Carers

Baroness Keeley Excerpts

Thursday 20th June 2013 Commons Chamber

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

The number of carers is growing, as is the impact of caring on the lives and health of carers. The right hon. Member for Sutton and Cheam (Paul Burstow) has touched on some of those issues, but I will go further.

Analysis by Carers UK of data published from the 2011 census has shown that the number of carers has increased substantially, by 11%, since 2001, and there are 35% more carers over the age of 65. We know that carers often combine paid work with raising their own children, as well as caring for other family members. In fact, one in four women and one in six men aged 50 to 64 have caring responsibilities for family members who are older or disabled. If we think about that for a moment, we start to realise the difficulties. Of course, many of us know people in that situation, or may be in it ourselves. Some 3 million carers juggle caring with paid work, so it is not surprising to learn that full-time carers are more than twice as likely to be in poor health as people without caring responsibilities.

Given all these stresses, carers should be getting advice and information to help them care, but it is becoming ever clearer that they are not. During the recent carers week, to which the right hon. Gentleman referred, Members met carers to find out about their issues. Last week I went to a speed networking event, as I think it is called, here in the House, at which I met six carers. Two were carers of family members with cancer, two had cared for a partner or family member at the end of their life, and two were carers of spouses with Parkinson’s. Despite the differences in their caring, the one thing they shared was not having been given the information, advice and support they needed to be carers. As the right hon. Gentleman touched on to an extent, Macmillan Cancer Support tells us that carers of people with cancer come into contact most with health professionals, by whom they need to be identified and signposted. However, 95% of cancer carers are not getting a carers assessment.

It was revealing to talk to carers of people with cancer about how this had affected them. Cancer patients, as we know, may have long days of treatment in hospital, yet no one had told the carers I spoke to that a discount was available on expensive hospital car parking costs. One of the carers had to buy a hospital bed for use at home by her daughter, yet she was given no advice on where to buy one.

Similar issues crop up for carers of people with a terminal illness, but those carers are also juggling with the knowledge that they only have a limited time with the person for whom they are caring. Carol and Lucy were the two carers I met. One had cared for a partner and the other for her mother, both through to the end of their lives. Both said how much financial hardship they had had to accept to undertake that caring. The carer of her terminally ill mother could only get unpaid leave from her job and took it for 11 months. She lost her flat because she could no longer afford to pay the rent. It seems wrong that carers have to struggle on unpaid leave while caring for someone who is terminally ill. She never told her mother that the leave was unpaid or of the difficulties she was having.

Carers of people with cancer and of people who are terminally ill both cited the same issue: as carers, they were mainly ignored by the health professionals they encountered. They rarely asked them if they were coping and they did not signpost them to carers centres or carers associations for help and advice. In the cases of the very few carers of people with cancer who managed to have a carer’s assessment, that had most often been prompted by a referral from a GP. As the right hon. Member for Sutton and Cheam says, 70% of cancer carers surveyed had come into contact with a GP, doctor or nursing staff, but they are in the health world—the NHS world—not the local authority world. Very few of them have contact with local authority staff.

I think I met the same people at the event as the right hon. Gentleman, because I met John and Karen, who were each caring for a spouse with Parkinson’s. We have already heard some of the points that those carers made, but John said:

“In more than 30 years caring for my wife, my own GP has never asked how I am. He provides excellent support for my wife, but has never asked me how I am coping as her carer”.

Karen cares for her husband, who has Parkinson’s and was diagnosed only shortly after they were married. She says:

“I gave up work to help support him. I’ve never been told about a carer’s assessment nor has my GP asked how I am. It’s as if you are invisible.”

Parkinson’s is a long-term condition, but despite the fact that they might be caring for many years, only one in 10 Parkinson’s carers have been offered a carers’ assessment. Parkinson’s UK tells us that most are full-time carers, caring for someone for more than 50 hours a week—even up to 24 hours a day as the Parkinson’s progresses. Such carers are those most in need of advice, support and respite care or breaks.

That all matters because the Care Bill puts great emphasis on carers’ assessments rather than the identification of carers and the need to signpost them to sources of advice and support. Last September, I introduced a private Member’s Bill, the Social Care (Local Sufficiency) and Identification of Carers Bill. Three sponsors of that Bill are in the Chamber. The Government, sadly, did not support my Bill and their Back-Bench Members talked it out. The clauses on the identification of carers would have ensured that NHS bodies had the procedures in place to identify carers, promote their health and well-being and ensure they receive information and advice. Those are the exact areas from which the carers to whom I have talked would benefit. As I said during the debate on the Bill, I believe that the key focus in identifying carers should be those with the heaviest caring commitments.

The 2001 census found that 10% of all UK carers were caring for more than 50 hours a week. By 2011, that figure had more than doubled to 22%. It is worth noting, as I said during the debate on my Bill, that the proportion of carers in Salford who provide full-time care at that level has been higher for all of the last decade. It has not just changed, and I am sure that it is related to health inequalities.

Two wards in my constituency have high numbers of people caring for people with stroke disease, heart disease or cancer, which means that they have the heaviest caring commitments. We know that full-time care can take a toll on the carer’s health, and the health needs of those carers must be recognised. We know that those caring for more than 50 hours a week are twice as likely to suffer ill health and that those caring for a person with dementia or stroke diseases are even more at risk. Early identification and support for those carers would mean that they can maintain their health and sustain their caring role better.

The Carers Trust has a centre in Salford with a project to identify carers within primary care and at the Salford Royal hospital. Let me take this opportunity to pay tribute to that centre for its work in identifying carers, which it has been doing within primary care for many years. GPs and primary health care teams in my constituency have started to tackle the task of identifying carers, but there is much more to do. The manager of the centre tells me that having established a network of links within GP practices to identify carers, local GPs made 300 referrals last year, but we have 20,000 carers in Salford, 5,000 of whom will be caring at the heaviest levels. So we need to ensure that health bodies take action that meets the scale of the task of identifying carers and referring them to advice and support.

Young carers are the most hidden of all carers, and my Bill would have required local authorities to have a policy in place for identifying young carers and providing support for pupils in schools who are young carers. It would also have placed a duty on colleges of further and higher education to identify students who are carers and have in place policies to support them. Young adult carers at university or college have to balance giving care with their academic studies and learning. Some do that by caring at a distance, returning home at weekends or holidays to provide care, whereas others have to balance care and study by continuing to live at home and travelling to their local university so that they can maintain their regular caring roles. Hardly any of the carers I have talked about in my speech are in contact with local authorities or are likely to have had a carers assessment from a local authority. So the duty on carers assessments in the Care Bill would not help the carers I have met recently—the carers of people with cancer or of people who are terminally ill. And, as I have said, the local authorities are reaching only one in 10 of carers of people with Parkinson’s disease.

Young carers are also not being reached or supported adequately. The Carers Trust feels that the current law surrounding identification, assessment and support for young carers is complex and incoherent. Young carers are vulnerable and compared with other children they are at risk of poorer outcomes if they take on excessive and inappropriate caring roles because the adult’s needs are not being met. We know that inappropriate caring roles have an adverse effect on a child’s educational and emotional development.

The current position we have reached on that issue is most unsatisfactory. In its evidence to the Joint Committee on the draft Care and Support Bill, the Law Commission made it clear that it felt that young carers should be given the same rights as adult carers, so that the Bill became a single statute covering carers. Yet, young carers still do not have the same rights as adult carers in the Care Bill and there is no mention of them at all in the Children and Families Bill. That is not acceptable. The care services Minister and the children’s Minister have been making reassuring noises about meetings they have had to discuss this and about their intentions, but they have so far ignored a cross-party consensus among MPs and peers that they should act to improve young carers’ lives. Young carers should not be left with unequal rights compared with adult carers.

[The Minister of State, Department of Health (Norman Lamb)]

The hon. Lady said that we have so far ignored what she has been arguing for in terms of action. I just wanted to reassure her that I have absolutely not ignored that. I have said, I believe in the debate on the Queen’s Speech, that I would seek to meet the Minister dealing with the Children and Families Bill, and I have done that. I take the point the hon. Lady makes very seriously and I want to see action to address the concerns that she and others have raised.

[Barbara Keeley]

I thank the Minister for that point, but I have to tell him that he and the children’s Minister have to start to accept that making reassuring noises and having meetings is not enough.

[Paul Burstow]

The hon. Lady is absolutely right to be pushing this issue forcefully. We were given a commitment by the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson) last week that amendments would be drafted, and presumably they will be tabled in the House of Lords. It would helpful for us to know, and to hear from this Minister, that the Government will shortly be publishing the amendments that will be made to the Care Bill as well as those that will be made to the Children and Families Bill.

[Barbara Keeley]

I thank the right hon. Gentleman for that point. I am, however, going to push the matter with the Minister because there was an opportunity in this regard. New clauses were moved during the remaining stages on the Children and Families Bill last week that were copies of clauses from my Bill, and they would have required those bodies that I talked about to have policies in place. We are not talking about a large financial commitment; we are talking about bodies having policies in place. Our schools, our colleges and our higher and further education institutions should have policies in place to recognise young carers, but up and down the country they do not have those. The disappointment that organisations outside here that support young carers will have felt results from the fact that the debate was managed last week so that those new clauses were not reached. That does not show good faith, and if I were a member of the coalition of organisations that support young carers, I would look at that and say, “I don’t know what the Government are going to do.” The Minister will have to accept that they are still disappointing people who have not been protected sufficiently by the law.

