, Madam Deputy Speaker.

--- Later in debate ---

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

It is a pleasure to speak in this important debate on the Youth Select Committee’s report, “Young People’s Mental Health”. I too want to thank the Backbench Business Committee for allocating time for the debate, but I agree with the Conservative Members who suggested that this matter should have been debated in Government time. We must underline the importance of this report.

I congratulate my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) and the hon. Member for South Cambridgeshire (Heidi Allen) on securing the debate. My hon. Friend talked about the focus on the need for early intervention, as did many other Members. She also talked about the need for beds, saying that sending seriously ill young people away from home had to stop. I think we all support that view. She made it clear that, in her view, the state of the service was a national scandal, and she raised a number of points that we hope the Minister will respond to. They included the recommendations for ring-fenced funding for CAMHS and for co-production involving young people in the design of CAMHS, and the need to improve mental health education in schools. I will talk about those issues as well. My hon. Friend also referred to the notion in the YMCA report on stigma, “I am Whole”, of young people feeling as though they are

“trapped inside a thousand invisible prisons”.

We should keep that in mind.

The hon. Member for High Peak (Andrew Bingham) acknowledged the legitimacy of the Youth Parliament. He also talked about the pressures on young people and related that back to his own experience when he was young. That has been a bit of theme in this debate. My hon. Friend the Member for West Ham (Lyn Brown) stressed the need for early intervention. That subject that has come up many times today, and quite rightly, because early intervention can decrease the severity of mental ill health. She made a powerful case for the Government’s funding pledges to be fulfilled.

The hon. Member for East Worthing and Shoreham (Tim Loughton) talked about the importance of the status of the report and rightly said that it should have been debated in Government time. I am glad to have his support for the fact that Labour has a shadow Cabinet Minister for mental health, which is me. It is interesting that the Scottish National party Government also have a dedicated Minister for mental health. I think we are moving towards a position in which that is seen as something to be supported. The hon. Gentleman also talked about the effect of the pressures of social media on the mental health of young people. It is interesting to note that we shall debate the impact of social media on the mental health of young people in Westminster Hall next Wednesday.

My hon. Friend the Member for North Durham (Mr Jones) talked about the real problems that parents and grandparents face in navigating mental health services. He talked about commissioning and made some important points about the difficulty of working through GPs in our medical model. He also talked about local government cuts and said that they were a false economy. I shall talk about that as well. He also talked about the need for open-access services, given the difficulty in navigating the system.

The hon. Member for Wealden (Nusrat Ghani) talked about a teenager with an eating disorder, the suicide rate and the problems faced by young men. Although there is a focus on the impact on women of mental health issues, young men are also badly affected.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) talked about access to mental health specialists in schools and training for staff, which has been a theme this afternoon. She also mentioned the need to modernise approaches. We keep hearing about the importance of IT and social media, and she referred to the SafeSpot app. Like several hon. Members, she also talked about online bullying.

The hon. Member for Bexhill and Battle (Huw Merriman) is back in the Chamber. He came out of a Bill Committee to speak today and regards this topic as very important. His clear commitment to mental health was shown by it being the subject of his first question at PMQs. He also talked about social media and the need for early intervention.

I did not know that my hon. Friend the Member for Ilford North (Wes Streeting) was elected an honorary president of the British Youth Council. He quite rightly thanked the Speaker for his support for the British Youth Council and the Youth Parliament. It is important, as he has done, to listen to young people’s concerns about mental ill health because that can lead to open, candid and courageous discussions. It is good that groups of young people can become more at ease with discussing mental health—there is hope for the future. He also talked about the exceptionally high incidences of mental health issues among LGBT young people, including high rates of self-harm and suicide. He referred to the poor standards of care at Brookside adolescent unit. It took a damning report from the CQC to highlight its problems, the consequence of which was the death of the young man Simon.

My hon. Friend the Member for Neath (Christina Rees) gave us the first speech of Matthew, a member of the Youth Parliament who works in her team, and talked about the lack of full and proper support for young people’s mental health. She also mentioned the difficult experience of a young person who had to visit the GP seven times before getting help and felt crushed by the lack of support. Like other Members, she referred to training for teachers and having a trained counsellor in every school.

My hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury) talked about hospital wards not being safe for young people with mental health problems. A headteacher in her constituency reported having three children sectioned from school, which is a sobering thought indeed.

The hon. Member for Linlithgow and East Falkirk (Martyn Day), the SNP spokesperson, talked about many local groups. It is a sign of the difficulties facing support within the NHS that there is a need for all the groups he mentioned.

Before I move on, I want to pay tribute to the work of my predecessor, my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger). She has campaigned tirelessly for improvements to the mental health system. Her work helped to raise the profile of many issues that had not previously been given the attention they deserve. I join other Members in congratulating the Youth Select Committee on its excellent report.

The Secretary of State for Health recently admitted to failings in mental health services for children and young people. He said:

“I think we are letting down too many families and not intervening early enough when there is a curable mental health condition, which we can do something about when a child is eight or nine, but if you leave it until they are 15 or 16, it’s too late”.

People working in mental health services know all too well the truth of what the Secretary of State says. We know that on average one in four people experience a mental health problem, that 50% of adult mental health problems start before the age of 15, and that 75% start before the age of 18. Yet just 8% of our mental health budget is spent on children, with CAMHS, which have been referred to extensively, representing just 1% of the NHS budget. Members have quite rightly referred to that as the Cinderella of the Cinderella service. Does the Minister agree that 8% is far too small a proportion of the budget to spend on youth mental health, and does she agree that more needs to be done to intervene earlier when mental health issues are involved? Demand is clearly outstripping supply. Demand for child and adolescent mental health services is growing, but Government action is not meeting that demand. Funding for overstretched mental health services is not reaching the frontline, where it is so badly needed.

