Carers

Baroness Keeley Excerpts

Thursday 9th June 2016 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

Thank you, Mr Deputy Speaker, for calling me to speak in this important debate. I thank my hon. Friend the Member for Eastleigh (Mims Davies) not only for securing the debate, but for bringing to the Chamber her powerful experiences and sharing them with us. I also want to thank the Minister for all that he does to ensure that carers are given the support they need and deserve.

I want to sign up to the suggestion made by my hon. Friend the Member for Chippenham (Michelle Donelan) that we should extend the pupil premium to all young carers. There are 160,000 young carers whose life chances are disadvantaged by the amazing duty that they perform. Extending the pupil premium to all those young people seems to me to be a very fair exchange for all that they do.

Looking at the other end of the age spectrum, 28% of my constituents in Bexhill and Battle are over 65. By comparison, the national average is 17%. Accordingly, I have a very high number of older carers in my constituency. That is what I want to focus my contribution on today. The 2011 census revealed that there are over 1.8 million carers aged 60 and over in England—almost 16% of the population in that age range. The number of carers aged 85 and over grew by 128% in the past decade, according to a report published last year by Carers UK and Age UK, and it is expected to double over the next 20 years, according to a Government report from 2014.

East Sussex has the highest proportion of over-85s in the UK. Again, that group will be highly pertinent to my constituency. Supporting this army of carers is absolutely essential if we are to ensure that our NHS continues to function. Given the Government’s welcome desire to support keeping people at home in their advancing years, rather than placing them in hospital, that support is even more important. I welcome the passing, by this Government when in coalition, of the Care Act 2014. The Act granted significant new rights to carers in England and placed duties on local authorities to ensure that support is delivered, advice is given and information is provided. It also placed a duty on NHS bodies to co-operate with local authorities in delivering Care Act functions, which, if the clinical commissioning groups in East Sussex can work as a whole, will lead to a “Better Together” integrated health system in East Sussex.

I am conscious that the delivery of those rights is contingent on local authorities having the necessary financial resources in place. I welcome the devolution of business rates to my county, but the yield in East Sussex is low and the demands from a population with above-average ageing is high. Our county will need more time to deliver and more investment in infrastructure to attract new businesses to the coast if this is going to provide for carers and other groups who need local authority finance and support.

I welcome the new 2% levy that local authorities can apply to council tax, provided that it is spent on adult social care. While I champion the rights of carers within the home, many carers are caring for loved ones who reside in care homes due to complex or advanced needs. It is absolutely essential that those carers have the comfort of knowing that their loved ones will be well cared for when they are not in the home to deliver it. I have championed the care home industry, which features heavily in my constituency. Funding them properly via the new 2% levy will, I hope, result in better Care Quality Commission ratings than those that have been awarded following recent investigations.

Across East Sussex, 60% of our care homes were found to be inadequate or needing improvement. It concerns me greatly that, because of these poor ratings, many of our carers may choose to soldier on at home when a care home would be the better choice for their loved ones. All the care homes that I have visited in my constituency have been fantastic. It is important that those that need to improve do so with the extra funding that the Government have procured.

In a rural constituency such as mine, social isolation can be a particular concern. This is exacerbated for older carers looking after loved ones. According to a report published in 2011, more than two thirds of older carers reported not getting breaks away from caring at all, with a further third getting a break only once every two or three months, or less. Let me therefore take this opportunity to thank all those constituents who do so much to give carers a break. While I am at it, let me name-check my mother and my two sisters, who regularly host teas at home attended by carers who do not get the chance to get out of the house and get looked after by someone else for a change. While it is right to look to the Government to be the ultimate support, very often it is the community and their acts of kindness, via visits, conversations, moral support and basic errands, who improve the welfare and wellbeing of our elderly carers. I salute all those who do it.

I am keen for the Government to look at the following suggestions that were made to me by the fantastic Care for the Carers team in East Sussex. First, we should help national partners reach more carers. Would it be possible to make it a duty for the NHS to identify carers, in the same way that the Care Act does for local authorities? Secondly, we should ensure that carers have good support. Would it be possible to ensure that local authorities do not charge carers for the support that they are entitled to? East Sussex is currently not charging carers, which I recognise and celebrate.

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

I thank the hon. Gentleman for his point about the NHS having a duty to identify carers. I have tried three times to introduce that in a private Member’s Bill, so I am really pleased to find support for it among Conservative Members.

[Huw Merriman]

I am pleased, as a novice in the House, that there is agreement across the House on that cause.

Thirdly, there should be help for carers in complex situations—those caring for people with dementia or mental health problems. It seems to me to be an obvious ask to promote good practice recommendations to commissioners and health professionals and to promote it in national policy making.

Finally, I thank and express huge admiration for all those who care for others in my constituency and beyond. I know that they seek little praise, but it is right that we should praise them this afternoon.

--- Later in debate ---

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

It is a pleasure to speak in this important debate on carers. I thank the Backbench Business Committee for allocating time for the debate and the hon. Member for Eastleigh (Mims Davies) for the thoughtful way in which she opened it.

There have been some interesting and thoughtful contributions from hon. Members. We heard from my hon. Friend the Member for Workington (Sue Hayman), the hon. Members for Chippenham (Michelle Donelan), for Ayr, Carrick and Cumnock (Corri Wilson), for Paisley and Renfrewshire North (Gavin Newlands), for Bexhill and Battle (Huw Merriman), for South Antrim (Danny Kinahan) and for Strangford (Jim Shannon), and the SNP spokesperson, the hon. Member for Central Ayrshire (Dr Whitford). We also heard briefly from the hon. Member for Dudley South (Mike Wood) and my hon. Friends the Members for Sheffield, Heeley (Louise Haigh) and for Foyle (Mark Durkan).

There are more than 6.5 million carers in the UK. We have all used different figures in the debate, but I tend to use that one. In my constituency, there are nearly 11,000 carers. I have known ever since I became a Member of Parliament that many of them have a heavy workload due to the ill health in my constituency.

In many areas of the country, people are living longer. As the population ages, we are living with increasingly complex care needs. Three in five of us will become carers—the hon. Member for Eastleigh touched on that. There are also more older carers. In England and Wales, almost 1.3 million people aged over 65 give unpaid care to a family member or friend. The hon. Member for Bexhill and Battle (Huw Merriman) spoke about the fact that, between 2001 and 2011, the number of carers who are over 85 increased from 38,000 to more than 87,000. More than half of carers aged over 85 give 50 hours or more of care every week. That is certainly something to think about.

We are failing to address key issues for carers. Inadequate support for carers and the people they care for damages carers’ quality of life. I will argue that Ministers must do more to recognise the importance of carers and to put in place policies to address their needs.

First, many carers continue to suffer financial hardship because of their caring responsibilities. As we have heard, a recent report by the New Policy Institute found that 1.2 million carers are in poverty. It is shocking to think that so many carers are struggling to make ends meet. In the Carers UK report, “State of Caring 2016”, half the carers surveyed reported cutting back on essentials such as food and heating. Others are having to borrow money, and more than a third use their own savings. The hon. Member for Strangford raised those issues. I feel very strongly that no carer should be pushed into poverty because of their caring responsibilities. I thank my hon. Friend the Member for Workington for talking about financial hardship among carers. It is an increasing problem.

Secondly, too many carers are left to cope on their own with little or no support. As we have heard, one in five of the carers who give 50 hours or more of care each week receive no practical support with their caring role. More needs to be done to protect carers’ health and wellbeing. We must ensure that carers are identified at the earliest possible stage so that they can find the help and support they need. As I said earlier, in the past I have introduced private Members’ Bills to place a duty on GPs and NHS bodies to identify carers and ensure that they are referred for support. The last time I introduced such a Bill, the coalition Government did not support it. However, that duty on the NHS to identify carers was included as a pledge in Labour’s manifesto in 2015.

The Government have promised a new carers strategy to give carers

“the support they need to live well while caring for a family member or friend.”

However, to achieve that aim, any new strategy must include a duty on GPs and NHS bodies to identify carers. After all, the NHS is nearly always the first point of contact for carers as they begin caring, and so is best placed to identify them. I welcome the support of the hon. Member for Bexhill and Battle for a vital change that we can make for carers.

Thirdly, I want to talk about the chronic underfunding of social care and the impact on carers. I have raised that many times with the care Minister and most recently with the Chancellor. In the previous Parliament, there were five years of funding reductions for adult social care, totalling £4.6 billion. Local authority spending on social care for older people fell in real terms by 17%, even as the number of people aged 85 and over rose by 9%. Three hundred thousand fewer older people receive publicly funded adult social care now compared with 2009. In the Carers UK survey, 60% of carers who had seen a change in the amount of support they received said that that support had been reduced due to cost or availability.

I hope that the care Minister will not repeat the Chancellor's mantra about the 2% social care precept and the increases in the better care fund arriving by 2019-20. The 2% social care precept is inadequate to meet even the Government’s minimum wage policy. In my local area of Salford, the cost of paying increases in the national minimum wage in the care sector will be £2.7 million, but the 2% social care precept will raise only £1.6 million. In effect, the council tax payers of my local area are paying for that Government policy of increasing the national minimum wage. The Minister knows that there is no increase in the better care fund this year and only £105 million extra next year. It is hard to understand why Ministers have refused the reasonable request from the Local Government Association to bring forward £700 million of better care funding to address the financial pressures that it faces this year and next year.

We know that there are real concerns about the financial viability of many of our social care providers. In evidence this week to the Public Accounts Committee inquiry on discharging older people from acute hospitals, the president of the Association of Directors of Adult Social Care, Harold Bodmer, said that the sustainability of the residential care and domiciliary care sectors was the main concern for social services directors. He also pointed to significant regional differences. He said:

“I wouldn't underestimate the impact of the differential effect on the social care market in different parts of the country, because there isn’t a domiciliary care problem in the north-east, but there is in parts of Hertfordshire, Oxfordshire and Norfolk. It is really difficult to get domiciliary care in north Norfolk."

I thank the hon. Member for Central Ayrshire for talking about home care not being valued. It may be that people in parts of the country where they cannot get domiciliary care are voting with their feet. People do not want to work in a sector that does not value or pay them properly. Home care should be a much more valued role.

I have real concerns that this fragility in care provision could leave more people without adequate care and put more pressure on unpaid family carers. This is worrying because more people are already providing care for more hours than ever before: 1.4 million people now give more than 50 hours of unpaid care a week, and that number is rising faster than the increase in the general population of carers. There has been an increase of 25% in people caring more than 50 hours a week in the past 10 years compared with an increase of just 11% in the total number of carers.

The Care Act 2014 entitles all carers to a timely assessment of their needs. However, one in three carers who have had an assessment in the past year had to wait six months or longer for it. Worryingly, nearly 40% of carers caring for someone at the end of life also had to wait six months or more for an assessment. That is unacceptable. Carers for people at the end of life should be prioritised. We have talked about that in different meetings here.