I conclude by touching quickly on the financial context of social care and how it affects carers. Giving carers rights in the Care Bill is indeed a positive step, but the Local Government Association reminds us that the Government’s austerity programme and the need for further savings do not fit well with the aspirations of the Bill. Councils have had to reduce their adult social care budgets by 20% over the past three years. At least a quarter of those cuts are from reductions in services and increases in charges. Almost 90% of councils only meet needs that are at the substantial or critical threshold.

Staff at our local carers centre told me that carers are being affected by the bedroom tax, the increase in the value of non-dependent deductions, fewer sources of grant funding, and reductions to care packages that appear to be driven by cutting costs, not by changes in need. That is particularly true where they are caring for somebody with a learning or physical disability. Worries continue into the future when the change from disability living allowance to the personal independence payment starts to affect carers. The Government’s own impact assessment published in February indicated that almost 10,000 fewer carers will be entitled to carers allowance by 2015 as a knock-on consequence of the loss of disability benefits following the introduction of PIP. Carers UK has calculated that this represents a £31 million cut in support to carers. We should bear in mind that if those carers were left unable to care as a result of not having access to those carers benefits, replacing the care that they provide would cost at least £300 million in replacement adult social care services. That is a serious point.

This morning I asked a question about the loss of £28.3 billion of income for disabled people over the next five years through the combination of the welfare changes being made. We must take on board the fact that that loss of income will hit the carers of those disabled people. Carers, as we learned during carers week, are prepared to care. We must do better in supporting them.

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[Sir Tony Baldry]

That is an extremely good point. These things are organic. A few years ago big employers such as Sainsbury’s would not necessarily have been involved in that way. Having been involved in carers policy over the years, what I find encouraging is that each year a further step is achieved.

[Barbara Keeley]

I had not intended to make this point earlier, but I will make it now because so much has been said about employers. The Independent Parliamentary Standards Authority does not allow MPs’ staff to take compassionate leave; it allows MPs to give only sick leave or maternity leave, as I discovered late last year. Given all the good work that has been done with employers, that is an issue the whole House should take forward.

[Sir Tony Baldry]

One of the non-executive members of the IPSA board will shortly be work-shadowing me for a day, so I will certainly raise that valid point with her. I will give her lunch, out of my own taxed income, along with other colleagues who might want to talk with her, and the hon. Lady would be very welcome. I think that the board’s non-executive members have to take some responsibility for the way IPSA functions.

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[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), the hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on organising this debate. I am grateful for the opportunity to speak after such thoughtful contributions. I want to focus on unpaid carers; I will leave others to talk about the care system as a whole.

As we have heard, carers play a vital role, not just for their family members and friends but for the country. In the past decade, the number of carers has grown from just under 5 million to nearer 7 million. By 2037, it is estimated that the number will have increased to nearly 9 million. In my constituency, there are 11,076 unpaid carers, nearly a quarter of whom provide care for more than 50 hours a week. As has been said, we know that this is an underestimate of the actual number who provide care. My hon. Friend the Member for Worsley and Eccles South talked about the lack of information and advice, which has certainly been identified in my constituency. Age UK in Oldham recently opened an information and advice centre, and I hope that people will avail themselves of that. Like other Members, I, too, have had the plight of carers increasingly brought to my attention in my surgeries. Their situation is a growing problem.

In today’s terms, the role played by carers saves the economy £119 billion a year. That is more than the total NHS budget and nearly six times the adult social care budget. The country could not survive without the work that carers do, and that is even more so today, with the crisis that social care is facing. We are facing the double whammy of an ageing society—it is great that we are, on the whole, living longer, although austerity is certainly having an impact on life expectancy—and a meltdown in social care in local authorities, with cuts to their budgets having an impact on social care budgets. Unfortunately, carers are picking up the tab. A recent Carers UK survey showed that a third of those caring for more than 35 hours a week have no support at all. Although 3 million carers juggle work with caring responsibilities, one in five has been forced to give up work.

In addition to the lack of support for caring, carers across the UK are starting to see the impact of the Welfare Reform Act 2012. Changes to financial support with housing and council tax in some areas mean that many families are experiencing reduced financial support from more than one of the changes. The discretionary funding set aside by councils to support people affected by the bedroom tax is enough to help only one in 10 disabled people. Carers who require an additional room because they cannot share with partners who sleep in hospital beds, or parents of disabled children who need the space for care workers to provide overnight care are being seriously let down. More than 5,000 families with care needs are faced with either moving or finding an extra £700 a year.

The cumulative effects of the economic downturn, a squeeze on wages and the increasing costs of essentials such as food and fuel, along with the cuts in social security support, are making it more difficult for carers to manage. More than four in 10 carers in the Carers UK survey said they had been in debt as a result of caring. This year will see other changes to the benefits system, as the transfer of disability living allowance to the personal independence payment and the universal credit are introduced, which is also of considerable concern to many carers. DLA was the gatekeeper to carer’s allowance. The changes mean that 10,000 fewer carers will not be entitled to carer’s allowance. Many of us have already called on the Government to review these changes and undertake a cumulative impact assessment of the effects of these welfare reforms. For many, they will be the tipping point.

In addition to that, and as a consequence of debt and a lack of support, there are significant effects on the health of carers. Eight out of 10 carers report that their caring role affects their physical health and nine out of 10 say that their mental health has suffered. This is not only a human tragedy; we are storing up problems for the future by not caring for our carers.

I know about that from my personal experience of caring for my mum—I have spoken about her before—who died of Alzheimer’s last September. She had Alzheimer’s for 10 years, and for the last three years was unable to communicate or to feed or toilet herself. Although my mum lived in the States, I provided respite care during leave, so I can personally attest to the physical and emotional toll that it had on me. In the last few months of her life she was bedridden. I am little, but I am fairly fit and strong, yet physically trying to lift her to bathe her or change her continence pads was something I found really difficult to manage. The worst thing was the emotional toll, however, as I worried how everyone was coping.

I want to spend the last few minutes talking about young carers. One of the last research projects I worked on before I was elected to this place concerned the effect on young carers’ health of their caring role. Many people will be surprised to learn that, according to recent census figures, there are more than 178,000 young carers in England and Wales. Those are the official figures, but we know that they are an underestimate. Children as young as five are looking after family members who are physically or mentally ill or disabled, their roles ranging from doing household chores to providing nursing or personal care.

The effects on those children and young people are immense and lifelong. Because of their caring responsibilities, nearly a quarter of young carers often miss school or have educational difficulties. Young carers are also more likely to grow up in poverty, to be socially excluded, to have low aspirations and achievement and to have relationship issues. Those problems can follow them throughout their lives. There is also evidence of significant effects on their physical and mental health, with anxiety, depression and self-esteem issues being particularly prevalent. It has been shown that, after a year of caring, morbidities fail to return to pre-caring levels.

Services do not always respect young carers and the role that they play. My research indicated that many young people felt excluded from discussions about their family member’s care, even though they were providing much of it. Some of the responses to questions on whether the young carers should be allowed to see their parents in hospital, for example, were quite heartbreaking. Similarly, many young carers felt that there was a lack of understanding and support from their teachers and schools. I echo what my hon. Friend the Member for Worsley and Eccles South said about this. We must ensure that schools take seriously their role in supporting young carers.

[Barbara Keeley]

I have mentioned the fact that we have a young carers project in Salford that is doing great work. It was interesting, however, that one of the schools involved came back to the project and said, “We have no young carers at all”, when the project knew that it did. The perception among some head teachers is that they do not have any. Is my hon. Friend worried about that as well?

[Debbie Abrahams]

I totally agree with my hon. Friend; that is very worrying, and we must try to do better by those young people.

I am encouraged by what the Minister has said today about the discussions, but I reiterate my hon. Friend the Member for Worsley and Eccles South’s sentiment that warm words are not enough. Will he tell us when we can expect to have the amendments included in the Children and Families Bill? The rights of parent carers of disabled children are also still in limbo, and the Government must bring forward changes to the Bill to ensure that the rights of that group of carers are not left behind. I recognise the Government’s commitment to carers’ rights, but I reiterate my earlier remarks: no matter how much we legislate for assessing carers’ needs, it is meaningless without the means to implement it. Local authority budgets have been pared to the bone, and that is having an impact on social care budgets. How are we going to deliver those assessments? A further £800 million of cuts are planned for this year alone. I would be grateful if the Minister would address that point as well.

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[Steve McCabe]

I think I probably would agree with that, although the right hon. Gentleman must recognise that the Government are moving increasingly towards systems that do not allow for face-to-face exchange. I understand that that is one of the major disputes about what is happening in the DWP. I think it would make classic sense, however. All of us hear enough about joined-up government, and this is one area where a bit of joined-up government could save money and provide a much better service.