As my hon. Friend the Member for North Durham said, essential support services are being lost as a direct consequence of Government cuts to local authority budgets. Ofsted has reported that between 2010 and 2015 there was a 38% cut—£538 million—in funding for children’s centres, and a 53% cut, which is £623 million, in funding for youth services. Very many children and young people are not receiving the help that they need until they reach crisis point, and those cuts in local authority services are part of the problem. By failing to address these critical issues, Ministers are letting down vulnerable children and young people.

Sarah Brennan, the chief executive of Young Minds, has said that children’s mental health services have been “woefully” underfunded for years and that:

“While the government’s extra investment is welcome, it’s unclear whether it’s making a difference to frontline services. Even if the new money is spent where it’s intended, the Chief of NHS England has admitted that it will only be enough to reach a third of the children who need help.”

She goes on to say:

“Because of long waiting lists the threshold for accessing specialist services has got higher. Without treatment, problems are very likely to escalate and children are more likely to self-harm or become suicidal, to be violent and aggressive, or to drop out of school, which can ruin their prospects for the future. Delays can also have a disastrous effect on families, with parents forced to leave their jobs to look after their children”.

A report for the British Medical Association underlines that by telling us that the number of young people aged under 18 attending accident and emergency because of a psychiatric condition more than doubled between 2010 and 2015. The number of children and young people self-harming has also risen dramatically in the past 10 years, with the upward trend more pronounced among girls and young women. We have heard examples of that in the debate.

The number of referrals to child and adolescent mental health services increased by 64% between 2012-13 and 2014-15, but 28% of children and young people referred to CAMHS were not allocated a service. Members have referred to that fact in this debate. A report by the Children’s Commissioner found that 79% of CAMHS imposed restrictions and thresholds for children and young people accessing their service—I could go on. We have a tale in this debate of an increasing number of referrals to CAMHS, high thresholds for care and long waiting times. What all those things mean is that many children and young people are not receiving help.

Let me come back to the Secretary of State, because in reference to the quality of care that CAMHS teams provide, he said:

“I think this is possibly the biggest single area of weakness in NHS provision at the moment.”

Does the Minister recognise that the statistics we have heard in this debate show that demand for mental health services has clearly outstripped supply? Can she tell us what actions Ministers plan to take to address those issues?

I want to talk about regional variation, because it is an important aspect of the issues we are seeing. The Children’s Commissioner’s report also highlighted regional variations in treatment, suggesting that access to CAMHS is, in effect, a postcode lottery. The data gathered suggest that in England the average waiting time between referral and receipt of services from CAMHS ranged from 14 days in the north-west to 200 days in the west midlands. Does the Minister agree that that level of variation is totally unacceptable? Can she highlight what Ministers are doing to achieve swift access to care across the country at the same levels? A recent report on the state of mental health by the Public Accounts Committee warned:

“Good access to mental health services matters. Many people can make a full recovery if they receive appropriate, timely treatment. However, a high proportion of people with mental health conditions do not have access to the care they need.”

I wish to dwell for a moment on the state of CAMHS services, because that has been an important aspect of this debate. There is a lack of crisis services, a lack of accountability for transformation plans, and a lack of co-production with parents, carers and service users. One person asked, “Who cares for the carers because it certainly isn’t the mental health service?” That view of CAHMS is borne out by nurses who work in CAHMS. In a survey of 631 CAMHS nurses, 70% said that the services were “inadequate” or “highly inadequate”—I put it to the Minister that it is very worrying that the very people who work in CAMHS refer to the services in such a way—73% said that the main problem was too few nurses, 48% said that there were too few doctors, and 62% said that there were too few beds for patients.

Last December, the Secretary of State made this pledge:

“CCGs are committed to increasing the proportion of their funding that goes into mental health.”

However, as we have heard in this debate, increased front-line funding is not being delivered, and that is clear in the provision of services.

Let me refer to a matter that was raised by a number of my hon. Friends. In the responses to the freedom of information requests made by my hon. Friend the Member for Liverpool, Wavertree, 73 out of 128 CCGs—more than half those that responded—admitted that they plan to cut the amount they will spend on mental health, which underlines the fact that the funding issue is just getting worse.

Does the Minister agree that the Secretary of State has clearly broken his promise and that many CCGs are not increasing funding for mental health? As we have heard in this debate, the pledge to achieve parity of esteem is repeatedly being broken. Despite Ministers’ promises about achieving parity of esteem between mental and physical health, there is still a great difference in the treatment of families of children with physical rather than mental health needs—a number of Members referred to that disparity. Indeed, many physical health hospitals now have family rooms or flats in which parents can stay to support a child, and parents can, in some cases, get help with transport costs. By contrast, the families of children in mental health units feel isolated. There is no provision for families to stay, and no support with transport costs, which can become prohibitive. Often a child can be sent home with no transition plan. It is clear from this debate that the Government are failing to achieve parity of esteem.

We had four questions on mental health at Prime Minister’s questions yesterday, which is an indication of the level of concern among hon. Members. The hon. Member for Bexhill and Battle made mental health the subject of his first such question. As my hon. Friend the Member for Ilford North said, there was real disappointment about the responses from the Prime Minister, so I hope that we get better answers from the Minister today.

Much has been said about education and the role of schools. A report by the Education Committee on the mental health and wellbeing of looked-after children made the clear recommendation that schools should have a role in teaching about mental health and wellbeing. That report said:

“The interface between schools and health services needs to be strengthened to ensure that teachers and schools are better equipped to identify, assess and support children and young people with mental health difficulties.”

It has been quite clear in this debate that Members feel that schools and colleges should play a key role in promoting the good mental health of children and young people. More young people are experiencing serious psychological distress because they are under unprecedented social pressures. It is a credit to Members that those pressures are recognised.

Although we will not have time to cover this subject today, I have to say that easy access to the internet poses new challenges for young people. Cyber-bullying is increasing with more than one in 10 children now saying that they have experienced it. Young people cannot get away from bullying even when they have closed the door of their homes.