Timely assessments are surely one of the starting points in providing support to carers, but even when carer assessments take place it seems that they do not properly address carers’ needs. Almost 70% of carers in the Carers UK survey felt that their need to have regular breaks from caring was not considered in their assessment. Members have rightly repeatedly referred to the importance of breaks for carers. Seventy-four per cent. of working age carers did not feel that the support they needed to juggle care with work was sufficiently considered. We need those important assessments to be more than box-ticking exercises, but that can happen only if the Government invest in support for carers and give local authorities the resources that they need to provide care and support. I hope that hon. Members have been able to meet and listen to a number of carers this week—indeed, I understand from the debate that that is already happening.

At the carers week parliamentary event I met Katy Styles, who cares for her husband Mark, and she told me about a number of issues that she has encountered as a carer for a person with motor neurone disease. What I felt most in talking to Katy was that she wanted to be recognised and listened to as a carer, but she also raised issues of financial hardship. Katy and Mark Styles told their story to the all-party group on motor neurone disease, and Katy said:

“We told them about how we were once two professionals and how our lives had been devastated by Mark’s condition. I explained that as a teacher I had earned £150 a day and now I receive £62.10 a week in carer’s allowance for providing never-ending care and support for my husband. Mark explained how he was forced to retire at 46, that our income had fallen off a cliff, but our bills continued to increase. He told the group about how we travel miles and miles to receive care, and how we had to make adaptions to our home which were paid for with savings that we will never be able to replace.”

The MND Association found in its survey that more than half of carers for people with MND care for more than 100 hours per week, yet only a third have had a carer’s assessment, and four out of 10 people were unaware of their right to one. Caring for more hours each week can mean carers having to give up work and facing financial hardship, and we have touched on that in this debate. Some 2.3 million adults in the UK have given up work to care, and almost 3 million have reduced their working hours.

I do not want to leave the issue of financial hardship without mentioning women born in the 1950s who are carers, but who are now not getting their state pension until later in their 60s. I have spoken about carers such as Marian, who has given up work at the age of 62 to look after her mother and her brother, both of whom have dementia. Her only source of income is a small private pension of £2,500, and her husband will have to support her until she gets her state pension at 65. The Minister has probably not been involved in many of the debates on the state pension age, but many women born in the 1950s are in such a situation and now face financial hardship.

We have mentioned those who give up work to care or who struggle to manage their working hours, and about combining care with work, and the feeling in the debate has been that more needs to be done to ensure that employers provide carers with enough support. Some companies are leaders in providing support for their staff who are carers. For example, Centrica offers flexible working, access to counsellors, and an employee-led carers network that is supported by the company’s senior leadership. Its carer’s leave policy offers up to one month matched paid leave per year to help with caring responsibilities, and it also takes into account that caring responsibilities may fall to people who are not immediate family members.

I have concerns that members of this House are not able to provide those levels of support. IPSA contracts for Members’ staff offer only five days’ leave for caring reasons, and even that is stated as being for emergencies and dependants only. That minimal policy does not reflect good practice—the Minister will know what that is—and we could do better for our staff. I invite the Minister, the hon. Member for Eastleigh and others who have raised that issue, to join me in talking to IPSA to request a change in that policy. It is not good enough not to have better practice when supporting our staff who are carers.

As has been said, carers week is an important annual event because it provides us with an opportunity to recognise the contribution that carers make to society, and to highlight the challenges they face. I thank all organisations that support carers and provide hon. Members with so much information about caring issues: Carers UK, Age UK, Carers Trust, Independent Age, Macmillan Cancer Support, the MND Association, and the Multiple Sclerosis Society. My constituency contains the excellent Salford Carers Centre, and an amazing group of young carers are supported by the young carers project. I look forward to meeting them tomorrow. I also thank Marie Curie, which launched a report on end-of-life care for LGBT people in the House yesterday, as well as Together for Short Lives and the Rainbow Trust Charity for their support for children with life-limiting conditions and their families. Finally, I thank the UK’s 6.5 million carers, and especially the 11,000 carers in my constituency, for the essential role that they play in supporting our health and care system. Carers need and deserve so much more respect and support than they are currently given.

[The Minister for Community and Social Care (Alistair Burt)]

I congratulate my hon. Friend the Member for Eastleigh (Mims Davies) on securing this debate and on the way she opened it, and I thank the Backbench Business Committee for allocating time for this important debate during carers week. I will start where the hon. Member for Worsley and Eccles South (Barbara Keeley) ended, and thank all those who are involved in caring in our society. As we have heard from every speaker, carers make an invaluable contribution to the UK that we could not do without, and perhaps I can illustrate that by citing some of the remarks made by colleagues during the debate.

I will touch on some of the points raised by my hon. Friend the Member for Eastleigh in the remarks I have prepared for this debate, and I will also comment on her other points. She started with a graphic description of what might happen if carers were not around and if they decided not to do what they do every day, which brought the point home to us. She spoke about how people become a carer, and said that it could happen to any of us at any time. At last year’s national care awards I remember watching a video in which the point was made vividly that any of us in that hotel room could become a carer within 24 hours, and we can all understand that. As others pointed out, carers are no longer a minority group but people we all know—many of us are closely connected to carers, if not carers ourselves—and we are all only going to become more closely involved in the future. She, like others, made that point very well.

My hon. Friend also spoke, as did others, about the need to identify people not solely as carers but as husbands, wives, partners, employees—everything else they still are—and about the great danger of someone being pigeonholed because they have become a carer. It is important to remember that someone does not lose their identity when they become a carer. Hon. Members also highlighted the importance of carers week. I am proud to be the president of Carers in Bedfordshire—I have been for some years—and I thank it for its work. All hon. Members have thanked their local groups.

My hon. Friend was not the only colleague to speak of her personal experiences of caring. As I have mentioned from the Dispatch Box before, the range of Members’ experiences goes far beyond what the media are keen to portray and touches on virtually all aspects of life outside. When I hear the cares and experiences that colleagues bring to this place, I always hope that people outside read our debates and understand a bit more about us, why we want to be representatives in Parliament and the personal experiences we bring.

The hon. Member for Workington (Sue Hayman) and others spoke about finances, on which subject I could spend the whole 15 or 20 minutes. I know that this subject is particularly important to the hon. Member for Worsley and Eccles South, the spokesperson for the Opposition. On carers allowance, which the hon. Member for Workington focused on, the Government keep the earnings limit under review and keep under consideration whether an increase is warranted and affordable. The increase of 8% in 2015 far outstripped the increase in wages. The earnings limit is currently £110 a week, but that is a net figure, and if allowable expenses, such as childcare and pension contributions, are deducted, a claimant might earn significantly more. The limit enables a carer to maintain some contact with the employment market and achieve greater financial independence, but I recognise and would not minimise the constant financial pressures and difficulties facing families. The limit is kept under review. Also, as I said, there is a wider review of the carers strategy, which has allowed a lot of people to make contributions on finance, not just the amount but the important interlinking of benefits. That point will not be missed, and I thank her for raising the matter.

[Barbara Keeley]

Carers charities often raise with us the link with things such as the national minimum wage. The Minister talked about the figure last year, but the national minimum wage changed in April, and many of the carers trying to keep a part-time job going will be at that level, so it seems sensible to link the threshold with the national minimum wage so that when the national minimum wage increases, so does the threshold.

[Alistair Burt]

I cannot make that specific commitment, but I understand fully the hon. Lady’s point. As I said before, the earnings limit and all the factors affecting it are kept constantly under review, but I am sure that Treasury colleagues will not have missed the remarks made today.

My hon. Friend the Member for Chippenham (Michelle Donelan) also made the point about carers not being a small minority. She commended Carers in Wiltshire, and I commend her for being a volunteer—another example of the experience we all bring to this debate—and she raised the important issue of entitlement to benefits and signposting. In our call for evidence as part of the review of the carers strategy, respondents raised the importance of people being directed towards the things they need as soon as possible. The moment someone becomes a carer, their world changes, and they need as much information as possible at that time. She was right to mention the importance of signposting in particular. She spoke with great passion on the subject.

The hon. Member for Ayr, Carrick and Cumnock (Corri Wilson), who also spoke from personal experience, made a point about access to work. I shall talk about employment later, but she made her point strongly, and again she was not the only person to recognise that, although we all wish for a world in which burdens are shared equally, in truth they are not. Women carry the biggest burden when it comes to caring, and will probably continue to do so for some time. Recognising the extra pressures on women is particularly important. The hon. Lady made that point very well.

The hon. Member for Paisley and Renfrewshire North (Gavin Newlands) was particularly helpful in saying that although it is carers week for us, it is just another week for carers. I also liked it when he said that it was a week to talk “with”, not “to” carers. That was a particularly well made point. He spoke forcefully about the reality of life—the sleepless nights and other issues that carers experience.

My hon. Friend the Member for Bexhill and Battle (Huw Merriman) brought up the issue of care homes. I am not going to linger on that subject, but, as some colleagues know, I am particularly exercised about safety in care homes. It is my belief that someone in the care of the state, whether it be the NHS, local authorities or anyone else, needs to be as safe in a care home, a mental health institution or in learning disability facilities as they would be in an intensive care unit. As I expressed in yesterday’s debate about Southern Health, that is simply not the case.

I am very conscious of issues surrounding care homes. I have a round-table meeting on Monday with those responsible for the monitoring and regulation of care homes, and I pay tribute to the Care Quality Commission and others who are trying to do a good job of regulation, but this also involves some of the groups that are critical of regulation, want to see more done and want to ensure that there is safety in care homes. Some of the stories of abuse that we read about in the papers need to become fewer and fewer until they are extinct.

I want to praise the National Care Association because there are many good care homes, as my hon. Friend the Member for Bexhill and Battle said. It is important to keep the right balance in recognising the quality of good homes without minimising the pressures on them. When things that should not be happening are going on, it is quite difficult to maintain that balance. I appreciate the fact that my hon. Friend mentioned this important issue. I commend, too, the ideas coming forward from the carers team in East Sussex, and I urge members to ensure that the ideas put to my hon. Friend will be put into our national call for evidence. They have until the end of this month to do so. I do not envisage a statutory instrument to extend that still further, should there be a rush of evidence at the end of the month, but we never know in the present circumstances. Getting that information in would be very helpful.

The hon. Member for South Antrim (Danny Kinahan) was not the only one to refer to the pressures on our own caseworkers, who do so much work to look after people in the House. I appreciated his mention of that point. He hoped that the carers strategy would be a long-term strategy. I hope it will, too. The strategy should be reviewed from time to time—this is the first review for two or three years—and that is certainly the aim. That is why I would like the strategy to look slightly beyond the immediate and consider how to build for the future rather than simply having a snapshot now.

My hon. Friend the Member for Strangford (Jim Shannon)—I call him my hon. Friend—is exceptionally generous and courteous to all Front-Bench Members when he speaks. I would like to tell him how much that is appreciated—it really is—when he is so genuine in expressing his views. He spoke of his personal experiences, pressures in Northern Ireland and the Crossroads young carers in Newtownards who particularly stressed the difficulties faced by young carers and the things that they often miss out on. My hon. Friend spoke about a singing group. A few weeks ago, I went to Biggleswade at the request of the Alzheimer’s Society to join a singing group, and I sang some songs with the people there. It was certainly an uplifting experience that morning. I commend those groups and the carers who work with them.