[Barbara Keeley]

I was at an event the other day—as was the shadow Minister, my hon. Friend the Member for Leicester West (Liz Kendall)—at which somebody from the DWP was talking about this issue. They said they had tried a project to get their data to talk to the local authority’s data, but had given up because the local authorities all used different forms. That seemed to me to be appalling. The Minister might like to think about whether there could be guidance for local authorities. If local authority forms are all that is stopping this vital sharing of data, it is about time we dealt with that.

[Steve McCabe]

One of the penalties of having been a Member of this House for quite a long time is that we get fed up with hearing such excuses. We know fine well they are nonsense; if we want it to happen, we can make it happen. That is the approach we should take.

My hon. Friend the Member for Corby (Andy Sawford) talked about older carers and carers who have been caring for older relatives, and I want to touch on one particular aspect of that. What will happen under the Government’s deferred payment equity release plans to surviving spouses who are carers, or elderly children caring for even older parents—it is not uncommon these days for a 70-year-old to be the carer for somebody who is 95 or 96, for instance? What rights will they have? In such situations, when the person who is being cared for enters residential care, what will happen to a carer whose name is not on the deeds of the house, although it may be their family home and they may well have lived there since marriage, or even childhood?

We must ensure that these carers do not end up homeless, destitute individuals with no pot of money to support them when they end up needing care themselves. I am not sure that the deferred payment scheme as currently structured takes account of the risk for those carers, and it would be the cruellest of rewards if, after a lifetime of care, we left them in this predicament.

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[The Minister of State, Department of Health (Norman Lamb)]

I am grateful to the shadow Minister, the hon. Member for Leicester West (Liz Kendall), for her thoughtful speech, much of which I agreed with. This has been a thoughtful debate in which many good points have been made and I thank Members for raising this very important issue. Many Members who have taken part in the debate have been long-standing advocates for carers and I welcome their interest and commitment. I completely understand why various Members constantly pursue issues such as those to do with young carers and will not accept my determination to help with that problem until it is dealt with. I accept that that is their role and it is their right to do so. The debate has been a good one and I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for securing it, together with his colleagues, and for all the work and championing he has done over the years for carers.

Let me make a preliminary point. Some of the Opposition speeches, including that made by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds), focused on the difficult financial circumstances for local government, the impact of welfare reforms and so on. We could have a partisan battle about the issues, condemning the Government and so on. However, the shadow Minister recognised at the start of her speech the scale of the challenge we face, not just today but in the future. The numbers of people growing older with care needs, often with multiple conditions and a mix of mental and physical health needs, just keep growing. If we are all honest, both in this Chamber and with the public outside, we must admit that any Government of any political persuasion would face this challenge.

There is no easy solution. We cannot just find a magic pot of money to throw at the problem. There is an obligation on us all, as the shadow Minister made clear, to find ways of using the money we have available much more effectively than we do. We know that there is massive waste in the system because of the care silos—between health and social care, between mental and physical health and between general practice and secondary care. There is an absolute obligation on us all to engage in a debate about using money more effectively to achieve better care and support for people and to ensure that the system remains sustainable. I want to ensure that we elevate the debate by recognising the challenges we face.

The speech made by my hon. Friend the Member for Truro and Falmouth (Sarah Newton) was, I think, really valuable. Ultimately, we need collaboration among statutory services, which should not abandon their responsibilities, the voluntary sector and, crucially, people—that is, the community, families, neighbours and friends. We need to unleash particularly the power of the many people who have entered retirement fit and healthy and want to give something back, but often do not know how to do so. An army of people out there are able and willing to help to meet the enormous challenges. Some of the schemes that my hon. Friend the Member for Truro and Falmouth alluded to in her county are happening in many parts of the country, and they point us to a better future—a more caring future, where community strength is rebuilt.

I wish to join everyone else in this debate in paying tribute to the extraordinary work that carers do, giving of themselves; it is self-sacrifice, and they get no plaudits from anywhere else. They are just committing to helping someone they love, often doing so in challenging and troubling circumstances, particularly where dementia is concerned, as the loss of recognition can be very distressing for a loved one. We also know that many carers are themselves frail, struggling to cope on their own. My hon. Friend the Member for Ceredigion (Mr Williams) mentioned the challenges in rural areas. My constituency of North Norfolk contains many elderly people who are often living in isolated communities and are struggling to get access to the services they need. We owe an enormous debt of gratitude to the work of every carer in our community. As we have identified in this debate, without carers the cost to the public purse would be enormous.

I therefore very much welcome this debate, coming, as it does, immediately after carers week. It gives us the opportunity to discuss how carers of all ages can be properly supported in their role and helped to have a better quality of life. That is what we should be focusing on: putting quality of life and well-being at the heart of the Care Bill. We should not be thinking about what service we deliver to passive recipients; we should always be thinking, “How do we make your life better? How do we make you happier in your life? What might you, as an older person, be able to offer to other people?” It should be about that, rather than about these people sensing that they have nothing more to offer and just facing dependency as they move towards the end of their life in a rather distressing way.

Carers are central to the Government’s proposals for improving care and support. The Care Bill, currently being discussed in another place, puts carers on the same footing as those for whom they care. We propose to simplify the assessment process for adult carers by extending their right to an assessment. The hon. Member for Birmingham, Selly Oak (Steve McCabe) made an absolute point: people need simplicity and they must not be faced with bureaucratic jungles to fight their way through. Our simplified procedures will consider the impact of caring responsibilities on the carer in order to help them to lead as independent a life as possible. We intend to remove the requirement that a carer must be providing

“a substantial amount of care on a regular basis”—

that is the test—in order to be entitled to an assessment. That will mean that many more carers—in essence, all carers—will be able to access an assessment. In addition, the Care Bill seeks to place a new duty on councils to meet carers’ eligible needs for support. Those measures will be underpinned by a Department of Health commitment to provide new resources for carer assessment and support, rising to £175 million per annum by 2020.

[Barbara Keeley]

Has the Minister really taken on board the message that has come from my colleagues in this debate, which is that assessment is not always the answer? A lot of carers do not go near local authorities and are not likely to know of, hear of or ask for an assessment. The people they are in contact with are GPs, doctors and nurses, so there must be much more onus on the NHS and its staff to undertake the task of identifying carers at the earliest stage and ensuring that they get information, advice and support.

[Norman Lamb]

The hon. Lady asks whether I have taken that message on board—I could not have missed it. I totally agree with what has been said and I am going to discuss the role of health professionals.

I know that there is a lot of concern about young carers, and it comes particularly from the hon. Lady. I said in the Queen’s Speech debate that I would meet the Under-Secretary of State for Education, my hon. Friend the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children and families, and I have done so. I appreciate that until something concrete happens the hon. Lady will, rightly, keep pressing. I give her my assurance, again, that I understand and accept the case she is making. My hon. Friend the Minister and I are entirely clear that our joint aim is to ensure that young people are protected from having to undertake excessive and inappropriate caring responsibilities. During debates on the Children and Families Bill, he confirmed that he and I are of one mind on the need to protect young carers by using a whole-family approach to the assessment of adult care needs.

The Care Bill itself is not the place to go into the detail of how assessments should be conducted; that will be set out in regulations and statutory guidance. A whole-family approach will undoubtedly benefit children, but I am keen that it also encompasses other significant family relationships. We need to look genuinely at the whole family, whatever the relationships are between those receiving care and those giving it.

In last week’s debate, my hon. Friend the Minister confirmed that his Department will look at what it can do to remove any legal barriers preventing young carers and their families from receiving the support they need, and how we can ensure that children’s legislation works with adult legislation to support the whole family. I am clear that we have to address the concerns, and while we significantly advance the position of adult carers, we cannot leave young carers behind. The approaches do need to be different, because we need to recognise philosophically that children should not be caring inappropriately. Of course sometimes they have to do that, but we want to relieve the caring burden as far as is possible, while recognising that sometimes there will be a caring role for some.

Care Quality Commission (Morecambe Bay Hospitals)

Baroness Keeley Excerpts

Wednesday 19th June 2013 Commons Chamber

[Mr Hunt]

That is the big culture change we need to see; we need to see Governments who are prepared, in all circumstances, however difficult and however politically inconvenient it is, to recognise that when there are safety issues, when there are terrible failures in care and compassion, we need to support the people who want to speak up, because if we do not do that, we will never root out these problems.

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

I support the comments made by my right hon. Friend the Member for Exeter (Mr Bradshaw). A real concern is being expressed by Members on both sides of the House, because a person committed this cover-up by deleting this report and we really want to know—there should be an investigation—whether they are currently working for the CQC or working in the NHS anywhere. It is vital to know that.

Today, the CQC’s chair has said that it is not currently capable of carrying out hospital inspections. The Health Secretary has talked about putting in place more specialist inspection teams, and I, of course, support that. However, CQC inspectors have had access to specialists for a long time—they have talked about it before the Health Committee—so if they are not using them, that is an issue to address. What measures will the Health Secretary put in place to ensure that from this day onwards—not at some future point—we can have the CQC competently carrying out inspections?