A number of Members have stressed the role of schools in ensuring that these problems are spotted as early as possible and addressed. Counselling services are vital. As a Salford MP, I am pleased that Salford has launched a register of approved providers of counselling in schools, and that one provider has already been appointed to deliver a two-year pilot to train and support a cluster of schools in counselling. My hon. Friend the Member for North Durham talked about the importance of counselling, but we recognise that there are funding problems. Many schools will not be able to afford to pay a trained counsellor.

Clear guidance is needed for schools on how to commission high-quality mental health support programmes and how to tackle mental health discrimination and stigmatisation. Will the Minister outline the Government’s plans to ensure that education, health and social services work together to provide an extra layer of support to spot and treat mental health problems? The hon. Member for East Worthing and Shoreham talked about how cross-departmental working can help.

Clearly, the best way to deal with a crisis is to prevent it from happening in the first place. It is critical that people can access the right information and that better support is provided in childhood and adolescence. That can help to reduce the incidence of young people developing mental health problems.

Overall, it is clear from the debate that actions speak louder than words. If Ministers are serious about tackling these issues, they must follow through with their funding pledges. Government cuts to local authority budgets, which I and others have referred to, have meant that many of the local services providing early intervention have had to scale back services or close their doors. I have talked about cuts to children’s centres, social workers, educational psychologists and mental health services in schools. There has been a reduction in care and support for under-18s, so we need urgent action. The Minister has been urged by Government Members, as well as Opposition Members, to relieve that pressure on overstretched CAMHS, but we also need to develop prevention and early intervention strategies. Crucially, the right help and support must be available for vulnerable children and young people when they need it, not 200 days later. I look forward to the Minister answering my questions and those of my hon. Friend the Member for Dulwich and West Norwood, and telling us what action will be taken to improve provision in this vital area.

--- Later in debate ---

[Nicola Blackwood]

One of the ways in which we are ensuring that money reaches the frontline is through driving accountability through transparency. Mental health services have lagged behind the rest of the NHS in terms of data and our being able to track performance. That is why the NHS will shortly publish the mental health dashboard, which will show not only performance but planned and actual spend on mental health. This is real progress.

[Barbara Keeley]

Let me make a couple of points in addition to the useful points made by my hon. Friend the Member for West Ham (Lyn Brown). First, it is clear that CCGs are ignoring the Government’s requests, so we will need more action than the dashboards and transparency that the Minister has mentioned. The Secretary of State will need to go back to CCGs and make the position very clear to them. Secondly, as other hon. Members and I have said, there is the question of local authority funding. Over £1 billion has been taken out of various services for children and young people such as children’s centres and youth services. That is a factor too. Those two things need to be addressed.

[Nicola Blackwood]

It is not fair to say that CCGs are ignoring the funding that is coming through. Moreover, it will not be possible for them to ignore what is going on when transparency and accountability is put in place with data sets that clearly show not only performance down to CCG level but the amount of funding that CCGs are given and the amount they are spending. These data will be much more detailed than before. In January, we introduced the first ever provider-level data set on children’s mental health services, and that will provide data on outcomes, length of treatment, source of referral, and location of appointment.

[Nicola Blackwood]

I am happy to look at it. We are very clear that there is a vital role for the voluntary sector to play in delivering some of these services. We hope that local transformation plans will be part of the way in which this is clarified. The programme to deliver transparency and accountability will be essential if local areas are not only to design effective services that match the needs of their local populations, but to be held to account for delivering them. I will not beat about the bush. We recognise that a complex and severe set of challenges faces children and young people’s mental health services. This area has been undervalued and underfunded for far too long.

While I am happy to investigate funding formulas such as those mentioned by the hon. Member for Ilford North in relation to Redbridge, I agree with him that leadership and accountability are also key to making the changes that we need. That is why we are committed to delivering real changes across the whole system, not just in funding, and to building on the ambitious vision set out in “Future in mind”. I pay tribute to my predecessors for the work they have done to bring those forward. As the hon. Member for Dulwich and West Norwood has said, we need to go further to drive through these changes, which young people have told us they want to see.

Children want to grow up to be confident and resilient, and they want to be supported to fulfil their goals and ambitions. We are placing an emphasis on building in that resilience, on promoting good mental health and wellbeing, on prevention—it is so important, as the shadow Minister has said—and on early intervention, as a number of the recommendations propose. We are looking, in particular, at how we can do more upstream to prevent mental health problems before they arise.

[Barbara Keeley]

The Minister is about to move on to intervention. Before she leaves funding, which has been pretty key, does she believe that the 8% of the budget spent on young people’s mental health—1% for CAMHS—has been anything like adequate? I did put that question to her. If she does not think that that is adequate, could Ministers tell us what they think it should be? If CCGs are ignoring Ministers’ continual urges to them to make pledges, will there be sanctions against CCGs that do not put in that extra funding?

[Nicola Blackwood]

I think I have already answered those questions. The Government have been clear that we think that mental health funding for children and young people, as well as for other areas of mental health, needs to increase. That is why we have increased mental health funding to local areas and we are putting in place measures to improve accountability and transparency, and the STPs, to make sure that that can be tracked locally. We are going to see how it works in the first instance.

Health Service Medical Supplies (Costs) Bill

Baroness Keeley Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

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

I thank all Members who have made contributions to the debate. We find ourselves in a situation where we have some time available, which is amazing.

Let me refer to the interventions we heard in the early part of the debate, because a range of interesting points have been raised. The hon. Member for Totnes (Dr Wollaston) made the point that the Bill provides the opportunity to look at drugs that have not been licensed, such as Lucentis and Avastin, which is not licensed for age-related macular degeneration but is so needed by that group of people. I was pleased to hear the Secretary of State say that he would look at that.

My hon. Friend the Member for Wolverhampton South West (Rob Marris), in a number of amusing interventions, talked about policy on profit control of the pharma sector and found that the Conservative party is marching on to the centre ground—or has perhaps gone past the centre ground.