The hon. Member for Central Ayrshire (Dr Whitford) made a considered and thoughtful contribution, as usual. She spoke about all the financial pressures. Particularly telling was her comment that although there are a relatively fixed number of carers and although it is steadily growing to 6.5 million, it is a replaceable 6.5 million and about a third leave for all sorts of reasons.

On bereaved carers, I was contacted through Twitter by someone in that position who asked whether the strategy and review would cover them, and I answered “Yes, it will and it should”. The moment that caring for someone stops because of bereavement, the carer’s life has changed—perhaps in an anticipated way, but it is has still changed. Caring for people in those circumstances is really important. We must not forget this group, so I greatly appreciated what the hon. Lady said. She also spoke of the need to ensure that social care is seen as a profession as much as nursing and domiciliary care are throughout the NHS and elsewhere, and I thoroughly agree with her.

The hon. Member for Worsley and Eccles South (Barbara Keeley), whose background in caring requires her to be listened to seriously every time she speaks about this issue, made a number of comments. I shall deal with the subject of finance a little later. Let me say first that I will ensure that the review that we are conducting will cover early identification in the NHS. We are trying to ensure that it takes place earlier and earlier. The issue of GP identification is very important, and I am pleased that the hon. Lady raised it again.

[Barbara Keeley]

I should be happy to send the Minister a copy of my Bill and the explanatory notes if that would help to elucidate the points that we have made.

[Alistair Burt]

I have no doubt that those are already deep within the recesses of the Department of Health, but if it would speed things up and provide encouragement, I should be grateful if the hon. Lady did indeed do that.

The hon. Lady also made an important point about our staff in the House. She said that we should look after them. I appreciate the point that she made about the staff of the Independent Parliamentary Standards Authority, and I will look into how we can best ensure that we recognise properly—in line with best employment practice elsewhere—that those who work for us bear considerable burdens of caring from time to time.

I am grateful for the opportunity to come to the House and share the important work that is under way to develop a new cross-Government strategy for carers. I continue to be humbled by the many powerful, honest and informed contributions that we have heard throughout the afternoon from Members who have described the carers whom they know and represent, as well as their personal experiences. Those views, and the many others that we have received so far, will be fully taken into account as the Department works with Government colleagues, stakeholders and, crucially, carers themselves to develop the new strategy.

Today we have been reminded that behind the statistics stand spouses, partners, parents—in fact, all manner of relatives, friends and neighbours—who are providing care right now in our communities. Their commitment can scarcely be quantified or questioned, and we must ensure that our own commitment to support people is demonstrated clearly as well.

I pay tribute to the national care awards, which are sponsored by LloydsPharmacy, Carers UK and The Sun. I was at the awards ceremony a couple of weeks ago, and we met the winners at lunchtime. The Prime Minister was kind enough to offer No. 10 Downing Street for a lunchtime reception, and we took people round. We are always struck when people like that say that it is a privilege to be there. We say to them, “No, it is our privilege that you are here with us. It is the other way round.” Those people were a great group—great winners. We went to a dinner that night. Radio 2 was very good: there is always a table of wonderful people to support the awards. When we hear the personal stories—which have been reflected in some of what we have heard in the House today—we are all immensely impressed. Let me again pay tribute to those awards: they do one of the jobs that we have all been speaking about this afternoon—valuing and recognising carers for what they do in so many different circumstances.

Before we go any further, may I offer a small philosophical comment? I picked this up from a piece in The Guardian by a writer called Madeleine Bunting. I do not read The Guardian all the time, contrary to the belief of many of my colleagues, but every now and again I am struck by something that is really good, and what Madeleine Bunting wrote is important. She was writing about what care is. We talk about it—we talk about the facts and figures and the finance here in the House—but what is it precisely, and where is it going? Madeleine Bunting wrote:

“We recognise instantly when we experience it: an interaction that acknowledges a moment of human connection. It may be brief, but it expresses and confirms a common humanity, a recognition of the individual—and always involves a particular quality of attention.

But the characteristics needed to provide this kind of care are losing cultural traction. Attentiveness requires two crucial ingredients: patience and the willingness to put one’s own preoccupations aside and to be available to another. Yet in a myriad of ways we are all being groomed by consumerism and digital media—to be the opposite: impatient and self-preoccupied. That impatience makes us easily distractable, addicted to the next stimulus.”

I think that Madeleine Bunting was making a really important point. The people about whom we have been talking have avoided that: they have patience, and a commitment to others that is beyond many of us. However, there is concern about society—concern about where it is going and the pressures that it is under. Demographics suggest that we will need more care, and yet certain pressures are making it more difficult for that to be realised. What will carers be like in the future if they have become too distracted and too self-occupied? That is not the case with carers now, but it is a valid point to raise with regard to the future.

We owe a duty of care to this vast army of people, who show their patience and their compassion for others. I am talking about not just providing them with the support, tools and information that they need to care well, but ensuring that their own health, wellbeing and life goals are not compromised. Our respect is unreserved, but respect is not enough. We must never lose sight of that fact if a new carer strategy is to succeed.

I should say at this point that I do not wish to paint a negative picture of caring. Although personal sacrifices are made each and every day, many carers have told us that it remains a privilege to care, and that they have a strong desire to repay the kindness of others. Indeed, carers derive immense satisfaction and peace of mind from being the primary source of comfort and reassurance for friends and loved ones. However, that satisfaction must not be at the expense of carers’ own mental and physical health.

We have also heard this afternoon about the great diversity in types of caring. There is no such thing as a typical carer—carers are people of all ages and from all walks of life, and those for whom they care have different needs. In particular, we neglect at our peril the needs of children and young people with caring obligations. They are most at risk of having not just their health and wellbeing compromised, but their education and career ambitions too.

There is no “one size fits all”. We must be alert to that as we attempt to craft new and improved support for all those providing care in our communities. It is no surprise that one in six of us is currently caring. As lifespans extend and our population grows, caring for others has already become part of the fabric of our lives. All those who have spoken today have made it clear that they are not affected by the lazy mindset that tells us that carers are other people; carers are all of us. As a constituency MP, I have had the privilege of visiting carers and carers’ groups in Bedfordshire. As a Minister, I have spoken to carers’ groups in relation to pulling together the new carers strategy. I strongly commend those who work in my own county.

Almost 20 years after the Carers Act 1995 first gave official acknowledgement to those providing “regular and substantial” care, the Care Act 2014 now gives carers new rights, including parity of assessment, advice and support with those for whom they care. Those new rights are a historic step forward. We have provided local authorities with £433 million in 2016-17 for new burdens arising from the Act.

We know that the Care Act is taking time to bed in. The hon. Member for Worsley and Eccles South referred to the matters that affect assessment, and I understand them very well. Care varies from place to place. A group from the Association of Directors of Adult Social Services working with the Department is looking at those variations in care, so that in places where assessments are much slower than in others, we are looking at what can be done and how things can be improved. That is very much on our mind.

[Barbara Keeley]

Having been present during discussions about certain groups of carers, perhaps the Minister will tell us whether he believes that carers of people who are at end of life should be prioritised for assessment. It is pointless to have people waiting six months when the person for whom they care may have only a few weeks or a few months to live.

[Alistair Burt]

I will ensure that that is considered as an important point of the assessment. I will write to the hon. Lady in relation to that.

Let me turn to finance now. There is always concern about the amount of finance that is available. It is almost impossible to get the right amount. By spending around £2.5 billion a year on benefits in Great Britain, benefiting more than three-quarters of a million carers, we are trying to respond to the needs that are there. That money provides a measure of financial support and recognition for people who give up the opportunity of full-time employment in order to provide care. As I said earlier, those allowances remain constantly under review. As this debate has made clear, it is not just about finance, but about all the other things, including supporting young carers and making sure that they are not forgotten and remembering that employers play an important part. I commend NHS England for the important work that it has done in relation to carers and for its commitment to carers.

I also want to mention the results that our call for evidence has produced, just to give people some assurance that these things are on our minds. We have received 3,800 responses so far, 85% of which are from carers themselves. A great number of the responses have been candid and honest, and it will frighten my officials if I read them out. They describe financial hardship; a lack of recognition and involvement; the impact on carers’ health and wellbeing; the difficulty of maintaining life outside caring; and frustration with access to assessments and services. All these issues are on our minds.

The need to ensure that carers get the recognition they deserve has been well illustrated in the compassionate speeches that we have heard today. Carers are vital, and not just in carers week. There is also a young carers awareness day—it was on 27 January this year—sponsored by the Carers Trust. I also commend my hon. Friend the Member for Truro and Falmouth (Sarah Newton) for holding a round-table about carers recently. This matter is on the minds of everyone in the House and I appreciate the courtesy of hon. Members in giving their time to deal with this important issue this afternoon.

Support for Life-shortening Conditions

Baroness Keeley Excerpts

Tuesday 7th June 2016 Westminster Hall

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

It is a pleasure to speak with you in the Chair, Mr Percy. I also thank the hon. Member for Pudsey (Stuart Andrew) for securing this important debate, to which he has been able to bring considerable knowledge. I congratulate him on how he opened the debate. We have had many important contributions this morning from the hon. Members for Strangford (Jim Shannon), for Castle Point (Rebecca Harris), for Lanark and Hamilton East (Angela Crawley), for Eddisbury (Antoinette Sandbach) and for Colne Valley (Jason McCartney). We have also had some shorter contributions from my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) and the hon. Members for East Londonderry (Mr Campbell), for Foyle (Mark Durkan), for Eastbourne (Caroline Ansell) and for Glasgow Central (Alison Thewliss).

Many of us have talked about the charity Together for Short Lives. We thank it for its input to the debate, which it has welcomed. It feels that discussion of children who are dying and the support they need is hindered by a public taboo. The palliative care needs of children can be coupled inappropriately with those of adults, when, as we have heard, their needs are much more complex and focused as much on quality of life as on quality of death.

A key point that has been made in this debate is that we do not have enough data to commission and fund appropriate services to support children with life-shortening illnesses and their families. The most recent estimate is that 49,000 children under the age of 19 are living with life-limiting or life-threatening conditions, although I understand that that is based on data from 2009-10. Without Government monitoring of changes in the data, there are real difficulties in providing the care and support needed by children, young people and their families. Local authorities and CCGs already find it challenging to commission and provide palliative care locally because relatively few children in any given area will need that care. Without more accurate data, it is harder to commission and provide the services needed. Cross-departmental collaboration and better co-ordination among organisations are also needed.

The issue with funding is clear. There are different funding streams from different Departments and from local organisations. As we have heard, a remarkable amount comes from fundraising. We have specialised children’s palliative care commissioning, general children’s palliative care commissioning and the commissioning of children’s social services. NHS England, CCGs and local authorities all have a part to play in funding palliative care services for children, but as we have heard it is often unclear who is responsible for funding different services. There is terrible uncertainty about the availability of future funding for services. Indeed, Together for Short Lives found that CCGs contribute just 10% on average to the cost of the care that children receive in hospices, compared with an average contribution of around 30% to the cost of care in adult hospices. As we have heard from the hon. Member for Eddisbury, the Department of Health is testing per-patient funding for children’s palliative care for commissioners to use in 2017, but I understand that is not going to be mandated, so there will be no obligation for clinical commissioning groups to adopt that level of funding. Will the Minister clarify how the Government plan to ensure that adequate funding will be provided in future for palliative care services for children?