[Mr Hunt]

When the CQC was set up in 2009, it was decided, with full ministerial approval, to go for a generalist inspection model—a model where inspection was not carried out by specialists; the same people would inspect dental clinics, GP practices, hospitals and slimming clinics. That was the wrong decision to take. Making sure that we have enough specialist inspectors in place, with appropriate clinical expertise, takes time—it is a very big recruitment job—and that is what the new chief inspector of hospitals, Professor Sir Mike Richards, is now setting about doing. It is also expensive—it costs money—but he has said to me that when his teams are in place he will start those inspections before the end of this year. So we are going as fast as we possibly can to try to put these problems right.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

I pay tribute to my hon. Friend’s campaign, which he has been running for some time, and to all the great work that he does for Lister hospital. I am slightly worried that if I give him any support it might be the kiss of death for his campaign, but I wish him all the very best and all power to his elbow.

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

One group of people greatly affected by a cancer diagnosis are the carers who suddenly find themselves to be carers of people with cancer. Yesterday I met some people who are carers of people with cancer, and they told me that they did not get the information, advice and support that they needed to tackle that important caring role. Does the Minister agree that it is about time that we recognised those carers and started to give them the advice and support that they need because they suffer financial loss, hardship, loss of career and impacts on their own health?

[Anna Soubry]

I very much do agree. That is why I am so pleased that the Care Bill that is making its way through both Houses has special provision for people who are caring for others with cancer in the way that the hon. Lady describes.

Accident and Emergency Waiting Times

Baroness Keeley Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

It is important for me to answer the Chairman of the Health Committee. Those of us who are in the club of former Secretaries of State understand that the health and social care systems are interconnected and must be seen as one system, because the failure of social care lands on the doorstep of the NHS.

To answer the right hon. Gentleman’s point directly, the money that I was talking about would come from the underspend. It is part of the allocated budget that his Government gave to the Department of Health for 2012-13. The Department did not spend the whole budget so there was a £2.2 billion underspend. As he knows, the practice has been that Departments can take forward that resource to meet new pressures in later years. I am asking the Secretary of State please to ask for access to that money to relieve the pressure on social care. Simply handing it back to the Treasury when there is an A and E crisis and social care is collapsing is not good enough.

The third point I want to address is out-of-hours advice and the introduction of the 111 service. Last week’s summit heard worrying evidence that the problems of 111 are not just teething problems, as the Secretary of State has claimed. We were told that the problems were more structural and were a result of how 111 has been set up—a feature of the cost-driven contracts that have replaced the successful and trusted NHS Direct. Contracts have gone to the lowest bidder, and they are saving money by having inexperienced call handlers working to a computer algorithm that too often results in the advice “Go to A and E”. There has also been a huge reduction in nurse-led call back, which was the norm with NHS Direct.

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

Does my right hon. Friend know that we had a useful debate on this subject in Westminster Hall this morning, when I made the point that the dropping back from clinician-led triage has caused a problem that the chief executive of my local hospital told me about—that falling back on computer and non-clinician advice has led to patients being brought into the emergency departments when they were actually on end-of-life pathways and should have community input?

[Andy Burnham]

That shows the human cost of the failure that we have seen in recent weeks; my hon. Friend has identified yet another aspect of it.

There has been a huge reduction in nurse-led call back, so inexpert advice is being to people who should probably have other options put to them. An internal graph produced by NHS Direct shows that under the old 0845 NHS Direct service, about 60% of calls received a nurse call back; under 111, that has now dropped to between 17% and 19%. What is happening to these people? They are getting poor advice, so they are frightened and are going to A and E. What is this Secretary of State doing about it? Absolutely nothing.

--- Later in debate ---

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

We have a crisis in A and E; that is clear from this afternoon’s debate. The King’s Fund report this week detailed the worst performance in nine years, with 5.9% of patients waiting more than four hours. It has been suggested that patients are just going where the lights are on. Is that the case?

I got information on A and E from the chief executive of Salford Royal NHS Trust, comparing the third and fourth quarters of 2011-12 with those in 2012-13. He found that there are 10% more ambulance arrivals every day. We actually have sicker patients, with more arriving by ambulance. There has been a 13% increase in admissions of people staying longer than 72 hours, and fewer are staying for shorter periods. There are 25% more triages into the hospital’s resuscitation area, and there has been a significant increase in risk and co-morbidity among patients and increased admissions into critical care. There is something going on there.

We know that the rising demand for A and E is particularly concentrated in those aged over 85, and cuts in social care budgets are now widely acknowledged as contributing factors. My local authority of Salford must make £24 million of cuts this year. It is the third year of cuts, and now the authority, having held on to services meeting a moderate level of eligibility, is moving to meeting only substantial levels of eligibility, taking £3.5 million out of adult social care this year and £3.5 million next year. Our former Salford primary care trust had already cut the two walk-in centres that we had, and axed the pilot of active case management for people with long-term conditions.

How is that affecting people? What do carers say? Carers UK has carried out a survey of 3,500 carers, 55% of whom are caring for a person who has been admitted to emergency hospital services in the past three years. A significant percentage of those carers referred to areas where additional support could have prevented those emergency admissions. What types of care were needed? Six per cent. said that they, the carer, needed replacement care because they were ill themselves; 21% per cent. needed a higher quality of care and support for the cared-for person; 10% needed adaptations in the home, and 7% would have been helped by telecare and telehealth. Those findings tie in with some of my casework in recent weeks, when I have heard some very similar cases.

The King’s Fund report tells us that the prospects for adult social care are bleak. Councils are planning to reduce their budgets by another £800 million a year. That is a cumulative cut since 2010 of 20% in adult social care. My local hospital tells me that patients are coming in sicker, they are admitted for longer stays, they require more time and attention and they are now heavy resource-users. It is time that Ministers stopped making excuses and started dealing with this crisis.

[Madam Deputy Speaker (Dawn Primarolo)]

I call Andy Slaughter. You have one minute.

--- Later in debate ---

[Anna Soubry]

That sort of cheap comment does the hon. Lady no justice whatsoever or credit. Let me explain to her—I was here for the debate, and she was not—that I did not in any way blame women doctors. As someone who has worked as a woman professional all my life, I really do not want to hear any lessons from Opposition Members. What I did was echo the comments of the president of the Royal College of General Practitioners, and I paid tribute to all our GPs for their hard work and dedication to our NHS, and to their patients.

There are immense pressures on the NHS as a whole, and on A and E in particular. Our A and E departments are dealing with 1 million more people than they did when the previous Government were in power. The causes of that increase in demand are complex: a long, cold winter; an ageing population; and more people with long-term conditions. The system itself, let us be honest, has not helped, from poor integration between health and social care to the lack of public confidence in out-of-hours primary care services. We can have an argument about the 2004 GP contract, but as the hon. Member for Southport (John Pugh) rightly said, it has not helped. Today, we have a situation in which, if people do not know where to go, or they are not sure that they will get a good service, they go to A and E. In a recent hearing by the Select Committee on Health, Dr Patrick Cadigan, a registrar from the Royal College of Physicians, set out the position perfectly:

“Patients will go where the lights are on. In many of these alternatives, the lights are not on after five o’clock in the evening or at weekends.”

That presents a set of challenges that the Government are determined to address. First, it is important that we deal with the current situation, and we are.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No.

Already, emergency departments have recovered from the dip in performance over the winter. [Interruption.] The hon. Member for Denton and Reddish did not give way, and I am adopting his admirable approach in this debate.

For each of the past five weeks, the four-hour waiting time target has been either reached or exceeded. The average wait in A and E is currently 50 minutes. More importantly, we are making the NHS fit for the future: a future where care is designed and delivered around the specific needs of an individual patient; where care is integrated across primary and secondary care and across health and social care; and where local clinicians, not national politicians, decide what is best for their communities. The Government have taken tough decisions that will create a strong and sustainable NHS, now and for generations to come. The Health and Social Care Act 2012 has finally brought local health and social care communities together to design integrated services around the needs of their patients, building in strength for the future. So if more services are needed outside hospitals, local clinicians working with community partners can make those decisions, without having to wait for a Minister to tell them what to do.

We have not stopped there. We have provided £7.2 billion to local authorities for social care. We have given hospitals the ability to carry over underspends—free to pool their budgets locally to improve care for patients. We have new urgent care boards which will use the savings from the marginal rate emergency tariff to reduce pressure on A and E. The NHS Medical Director, Sir Bruce Keogh, is currently reviewing the provision of urgent and emergency care. This autumn the vulnerable older people’s plan will set out how we will improve primary and out-of-hours services for the frail and the elderly and how we can remove barriers to integrated care. At every step of the way we are putting local doctors and nurses in charge and designing care around the patient.

I shall deal briefly with some of the very good speeches that were made on both sides of the House. We heard first from two former Secretaries of State for Health, the right hon. Member for Holborn and St Pancras (Frank Dobson) and my right hon. Friend the Member for Charnwood (Mr Dorrell). Both were eloquent and informed. I have to say that the speech and the comments of my right hon. Friend found more favour with me. The hon. Member for Lewisham East (Heidi Alexander) asked for a grown-up debate, and we had a good contribution from my hon. Friend the Member for Totnes (Dr Wollaston). I have addressed the unfortunate remarks that she made, perhaps not having read Hansard, if I may say so.