My right hon. Friend the Member for Leicester East (Keith Vaz) talked about the proportion of the NHS budget spent on dealing with diabetes. He was concerned about the increase in the drugs bill and suggested the use of structured interventions, not just more drugs, because such a large proportion of the NHS budget is being spent on diabetes.

My hon. Friend the Member for Alyn and Deeside (Mark Tami) made the important point that we need to ensure the measures in the Bill do not act as a disincentive for pharma companies to conduct research into rarer conditions. I think that hon. Members who have contributed know we are walking the line in terms of making savings but making sure there are not disincentives.

The right hon. Member for Chelmsford (Sir Simon Burns) welcomed the Bill. He talked about our ageing population—we returned to that with our last speaker—and the increasing drugs bill. He talked about the importance of new drugs, but also the need to deal with unacceptable profiteering, something referred to by a number of Members.

The hon. Member for Central Ayrshire (Dr Whitford) talked about the UK having the biggest research network in the world. She talked about change and the fact that the pharma companies would be nervous and anxious. She welcomed the tidying up aspect of the Bill and I think the general view of Members in all parts of the House was to welcome that. Like a number of hon. Members, she talked about not just enabling the management of cost pressures but doing something more radical. That has been a real flavour of the debate: using this as an opportunity to do something different. I agree with her concerns about the data collection aspects of the Bill and I will say more about that. I also agree that we need to do something more radical. She talked about tackling the five-year delay to access new medicines and rightly pointed out that that is probably where our poorer survival rates are coming from.

The hon. Member for South West Bedfordshire (Andrew Selous) commended The Times for investigating this issue. He also talked about the information powers and questioned whether the Department of Health had the analytical ability to use the data being gathered. That is an important question. If new data needs to be gathered, what are we going to do with it?

The right hon. Member for North Norfolk (Norman Lamb) acknowledged the value of the competitive market, but talked about the sometimes outrageous increases in the price of generic drugs—and we have heard some staggering examples today. He gave the example of a rise of £600 per item dispensed in one particular case, and he hopes, as other hon. Members do, that the Competition and Markets Authority will take action. That has been a key theme in tonight’s debate.

The right hon. Gentleman also talked about not wanting to pit the needs and interests of some patients who need drugs such as PrEP against those who need other drugs. I agree, and I do not think that we should go there in our debate. He spoke about the slippery slope when we get into debating whether to delay adopting even approved treatments. In his view, that provides more evidence that the NHS needs more resources.

The hon. Member for Vale of Clwyd (Dr Davies) talked about the impact on his constituent of a drug prescribed to her that helps her to work and increases her energy levels, the cost of which has increased by 645%. We must maintain a focus on the impact on individuals of the decisions that we make. She has found a drug that suits her, and it would be dreadful for her if it were withdrawn. The hon. Gentleman also talked about the difficulties of introducing new competition into the market. His constituent is hoping that the Bill goes through, as are many others here tonight, and wants action on competition and markets. Let us all hope this goes through.

The hon. Member for Torbay (Kevin Foster) talked about intervention to deal with market failure. In his view, we need to separate out the companies that are doing good research, such as the brain tumour research that he has recently seen, and those that have nothing to do with producing new and innovative products, but are just making money.

[Rob Marris]

I would like to cite for my hon. Friend and the House the Library briefing, which shows that it is not exactly as cut and dried as the hon. Member for Torbay (Kevin Foster) seemed to think. It tells us that the Competition and Markets Authority took action against pharmaceutical companies with regards to generic pricing, and that GlaxoSmithKline and a number of other companies were fined £45 million when it was found that payments had been made in order to prevent the antidepressant medication Paroxetine being offered on the generics market. GSK is a great pharma company for coming up with new drugs, but it crossed the line in this case, according to the Library briefing, so it is not always either/or when it comes to these pharma companies.

[Barbara Keeley]

No, but I think the hon. Member for Torbay was talking about companies that are not doing any research, but just buying up generic products and profiteering from them. There has been general condemnation of those sort of companies on all sides.

[Kevin Foster]

I want to be clear about this point. I think the shadow Minister would probably agree that certain names keep on popping up, particularly in The Times investigation, of companies that seem to be regularly involved in some of the most eye-watering price increases and involved in the mixed model. This Bill is about tackling anyone else who might be thinking of following that kind of business model as a way of exploiting the NHS for money.

[Barbara Keeley]

Very much so.

The hon. Member for Bury St Edmunds (Jo Churchill) welcomed the Bill and talked about the fact that individual CCGs could save £1 million on unused repeat prescriptions. A number of different forms of savings could clearly be made. She talked about the pressure on social care, and I join her in my concern about that. The right hon. Member for Chelmsford spoke earlier about an ageing population and the need for drugs, but older people also do not want to be isolated. It is worrying that 16,000 cases of malnutrition were found last year with an average age of 64 among those cases. People need social care, and I hope that the new Chancellor will listen and bring forward funding for social care in the autumn statement, because people need more than drugs.

As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) made clear earlier, Labour supports the broad aims of the Bill and what the Government are seeking to achieve—better control of the cost of medicines. However, as my hon. Friend also outlined, we have a number of concerns, and I hope that the Minister will address them in his closing speech.

As well as taking the understandable measures to collect pharmaceutical data and manage costs, the Bill also introduces provisions to manage the purchase of other medical supplies. I was glad to hear the Secretary of State raise in his opening speech the issue of the impact on the medical supply sector, but I have heard concerns expressed that the medical technology sector sees the new information measures as “onerous”. The hon. Member for Erewash (Maggie Throup) mentioned that, too. There is a concern that measures in the Bill fail to take into account the unique characteristics of medical devices and the medical device industry. I hope that they will start to be taken into account as the Bill progresses. There is seen to be a danger that the measures will put additional burdens on that sector and the NHS, and lead to higher costs. I hope that that is not the Government’s intention; it would be ludicrous if costs were increased by a Bill that is designed to manage them.

