Accountability and Transparency in the NHS

Baroness Keeley Excerpts

Thursday 14th March 2013 Commons Chamber

[Rosie Cooper]

Yes, and if MPs have problems, God help members of the public and patients.

We had to demonstrate that we were really listening to patients. The medical and managerial staff had to take ownership and responsibility for complaints. They knew that at each board meeting they could be questioned and challenged. If we accept that there are large parts of the system that work well and focus our time and resources on areas that do not, we can raise standards and tackle deep-seated problems. As chair, I sought to build in assurance and be transparent about complaints; to solve them, not hide from them, and ensure that everyone was accountable right up through the management structure. I never believed in no blame; I believed in fair blame. Each time a problem was resolved properly, we became a better hospital. We were rightly proud that on the front page of the Liverpool Echo Liverpool Women’s hospital was called an NHS gem. Sadly, the main board’s complaints report stopped after I stepped down as chair.

We do not need to reinvent the wheel or have more reorganisation in the NHS, but we must make the complaints system work. From that important but simple action, culture changes happen and become embedded in the organisation. We then have real change, real transparency, real openness and real accountability—something we can all be proud of.

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

A complaints system sounds very useful. When staff knew that complaints were being assessed and reported on every month, what impact did it have on them?

[Rosie Cooper]

In essence, it encouraged a change of culture. They were not operating in a vacuum, where patients did not matter and where the complaint might not ever get resolved—where, if a manager said it was okay, it disappeared. The fact that the light was switched on and that people could ask questions was valued.

There is a huge disconnect between the rules and the enforcement of rules. When local resolution fails there must be another, proper avenue for patients to appeal that decision: just having the NHS investigate the NHS is not the way to improve the health service, or patients’ confidence in it. Currently, the message we send out is that unless people have the financial resources to fight the system in the courts it is easy for families and patients to be ignored.

Chief executives and boards know that the ombudsman investigates only a tiny proportion of the cases referred to it, and it is not as feared as it should be. I say to the Secretary of State that we need an ombudsman service that is properly resourced, has the necessary investigative powers and sanctions, and makes public in its reports its findings to everybody who pays for the NHS, not just to Ministers. Being able to name and shame in the spirit of openness and transparency will be a powerful tool, especially when, in these times of foundation trust hospitals competing to attract business, reputation is the key.

Given that all hospitals will eventually become foundation hospitals, is the Secretary of State willing to say that foundation hospitals will have to report all their statistics openly and that every board meeting should be a public meeting? There should be no hiding; there should be openness and transparency right across the NHS. The light needs to be switched on not just in individual rooms but in the NHS, full stop.

I have on the wall of my constituency office this quote from an editorial in the Liverpool Echo:

“Doing the right things does not automatically follow saying the right things”.

At present, everyone in the national health service is saying the right things. What assurance can the Secretary of State give us that the NHS will do the right things? Frankly, the public do not want any more politics from anybody. They do not want warm words or excuses; they want actions that will lead to real change. No more big reorganisations; we just need to make a difference. He must listen to the people’s complaints. Actually, in Mid Staffs the complaints could not have been any louder.

I said to the hon. Member for Bristol North West (Charlotte Leslie) earlier that we cannot keep on saying that it is somebody else’s fault, that somebody else should be held accountable and that somebody else is going to supervise. This goes to the core of the Department of Health. If we listen to the people and give the ombudsman—the right person for the job—the powers to deliver, we will see a culture change.

[Mr Stephen Dorrell (Charnwood) (Con)]

I want to follow the hon. Member for West Lancashire (Rosie Cooper) on to very similar territory. She and I both sit on the Health Select Committee, which I chair. I want to start where my right hon. Friend the Secretary of State and the right hon. Member for Leigh (Andy Burnham) started, with what happened in Mid Staffordshire. It was shameful, and we will be judged today by whether we show a serious willingness to learn and apply the lessons of the Francis inquiry.

Francis made 290 recommendations, but they amount to just one core recommendation, which is that there needs to be a fundamental culture change through the whole of the national health service. With respect to the shadow Secretary of State, that is the sense in which challenges are posed for the health service way beyond Staffordshire. We have to learn the lessons of Staffordshire and apply them beyond it, as well as demonstrating that we understand what we mean—in the modern jargon, we “get it”—when we talk about the need for a culture change.

My hon. Friend the Member for Bristol North West (Charlotte Leslie) encapsulated that when she used the words “accountability” and “transparency”. I will not follow her down the route that she took in her speech. I want to focus exclusively on what we mean by those two words. They seem to trip too easily off the tongue, without anyone understanding what they mean, and that must change if we are to sustain a culture change in the health service.