I turn to other valuable contributions. The right hon. Member for Cynon Valley (Ann Clwyd) made a contribution, as we would expect. Then we heard from my hon. Friend the Member for Brigg and Goole (Andrew Percy), who spoke briefly about his local experience in his constituency and brought those experiences, rightly, into the debate. He touched on walk-in centres, an issue that was raised by—I nearly said my hon. Friend; I beg his pardon if that is in any way disparaging to him—the right hon. Member for Rother Valley (Mr Barron), who beautifully forgot that any decision about the future of any walk-in centre is a local decision. It is for local people—[Interruption.] I am not knocking anybody; I am explaining the facts. I appreciate that the right hon. Member for Leigh (Andy Burnham) has a problem with the facts, but the facts are that these are local decisions made by local communities and local clinicians.

My hon. Friend the Member for Bracknell (Dr Lee) gave a thoughtful and challenging speech, and I hope that many will take that away and listen to what he said. I shall deal briefly with the comments of my hon. Friends the Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Stevenage (Stephen McPartland) and the hon. Member for Cheltenham (Martin Horwood), who spoke about some of the difficulties that we have with the recruitment of doctors. Departmental officials have met. We know that it is a problem. We have worked with the College of Emergency Medicine and we know that we need to tackle the problem. We did that in 2011 and those issues will in due course be considered. I hope we will see some changes.

The hon. Member for Mitcham and Morden (Siobhain McDonagh), as ever, championed her local hospital, as I expect her always to do, but she spoke about a lack of public consultation and many of us will take away her wise observations on that. It is important to remind the House of the comments of my hon. Friend the Member for Lancaster and Fleetwood. He, like others in the debate, reported that his constituents get a good service from good staff. All of us should remember that.

To conclude, in challenging circumstances, and with this Government’s support, the people of our NHS are performing admirably. There are over 400,000 more operations now than under Labour. The proportion of cancellations remains unchanged. Fewer than 300 people—276—are waiting more than a year for an operation, compared with 18,000 under the Labour Government. Some 8,500 more clinical staff are working in our NHS, including 5,700 more doctors. MSRA rates have halved. Mixed-sex wards have been practically abolished. We are finally moving towards a paperless NHS by 2018. In addition, in stark contrast to the Labour party’s plans, we now have a protected NHS budget, with real terms—

111 Telephone Service

Baroness Keeley Excerpts

Wednesday 5th June 2013 Westminster Hall

[Miss McIntosh]

I believe a local solution should be found. A question I will come to is whether there is a difference in the roll-out of the service in rural and urban areas—in my hon. Friend’s case, an island. Local solutions must be found. To me, the best solution will always be for someone to see their own GP on the day they are ill.

I hope that my hon. Friend the Minister will put our minds at rest and say that the story in the newspapers about rationing our visits to GPs is a myth. We cannot dictate how often we will be ill. If an elderly person has a chronic condition, they cannot limit the number of times they might have to call on a medical service in one year.

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

rose—

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Will my hon. Friend give way?

[Miss McIntosh]

If I may, I will give way first to the hon. Member for Worsley and Eccles South (Barbara Keeley).

[Barbara Keeley]

I thank the hon. Lady; she is being very generous with her time. Dr Clare Gerada of the Royal College of General Practitioners told the Health Committee yesterday that many GPs’ books are now full at 8.30 in the morning, and that if they have open slots there are often queues down the street, which she said she had not seen for years. I agree with the hon. Lady that we need more GPs, because that is what most patients want.

[Miss McIntosh]

I know what I am going to say is controversial but perhaps I, as a woman, can say it. Some 70% of medical students are women and they are well educated and well qualified, but when they go into practice, many marry and have children—it is the normal course of events—and they then often want to work part time. Training what effectively might be two GPs working part time obviously puts a tremendous burden on the health service. I will now give way to my hon. Friend the Minister.

--- Later in debate ---

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

It is a pleasure to speak under your chairmanship, Mr Robertson. I congratulate the hon. Member for Thirsk and Malton (Miss McIntosh) on securing this debate and on the way that she has opened it, which has been really helpful.

The British Medical Association has consistently expressed serious concerns about the transition from NHS Direct to NHS 111. I understand that the BMA wrote to the then Health Secretary—the Leader of the House of Commons, the right hon. Member for South Cambridgeshire (Mr Lansley)—in February and April 2012, to warn

“of the dangers of rushing implementation of NHS 111.”

It also wrote to Earl Howe, the Health Minister, and to the chief executive of NHS England, David Nicholson, urging them

“to delay the launch of NHS 111 beyond April 2013, due to concerns that many areas were not ready for the transition.”

Those concerns were borne out when the service was launched in Greater Manchester on 21 March, prior to the national launch one week later. I have collected information on the launch in Greater Manchester from the chief executive of Salford Royal NHS Foundation Trust. He told me:

“Significant operational problems were experienced when 111 first launched at the end of March and these problems persisted for the first two weeks of operation. 111 did not equip their call centre with the required levels of trained staff and were therefore unable to deal with the volume of calls received; some patients were left waiting up to an hour to get through on the phone lines and as a result patients just turned up at A&E/GP Out Of Hours Service causing significant capacity and demand issues.”

That is just the point that the hon. Member for Thirsk and Malton made about what people would do if they could not get through to 111.

Senior staff of the Salford clinical commissioning group told me that NHS Direct had given assurances that it had the capacity to handle calls, but after the failures that we experienced in Greater Manchester, NHS Direct admitted that it had insufficient call handlers in place. Apparently, when these problems occurred, 111 asked all GP out-of-hours providers to return to their pre-launch call-handling service. However, that was not an option for us in Salford, as our previous call handlers had transferred all their staff over to 111 under TUPE arrangements. So the problems with NHS 111 continued. Salford CCG staff also told me that the out-of-hours service in Salford came under pressure owing to this NHS 111 failure, and that pressure had to be met with increased staff capacity.

Salford Royal NHS Foundation Trust has commented that further improvement to the service is still required. It feels that

“the care pathways still need further modification to reflect local services”

and that

“there are currently gaps in alternative routes of care”,

which the 111 service is showing up. If there are issues with social care, the community team, the district nurse or self-care, that becomes apparent. The trust also said—this is important for our debate this morning—that

“there are also concerns that what we have done with this service is to replace clinician triage in Out of Hours service with computer or non-clinician advice.”

To give an example of the problems that this change has caused in Salford, I will quote the trust again:

“This has led to patients being brought to the emergency department when they are actually on end-of-life pathways”

and should have “community input”. That is just the problem that the hon. Lady talked about—that situation has happened in Salford. It is distressing to think of people who are in their last few days of life being dragged into hospital, when they should really receive care in their own community and in their own home, which is the care that they probably desire.

Salford CCG has reported that feedback forms on NHS 111 have been received from clinicians and that two “significant events” were recorded, which are under formal investigation. The feedback tends to relate to delays in treatment. The CCG also says that its

“immediate priority has been to stabilise the service after a disappointing start. Some positive improvement has occurred but long term there are serious doubts, with NHS Direct identifying the need for extra investment about the contract level to make the service effective.”

I was also told by staff at Salford Royal NHS Foundation Trust that they felt that expectations were set too high about the outcomes that 111 would deliver. They commented that NHS 111 was operating at a level and in a role that an “experienced grandmother” might historically have achieved. That is an important point; my local NHS trust thinks that is what it is getting from the service. That advice—that of an “experienced grandmother”—could be seen as helpful, but staff told me that their preference was for

“an alternative service which had at its core clinically trained primary care staff available over an extended working day, 7 days per week.”

They also believe

“that this service would be better if it was included within a single integrated urgent care service, incorporating responsibility for GP out-of-hours triage.”

[Guy Opperman]

I am listening to the hon. Lady’s contribution, and given her background, it is clear that she is a specialist in this area. Like her, I met staff from my local CCG and local ambulance service last week to discuss the development of this system. I note that she talks about integration. Does she agree that the integration of those various parts of the NHS system is the absolutely crucial thing going forward?

[Barbara Keeley]

Indeed. We talk a lot about integration, but the feedback that I have received from both my local CCG and my local NHS trust is that we have just taken a backward step. We had a nurse-led service that was working fairly well, although it was not as integrated with other services as it should have been. We now have a system that is led by computer scripts and non-clinicians, in which the patients calling the service—if they get through to it—do not have confidence, and as a result, they are falling back on visiting their GPs or going straight to A and E. My point was that that single, integrated urgent care service—the single service that the hon. Gentleman just talked about—should include responsibility for GP out-of-hours triage, and at the moment it does not. The system could have been set up that way, but it was not. Does the Minister believe that the alternative that I have just put forward is the right direction for an improved NHS 111?

Beyond our experience in Greater Manchester, there have been many criticisms of the NHS 111 service and the shambolic transition to it from NHS Direct. Dr John Hughes, a GP from Manchester, said the service had been withdrawn in his area hours before the launch, owing to problems. He told the BBC that it was “an omnishambles” and

“a waste of public money.”

Dr Hughes has called for a full public inquiry into the procurement of that service, because he feels that it was

“forced forward to meet a political objective.”

Janet Davies of the Royal College of Nursing has argued that nurses from NHS Direct have been running NHS 111. She told the BBC for a report:

“Staff from NHS Direct, the service being abandoned, are supplementing the work of 111—staff that were being made redundant and still are at the end of this month… Specialist nurses that can talk to patients have not left and they are propping up that service.”