We need to bear it in mind that the medical technology industry employs around 89,000 people in the UK, has an annual turnover of over £17 billion and has seen employment growth of around 11% in recent years. Some 99% of the UK’s 3,310 medical technology firms are SMEs, with 85% of them having a turnover of less than £5 million. The cap levels at which data could be collected were mentioned earlier. We should bear it in mind that we are talking about an awful lot of small companies.

The Bill imposes a regulatory burden on all companies in the supply chain. The reporting requirements will affect all firms producing medical supplies, including the very small organisations. The issues we have extensively discussed on pharmaceutical pricing bear no relation to the price of other medical supplies. The example of a particular type of product was mentioned earlier, but they are or seem to be treated the same way in the Bill.

On the scale of the burden being imposed, the Government’s impact assessment is not much help. It says:

“The main costs will be on manufacturers, wholesalers and dispensers. These costs have not been quantified, as their magnitude will not be known until after consultation on subsequent regulations.”

Measures seem to have been bolted on to this Bill, as Members have mentioned, at the last minute, but because they could have a negative impact on the medical technology sector, we need to be very aware of them. The new information powers proposed by the Government are being put forward at a time when manufacturing firms are going through the uncertainty surrounding this country’s leaving the EU. These measures can only add to that uncertainty. As I said, 99% of the medical technology firms are SMEs, with 85% of them having a turnover of less than £5 million.

Notes on the financial implications of the Bill put forward a curious position that

“no policies will be directly implemented as a result of these changes. Their implementation would require additional future changes to secondary legislation and additional Impact Assessments to assess their cost effectiveness.”

Ministers are asking us to change primary legislation to give the Government new information powers, but the details and impact of those new powers on the supply chain will emerge only in future. That level of uncertainty is unacceptable, and we will seek to amend the relevant clauses in Committee if we feel that this still needs to be resolved.

Importantly, the information powers will also impact on dispensing GPs and pharmacists. I note that the BMA was not represented at the workshop held by the Department of Health on the information powers. We wait to hear, but I would find it unusual if our hard-pressed dispensing GPs would welcome the additional work required of them to provide and disclose information to the Government.

The other part of the supply chain affected by the new information powers will be pharmacists. The Government have just imposed punitive cuts on pharmacists, which we discussed in the House last week. I am still deeply concerned about those cuts. Ministers do not seem to understand what they are doing to the sector. On Friday, an independent community pharmacist in my constituency told me that he estimated that the Government cuts would cost him £86,000 a year, and that he envisaged an average cut of £60,000 for many pharmacies. That will certainly mean staff cuts, but it also means potential bankruptcies for the pharmacies that will be hardest hit.

In relation to that, and the new information powers that the Bill imposes, Pharmacy Voice told me that

“small volume pharmacies are the hardest hit by the proposals and many face a funding cut of around 20% in 2017/18 from the imposition of cuts announced…They do not have teams of administrative staff who can respond to demands for information, and the likelihood is that the NHS would insist on information being provided in a specific format.

It could be information that they do not currently analyse. For example, when a pharmacy buys stock for dispensing, it may also include purchases of medicines for sale over the counter. The overall discount the pharmacy gets on the order is not allocated to each item, and pharmacies could not provide the actual price paid per item.”

On behalf of the pharmacists that it represents, Pharmacy Voice wants to ensure that the cost of meeting the Government’s information requirements is fully funded by the NHS. It feels that the imposition of cuts has already jeopardised the future of the pharmacy sector, and that of small pharmacy businesses in particular. Can the Minister assure me that the cost of the information that must be gathered under the new information powers will not impose an additional burden on pharmacists?

The Labour Opposition support the broad aims of the Bill and the measures to control the costs of medicines, but, as I said earlier, we are concerned about the information powers that the Government want to take, which are considered to be “onerous” by the medical supplies sector. We want to be reassured that they are not. The work and the costs involved could deal yet another blow to the pharmacy sector, which, as I have said, is still counting the costs of the Government’s imposition of funding cuts amounting to 12% for the rest of this year and over 7% next year. We will table amendments in Committee relating to the work and the costs involved in information-gathering.

We also ask Ministers to give serious consideration to using all future rebates from the pharmaceutical sector to improve access to treatments for patients. A number of Members have referred to the need to examine that much bigger issue of access to drugs and treatments, and I hope that Ministers will take the opportunity to do so as the Bill progresses.

[The Minister of State, Department of Health (Mr Philip Dunne)]

What a great pleasure it is, Mr Deputy Speaker, to stand before you after this important debate, with a little time in which to satisfy as many Members as I can, while recognising that the Committee stage will begin shortly and we shall then have an opportunity to discuss points with which I cannot deal today. I thank everyone who has taken part in the debate. We have heard a number of excellent contributions, some of which showed a surprising knowledge of the intricacies of pharmaceutical pricing but were none the less very welcome.

The Bill deals with a treasured national institution, our national health service, and with the need to secure the best possible value for the taxpayer. Medicines represent the second largest cost to the NHS, after staff, and it is important that we do not pay over the odds. The level of interest and the quality of the contributions that we have heard today have shown how important that is to all Members. I find it refreshing that a debate involving the NHS should feature the degree of consensus that has erupted across the House today. I am led to believe that—as has been pointed out by other Members—this is a relatively unusual occurrence, so I shall enjoy it for as long as I can.

The debate reinforces the principles of securing the best possible value for the NHS, making decisions on the basis of good-quality information, and supporting this country’s innovative pharmaceutical industry, to which several Members have referred. Those are principles on which we can all agree. However, the debate has raised a number of other issues, some of which I hope to clarify for the benefit of Members who have commented on them. In one of her closing comments, the hon. Member for Worsley and Eccles South (Barbara Keeley) sought to link last week’s announcements about community pharmacy funding with the Bill. I can reassure her that there is no link whatsoever between the Bill’s provisions on information collection and the announcement about decisions on community pharmacy funding. The funding changes will come into effect in December and are not reliant on any of the provisions in the Bill, and the provisions in the Bill will not change those decisions.