My first proposition is that accountability without transparency is entirely meaningless. The ability to see what is going on and how decisions are being made in the health service, and to see the effects of those decisions, is fundamental to the delivery of the objective of culture change. With respect to the right hon. Member for Leigh—and, indeed, to some of the points that my right hon. Friend the Secretary of State made—we have to acknowledge that a lack of transparency lies deep in the culture of the health service, and that it goes back to way before the previous Government were in office. It was present in my time as Secretary of State and well before that, too. I was regularly accused of supporting a gagging culture in the health service, although nothing could have been further from my intention. However, that charge was made against me, against the right hon. Members for Leigh and for Kingston upon Hull West and Hessle (Alan Johnson) and, in truth, against all our predecessors right back to 1948.

The instinct to protect, rather than the instinct to reveal, is deeply embedded in the health service. When something is said to be going wrong, there is an instinct for the wagons to gather round. That is why Francis’s recommendation for a duty of candour is key to the delivery of the objective of greater accountability and transparency.

[Barbara Keeley]

Was the right hon. Gentleman as disturbed as I was to hear that the £500,000 gag at the United Lincolnshire Hospitals NHS Trust was put in place without any sign-off whatever, on the basis that it had involved judicial mediation? The Secretary of State refused to answer my question about this. Does the right hon. Gentleman agree that the Secretary of State really has to stop that, because it involved a very large amount of money, which was used very ill-advisedly?

[Mr Dorrell]

The position I take is the one set out in the Francis report, which was explicitly endorsed by Sir David Nicholson in the Select Committee inquiry to which the hon. Lady has referred. I believe that it would also be endorsed by my right hon. Friend the Secretary of State, but he must speak for himself. That position is that it is hard to imagine circumstances in which the use of public money in the context of a compromise agreement should be governed by a confidentiality clause. In an age when a bill from Pizza Express has to be published on the internet, decision makers should be held publicly accountable for the use of large sums of money in the context of a compromise agreement.

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

I was appalled to read in the Francis report on the Mid Staffs inquiry the stories of the unnecessary suffering of hundreds of people and, indeed, to hear the examples given by my right hon. Friend the Member for Cynon Valley (Ann Clwyd) in this debate. Those Mid Staffs patients were let down and there was a lack of care, compassion, humanity and leadership. The most basic standards of care were not observed and fundamental rights to dignity were not respected.

Our Health Committee has taken evidence from Robert Francis, who has said that there was a failure of the NHS system

“at every level to detect and take the action patients and the public were entitled to expect.”

He has summarised his own recommendations as: fundamental and easily understood standards; openness, transparency and candour; accountability to patients and the public; enhanced training for nurses and leaders; and ever-improving measures of performance.

In the short time available, I want to focus on two areas: first, accountability or, indeed, the lack of it in our NHS structures, and secondly—this has already been touched on—the question of what is good practice on patient safety.

The Health Committee is increasingly seeing examples of a gap in accountability in the restructured NHS and I will touch on one small example that we heard this week. We had a session with senior Department of Health staff—the director of mental health, the national clinical director of mental health and the deputy director of secure mental health services—who are responsible for advising Ministers on mental health strategy, for devising mental health legislation and for clinical leadership on mental health. They did not know that patient groups were reporting cuts to community mental health services or that they lacked access to therapeutic services, with very long waits.

[Alison McGovern (Wirral South) (Lab)]

Does my hon. Friend agree that scrutiny to make sure that the dignity of mental health patients is protected is of utmost importance?

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[Barbara Keeley]

Indeed. It is disturbing that the people responsible for advising Ministers on legislation are not aware of what is going on. In fact, they started by trying to tell me that they thought that community services were still expanding, as they had been up to 2010. They did not have a picture of the services. Indeed, they told us that there was no routine collection of waiting times for mental health services and they did not have data on readmissions. They did not even seem to understand the trends involved in those important issues.

The exchange left me feeling very concerned about accountability in our new NHS structures. If staff at the most senior levels of the Department of Health who are responsible for strategy and legislation have no idea what is going on in health services across the country, that is serious. The major restructuring of the NHS seems to us—this has been mentioned by fellow members of the Health Committee—to represent a decline in accountability.

We need to learn from good practice to improve patient safety, which has been touched on by my hon. Friends the Members for West Lancashire (Rosie Cooper) and for Walsall South (Valerie Vaz). A major review is taking place of the 14 hospitals with the worst mortality rates. In recent Health questions, I told the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) that good practice in hospitals with low mortality rates should be investigated alongside the review of high mortality rates and poor practice in the worst-performing 14 hospitals. He did not take that point on board, so I will try again today.