She felt that, unlike the nationally run NHS Direct, NHS 111 was a

“fragmented service with local contracts”,

which in her view was “very, very chaotic”. She also said that NHS 111 was an attempt to cut the cost per call, by using non-clinical staff to handle the majority of call time, and that it was

“not using qualified nurses, people with the skills to talk to people and make a sensible decision”.

She felt that the Government had thought about costs but not value. As we have seen, NHS 111 is offering poor value if patients turn away from that service, because it is far more expensive to go to A and E or a GP than to have a conversation with a trained nurse.

In Salford, patients were left waiting on phone lines for up to an hour and then turned to the more expensive options of a GP visit or A and E. Our out-of-hours service came under pressure and extra staff capacity had to be brought in. The opinion of staff at Salford Royal NHS Trust is that NHS 111 operates at a level and in a role that an “experienced grandmother” might achieve. Surely, we can and should do better.

--- Later in debate ---

[Mr Reed]

I am going to make some progress, because I want to get on to the substantive issues in play.

When Labour first suggested a new NHS 111 service, we were clear—the hon. Gentleman should listen—that it would not replace NHS Direct. Our manifesto in 2010 said:

“A new national 111 telephone number will make nonemergency services far easier for people to access and book.”

The 111 service was planned to help people find an emergency dentist, a late-night pharmacy or an out-of-hours primary care GP. This Government scrapped that and instead pressed ahead with the botched implementation of a system that just could not cope with what it was expected to do. They were warned, but, as usual, they did not listen.

There is no doubt that the 111 service is not fit for purpose. The statistics show it, the examples given by Members today show it and, most importantly, patient testimonies show it. Indeed, the Minister herself acknowledged it in response to the right hon. Member for Mid Sussex (Nicholas Soames) in late May, when she stated:

“We recognise that the service has not been good enough and we are working closely with NHS England to ensure improvement in performance. NHS England have put a number of measures in place already.”—[Official Report, 21 May 2013; Vol. 563, c. 740W.]

I hope the Minister will outline what those measures are and what their effects have been, because the contributions we have heard today suggest they are having a negligible effect.

The implementation of the system has undoubtedly caused serious problems; indeed, in my area, NHS Direct is having to be maintained alongside the 111 service to cope with demand. The Minister must explain in detail how a botched, fragmented implementation was allowed to happen despite there being a significant pilot scheme.

[Barbara Keeley]

On the issue of propping up NHS 111, I wonder whether this is the point at which to give credit to the NHS Direct nurses whom Janet Davies of the Royal College of Nursing cited. Even though some of them are being made redundant, they were prepared to prop up the service during its few weeks in places such as Greater Manchester. We really should give those nurses credit. What a dreadful experience, just before they were made redundant, to have to prop up the service that was replacing them.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mr Robertson, for what I believe is the first time.

My hon. Friend the Member for Thirsk and Malton (Miss McIntosh) made an admirable speech, raising many points and asking many questions—some of which, I will say bluntly, I will not be able to answer in my speech. I assure her that she will receive an answer to those by way of a letter. Before I discuss her speech, I want to deal with the points raised by the hon. Member for Copeland (Mr Reed). It does neither him nor his party any credit to use the serious problem in A and E as a political device to attack the coalition Government. It is not as simple as that. To suggest that the problem has been caused by the Government is plain, simple rubbish. It is accepted that there are many complex reasons for the situation, although I am reliably informed that the number of people being seen within the four-hour target is improving and that many accident and emergency departments are achieving the target, and have been doing so for some weeks. Some, indeed, are exceeding it.

There is much evidence emerging that a firm grip is being taken on the situation, but things are complex. There is no magic bullet. It does not matter which party is in power, the Government would face the problem that we have, because there are many causes. One of them, which people on all sides of the argument have identified, is the fact that we do not have the out-of-hours service we want.

[Barbara Keeley]

The Minister says that the issue is complex and accuses the shadow Health Minister of making political points. It is about time that Health Ministers stopped making excuses. They have been in office three years and it is time they started to take responsibility for what they are doing.

I have gathered evidence, and the causes of what has happened clearly include insufficient call handlers, which is not complex—it is just a shortage of staff. Another factor is the replacement of trained nurses and trained clinician input for phone triage with computer-led or non-clinician advice. Those things are not complex. They are just wrong.

[Anna Soubry]

I am not for a moment saying that there are not difficulties and problems in 111. We know there are, but if only the issue were as simple as solving the 111 problems. The out-of-hours service is just one of many factors. [Interruption.] I want to make some progress on this point: 111 is one factor among the failings in relation to the sort of out-of-hours service that people want. We have also had the difficulty of a long, cold winter, which has added pressures—that is something that often happens. Also, there are 1 million more people attending A and E. That is not the fault of the Government. We have not suddenly caused it. It is because of changes—

--- Later in debate ---

[Anna Soubry]

I will not accept any of what the hon. Gentleman says, because he does his cause no service when he makes cheap political points. The matter is hugely complex, but it is wrong to say that the Government caused the problems in A and E. He is wrong in that. It is difficult and complex.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No, I will not. The responsibility, if we are honest—would not it be refreshing if we could for once have an honest debate about the national health service?—probably goes back 10 or 20 years, a period encompassing Governments of different political colours. I am happy to say that—by which I do not mean I am happy that those Governments have failed, but people may think the honesty is refreshing.

I want to deal now with the excellent speech of my hon. Friend the Member for Thirsk and Malton. I pay tribute to her and her work in this place, but also to the considerable efforts and work of her late father. I am sure that if he could have heard his daughter’s speech he would have been very proud. I remember my own father saying that out of all evil comes some good, and perhaps some good may come from her late father’s terrible experience of 111 and the fact that he died shortly thereafter.

I pay tribute to all GPs. There are huge difficulties with the GP contract, which was introduced in, I think, 2004. The consequences have included the loss of the out-of-hours service that I enjoyed as a child, teenager and young woman. With few exceptions, we have wonderful general practitioners, and many whom I know, including my own, and others who are friends of mine, work long, difficult hours. It is important to make that point.

As you know, Mr Robertson, during the recess, far from enjoying holidays, as the popular press makes out, we go back to our constituencies and use the time to make or renew contact with, for example, our local clinical commissioning group or ambulance trust. Alternatively we just go out and about, as I have done, knocking on doors and talking to people. One of the things I did during my recess was meet the head of the A and E department of the Queen’s medical centre, which is the local hospital in my constituency of Broxtowe in Nottingham. The head happens to be one of my constituents, and they tell me that there is much improvement at the Queen’s medical centre, as I know from the stats and so on. I also talked to GPs, and the CCG in my constituency now opens its doors for Saturday morning surgeries, which do not replace any other surgeries; they are extra facilities. The CCG has done that for two simple reasons: first, to improve the service it gives to its patients, and, secondly, in recognition of the need to reduce the pressure on the A and E department of the Queen’s medical centre.

It is right and fair to say that many GPs look with concern at what is happening in many of our A and Es, and with 111, which is commissioned in some areas by CCGs and in other parts of England by clusters of GPs. They are by no means fools. What motivates anyone to enter the medical profession, in my experience, is a real desire to serve people. They want to help and treat people. They are motivated by the very best of motives, so of course our GPs are concerned about the situation.

There is much work to be done with the GP contract to improve out-of-hours service, but we also have to be honest in this debate. There are often urban myths and anecdotes, but it is a fact that many GPs have already said that, far too often, people who come to see them in their surgeries, who attend A and E or who dial 999 or 111, are calling when they do not need to make that call or that appointment. They might be better off making their pharmacist their first port of call.

--- Later in debate ---

[Barbara Keeley]

The Minister talked earlier about the issue being about out-of-hours service. The NHS 111 problems in Greater Manchester put greater pressure on our out-of-hours service. She said there was a long winter, but 111 was rolled out at the end of March. Does she think that was a sensible time? It was not even the end of a very hard and long winter. Finally, she said that we have had more A and E attendances, but the problems have caused further pressure on A and E. The point many hon. Members have made, which I hope she accepts, is that the chaotic launch of NHS 111 in the end part of winter caused more problems than it solved.

[Anna Soubry]

Again, I do not think it is as simple as that. Of course we have not been happy with the roll-out of 111, which is accepted. The service has not been the success that we had hoped. We agree on that.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No; forgive me. The most important thing, though, is that things are improving.

A and E Departments

Baroness Keeley Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

My hon. Friend will be pleased to know that that actually happens in many places throughout the country, but we need to go even further. When it comes to the most frail, vulnerable older people, we need to commission services in a way that ensures that someone outside hospital knows what is happening with them the whole time, is accountable for their care and treatment, and can pre-empt the need to seek emergency care in the middle of the night. That will be the key to ensuring that the pressures on A and E are sustainable.

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

Today, the Health Committee heard that this Government’s cuts to social care were a direct cause of increased A and E attendances: patients cannot be returned home on time, and all the services that used to keep people well have been cut. This Government cut local authority budgets, resulting in £2 billion going out of adult social care. Will the Health Secretary now accept what the experts are telling us on the Health Committee: that that is the direct cause of the increased A and E attendances?