We know that funding from local authorities for children’s social care has become even more stretched. Local authorities can of course raise additional funds for adult social care through the social care precept, but that does not apply to children’s services. We also know there has been a significant increase in the number of referrals to children’s social services since 2009. The Local Government Association has raised concerns that the 40% real-terms reduction in core Government funding over the previous Parliament and subsequent budget cuts have meant that local authority services are being reduced significantly. The 2014-15 budget figures show a reduction of 20% for spending on children’s centres and early-years services since 2010.

We have heard quite a bit about breaks. Although local authorities are required to provide short breaks for disabled children, the funding for this has decreased, which means families are receiving less support, despite having significant caring responsibilities. We have heard about the extent of the caring responsibilities for carers of children with life-limiting conditions. The Every Disabled Child Matters partnership found that 58% of local authorities had cut their short-breaks spending by an average of 15% between 2011 and 2015, with some councils cutting this funding by up to 26%. In carers week, the fact that family carers are receiving less support and fewer short breaks should be of real concern to us.

I do not often go to my iPad for notes, but I had a look at Lucy’s blog; what she says about her mother as her carer is important.

“In reality, it is all down to my mum. She phones person after person, arranges blood tests and appointments and sorts out all of my medication, one of which has to be couriered down from London every few months, and when I’m on intravenous antibiotics, she drives to the hospital to pick up the drugs and picks up the equipment from the district nurses. My mum does my TPN and medication every day, she administers IVs and takes blood from my hickman line, gives injections, dresses wounds, can catheterise me, mixes and prepares medication, and so much more; she can do things many nurses can’t do...She liaises between consultants and departments. She sorts out my prescription and collects medication. She deals with my personal budget and pays my carers. She’s my mum, nurse, carer, PA and best friend. It’s all down to her. She’s given up her life to keep me alive, not having a holiday or break in 6 years.”

She should be able to have a holiday and a break.

As has been said in this debate, we need to find a way to hold local authorities to account for the money to spend on short breaks for disabled children. I hope the Minister can tell us what action he will take to make sure that seriously ill or disabled children and their family carers can access short breaks.

In March 2015, the Health Committee published a report of its inquiry into palliative and end-of-life care. It called on the Government to ensure that future funding proposals fully recognise the importance of the voluntary sector. The report also called on the Government to set out how they intend to ensure the sustainable long-term funding that we have talked about in this debate. It is clear from the many contributions today that improvement is needed to ensure a sustainable funding settlement for children’s palliative care in future.

I want to touch briefly on the importance of social and community palliative care and support services. Hospices do a wonderful job, but children are not always in a hospice. The Rainbow Trust children’s charity supports more than 2,000 families across England whose children have a terminal or life-threatening illness. This includes families in my constituency. The trust supports 99 families in Greater Manchester, including nine families in Salford. The family support officer for the team in Greater Manchester says that the most common concern raised by parents is the reduction in the statutory hours of support they receive. Increasingly, families are reporting having the number of hours of support reduced with no alternative service offered. It is important that the support provided by charities such as the Rainbow Trust should not be seen as a substitute for inadequate statutory support. The Greater Manchester Rainbow Trust team works closely with the Diana nursing team in Salford to provide all-round support to children’s families at home and in hospital. Both services are vital.

Charities such as the Rainbow Trust provide an essential service to families outside a hospice setting, and we must make sure that those community palliative care services are supported. I can tell the Minister that the statistics are very impressive for a small charity. In 2014-15, the Rainbow Trust provided nearly 3,000 hours of sibling support, more than 10,000 hours of home support, 7,700 hours of hospital support and more than 1,000 hours of bereavement support. Members have referred to the importance of bereavement support, which is a key aspect of the issue. Sadly, the Rainbow Trust receives only 3% of the funding needed for all those services from statutory authorities. I hope the Government will recognise the value of community palliative care and support and how it can work alongside hospice care to provide families with the support they need from the moment a diagnosis is made.

Children’s services provide excellent care in an age-appropriate environment, but, as we have heard, young adults tend to have different needs from young children and older adults. As more children with life-shortening conditions live longer—we are all grateful that they do—they are more likely to make the transition into adult care settings. Unless suitable age-appropriate services are offered to help with this transition, young adults may be lost in the system. The hon. Member for Castle Point spoke of the impact on Lucy and the travel she had to do to find services. What will the Minister do to ensure that young adults making the transition to adult palliative care services have the support that they need?

As we have heard in this debate—like everyone else, I want to touch on this—changes in benefit eligibility could also help to ensure that families get the level of support they need. Most people would not think of the importance of the mobility component of the disability living allowance and perhaps not register that the fact that it does not apply to children under three was such an issue, but of course those children need special equipment such as ventilators or the permanent wheelchairs that we have heard about, and families need to transport that equipment. It is a dreadful thought that with precious and limited time for children and families to spend together, the families are unable to get out and are stuck at home because of equipment issues. Will the Minister raise with his colleagues at the Department for Work and Pensions the need to change the eligibility criteria of the DLA mobility component so that the families of children under three with life-shortening conditions can access it? It has been said that it is easy to fix: I hope that he thinks it is.

Many hospices, hospitals, social care providers and charities provide excellent care and support for children with life-limiting conditions and their families. I want to join others in this debate in thanking them for all that they do, but it is clear that more needs to be done to develop a sustainable funding system that can provide a fully integrated service for families at all stages of their child’s illness. The importance of those services for families with a child who has a life-limiting illness cannot be overestimated. We are talking about people who give up their lives to provide support, as Lucy’s mum has done. We are talking about parents who get very little sleep. We should really think that through during carers week. I hope the Minister will assure us that more will be done in future to make sure that every family with a child living with a life-limiting condition can access the support that they need when they need it.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 10th May 2016 Commons Chamber

[Alistair Burt]

The better care fund has been adjusted to recognise that not all councils can raise a similar amount of money through the social care precept, so the issue that the hon. Lady raises has been noted and recognised. The only way in which the NHS can achieve better outcomes and meet the challenges of rising demand is through an increased focus on preventive community health and social care, and closer working with local authorities. That is what the pooled budget is designed to deliver, and that is what it will do.

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

Indeed, good morning, Mr Speaker.

A big challenge for local authorities and adult social care is how to fund the increases in the minimum wage that care providers have to pay. As my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) just detailed, the 2% social care precept does not cover all the increased costs and, indeed, in some areas, it is not even being passed on to care providers. The Local Government Association asked Ministers for £700 million from the better care fund to help with that increased cost this year and next year—not in 2019. When will Ministers listen to local councils and agree to bring forward that much needed funding to support what is effectively their own policy in the care sector?

[Alistair Burt]

I do not think that anyone fails to recognise that the next couple of years in social care will be very tight, but that is why the better care fund is there. Work has been done to increase the amount of money available to meet the challenges that the hon. Lady raises. I have to repeat that to fund this properly there has to be a sufficiently strong economy. There has to be the commitment to funding that the Government have been able to make almost uniquely in the House. I sometimes think it would help if she recognised the strength of the economy that has been able to do that by assisting local authorities, rather than complain about the amount of money available.

Contaminated Blood

Baroness Keeley Excerpts

Tuesday 12th April 2016 Commons Chamber

[Diana Johnson]

My right hon. Friend makes an important point.

Fourthly, there are concerns that under the plans money will be used to pay for new drugs to treat hepatitis C, which will be bought separately from the NHS budget, so will cost more. Under guidelines from the National Institute for Health and Care Excellence, everyone with hepatitis C should be eligible for treatment with a new generation of drugs from the end of February 2016, so when funds are allocated for treatment, that means once again that money does not go directly to those who need financial support.

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

Does my hon. Friend, who is making an excellent speech, agree with my constituent, who is affected and feels that the changes are deliberately punitive and exceedingly cruel, as they use requests for changes to support schemes to affect people in that way? My constituent has had to use the ex gratia payment from the Government to fund treatment refused by the NHS, as many other people have had to do. His annual payment will decrease over time and he will lose the additional support that is currently provided. People such as my constituent are hit again and again, so how can the consultation on reform go ahead on that basis?

[Diana Johnson]

I shall move on and complete my speech.

Fifthly, there is concern about the fact that beneficiaries in England will be worse off than beneficiaries in Scotland. The Scottish proposals are far more generous to hepatitis C stage 2 and HIV sufferers, who will receive £27,000 per annum or £37,000 if they are co-infected, which is welcome, but are much less generous for hepatitis C stage 1s, who will receive an additional lump sum payment but no ongoing support. The Scottish proposals have been broadly welcomed, partly because of the way in which the consultation was conducted in Scotland, and the clear acknowledgement, for example, that the existing trust structure will be scrapped.

--- Later in debate ---

[Sir Gerald Kaufman (Manchester, Gorton) (Lab)]

Thank you for calling me to speak, Mr Deputy Speaker. I would like to join other Members of Parliament in thanking my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) for her work on this matter, which, among other things, has enabled us to take part in this debate.

Everything that we deal with in this House of Commons is about people, whether they are Syrian refugees or steelworkers from south Wales. Whatever we do deals with the lives of people, and we are somehow led to believe that the larger the number of people involved, the more important the issue will be. That is a basic problem about this issue. There is not, sub specie aeternitatis, a huge number of people who are affected by blood contamination, but those involved have been affected in a way that damages their lives every minute of every day. I would not have known about this issue if it were not for a person in my constituency called Mohibul Islam, who has been in contact with me year after year—I now have a file of correspondence so enormous that I could not bring it into the Chamber—and who has asked me to participate in the debate and to ask a specific question.

Let us be clear about this: I do not accuse the Government of being heartless. It would be easy to do that, given the suffering of the people involved. However, the Government do not seem to grasp the fact that a process that should have been followed to produce an effective outcome has been left in such a way that we still cannot believe that we are going to get a result. We still cannot believe that the outcome will be known to, and potentially satisfy, the relatively small number of our constituents who are suffering in this way. Also, when I say that this involves a small number of people, I must stress that it occupies 100% of their lives.

It may well be that every Member in this Chamber has in her or his family someone who suffers from some deeply upsetting illness, but unless one knows about blood contamination, it passes us by. The Government have not given the matter the active attention that it deserves, and that may simply be because the number of people affected is relatively small. This is not in any way an accusation against the Government—I will make accusations against them when I need to—but there are no votes in this, because the number is small. However, the numbers suffering cannot be pinned down by statistics. Unless any of us in the Chamber have actually suffered from blood contamination or its consequences, we do not really know about it, even if we are told.

Mohibul Islam has asked me to put a specific question to the Minister, and I will ask her to respond to him, so that I can let him know that his voice has been heard in the House of Commons. He wants to know why, instead of raising payments and bringing them above the poverty threshold, the payment for the dual-infected group is being cut substantially, leading to some people being £7,000 a year worse off. For someone with tax relationships with Panama, £7,000 may not seem like a large sum of money, but it is everything to somebody who needs the money and goes day after day without any prospect of alleviation.