[Barbara Keeley]

Perhaps I was not clear enough, but I was not making that point. I was making the point that the cuts imposed by the Government will mean that some community pharmacies—the smaller ones; the independent ones—will not have the necessary staff. If the Government are imposing a new information-gathering requirement, who will carry out that task? As I said, there may be staff cuts amounting to between £60,000 and £80,000, and people will simply not be able to absorb a new requirement.

[Mr Dunne]

Just to reassure the hon. Lady, I can tell her that the establishment cost for each pharmacy is currently £25,000, and there will be a reduction in that cost rather than a much larger cost. She must be referring to companies that have several establishments, rather than to individual ones. I will touch on the points that she has raised about information gathering in a moment.

We have heard a number of allegations during the debate, starting with those made by the hon. Member for Ellesmere Port and Neston (Justin Madders), who I am sure will be joining us shortly, that the Conservative party appears to have broken out in a rash of Corbynism. I can assure the hon. Gentleman categorically that that is not the case. What we are seeking to do through the Bill is address points, which have been made by hon. Members on both sides of the House, about the potential for exploitative pricing, particularly of unbranded generics that are of low volume, in circumstances where there is no competition from an alternative supplier in the market. I believe that there is considerable agreement on that across the House.

I welcome the support for the Bill from the Labour Front Bench, from the Front Bench of the Scottish National party and from the Liberal Democrat spokesman, the right hon. Member for North Norfolk (Norman Lamb). They all support the principles behind the Bill. I look forward to what I hope will be a rapid conclusion to proceedings on this short Bill in Committee. Doubtless hon. Members will be raising important points in Committee, but I am sure that we will continue to have constructive contributions throughout.

The hon. Member for Ellesmere Port and Neston mentioned difficulties of access and funding for new medicines. These points were also raised by the hon. Member for Central Ayrshire (Dr Whitford). The NHS is investing in innovative medicine and, in the first year of the current voluntary scheme, medicines covered by the innovation scorecard saw an increase of more than 18% compared with growth of about 5% in medicines not on the scorecard. That illustrates that we are prepared to fund patients’ use of innovative medicines under the existing scheme. However, we recognise the need to continue to ensure patient access to new medicines. That is why my right hon. Friend the Secretary of State referred earlier to the accelerated access review, which was announced earlier today. That will accelerate the speed at which 21st-century innovation in medicine and medical technologies can be taken up by patients and their families through the NHS. That will present a real advantage—bringing forward innovations from pharmaceutical companies, not only in this country, and driving them through for use in the NHS.

A number of hon. Members have referred to the investigative work of The Times in helping to highlight the problems with unbranded generics. I would like to add our welcome to the investigation that was undertaken by those journalists, but gently to point out that the Government were already aware of some of the problems. Indeed, we published a consultation in December last year raising that issue, and I think it was partly in the light of that that The Times decided to do its work. I do not wish to decry that work in any way, however. It was clearly helpful.

We have referred cases to the Competitions and Markets Authority, as the hon. Member for Wolverhampton South West (Rob Marris) mentioned. The CMA has imposed fines in one case, as he said, and it is expecting to reach a final decision on another in the coming months. Two more cases were opened in March and April this year. We are looking to refer examples of bad practice to the relevant authorities when we come across them.

The hon. Member for Central Ayrshire asked how the data collection would work. That point was also raised by other hon. Members. We already collect significant data from the supply chain for medicines under the voluntary scheme and the statutory scheme. We collect data from manufacturers and wholesalers of generics, and from pharmacies themselves. As part of developing the regulations, and of the consultation that will take place before we introduce the scheme, we are looking to identify as many automated data collection solutions as possible, in order to minimise the burden to which the hon. Member for Worsley and Eccles South referred. In particular, we recognise that some of the medical products companies are small companies, and we want to make their burden as light as possible.

The hon. Member for Central Ayrshire referred to the devolved Administrations and how we will work with them. Our intention is that they would be able to access data not on a timing of our choosing, but as they require, and that, again, will be undertaken in a manner that we hope to capture in a memorandum of understanding so that there is clarity between each Administration and ourselves as to how that will work.

The right hon. Member for North Norfolk asked in particular about how we intend to control the medicines bill overall, and a number of Members have mentioned that. The cost of medicines across the NHS is rising quite rapidly. That is a concern, and it gets to the heart of why we have sought to introduce this legislation.

We are looking in the first place to align the statutory and the voluntary cost control schemes for the supply of medicine. At present, companies may decide to join either scheme depending on the other benefits they perceive in the schemes, but we believe that the financial benefit to the NHS of each scheme should be the same. Our proposals will put beyond doubt the Government’s powers to amend the statutory scheme to achieve this objective, which the impact assessment has indicated should save the taxpayer some £90 million a year. Draft regulations of these provisions will be available at the Committee stage.

The second element of the Bill strengthens the Government’s powers to set prices of medicines where companies charge unreasonably high prices for unbranded generic medicines. In most cases, competition works well to keep prices down. However, when it does not, and when companies are making excessive profits, the Government should be able to take action. This Bill closes a current loophole in the legislative framework. We are all agreed across the House that we cannot allow profiteering at the expense of the NHS.

Thirdly, the Bill will strengthen the Government’s powers to collect information on the costs of medicines, medical supplies and other related products from across the supply chain. Putting existing voluntary provision of information regarding medicines on a statutory footing will enable the Government to set more accurately and fairly the reimbursement arrangements for community pharmacies and dispensing GPs. In addition, the power will provide vital data to underpin the reformed statutory scheme for controlling medicine pricing, and will give us more evidence about whether companies are making excessive profits at the expense of the NHS.