[Mr Hunt]

Once again, the Labour party opposes every single cut made by this Government then tries to pretend that it is serious about getting the deficit under control. On this point, I remind the hon. Lady that the NHS is giving £7.2 billion of support to the social care system for health-related needs, precisely in order to ensure that services are not compromised. Where they have been compromised, we are looking into it and we are disappointed about it, but we continue to monitor the situation and to urge local authorities to ensure that they discharge their responsibilities properly.

Health and Social Care

Baroness Keeley Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

I will make some progress, then take more interventions.

The Care Bill will allow for comprehensive Ofsted-style ratings for hospitals and care homes, so that no one can pull the wool over the public’s eyes as to how well or badly institutions are performing. The Bill will make it a criminal offence for any provider to supply or publish deliberately false or misleading information. We cannot legislate for compassion, but in a busy NHS, we can ensure that no institution is recognised as successful unless it places the needs of patients at the heart of what it does. The Care Bill will be a vital step forward in making that happen. That compassion should extend not just to patients, but to carers. The Bill will put carers’ rights on a par with the people for whom they care. They will have a right to a care assessment of their own and new rights to support from their local authority.

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

Is the Secretary of State as disturbed as I am that the Bill puts young carers backwards a step? Adult carers’ rights might be taking a step forward, but young carers’ rights are not. We must address that during the passage of the Bill.

[Mr Hunt]

We are not putting young carers backwards. We very much recognise their needs—and a children’s Bill will address their concerns in a way that I hope will put the hon. Lady’s mind at rest.

The second issue that we need to address for the NHS going forward is joined-up care. It is shocking that, in today’s NHS, out-of-hours GP services are unable to access people’s medical records; that paramedics and ambulances answer a 999 call without knowing the medical history of the person whom they are attending; and that A and Es are forced to treat patients with advanced dementia, who are often unable to speak, without knowing a thing about their medical history.

--- Later in debate ---

[Andy Burnham]

I assure the hon. Gentleman that I will come on to that, but I have a job to do in holding this shambles to account and that is exactly what I am doing.

Under this Government, people are paying more out of mum or dad’s bank account for care, which often does not come up to the standards that they want, because their council has been cut to the bone. What are they meant to make of a promised, far-off cap of £72,000, or £144,000 for a couple? The Government are giving a little with one hand, while with the other they are grabbing a fortune from people’s bank accounts.

[Barbara Keeley]

Does my right hon. Friend acknowledge that this is not even a question of £72,000 or £144,000, because those caps will be metered at the level that the council would pay, and will take no account of top-ups or accommodation costs? I have seen examples that show that people might have to pay £250,000 before they get anywhere near the cap and any help from the state.

[Andy Burnham]

My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.

How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—

--- Later in debate ---

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

I welcome the fact that we have a Care Bill to debate. I pay tribute to the hard work of colleagues on the Joint Committee on the draft Care and Support Bill. I also welcome the fact that the Government have taken on board a number of the Committee’s recommendations. However, some have not been adopted. I want to speak about the areas where the Bill could be improved and strengthened: the identification of carers and, as the right hon. Member for Sutton and Cheam (Paul Burstow) mentioned, the clauses relating to young carers.

[Roberta Blackman-Woods (City of Durham) (Lab)]

Does my hon. Friend agree with the National Young Carers Coalition, which has written to all Members pointing out that the Bill does not do enough for young carers and needs to be amended so that there is a greater responsibility for identifying young carers? Does she agree that the Government should have taken heed of her excellent private Member’s Bill and incorporated it into the draft Bill?

[Barbara Keeley]

I am absolutely bound to agree with that point, and I will come on to it shortly.

As has been said, we cannot separate the funding of social care from the law on social care. We need to take on board the fact that the Bill will not help those who are struggling without the social care support they need, either today or in the months and years ahead.

The Bill builds on the recommendations of the Law Commission’s review on social care and carers, but we should remember that until the Care Bill, carers had been given rights only through measures in private Members’ Bills: the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004. We should pay tribute to the late Malcolm Wicks, Tom Pendry and my hon. Friend the Member for Aberavon (Dr Francis) for their work on that early legislation to give rights to carers.

When I came to Parliament in 2005, I raised the issue for the first time that GPs and other health professionals needed to identify carers within their practice population. GPs are best placed to help carers at the start of caring, which is when they need that help and advice. It is the GP who deals with the patient with dementia, the patient recovering after a stroke, or the patient with cancer. The GP and primary health care team are, after those life-changing events, well placed to see if there is an unpaid family carer. It is then a simple step for them and their teams to take time to check the health of the carer and to refer them to sources of advice and support. Caring can have a serious impact on the health of carers. In a recent survey of 3,000 carers, Carers UK found that 84% said that caring was having a negative impact on their own health—up from 74% in 2011-12.

I have introduced three private Members’ Bills on the identification of carers, and in September I introduced the Social Care (Local Sufficiency) and Identification of Carers Bill. The Bill had good support in the House. My hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and 11 MPs from across most parties were supporters. We also had support from 27 national charities, the National Union of Students, the business group Employers for Carers and 2,000 individual carers. However, the Government did not support the Bill. In the debate, the Minister of State, Department of Health, who is responsible for care services, stressed that it was best to get everything codified in one place so that one piece of legislation addressed all issues of care and support. However, the Care Bill does not help with the identification of carers; it puts the duty of assessment on to local authorities. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers in any way that makes it a worthwhile exercise for those carers. If the Minister wants to look at the Joint Committee’s web forum on the draft Care and Support Bill, he will see that many of those who commented said that local authority assessments are of little practical help in their caring role.

[Mrs Moon]

Last week, I had a telephone call from a young man who is caring for his father. His father has the same condition as my husband, and he contacted me because of the debate we had on dementia. He told me that he had phoned his social services department twice and the psychiatric nurse twice to ask for help and support. He did not know where to turn. Is this not increasingly the problem? There is just no money: no money to provide the assessments and no money to provide the care if those assessments are carried out.

--- Later in debate ---

[Barbara Keeley]

I agree with my hon. Friend: it is about carers knowing where to go for that help and support when they are so desperate.

In contrast to assessments, projects that work within primary care to help identify carers are producing outcomes that are genuinely helpful to carers. I spoke at an event last Friday organised by Salford carers centres for staff from those teams. The staff will help to identify carers and refer them to help and support. They will have a list of agencies and know where to go.

[Paul Burstow]

The hon. Lady is making important points about carers—an issue on which she has campaigned consistently. Would she join me in welcoming the announcement from the Royal College of General Practitioners over the weekend about the priority it wants attached to carers and the guidance it is now issuing to GPs to ensure that they do more? One in 10 of a typical practice’s patients are carers, so they could do a great deal more by identifying them.

[Barbara Keeley]

Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

[Norman Lamb]

I look forward to visiting the hon. Lady in her constituency on Thursday and discussing this matter further. I totally agree with her concerns about young carers, and will seek to meet the children’s Minister to discuss it further. It is really important that we get the framework right.

[Barbara Keeley]

Indeed, but a cross-party approach did not convince the children’s Minister in Committee, which is why I am stressing it today. It is very important. I welcome the Minister of State’s assurance just now, but he has given assurances before. We cannot let the opportunity presented by these two Bills pass. Younger carers and their organisations feel that the coalition Government are leaving them out of the equation. At the moment, the threshold for an assessment is higher for young carers than for adult carers. In its evidence to the Joint Committee, the Law Commission said that the inclusion of clauses on young carers was an important area of improvement for the draft Care and Support Bill. Frances Patterson QC told us that the Bill should make provision for services for young carers as well as their assessments, and that the assessments were of limited use for young carers.

The picture of provision for young carers is now very confused, and it is a priority for Parliament to sort it out. It is not good enough to have this partial recognition of young carers in the Care Bill or to have the children’s Minister rejecting cross-party amendments on provision for young carers. The Minister of State, who is responsible for care services, has said several times that he wants a single statute. If that single statute is the Care Bill, it has to deal with young carers properly. It is plainly wrong that it does not. I am grateful for his intervention, but we need to get this right. Does he still support a single statute, and if so, can we get it right for young carers?

I welcome the steps being taken in the Care Bill, but it must be strengthened and improved in the ways I have outlined, because things such as assessments are not very helpful for carers and young carers, if that is all we are offering. As was said earlier, older people face continuing increases in home care charges. The number of people receiving publicly funded care has fallen by 7%. Unmet need is soaring, which is putting pressure on carers and our acute services. We need a bold response to the crisis in care, greater investment in social care and genuine integration of health and care services.

--- Later in debate ---

[Mr Leigh]

I have no idea when that will happen.

I said I wanted to talk about opinion in Lincolnshire. Despite all the Government’s success in their central aim of attempting to cut the deficit—we have cut it by a third—people there undoubtedly feel that their voice is not being heard. We have to listen to that voice. If I may be forgiven for being party political for a moment, I should point out that there is absolutely no enthusiasm for the Labour party, because people have not forgotten who created the borrowing mess we are in. We heard a lot about plain packaging from the right hon. Member for Leigh (Andy Burnham), who led for the Opposition today, but the whole Labour party is plain packaged. We have no idea, frankly, what it will do.