[Barbara Keeley]

We have heard Government Members say that money is tight, but like my right hon. Friend’s constituent, my constituent Mr Dave Gort has had to cover the cost of his own treatment and is facing a decrease in the annual payment. He will also lose additional support such as winter fuel payments and the prescription prepayment programme. Those affected also have issues with insurance, for example, with premiums being loaded even when the virus has cleared. I support my right hon. Friend’s points about hardship and the hit that the change represents.

[Sir Gerald Kaufman]

What my hon. Friend says is remarkably valid and I concur with it. As a consequence of what she and other Members have said and, most of all, of my communications from Mohibul Islam, I want to know why the Government cannot at least provide parity with Scotland. That would not solve the problem, but it would to some extent alleviate the financial consequences.

As I said, every one of us in this House, either personally or through someone in our family, has suffered the effects of some kind of health-related problem. In my case, my brother and one of my sisters died in suffering after a long experience of Alzheimer’s disease. There are many ways in which the human condition can be hurtful or troublesome. I am not looking for a solution—frankly, I do not believe that there is a solution in health terms—but I am looking for the Government to show that they care, that there will be an outcome, and that that outcome will, as a minimum, alleviate the anxieties and concerns of those who live with this affliction every single day.

Dementia and Alzheimer’s Disease

Baroness Keeley Excerpts

Tuesday 12th April 2016 Westminster Hall

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

It is a pleasure to speak in this debate with you in the Chair, Mr Stringer. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate. I recognise the remarkable amount of work that he does on social care and carers, and I thank him for that. We have had some excellent contributions from 14 hon. Members—almost too many to mention, so I will not mention them all. We are making some progress but we have a long way to go to improve care for people with dementia and support for their carers.

The Labour Government launched the first ever national dementia strategy, appointed the first national clinical director for dementia, and commissioned the National Institute for Health and Care Excellence to develop the quality standard for dementia. Together, those began the process of establishing memory clinics, providing better training for GPs and improving the quality of dementia care for people in hospital. I thank the hon. Member for Charnwood (Edward Argar) for mentioning that record. It is welcome that the Government are carrying on that work through the Prime Minister’s important challenge on dementia 2020. I am sure that hon. Members here today agree with the aims of that challenge but we have to accept that there is a long way to go before they become a reality.

Dementia is a distressing condition. In the long term we should be aiming for a cure, but while working to find a cure we must put equal emphasis on the care provided to people with dementia and the support provided to their families and carers. Carers UK reminds us that the symptoms of dementia can make providing care particularly difficult. People with dementia—we have heard about this in the debate—can grow agitated and violent, and night-time wandering and shouting can disrupt carers’ sleep.

Families report challenges in finding services that have the expertise to provide the right care and support. Of course, that means that it is more difficult for carers to get practical help or to take essential respite breaks as they do not have, or they lose confidence in, the quality and appropriateness of the care available. I welcome the strong case made by my hon. Friend the Member for Burnley (Julie Cooper) for better support for carers.

The care sector has a turnover rate of 25% so even when a care package at home is arranged, high staff turnover makes it harder to build familiarity and trust. For people with dementia, receiving care each day from someone they see as a stranger can be upsetting and confusing, and can make them more likely to refuse support, putting further pressure on their family carers. It is clear that improvement is needed, so can the Minister say whether the carers of people with dementia will be a key strand of the upcoming carers strategy?

I applaud the Alzheimer’s Society “Fix Dementia Care” campaign, which wants to ensure that people with dementia receive the highest standards of care in hospital, in care homes and in the home. It is of great concern that a survey of carers of people with dementia found that only 2% believed that hospital staff understood the specific needs of people with dementia, more than half felt that the person they cared for was not treated with understanding and dignity in hospital, and nine out of 10 felt that the person with dementia became more confused while in hospital.

The Alzheimer’s Society is calling for all hospitals to publish an annual statement of dementia care. In my area, it was pleasing that Salford Royal recorded information for patients with dementia and that the records showed that Salford Royal’s performance on a number of elements of care was better than national averages. However, other local hospitals did not record that information so there is much to do to bring that up to standard.

As part of improving hospital care for dementia patients, listening to carers would be a step forward. Nicci Gerrard is leading John’s Campaign for the right for family carers to stay with people with dementia in hospital, as we heard earlier. Nicci’s father John suffered a significant decline when he was in hospital for five weeks. Although the family felt that individual nurses and doctors were kind, conscientious and respectful, restrictions on waiting times meant that the family could not sit and talk to John, read to him, make sure he ate or keep him attached to the world.

John’s Campaign calls for the families and carers of people with dementia to have the same rights as the parents of sick children. They should be allowed to remain with them in hospital for as many hours as they are needed or are able to give. I understand that 272 hospitals across the UK have pledged their support to John’s Campaign. Will the Minister outline what is being done to improve hospital care for dementia patients and whether she supports John’s Campaign?

As well as improving hospital care, there are real concerns about the state of social care. The Association of Directors of Adult Social Services reports that £4.6 billion has been cut from adult social care budgets and that 300,000 fewer people are receiving publicly funded services than in 2009-10. Social care has been an easy target for cuts. I am concerned now that the Chancellor’s aim to find a further £3.5 billion in savings by 2019-20 will hit council and social care budgets even further.

The Government have stated that, by 2020, they want to see an increase in the number of people with dementia being able to live at home with more personalised support available to them and their families. That is a laudable aim, but the Channel 4 “Dispatches” programme last week showed just how poor home care can be, with time clipped from care visits, careworkers working very long days and not being paid for travel time, care needs neglected, and no time for the careworker to talk and listen to the person receiving care.

This year and next year are tough years for social care funding because home care and residential care providers bringing in the so-called national living wage have estimated they will face costs of £330 million in 2016-17 with no additional funding for this Government policy. The better care fund only provides £100 million extra next year, so this year is a problem. It is not surprising that careworkers say that issues with their pay and conditions prevent them from delivering good quality care. Unison found that three quarters of domiciliary careworkers do not have enough time to provide dignified care and that 84% of service users not getting enough time for care are people with dementia.

Caring for someone with dementia is not just about aspects of physical care. It is about conversations—knowing the person and knowing what is a comfort to them. Across hospitals, primary care and home care, we need to improve staff training and understanding of how to support people living with dementia and how to support and work with their family carers.

Carers UK reminds us that carers are the experts in the care needs of the person they care for, so it is heartening that today, Dr Julie Wray of the School of Nursing, Midwifery, Social Work and Social Sciences at the University of Salford is launching her book, “Supporting families and carers: a nursing perspective”. I hope that her nurse colleagues use the book to develop their knowledge of how to work with carers of people with dementia. They are the people who make such a vital contribution to the care of all those people.

[Graham Stringer (in the Chair)]

I call the Minister. Would you leave a couple of minutes for Jim Shannon to sum up?

National Minimum Wage: Care Sector

Baroness Keeley Excerpts

Wednesday 23rd March 2016 Westminster Hall

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

It is a pleasure to speak in the debate with you in the Chair, Mr Rosindell. I congratulate my hon. Friend the Member for Sheffield Central (Paul Blomfield) on securing the debate and on the excellent way in which he opened it.

I want to talk about what I describe as the funding crisis in social care. Many providers are struggling to provide good-quality care—even if they want to, as they should—against the backdrop of years of cuts to local authority budgets for adult social care. The increased costs associated with the national minimum wage and the so-called national living wage are going to place providers under additional financial pressure, and that is of great concern. The Local Government Association has estimated that introducing the so-called national living wage from April will cost at least £330 million for home care and residential care providers. There was no additional funding for that in the Budget. There is a risk that too many providers will become financially non-viable. We do not want care providers to cut staff numbers even more, threatening the quality of care.

The social care precept is not the answer to finding enough funding for what is a Government policy change. My local authority, Salford City Council, needs £2.7 million to pay for the minimum wage increases in our local care sector, but the council can only raise £1.6 million from the social care precept. The Government are not providing funding for their own wage policy. In my area, the people of Salford are finding the money, from their council tax. I am sure that there will be agreement in the Chamber that care workers should be paid the national minimum wage. Care work is a demanding job that requires skilled workers who are compassionate and who provide empathy and good-quality care. It is completely unacceptable that a job that historically has been undervalued is still being exploited today, and that those workers are not being paid the basic wage.

I give credit to Unison for its work interviewing care workers and finding out in detail the constraints on them, such as having to rush between calls and reduce the amount of time spent with individuals who are socially isolated. We are concerned about social isolation among older people, and the fact that there is no time to care. Staff sometimes work from 7 am until very late in the evening, but they have dead time that they do not get paid for; and they do not get paid for travel time. The Cavendish review highlighted the impact of non-payment for travel time on care provision:

“Some low paid Home Care Assistants and support workers will…keep going as long as they feel they are still giving good care. But the advent of zero hours contracts, fee cuts and no payment for travel time”

is really to blame because it

“is making it financially prohibitive for some domiciliary care workers to struggle on.”

The Government agreed that the statutory guidance should require councils to include payment for travel time in provider contracts, but that guidance is clearly not being complied with. There are even examples, in an excellent Unison study, of a home care worker being given 20 minutes to visit an old lady of 102, to help her shower and get dressed, make food, tidy her kitchen, give her medication and put her bins out. That is not enough time to give safe and dignified care. Tackling non-compliance should be a priority. The Government must consider the impact of their policies and act on the chronic underfunding of the care sector that I outlined.

My hon. Friend the Member for Sheffield Central made a number of suggestions about how to improve national minimum wage compliance. We must have monitoring of the commissioning practices of councils; it should be a priority. Employers and commissioners could also publish, or provide employees with, a statement that they comply with the national minimum wage, increasing transparency. As he said, we must improve the protocol for supporting whistleblowers who bravely tell the story of what is happening. It is only when care staff are valued and paid adequately that service users will receive the good-quality, compassionate care they need. As he said, we should be ashamed that we trade on the good will and commitment of our home care workers.

--- Later in debate ---

[Chris Stephens]

I agree with my Unison comrade and friend. One barrier to getting back-payments in this sector in particular is that the fees charged are often greater than the wages claimed for. I thank her for making that point.

If the green light is to be given to more employers, they will take that. In Scotland, with only two offices—in Glasgow and Edinburgh—to be retained under the proposals, it is simply not credible to suggest that, despite best efforts, HMRC’s minimum wage enforcement can continue at the same level. Given that the workforce in the care sector is female-dominated, it seems that a double whammy is created. We as a society pay women less overall and, even when a legal floor is put in place to stop wages falling below a certain level, many women are victims of their employers’ criminality and earn even less. There can be no place in a civilised society for the law-breaking that appears to be happening in areas of the care sector. A civilised Government should do all they can to stamp out that insidious practice.

Other Members have set the scene. As usual I enjoyed the contribution from the hon. Member for Sheffield Central (Paul Blomfield). He rightly said that the sector looks after the most vulnerable. The hon. Member for Ashton-under-Lyne (Angela Rayner) indicated her personal experience and the right hon. Member for Oxford East (Mr Smith) was correct when he said that it is not unreasonable to demand that the national minimum wage is paid.