I want to reiterate what my right hon. Friend the Secretary of State said in his opening remarks to assure the House about the impact of the information powers on the medical technologies industry. It may surprise Members, and in particular Opposition Members, that the powers to require information from suppliers already exists in section 260 of the National Health Service Act 2006—[Interruption.]—which the hon. Member for Wolverhampton South West says from a sedentary position he remembers bringing into effect, but we think that those enforcement powers are draconian and wish to make them more proportionate. The Government have never in fact used the powers under the 2006 Act, and we want to marry powers for information gathering with those we will have for medicines, so that there is no confusion in future about which information regime applies.

Community Pharmacy in 2016-17 and Beyond

Baroness Keeley Excerpts

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

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

I thank the Minister for allowing me advance sight of his statement.

Community pharmacies play a crucial role in our health and social care system: indeed, 80% of patient contact in the NHS is in community pharmacies. The Government’s decision to press ahead with damaging cuts which represent a 12% cut for the rest of the year, on current levels, and a 7% cut in the following year will therefore cause widespread concern and dismay. The public petition that was launched when the funding cuts were first proposed became the largest petition ever on a healthcare issue. It now bears 2.2 million signatures. The message is clear: people want their community pharmacies to be protected.

In the face of unprecedented demands on health and social care services, the importance of local pharmacies is greater than ever. They help to safeguard vulnerable people and signpost them to other services; they are very important to carers; and, crucially, they reduce demand on GPs and out-of-hours services. Do Ministers not recognise the extent of the support that those pharmacies offer, and the impact that their loss will have on communities?

As the Minister said, the Government’s latest funding offer was rejected by the Pharmaceutical Services Negotiating Committee, because it was clear that there was little substantive difference between that settlement and their original proposal in December 2015, and that the outcome would be the same. Earlier this year the Minister’s predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), said that up to 3,000, or 25%, of community pharmacies could close, and clearly the thousands of remaining pharmacies could be forced to scale down their services. If the Minister does not agree with his predecessor, will he now tell us how many community pharmacies he expects to close as a result of the Government’s cuts? Pharmacies that do survive the cuts will be under significant pressure, which will result in job losses and service reduction. That is putting patient safety and welfare at risk.

The Government’s plans are not only deeply unpopular; they are short-sighted, and will hit the areas with the greatest health inequalities hardest. A study by Durham University has shown that pharmacy clusters occur most in areas of greater deprivation and need. Will the Minister reassure us that the areas of greatest deprivation will not lose pharmacies on which they rely, and will not be disproportionately hit by the cuts? I was not reassured by what he said in his statement.

The cuts will have a significant impact on older people, people with disabilities or long-term illnesses, and, I reiterate, carers, who do not have time to look after their own health and often do not even seek GP appointments. The Minister has said nothing today about releasing an impact assessment. Given that the effect of the cuts is likely to be substantial, with rural, remote and deprived areas most affected, when will we see an impact assessment to justify them?

Community pharmacies help to relieve pressure on our already overstretched health and social care services, and in recent years they have delivered more than 4% of savings for the NHS in cost reduction and quality improvement year on year.

It seems to me that Ministers are ignoring the conclusion of a recent PricewaterhouseCoopers report showing that community pharmacies contribute a net value of £3 billion through just 12 of their services—not all of them; just 12. Therefore, if one in four community pharmacies were to close, that value would be lost and the cost to the NHS would be significantly increased. Has the Minister considered the long-term impact that that will have on other NHS services?

We know that there is concern in many parts of the healthcare sector about these proposals. Can the Minister reassure us that all parts of the health service, including NHS England, support the proposals? Earlier in the week, he said that no community would be left without a pharmacy, but he was then unable to say which pharmacies would close and where. Will he repeat the pledge that no community will be left without a pharmacy?

We recognise the need, as does the Minister, to integrate pharmacy services better with the rest of primary care, but introducing cuts on this scale to community pharmacy services will not improve health services—it will damage them.

[David Mowat]

Frankly, a lot of that was scaremongering, which does not help what we are doing here and does not help with some of the difficult decisions we have had to make. Those difficult decisions are directed at modernising the service, bringing it up to date, making it much more dynamic in terms of added value and less static in terms of dispensing and all that goes with that.

I will answer some of the specific points that were made. There is a full impact assessment and it will be released immediately after the statement.

The hon. Lady asked about the PwC report. I have said on the record on a number of occasions that the report is an excellent piece of work. It does drive home yet again the value of community pharmacies, which we on the Conservatives Benches and in the Government accept. What it does not address is the extent to which those services could be delivered for less cost to the NHS. That is what I have to address and that is what we have done.

The hon. Lady asked whether NHS England supports the changes we are making. She might have heard the comments made by Simon Stevens, but I will read out, in answer to her question, a quote from the chief pharmaceutical officer of NHS England:

“NHS England, as the national commissioner of community pharmacy services in England, can reassure the public that the efficiencies which are being asked of community pharmacy will be manageable and there is sufficient funding to ensure there are accessible and convenient NHS pharmacy services in every community in England.”

[Barbara Keeley]

How many are closing?

[David Mowat]

The answer to that question is, I do not know. It is possible that none will close. I do not believe that 3,000 will close. However, I would say this. The average operating margin that the pharmacy makes on the numbers that I quoted earlier is 15%. That is after salaries and rent. The cuts that we are making, or the efficiencies that we are asking for, are significantly lower than that. Of course there is no such thing as an average pharmacy, which is why I cannot guarantee that there will be no changes. What I can say is that, if there are mergers and if there is some consolidation, that demand does not go away—it goes to the other pharmacies in the cluster. To say that those pharmacies will be put under more pressure is plain wrong.

I say again that what we are doing is building an industry that is fit for the future, that is modern and that is adding value in a way it has not been able to do in the past.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Hunt]

I can do better than that, because I have said that I am prepared to go to the health centre. I remember a very good visit to Thornbury community hospital during the general election campaign. I understand what those at the health centre are trying to do and they are absolutely right to be thinking about how they can improve out-of-hospital services.