I want to talk about what has been achieved at my constituency’s local hospital trust, Salford Royal NHS Foundation Trust. I visited the hospital recently in the wake of the Francis report and was impressed to hear what it has achieved over the past five or six years. It already seemed to have in place many of Robert Francis’s recommended actions, which I touched on earlier. Salford Royal has taken action on nurse staffing ratios, which my right hon. Friend the Member for Leigh (Andy Burnham) touched on; reducing MRSA infection and pressure sores; the transparency of patient information; and involving clinical staff in quality improvement.

[Mr Jeremy Hunt]

I completely agree with the approach that the hon. Lady is taking. One of the jobs of the new chief inspector of hospitals will be to identify the outstanding hospitals, the safest hospitals and the hospitals with the best compassionate care, so that other hospitals can learn to do the same things.

[Barbara Keeley]

That is very good. I hope that the Secretary of State will make that point to the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, because he did not seem to appreciate it when I made it to him in Health questions.

Let me touch on what other hospitals might find if they start looking at the excellent practices at Salford Royal. I do not underestimate the importance of the terrible examples that we have heard about, but at the same time, my trust has had a quality improvement strategy since 2008, with specific projects that are aimed at reducing falls, unexpected cardiac arrests, surgical site infections, sepsis and other harms. Because harm tends to be caused to patients much more over the weekend—we have seen many examples of that in the cases that we have looked at—the trust has moved back to seven-day working in an attempt to achieve the same standard of care on the weekend and overnight as people receive on a weekday during working hours.

I believe that having the right nurse staffing ratios is vital to patient safety, but that issue keeps being glossed over by NHS leaders and Ministers. I have asked questions about it repeatedly in this House. Salford Royal uses a safe staffing tool to ensure that it works to safe staffing levels. There are minimum staffing requirements throughout the hospital and incident reports are completed if the ratios are not met. Each division reviews its staffing establishment every day and escalates concerns if the numbers fall below the minimum safe level. Salford Royal is a mentor site for nurse rounding which, as we have heard, means that nurses go round their patients each hour to ensure that their needs are being met.

My right hon. Friend the Member for Cynon Valley gave examples that showed the impact of hospital-acquired infections. All the work that is done to reduce MRSA and other infections is crucial. As in the other examples of flattened hierarchies that we have heard about, anyone at Salford Royal can challenge others on issues related to infection control. There is also mandatory training in aseptic non-touch techniques.

Teams design their own quality improvement projects in a clinical quality academy. There has been a specific quality improvement project over the past two years that is aimed at reducing the number of pressure ulcers. Each pressure ulcer is declared, the root causes are analysed and the patients are involved in the investigations. Nurses can monitor the positioning of patients on their hourly rounds and help to turn them if required. Those examples of good patient care can help us to get over the kinds of awful care that have been described today.

My final point is about transparency. Patients and families can check the harm data, because they are shown on a whiteboard at the entrance to every ward. The board records not only how many days it is since the last MRSA infection or pressure ulcer, but provides assessment scores on 13 fundamental nursing standards. Such public reporting to patients and families is important because it aids accountability and helps staff to feel accountable for the standards on their ward. We need that now more than ever.

Unsurprisingly, Salford Royal has achieved the highest rating in the NHS staff satisfaction survey for acute trusts in the NHS. Staff are supported to challenge existing systems and test new ideas to improve standards. I am aware of how much of a contrast that is to what we have heard this afternoon. The NHS is a system in which one area has had a catastrophic failure at all levels of patient safety, while other areas have achieved the highest standards of safety and patient care. We must look at both if we want to understand why that is.

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[Mr Slaughter]

I am grateful for that. I did a company profile for Harmoni. It revealed that, although he might have sold his shares for that amount of money, Dr Goodman is still listed as head of clinical spine. A series of press articles deals with the failings of Harmoni—failures that have caused deaths through under-staffing or poor-quality staffing—and why it is under investigation.

Let me return in the time I have available to my attempts to get to the bottom of the matter. The same day as I read the article in The Guardian, I wrote a short letter to the chief executive of the NHS in north-west London. I said:

“I attach the front page article from today’s Guardian, which you may have seen, regarding the sale of out of hours GP service provider Harmoni to Care UK. The article states that a number of GPs will make substantial sums from the sale.

I note that four of the CCG chairs in NW London declare shareholding or directorship in Harmoni, as does your Medical Director. It would be helpful to know if they are beneficiaries of the sale and by what amount.”