[Barbara Keeley]

Many practices have been talked about during this debate, but we have not addressed the new practice of paying care staff by the minute—minute rates. I do not know of any other group of people paid and measured by the minute.

[Chris Stephens]

I am not aware of that either, but it is an important point. Bad employers will try such methods. I am concerned to hear about companies that are trying to get around paying the living wage by taking premium payments off staff. That is another important point that this Parliament will need to address.

Mixed messages are coming from the Government in this regard. Ruby McGregor-Smith, the leader of a home care company that the BBC had revealed was not paying its home care workers the national minimum wage, was recently elevated to the House of Lords. In August 2015, the Prime Minister commented to The Times:

“So to unscrupulous employers who think they can get labour on the cheap, the message is clear: underpay your staff, and you will pay the price.”

Also in the summer of 2015, HMRC launched a national minimum wage campaign that allows employers that have not been paying the national minimum wage to escape punishment. The Government have been saying to companies that HMRC

“will not undertake an enquiry or investigation on your National Minimum Wage records”.

That is a mixed message.

That leaves an over-reliance on workers making complaints to HMRC. As has been revealed during this debate, many care workers fear reporting their employers because reprisals can include dismissal or having their hours cut. As was stated earlier, many home care workers are on zero-hours contracts.

Action needs to be taken. I hope that the Government will give a commitment that where a company is non-compliant, HMRC will extend its investigation to cover that company’s whole workforce. HMRC should publish results regularly, carry out assurance checks in the sector and allow third-party reporting. We have heard from many Members who have spoken so far about the vital role that the trade union movement is playing in the sector. HMRC should maintain records of the number of employees who contact it through the helpline, and there should be a formal protocol for HMRC to ensure that no action is taken against whistleblowers.

Minimum wage rates exist to protect working people and their wages, with a legal floor that stops wages going below a certain level. The insidious practice of not paying the national minimum wage must end, but it can end only if the Government are willing to ensure that compliance with minimum wage rates is monitored rigorously.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I start by congratulating the hon. Member for Sheffield Central (Paul Blomfield) on bringing this debate to the House. It has been a very helpful opportunity to focus attention on this important area, and it gives me a chance, on behalf of the Government, to make clear our commitment to ensuring that this issue is properly dealt with. I know he is a robust champion of workers in the care sector, and I want to praise him for his work in representing them here today.

I also pay tribute to the right hon. Member for Oxford East (Mr Smith), the hon. Members for Brighton, Pavilion (Caroline Lucas) and for Hampstead and Kilburn (Tulip Siddiq) and others who have taken such an interest in this issue. Opposition Members may be surprised to hear me single out and congratulate Unison and the Resolution Foundation, which have done really good work on behalf of workers in the sector by shining a light on the complex issues and some of the completely unacceptable practices that have gone on for too long.

I take this opportunity to pay tribute to our nation’s 1.5 million care workers, who, as hon. Members have said, work tirelessly to provide invaluable support to some of our most vulnerable citizens. Without their support in caring for the frail, the disabled and the elderly, we simply would not be able to cope as a society with the pressures of an ageing population. Hon. Members are right that we must ensure care workers are treated fairly by their employers and receive the money to which they are legally entitled—and that is a priority area for the Government, for this Minister and for the Minister for Skills, my hon. Friend the Member for Grantham and Stamford (Nick Boles), who leads on this within the Department for Business, Innovation and Skills.

Perhaps I could take this moment to make it clear, lest anybody watching the debate is in any doubt, that this generation of Conservatives in government strongly supports the national minimum wage. We are very proud that we have gone further and introduced the national living wage, as well as increasing penalties from £5,000 per employer to £20,000 per employee, which last year saw one investigation lead to a fine of half a million pounds.

We have also increased the budget for compliance by 50% since 2010 and strengthened the naming and shaming provisions. Let me send the strong signal that we will not tolerate non-compliance with the national minimum wage. It applies across all sectors, and the nature of the work that these care workers do, in a fragmented, challenging and geographically difficult sector, is no excuse for non-compliance.

I want to make it clear that any employer who treats the Government’s commitment to this space with contempt needs to be very careful. I am very disappointed to see that the Business, Innovation and Skills Committee’s request for Mike Ashley from Sports Direct to come and give evidence has not been responded to. Let me take this opportunity to say that contempt for this area of law is not acceptable, and to welcome the recent court case in which Caroline Barlow successfully prosecuted MiHomecare. It led to the court ruling that she and, by implication, others should have been properly paid. I welcome that, and the signal should go out very clearly to businesses, councils and all those who employ the low-paid that they have to abide by their duties under the law.

[Mr Philip Hollobone in the Chair]

[Barbara Keeley]

Most Members here would agree with the Minister about Mike Ashley, I am sure, and would applaud the Chair of the BIS Committee and the Speaker for the way in which they are handling the situation.

The key point I want to make is this: although it is good that the Minister is proud of the Government’s policy on the minimum wage, does he not think that the Government should have funded that? Is not the key problem the one that I outlined: the 2% precept will only raise £1.6 billion, but my local council will need £2.7 billion just to deal with these pressures? We cannot get to a position in which those in the care sector can pay the minimum wage unless there is funding for it, and that is the Government’s responsibility.

[George Freeman]

I will come on to the funding of social care, which is a major issue that we all face as a society and will require some pretty deep thinking over the years ahead. I will also describe the extra money that the Government have put in. Although there is never enough money, we have made this priority very clear.

It may help if I review how we got to be where we are today. In 1999, the national minimum wage came in. It was the first time that legislation had been introduced in the UK to ensure a minimum level of pay for virtually all workers. Its aim is to help as many low-paid workers as possible, end extreme low pay and ensure a level playing field for employers. We are absolutely clear that anyone who is entitled to be paid the national minimum wage or, from 1 April, the national living wage must receive it.

--- Later in debate ---

[George Freeman]

Perhaps I can come back to the hon. Lady on specific cases—I do not have them to hand. I just want to talk about what we are doing to deal with the issues that have been raised, but she makes an interesting point.

In the care sector, we have a particularly high incidence of workers who have not been paid the national minimum wage in the right way. Other sectors are hairdressing and retail, and there is some dispute about where the worst practice exists, but the care sector clearly has a major historical problem. That is in part attributable to the fact that many of the more complex rules on calculating working time are prevalent in the sector—for example, the calculation of travel and sleeping time. On those points, although I am sure that Members will appreciate that I cannot comment on individual cases, I want to restate the Government’s position: when workers are performing work under their contracts, they must be paid the minimum wage.

It is also worth noting that there is no perfect measure of non-compliance within the sector, and there is a possibility that current estimates of non-compliance overestimate work time and underestimate pay, because the information is reported by workers themselves. That is why we are continuing to work with the Low Pay Commission, the Office for National Statistics and others in order to improve our estimates and better understand the scale of the problem.

On the point that was mentioned by the right hon. Member for Oxford East (Mr Smith) and others, the Low Pay Commission’s proposals on transparency merit serious consideration, and we are looking at those and a number of its other recommendations. We are determined to continue to drive forward and send the very clearest signal to companies and employers that we are becoming less tolerant of non-compliance, and we want them to recognise that.

None the less, increasing compliance with the minimum wage in the sector remains a top priority for us and we are taking a number of steps to promote compliance and take stronger action against those who break the law. First, HMRC continues to focus on tackling non-compliance, but that activity is no longer reliant on worker complaints and instead targets employers with the highest risk of non-compliance, based on a range of intelligence and information. HMRC can now analyse information from, for example, other Departments, trade union representatives and the Low Pay Commission, and the evidence indicates that this targeted approach in the care sector is working. From April 2013 to January 2016, HMRC opened 443 cases in the social care sector and closed 308 of those. Of the 308 closed cases, underpayment of the national minimum wage was found in 32% of investigations—for total arrears of £442,000 to 3,000 workers, with penalties issued for a total value of £100,000.

Members have also raised the important issue of affordability within the sector, given the introduction of the national living wage. That pay rise for the lowest paid could be seen to be a threat in terms of increasing non-compliance. That is partly why we are taking steps to signal strongly our commitment to clamp down on it.

With an ageing society, social care funding is a major strategic issue for the country and this Government. We are engaging closely with all the relevant stakeholders on that issue to ensure that councils recognise the need to increase the price that they pay for care in order to cover costs and to reflect rising costs and, not least, the national living wage. That is partly why we are giving local authorities access to an extra £3.5 billion of new support for social care by 2020, to be included in the better care fund. Councils will also be able to introduce a new social care precept, allowing them to increase council tax by 2% above the existing threshold. Taken together, the new precept and the additional better care fund contribution mean local government has access to the extra funding that it will need to increase social care spending in real terms by the end of this Parliament.

[Barbara Keeley]

I thank the Minister for giving way again, but there is a two-year gap. There is nothing from the better care fund this year, only £100 million next year, and—as I said in giving the example from my local authority—the 2% social care precept only covers about half of what is needed. Nationally as well as locally, that is the problem and that is why the Local Government Association asked the Government to bring forward £700 million.

[George Freeman]

I understand. These things are never straightforward or simple. As the right hon. Member for Oxford East pointed out, a lot of creativity is required from councils and the healthcare sector. There is best practice across the country to ensure that health and care are better integrated. [Interruption.] It is all very well for Opposition Members to shake their heads as if this were an easy problem to solve. It is a problem we inherited from the last Government. I am trying to be reasonable in setting out our commitment to deal with it, but it should be remembered that we inherited the problem from the Members who are shaking their heads and suggesting that it is easily solved. I hope that the measures I have set out provide reassurance that we are taking the matter seriously.

Perhaps I may conclude by framing the central elements of the package that we are putting in place. We have toughened up the sanctions and made it easier to name and shame. We have now named 490 employers, raised over £1 million in penalties and recovered over £30 million in unpaid arrears. We are now running at a 94% rate of naming since our revisions to the code in 2013.

Several hon. Members made the point about four-year delays, including my hon. Friend the Member for Dudley South (Mike Wood). I think that that is completely unacceptable. Although we are seeing progress in the speed and rate at which investigations are being pursued, I will talk to the Minister for Skills to make sure the very strongest signal is sent to HMRC saying that we cannot tolerate such delays.

As I have signalled, we are seriously interested in looking at the Low Pay Commission’s recommendation on payslip transparency. It is important that employers are held to account and that employees, particularly when it comes to individual elements of time, can see clearly what time they are being paid for.

I want to highlight the fact that the advice available for employees is free and confidential and that we have introduced important measures to ensure that, when HMRC has information from a third party to carry out an investigation, it keeps the complainant’s identity confidential and that that should trigger a whole workforce investigation.

I also want to highlight the fact that HMRC offers a free service to any employee who believes they are not being reimbursed properly. HMRC also has powers to enforce the reimbursement of expenses. That gives me the chance to highlight the fact that all expenses properly incurred by care workers in the course of doing their duty, often in a sector that requires them to travel extensively across large areas, should be, must be and the Government expect will be, properly reimbursed.