[Barbara Keeley]

I cannot speak for all parts of the country, but I campaigned in the recent county elections in Lancashire and there was huge enthusiasm for the Labour party.

[Mr Leigh]

We will have to see what happens in various parts of the country.

It is said that this is a thin Queen’s Speech. As a Conservative, I do not object to a thin Queen’s Speech. I do not object to deleting unnecessary legislation either, whether on minimal alcohol pricing or plain packaging. I view all these as creatures of the nanny state, so it is good conservatism that we are not introducing them. However, if we are to have a Queen’s Speech that is, shall we say, somewhat light and has lots of room in it, that means there are various other things that we could do. One thing we do not need to do, I would have thought, is persevere with the Marriage (Same Sex Couples) Bill. I will not repeat all the arguments, but this is an area where many people in Lincolnshire feel that their opinions are being not represented.

If anybody wants to look at an excellent article on this subject, they should read Charles Moore’s in The Daily Telegraph on Saturday. There is a real problem. We are trying to deal with an economic crisis and the very first thing we will do after this Queen’s Speech debate—although it was not mentioned in it; as far as the Government are concerned, this is the Bill that dare not speak its name—is have two days on same-sex marriage. The Bill will then go to the House of Lords. There are enormous, complex issues at stake for the Church of England. I have no doubt that we are moving to a world in which the Church of England will be allowed to conduct only religious marriages, but will not be able to complete them. They will have to be completed by the state because of equality legislation. These are serious issues. The Government could easily mend fences with many of their supporters by putting the Bill out to further consultation.

--- Later in debate ---

[Norman Lamb]

What I would say to the shadow Minister is that since 2010, 1 million extra people have visited A and E. These are real pressures and we all have to think about how we manage them. Surely the way to do that is to try to improve people’s care so that they avoid ending up there in the first place. Tomorrow I will announce a decisive shift towards integrated care, which will be part of a major strategy for vulnerable older people, whom the Secretary of State talked about earlier. We have to focus on preventing people’s health from deteriorating, stopping the crises that end up with people in A and E despite the system’s best efforts.

Several hon. Members referred to pressures in social care, including the hon. Member for City of Durham (Roberta Blackman-Woods) and my hon. Friend the Member for Bradford East (Mr Ward). The Government have done what they can. We have put £7.2 billion extra into social care and local government to support the system through these difficult times because of the local government settlement, but we all know that things have to be done differently. The Care Bill is totally consistent with that approach: it focuses on prevention, co-operation, integration of care and spending money more effectively to improve care for patients. I was pleased that the hon. Member for Easington (Grahame M. Morris) welcomed the Bill, as did the hon. Member for Salisbury (John Glen) and many others. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his work as Minister and subsequently as Chair of the pre-legislative scrutiny Committee. He has done a lot of brilliant work to highlight the issues that the Bill deals with.

It is hard to exaggerate just how badly the Care Bill is needed. Previous legislation is now hopelessly outdated and almost irrelevant to the needs of today’s society. Tinkering around the edges was keeping the system afloat, but no more than that. The shadow Secretary of State was dismissive of the value of the Bill, but it will be a big social reform—one of which this coalition Government should be proud. The new Care Bill will reform an antiquated, paternalistic system, improve people’s experience of care and establish both health education England and the health research authority as non-departmental, stable, independent public bodies. The Bill will pool together threads from more than a dozen Acts into a single, modern framework for care and support, but it is far more than a mere compilation. The Bill will fundamentally reform how the system works, prioritising people’s well-being, needs and goals, so that they no longer feel they are battling against the system to get good care.

[Barbara Keeley]

The Minister is back on his point about the Bill creating a single statute, but it will not do that for young carers, who will be left with the protection only of the private Member’s Bills I mentioned earlier. It is not good enough for young carers to face a higher threshold than other carers before their needs are assessed. That has to be looked at. The children’s Minister has let the House down on this issue; I hope that this Minister will not do that.

[Norman Lamb]

I was coming on to pay tribute to the hon. Lady for the work she has done. I absolutely agree with her that we need to get this right. We have the juxtaposition of two Bills, dealing with children on the one hand and adult social care on the other. Earlier I made a commitment to meet the children’s Minister; I had an opportunity to speak to him briefly when he was in the Chamber earlier. I am also meeting the hon. Lady later this week. I am committed to doing everything I can to get this right, and to ensure that young carers are not let down.

The Care Bill also highlights the importance of preventing and reducing ill health and of putting people in control of their care and support. This will involve the right to personal budgets, taken as a direct payment if the individual wants it, and putting people in charge of their care and of how the money is spent. This will put carers on a par with those for whom they care for the first time. The hon. Lady has consistently argued her case, and I am determined that we should get this provision right. The hon. Member for Rotherham (Sarah Champion) also made some powerful points on the subject.

The Bill will also end the postcode lottery in eligibility for care support. My hon. Friend the Member for Totnes (Dr Wollaston), the hon. Member for Easington and others raised concerns about the level of the eligibility. That question will obviously have to wait until the spending review, but I point out that if we were to set it at moderate need, the cost attached would be about £1.2 billion. All hon. Members need to recognise that this is difficult, given the tough situation with public finances. We also need to do longer-term work on developing a more sophisticated way of assessing need and providing support before people reach crisis point.

The Bill will refocus attention on people rather than on services. It will bring in new measures based on the Francis inquiry, ushering in a new ratings system for hospitals and care homes, so that people will be able to judge standards for themselves. The hon. Member for Walsall South (Valerie Vaz) criticised the idea of appointing a chief inspector of hospitals, but I disagree with her. It will be really important to identify where poor care exists and to expose it so that improvements can be demanded without fear or favour. The chief inspector will be able to do just that. It will also be really important to celebrate great care, so that those people in the health and care system who are doing everything right can be applauded and recognised for the work they are doing.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 16th April 2013 Commons Chamber

[Norman Lamb]

I pay tribute to the hospice movement, including Katharine House in my hon. Friend’s constituency. It is crazy that we are spending a lot of public money on caring for people at the end of life in places where they do not want to be. Most people do not want to end their life in hospital, yet about 50% of people still die in hospital. We are looking to create a new funding regime where money will follow the patient, to ensure people’s choice is respected so they can die where they want to, and so that hospices have fair funding.

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

I recently had a case of very poor care of a terminally ill patient in the last few days of her life. She was let down by a GP who refused to prescribe the pain relief she needed and a district nursing service that provided wholly inadequate support. Given what the Minister has just said and that 20% of people want to die at home, what action will be taken to ensure that such cases do not happen and that instead we start to provide much better support for people so they can die peacefully at home?

[Norman Lamb]

My ambition is that the UK have a global reputation for the best possible care at the end of life. Whether we are talking about the Liverpool care pathway and concerns that have been raised about some care in hospital or care in the community and caring for people at home at the end of life, it is essential that people have a dignified death and the best possible care. Everything we are doing is aimed at achieving that. Where there are specific cases such as the one the hon. Lady raises, the relatives have the right to pursue a complaint, and ought to do so if care has fallen below an acceptable standard.

Mid Staffordshire NHS Foundation Trust

Baroness Keeley Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. It is important that these assessments are made not just at an organisation level, but drill down into the different parts of a hospital, and we have taken that message on board from the Nuffield report on ratings. She is right that it is not just about resources, but sometimes it is about resources. Parts of a hospital can be understaffed when it comes to people who are required to perform basic and important roles in terms of care. Because it is a complex picture—and because numbers can be part of the problem, but are certainly not the whole problem—we want a chief inspector who will take a holistic view of every aspect of the performance of a hospital and be able to give proper feedback that a hospital can use to improve its performance.

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

May I press the Health Secretary on this point? I have raised several times the point that adequate staffing levels are crucial to patient safety and good care, but we seem to dodge around saying that it is a question of values, not of numbers. Francis said clearly that one of the issues was numbers. I have given examples of my local hospital, which views it as crucial that it has the right staffing mix, which it adjusts every single day, for the patients that it has. Will he stop avoiding this question and address it directly, because one in 10 hospitals do not have adequate staffing levels?

[Mr Hunt]

I am not avoiding it. I agree that adequate staffing levels are essential to patient care. I remind the hon. Lady that the shadow Health Secretary said to the Francis inquiry:

“I do not think that the Government could ever mandate a headcount in organisations. Whilst we could recommend staff levels, we were moving into an era when trusts were being encouraged to work differently and cleverly, and take responsibility for delivering safe care whilst meeting targets”.

Immigrants (NHS Treatment)

Baroness Keeley Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

Obviously, I want to ensure that as much money as possible goes to residents throughout the country by tackling abuse, and I would not want to minimise what the issue might be in Worcestershire. I stress, however, that the biggest problem we face is in big urban centres where there are large numbers of illegal immigrants, and we must get a grip of that problem for the sake of the elderly population in those cities.

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

If the Secretary of State is concerned to protect NHS budgets, why is he allowing a £2.2 billion raid from the Treasury? Is that not a much more serious cut in the NHS services we can pay for in this country?

[Mr Hunt]

If the hon. Lady is worried about that, perhaps she might like to complain to her own party leadership, which, during Labour’s last five years in office, had an average underspend in the NHS of £2 billion.