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

Will the Secretary of State look into the creation of a sideways move for a chief executive of a trust that was criticised for failing to investigate patient deaths? Six weeks after the special recruitment exercise by Southern Health, Katrina Percy has resigned from her advisory role, with a substantial 12-month salary payoff that has been signed off by the Department of Health and the Treasury. The campaign group, Justice for LB, has called that “utterly disgraceful” and I agree. Will the Secretary of State investigate?

[Mr Hunt]

I agree with the hon. Lady that the way this case was handled was by no means satisfactory. The truth is that it took some time to establish precisely what had gone wrong at Southern Health. As this House knows, because we made a statement at the time—I think it was an urgent question, actually—there was a failure to investigate unexplained deaths. I do not think the NHS handled the matter as well as it should, but we now have much more transparency and we do not have a situation where people go on and get other jobs in the NHS, which happened so often in the past.

NHS Sustainability and Transformation Plans

Baroness Keeley Excerpts

Wednesday 14th September 2016 Commons Chamber

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

Does the hon. Lady agree that there is a startling fact about the underfunding of social care that Ministers cannot get away from, whatever they do or say? We have heard today of the case of care workers who are suing the contractor that they work for because they were paid only £3.27 an hour. How can somebody be discharged from hospital in an adequate way when that is the domiciliary care that will be waiting for them? It was interesting to hear the former care Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), say this morning that

“we have not got the cost of…adult social care really sorted out.”

[Dr Whitford]

I totally agree with the hon. Lady. I am not sure whether she took part in the carers debate that we had not that long ago, where I pointed out that unless we develop social care as a profession, then we all face a fairly miserable time in our old age. Nursing is a profession that is recognised and valued, and caring for our older ill population should also be recognised. We need to recognise them, to give them time to do their jobs, to pay them adequately, and to give them a career development structure that means that we bring the best people up and get them running teams.

As I said, I am disappointed by the aggression on both sides of the House. I know that such a debate is always a good tennis match for point-scoring, but the development of the STPs is an opportunity to do things that everyone in this House would agree with. However, if it is not done properly—if it is just a fig leaf whereby we pretend that something is being done—the NHS will suffer and we will be the generation of politicians who moved the deckchairs on the Titanic.

--- Later in debate ---

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

The Nuffield Trust has said that the sustainability and transformation plans could lead to

“fundamental changes in the shape and nature of health and care services.”

As we have heard in this debate, despite the significance of the plans, there has been very little opportunity for patients, the public, NHS staff or Parliament to scrutinise them. The BBC has seen draft STPs that propose ward closures, cuts in bed numbers and changes to both A&E and GP care. The Nuffield Trust, which has examined the STPs, sees the same possible changes plus a questioning of the role of community or cottage hospitals, which Conservative Members have referred to. Those are the reasons why many people, including my constituents, are concerned about the lack of consultation on the plan.

In Greater Manchester, the devolution document “Taking Charge”, which was published last year, is being used as the basis for the STP for Greater Manchester. It outlines the need for integrated health and social care, and reform plans for cancer, mental health and a number of other services. Our health and social care partnership believes that it made significant efforts to reach out to local people with the “Taking Charge” document, but when I looked at it I found that the actual number of people who were definitely reached was quite a small proportion of the 2.5 million population of Greater Manchester. A number of information booklets were sent out, there were 200 meetings and 6,000 people completed a survey, but we have 2.5 million people living in Greater Manchester.

The document does not include detailed plans about which services will be changed or any cuts that will be made in Greater Manchester under the STP. The document does outline savings totalling £1.5 billion—including from things such as prevention, reform of NHS trusts, productivity savings and joint working—but it provides no detail about how that will be done.

The health and social care partnership board is now finding a number of gaps that need addressing, including in the delivery of the nine “must dos” in the five-year forward view. As with savings, decisions about how to deliver those “must dos” are bound to have a significant impact on existing local services. The financial situation of our health and social care sector is, to me, one of the most important issues. I am concerned that the Government are passing the buck to local authorities and NHS trusts, leaving them to make plans without sustainable funding.

In Greater Manchester, as the Minister probably knows, we have revised down the size of the funding gap to £1.75 billion, but that is still a very significant financial challenge for our area. There are plans to centralise mental health, pathology and radiology, but what will it mean? Will services close? Those are the sorts of decisions that local people are entitled to know about before the STPs are signed off. We have an opportunity in Greater Manchester to tailor services to local needs, but that opportunity for positive change will be lost if we do not have a more sustainable financial model for our health and social care services.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 5th July 2016 Commons Chamber

[Mr Hunt]

I recognise the important role that community hospitals play in many of our constituencies, and that role will change as we get better at looking after people at home, which is what people want. We can all be proud of significant progress on dementia in recent years. Dementia diagnosis rates have risen by about 50%—indeed, we think we have the highest diagnosis rates in the world. However, it is not just about diagnosis; it is about what happens when someone receives that diagnosis, and the priority of this Parliament will be to ensure that we wrap around people the care that they need when they receive that diagnosis.

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

The Health Secretary has just promised 5,000 new GPs, and GP Forward View mentions recruiting 500 GPs from overseas. I understand that Lincolnshire GP leaders are looking to recruit GPs from Spain, Poland and Romania. As we have heard, EU nationals who live in the UK and work in the NHS are seen by the Home Secretary as bargaining chips, which has made them incredibly nervous about their status. How successful does the Health Secretary think that that GP recruitment will be?

[Mr Hunt]

This is a time when all sides of the House should be seeking to reassure many people from other countries who do a fantastic job in our NHS that we believe they will have a great future here. The Home Secretary has prioritised doctors, paramedics and nurses in the shortage occupation lists, and in all countries that have points-based systems—look at what happens in Australia or Canada—the needs of the health service and health care system are usually given very high priority.