I hope that that helps to set out the Government’s real commitment to tackling the issue. I again thank and congratulate the hon. Member for Sheffield Central on raising it and giving me the opportunity on behalf of the Government to set out how strongly we support cracking down on non-compliance.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Ben Gummer]

I happily congratulate the staff at my hon. Friend’s local hospital. This shows where good constituency representation, reinforcing the efforts of local people working in local hospitals, can produce improvements in staff morale and therefore in the experience of patients, which is something from which Labour Members would do well to learn.

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

In a recent survey, 70% of GPs warned that their workloads were becoming unmanageable, and 55% said that the quality of the service they provided had deteriorated, with too few patients getting appointments, treatment and the range of services needed. We now hear reports of a large decrease in applications for GP training places, and this is one of the last cohorts to be fully trained by 2020. Unless the Minister takes urgent action to address these issues affecting GP morale, workload and recruitment, patient care will just get worse. What is he going to do about it?

[Ben Gummer]

The hon. Lady raises the issue of GPs. We are ensuring that there will be 5,000 additional GPs by the end of this Parliament, which addresses precisely the issues that she raises.

[Barbara Keeley]

indicated dissent.

[Ben Gummer]

I do not know why the hon. Lady is shaking her head. She asked what I am doing, and 5,000 additional GPs will help to solve her problem. Secondly, we are putting a greater proportion of funding into general practice, by comparison with the proportion of the NHS budget as a whole, than any previous Government. Thirdly, we are increasing the number of GP training places. I am pleased to report that we are doing well in ensuring that more people in training positions are choosing to become general practitioners.

End of Life Care

Baroness Keeley Excerpts

Wednesday 2nd March 2016 Commons Chamber

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

I join other Members in thanking the Chairs of the Select Committees for the work on the reports that we are debating today. I was a member of the Health Committee when it produced the end-of-life care report.

Although Ministers have talked of rising to the challenge of improving palliative care, they have yet to take the action needed. They have not responded to the independent panel’s “Choice” review report published in February 2015. I know that the Minister and his colleagues repeatedly promised to respond to that report by the end of 2015, although I note that the Minister has recently changed to saying they will respond “soon”. The hon. Member for Strangford (Jim Shannon) noted that 48,000 people have experienced poor end-of-life care since the “Choice” review was published. Given that figure, we need a swift Government response now, and I ask the Minister to tell us when he expects that response.

As many Members have mentioned, the palliative care workforce works extremely hard to provide good care for people nearing the end of their life. We owe a debt of gratitude to our hospices, palliative care staff in hospitals, and Macmillan and Marie Curie nurses, because when end-of-life care is delivered well, the benefits to the patient and the family are immeasurable; when it is delivered badly, it can cause considerable pain and distress to those involved.

Even though we have the excellent St Ann’s hospice in my constituency and we have one of the best hospitals in the country in Salford, I have dealt with cases in my constituency where end-of-life care has not been delivered as it should have been, leaving bereaved family members distressed and anguished. The National Council for Palliative Care has said that despite high aspirations,

“there is still unacceptable variation, which would not be tolerated in any other area of practice.”

The ombudsman’s report shows us the consequences of people dying without access to high-quality care and support.

In my constituency I have had cases with similar failures to those that the ombudsman highlights—not recognising that the patient is dying, not responding to their needs, poor symptom control, poor communication and inadequate out-of-hours services. One of the cases I dealt with happened in 2005 and was included in a previous report by the ombudsman. Another occurred in 2013. It worries me that I have had constituents suffering the same heartache caused by poor end of life care when it is clear what needs to be done to improve their care.

My constituents died without dignity and in pain. Their carers and family members were left to run around trying to find suitable pain control for them, which meant that they lost the chance to spend precious time with the family member who was dying. The SNP spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), has just highlighted for us how important it is to have those last few hours with a loved one. The Health Committee report recommended that a named clinician support the co-ordination of care. Clearly, that would help in so many cases, and the idea was supported by the right hon. Member for Wokingham (John Redwood).

We know that each year around 500,000 people die in England and Wales and half of those deaths occur in hospitals, so we must make sure that end-of-life care is fit for purpose in all settings and that staff are trained to recognise when someone is nearing the end of life. However, the End of Life Care Coalition tells us that NHS England has made no substantial move to invest in palliative or end-of-life care. Investment in those services is essential to ensure that they are co-ordinated and that people receive the correct care wherever they are.

The Health Committee report asks the Government and NHS England to set out how universal, seven-day access to palliative care could become available to all patients, including patients with a non-cancer diagnosis. Marie Curie tells us that only one in five trusts in England provide face-to-face access to specialist palliative care seven days a week from nine to five, despite this being the National Institute for Health and Care Excellence standard since 2004, and only 2% of trusts provide a 24/7 face-to-face service. People should not have to die in pain and distress because trusts are not complying with a decade-old NICE standard.

A common theme in the Health Committee’s reports has been the need to ensure that choice is on offer. People want to have choice. Will the Government review the choice on offer for children and young people at the end of their lives, as they have done for adults? I have a further concern that without proper investment in community services and specialist palliative care services, choice will remain restricted. In the previous Parliament the number of district nurses fell by 2,400, and many other community nursing posts, particularly senior posts, were cut. With such a hollowing out and deskilling of the community sector, I am concerned that the nurses who provide end-of-life care services are coming under increasing pressure, without the time or specialist skills to provide the quality care and compassion needed at the end of life.

My hon. Friend the Member for Burnley (Julie Cooper) raised the serious issue of the level of cuts to adult social care. We know that we have already lost £4.6 billion from adult social care budgets since 2010. The King’s Fund, the Health Foundation and the Nuffield Trust have said that there will be a gap of around £3 billion in social care by the end of this Parliament. As we approach the Budget, it is important to acknowledge that the Government’s funding plans will not address that gap. The Local Government Association reported last week that councils are looking at council tax options that will raise only £370 million this year, which is less than the Government predicted. The promised better care funding is back-loaded, with nothing this year and only £100 million next year. In my local authority area, Salford, we will raise only £1.6 million this year, compared with cuts of £15 million since 2010.

GPs are also finding that they are under increasing pressure. In a recent survey, around 70% said that their workload is sometimes unmanageable, and over half said that the service they provide has deteriorated in the past year. One factor that is key to providing quality end-of-life care—we have heard about this in this debate—is ensuring that doctors and nurses have time to have the conversations needed with patients, families and other care providers, but the funding and staffing pressures I mentioned will not help staff to have time for those conversations.

The Health Committee’s report called for free adult social care at the end of life, and we made that a commitment in the Labour party manifesto, as my hon. Friend the Member for Luton North (Kelvin Hopkins) mentioned. In recommending that, there is clearly the issue of where we find the funding that we have talked about in this debate. It is clear that offering better support in the community would mean fewer hospital admissions. Too many people approaching death are forced to spend long periods of time in hospital owing to a lack of social care or alternative support options, and that is unsustainable.

The Chair of the Health Committee referred to the Nuffield Trust’s evaluation of the Marie Curie nursing service, which found that people cared for by a Marie Curie nurse had total care costs of around £500 less per person, and hospital stays and costs were often avoided. Only 8% of Marie Curie patients died in hospital, compared with 42% of people without a Marie Curie nurse. The End of Life Care Coalition thinks that those results can be replicated in other palliative care nursing services. Free adult social care at the end of life could also help to reduce the inequalities that currently exist in end of life care services due to age, gender, diagnosis, geography and deprivation, as has been mentioned.

We have heard that 88% of palliative care in-patients and 75% of new referrals were for people with a cancer diagnosis, even though cancer accounts for only around 29% of deaths. Older people receive less specialist palliative care than other age groups: only 16% is provided to people aged 85 or over, although 39% of deaths occur in that age group. We should be delivering services that enable someone living with dementia and someone living with cancer to receive the same quality of end-of-life care.

Will the Minister tell the House whether the Government will implement free social care for people nearing the end of life? The Opposition believe that altering the funding criteria for NHS continuing healthcare is not enough. He said in response to an earlier debate on end- of-life care:

“We have enough paper evidence. We know what looks good, how to make it happen and that it needs to happen, and we know that many people die in circumstances that leave much to be desired.”—[Official Report, 4 November 2015; Vol. 601, c. 1089.]

We need action. We need a response to the “Choice” review, describing what action the Government will take on the key issues of choice, funding for end-of-life care and social care services, co-ordination and the identification and support of carers. If end-of-life care is the litmus test for health and social care services, we are currently failing it for too many people. We need good quality, compassionate end-of-life care to be available so that each person nearing the end of life can feel supported and safe in the knowledge that they will receive the very best care.

--- Later in debate ---

[Barbara Keeley]

It sounds as though the Minister is about to conclude his remarks, but he has not yet said when the Government will respond to the “Choice” review, which I asked about, as did several other Members. That is very important.

[Ben Gummer]

As I have made clear publicly, we will respond in short order to the “Choice” review, but I want to get this right. It is important that we make the content of the response as good as possible, and I do not want to compromise on that. Moreover, the hon. Lady’s party did not bring forward such a review.

This has been a very good debate on all sides. I am delighted by the cross-party support for the need to make changes. I hope that we will return to this debate in the weeks and months ahead and will be able to continue making a real change in the way that we approach death and end-of-life care in this country.

Community Pharmacies

Baroness Keeley Excerpts

Tuesday 23rd February 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for St Ives (Derek Thomas) on securing this important debate. I join the Scottish National party spokesperson, the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), in sending good wishes to Pauline Cafferkey, which I am sure we all wish to do. It is very disturbing to hear that she has become ill again.

In what has been a wide-ranging debate, we have had heard from Members about the importance of community pharmacies to their constituents. I thank my hon. Friend the Member for Ealing North (Stephen Pound) for not only giving us an impressive list of the additional services available from community pharmacies but, importantly, discussing the role that they can play in under-doctored areas, which is an issue in my constituency. We must of course consider rural areas, but urban areas can also be very short of services. In my constituency, we have lost walk-in centres and other forms of community support, such as active case-management pilots. It is a pity that such excellent services that keep people away from GPs and hospitals are being cut.

As we have heard again and again in the debate, community pharmacies provide an essential service in dispensing both medication and the essential information and advice that can prevent people from having to visit their GP for common health problems. On 17 December, the day the House rose for the Christmas recess, the Government announced a £170 million cut to community pharmacy services, with further cuts to follow. That initial 6% cut in the funding for community pharmacies will put significant financial pressure on many of them and will result in closures and job losses. Can the Minister assure us that the service offered to patients will not suffer due to the cuts? It is hard to see how there will not be a loss to patients. Will he comment on the additional pressures that will be placed back on the NHS as a result of that loss?

As my right hon. Friend the Member for Rother Valley (Kevin Barron) said, the Minister had a meeting with members of the all-party parliamentary group on pharmacy. I understand from the note of that meeting that he estimated that between 1,000 and 3,000 pharmacies, out of the overall total of 11,700, could close. He also recognised that smaller pharmacies are likely to be squeezed. Such a significant number of pharmacy closures will have a substantial impact on the way that the pharmacy sector operates. The sector called the cuts a “profoundly damaging move”, so it is important that the Minister updates us on the number of pharmacies at risk of closure. The Government failed to outline funding plans for subsequent years, raising concerns that there could be even deeper cuts later in this Parliament. Will the Minister tell us what further cuts are planned?

Despite the cuts, the Government say they want

“greater use of community pharmacy and pharmacists: in prevention of ill health; support for healthy living; support for self-care for minor ailments and long term conditions; medication reviews in care homes; and as part of more integrated local care models.”

As with everything else to do with care, a letter from the Department for Health suggests that the reforms can be carried out by integrating community pharmacies into a range of primary care settings. Integration is fine in itself, but it will not be achieved through funding such as the pharmacy integration fund, which is set at £20 million and will rise to £100 million by year five. I understand that the majority of the funding will focus on providing pharmacy services at GP practices, but that overlooks the wider role that community pharmacies play, which hon. Members have talked about in the debate.

My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) passed me a note about the Windmill Pharmacy in his constituency. In a couple of hours on Saturday, its pharmacists dressed an elderly man’s superficial wound, gave advice on a fungal infection, advised on vaccines and malaria tablets for people travelling abroad, counted and sorted the tablets for many patients with multiple conditions, gave an antibiotic eye drop for a child with an infected eye, gave repeat blood pressure tablets to a patient whose GP was away, and, of course, had their technicians set up the dosette boxes for patients, including those with dementia, who rely on that service. All those services are freely provided in pharmacies. That is an excellent example from my hon. Friend’s constituency. How does the Minister expect community pharmacies to improve their services and continue to do all of those things when they face a significant decrease in funding and are simultaneously being asked to provide greater support to GP practices, care homes and accident and emergency units?

It has been suggested that we should facilitate hub-and-spoke arrangements, but there are real concerns about that system. My right hon. Friend the Member for Rother Valley said:

“Warehouse dispensing, or ‘hub and spoke’, raises questions around safety, quality and access. The supply of prescription medicines cannot be treated like buying clothes and DVDs. High quality, safe dispensing depends on the opportunity for a face-to-face discussion between the pharmacist and the patient. I don’t see how that can be done in a warehouse.”

I share those worries, which were expressed very well by my hon. Friend the Member for Hyndburn (Graham Jones), who asked some important questions about warehouse chemists’ practices and the data security implications of what they do. Most importantly, the Government must tell us how they will ensure that the essential face-to-face contact between pharmacists and patients is maintained.

Pharmacy Voice outlined the negative consequences of the cuts to community pharmacy services. It is concerned that the funding cuts will increase the risks to patient safety and will decrease patient access to medicines and vital support. The cuts risk job losses and will diminish community assets and the long-term potential of community pharmacies. Pharmacy Voice also warned that the cuts are likely to undermine existing health improvement plans and recent initiatives to integrate and develop community pharmacy services. We heard about some wonderful examples of integration and new ways of working in this debate, but all of that will be dashed.

Sue Sharpe, the chief executive of the Pharmaceutical Services Negotiating Committee, said that the plans

“can only impair pharmacies’ contribution to keeping people well and out of GP and urgent care settings.”

The Government are, in her words,

“proposing to drive ahead to radically change the market with a real paucity of knowledge essential for good decision making.”

We want decisions to be based on better information than we have heard about here.

In my constituency, I have been in contact with the chair of the Salford and Trafford local pharmaceutical committee, Varun Jairath, who is a board member of Community Pharmacy Greater Manchester. He believes that patient safety and welfare are at risk from the planned funding cuts, which means that the community pharmacy network will have to reduce staffing levels and the services it offers for free, such as the home delivery of medication, which has been referred to again and again. I went with a delivery driver from a local pharmacy to hand out information to carers in homes who receive medication. Vital extra things such as that can be done, but only with the existing service levels.

The additional services provided by community pharmacies are at risk from the funding cuts. The minor ailments scheme, which was piloted in Eccles in my constituency, was shown to free up capacity and cash for other areas of primary care by allowing GPs to focus on the more complex patients. That service can continue at £3 per consultation only if community pharmacies continue to be funded at current levels. Such services, which improve quality and save cash, are under threat due to the proposed cuts.

As a number of right hon. and hon. Members said, one of the most worrying effects of the cuts is the potential reduction in rural pharmacy services. Access to pharmacy services should not be reduced for people who live in areas with widely dispersed populations. I ask the Minister—he has been asked this question already—what his assessment is of the impact that the funding cuts will have on rural pharmacies.

To reduce pressure on NHS services, the Government have repeatedly suggested that people should visit their local pharmacy for advice and the extra services we have talked about in the debate. Putting extra pressure on GPs through these funding cuts to community pharmacies is risky. GPs have warned that their workload is becoming unmanageable, which is likely to have an impact on patient safety. In a recent survey of about 3,000 GPs, 55% said that the quality of the service they provide has deteriorated in the past year, and 70% said they feel that their workload is unmanageable some or all of the time. I spoke to a local GP in my constituency recently in a practice whose list size had just been increased by 15%. The GPs at that practice cannot cope with that increase plus any extra that they gain from the losses that have been outlined in the debate.

We recognise the need to integrate pharmacy services better with the rest of primary care, but introducing cuts on this scale to community pharmacy services will not improve primary care outcomes. It will do the opposite. I fear that pharmacies will struggle to provide safe, good-quality services to patients. In proposing the cuts, the Government failed to recognise the value of community pharmacies and to put patients at the heart of their plans for pharmacy services. Patients will bear the brunt of these inappropriate cuts to an essential community service. A joint co-ordinated approach to planning and investment is needed across primary care to ensure that the pharmacy sector can play the important role it could fulfil, and, as I know from all the contacts I have had, wants to fulfil, and ensure that patients get the most out of both the NHS and pharmacies.

--- Later in debate ---

[Alistair Burt]

The hon. Gentleman makes a fair point, and that is indeed being done in the NHS, but we are looking at where efficiencies can be made and at what different parts of the health sector can contribute. In doing so, we can see what changes are inspired in the service provided to patients.

To emphasise where we are with pharmacy, there are 11,674 pharmacies in England, which has risen from 9,758 in 2003—a 20% increase—while 99% of the population can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport. The average pharmacy receives £220,000 a year in NHS funding. On clusters, which my hon. Friend the Member for Plymouth, Sutton and Devonport mentioned, the Government contend that money can perhaps be saved in one place and used elsewhere for the delivery of new services. That is the reality of life. It would be great if new money was always coming from somewhere, but bearing in mind that the Government are dealing with an Opposition who could not commit to the extra £8 billion that the NHS was looking for, we have to make the changes that others were not prepared to make and still deliver services.

Let me move on to where we are going. Everyone in this room, Government Members included, recognises the quality of the best pharmacy services around the country. We are familiar with the valued role that community pharmacy plays in our lives and those of our constituents. I am grateful to my hon. Friend the Member for St Ives for giving me the opportunity to put on public record the high esteem that we hold them in and to set out our plans for the future.

I am a firm believer that the community pharmacy sector already plays a vital role in the NHS. I have seen at first hand quite recently the fantastic work that some community pharmacies are doing across a wide range of health services that can be accessed without appointment. Many people rely on them to provide advice on the prevention of ill health, support for healthy living, support for self-care for minor ailments and long-term conditions, and medication reviews. There is also real potential for us to make far greater use of community pharmacy and pharmacists in England. For example, I am due to speak at an event tomorrow that is looking at the role that pharmacy can play in the commissioning of person-centred care for vulnerable groups.

Our vision is to bring pharmacy into the heart of the NHS. We want to see a high quality community pharmacy service that is properly integrated into primary care and public health in line with the “Five Year Forward View”. I cannot answer all the questions that the hon. Member for Worsley and Eccles South (Barbara Keeley) asked, but she did at least mention the integration fund for the first time in the debate.

[Barbara Keeley]

There is a difficulty, in that funding for integration should recognise that the extra work needs to be done. The point of today’s debate has been about the Government using blunt instruments, such as a 6% cut in funding, reducing the number of pharmacies in clusters, changing dispensing charges, and the warehouse pharmacy that my hon. Friends mentioned. It is the use of those blunt instruments, not the working with the sector, that is the fault.

[Alistair Burt]

That working with the sector is ongoing. That is what the negotiations with the Pharmaceutical Services Negotiating Committee are all about. I take the hon. Lady’s point, but those discussions are under way. We are consulting with a wide range of groups, not just the PSNC, including patients and patient bodies.

As part of what we are doing for the future of pharmacy, we want pharmacists and their teams to practise in a range of primary care settings to ensure better use of medicines and better patient outcomes and to contribute to delivering our goal of truly seven-day health and care services. As part of that, I want to work with NHS England to promote local commissioning of community pharmacy within the health community, so that we can ensure the best use of this valuable resource. That is why we are consulting on how best to introduce a pharmacy integration fund to help to transform the way pharmacists and community pharmacy will operate in the NHS of the future. By 2020-21, we will have invested £300 million in the fund.

While it is understandable that the focus of most colleagues’ comments today was access to existing services, little was said about where pharmacy might be going and what new opportunities there will be. That is part of the overall development that we are hoping to achieve, which will include the work not only of the access fund, but of the integration fund.

Colleagues asked several questions about access. I want to provide some reassurance. We recognise that some of the Government’s proposals have caused concern, and that will take some time to distil as the negotiations are worked through. We are committed to maintaining access to pharmacies and pharmacy services. We are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, both of which were raised today. Qualifying pharmacies will be required to make fewer efficiencies than the rest of the sector. We certainly recognise that rural pharmacies will need to be considered in that, and we want to ensure that location matters in areas of sparsity. That work is ongoing.

In conclusion, the process has some way to run. I simply put it to colleagues that, in relation to good community services on the high street, there is more for modern pharmacy to do. Looking at the proposals of the past, we hope that the profession shares the Government’s determination to move pharmacy into a new future, and I am convinced that the future will be good.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 9th February 2016 Commons Chamber

[George Freeman]

I would be concerned if that were true. The point is that we are facing extraordinary, exploding demand in our system. At the risk of sounding like a Monty Python sketch, what have the Government done, apart from launching the £3.9 billion better care fund and a £2 billion social care precept; fully funding the NHS five year forward view, with a front load of £3.5 billion; driving health devolution; and providing £4 billion for health technology? We are funding the integration of health and care in a way the last Labour Government never did.

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

That is really not true. Ministers are presiding over the hollowing out of social care, because their funding falls far short of what is needed. Some £4.6 billion has already been cut from adult social care, and the funding gap is growing at £700 million a year. The social care precept the Minister has just been talking about will raise £400 million a year, and the better care fund does not start until next year, when it starts at £105 million. Simon Stevens has called this “unresolved business”. When will Ministers face up to the fact that the Government’s figures just do not add up?

[George Freeman]

I think that that question could be taken more seriously, first, if the Labour party had tackled this issue in office and, secondly, if it had any suggestions. Let me summarise the pressure the system is under. Over the next 10 years, there will be a 22% increase in over-65s, and the number of people aged over 75 will rise by 90% in the next 20 years. We face extraordinary challenges. That is why we have announced the better care fund increases, why we have launched the social care precept and why we are driving devolution powers for local areas, which allow local health and care leaders to integrate. If this was as easy as Labour Members say, perhaps they would have done these things during their term in office.