I then asked for assurances as to the future.

A month later I received a non-reply reply, the most relevant sentence of which was:

“Any member who declares an interest in a meeting is expected to take no part in discussions and step out of the meeting.”

I wrote back a much longer reply, in which I pointed out that the chair of the Royal College of General Practitioners had said:

“it is not about excluding yourself from the room whenever there is a discussion; it is about how it will drive your decision-making overall”.

I pointed out that, as a consequence of hospital closures in north-west London, there had been a shift in funding from hospital to primary care, a greater involvement of private companies in the primary care sector, and an opportunity for those companies to increase their profits by cutting back on the level of service offered.

I principally raised the fact that the information that should be provided is not provided on declaration of interest forms, especially the scope and value of any interest. I listed doctor by doctor and CCG chair by CCG chair what those interests were and how they were not adequately declared. I dealt with seven out of the nine CCG chairs and the medical director. That was in a letter on 20 December.

I received a reply on 3 February which said:

“The Cluster does not hold this data.”

So three months on from my original inquiry, I am none the wiser in relation to these matters.

I advise any hon. Member to look at their CCG declarations of interest online—not Hillingdon, because it does not publish them online. I use Hammersmith and Fulham as an example here. The husband of one member is a partner of Drivers Jonas Deloitte. The first thing I found on the website of Drivers Jonas Deloitte was that it had been appointed to sell the Kent and Sussex hospital in Royal Tunbridge Wells when it closes in 2011. Another member is the owner of a provider of home care services. Another is the brother of the director of a design company that holds a number of contracts with NHS organisations. It might be that none of them has a direct financial pecuniary interest now or in the future, but it shows touching naivety, complacency or worse.

Before the 28 members of the joint PCT board made the decision to close the four A and Es in north-west London, I said at the public meeting that if any of them had or was likely to have interest of a pecuniary nature they should not take part in that decision. One of them rather touchingly volunteered the information that they had sold their shares. What world are we living in when a third of GPs on the new CCGs can hold financial interests in anything from land sales to an alternative provider?

I raised the question with the Prime Minister yesterday and mentioned Dr Goodman, although not by name, and his estimated minimum return of £2.6 million. Again, I got a non-reply in reply. Sooner or later the Government will have to address these matters.

There is another story in the Daily Mail today that states:

“In 1981 there were eight NHS press officers in Britain. Now there are 82 in London alone”.

It is not that there is a lack of spending on publicity in the NHS. Indeed, almost £1 million has been spent on a private consultancy firm simply to carry out the bogus and botched consultation on the closure of A and Es.

We are seeing the creation of a second-grade health service in north-west London.

[Barbara Keeley]

A number of months ago, I raised the case of a person who rejoices in the title “NHS head of brands”. There seem to be a whole set of units that keep cropping up.

[Mr Slaughter]

I am sure that all Members will have similar examples. It is an obscenity that millions of pounds are being spent on spin and disinformation while basic information is not being provided even to Members of Parliament after three months and persistent requests. Sooner or later, these issues will have to be addressed.

Of course, our main preoccupation is to maintain our first-rate health service—our blue light A and Es, our stroke centres and our major hospitals—rather than having it replaced by urgent care centres and minor primary care facilities. That is what we face in north-west London and, I am sure, around the rest of the country. It adds insult to injury if the individuals who are making the decisions to sell the land and to transfer services into the private sector are also the shareholders and owners or if they benefit in any other way. This is a corrupt act and it must be addressed by the Government. They cannot continue to turn a blind eye to it.

NHS Commissioning Board

Baroness Keeley Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

It is absolutely not the case that the regulations, as currently drafted, drive the privatisation of the NHS. As the hon. Gentleman will discover in the next few days, the amended regulations will make it abundantly clear that CCGs will be in the driving seat—the letter from the former Secretary of State made that clear back in 2012. They will take into account the importance of co-operation, integration and putting the patient’s interest first.

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

On competition and integration, my hon. Friend the Member for Walsall South (Valerie Vaz) and I spent some time this morning talking to academics from Sweden, who told us how competition and fragmentation were preventing them from moving ahead with integration. The Minister should be concerned about the integration of health care and social care, so will he address that point? We will certainly never make progress on integrating health care and social care if we move ahead with all this privatisation, which will lead to a lot more fragmentation. Leaving that aside, 70 of my constituents also think this is just the wrong way to go.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 26th February 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that all staff in the NHS should feel able to speak up and raise concerns about patient safety, so that the organisations for which they work can take up their concerns and investigate them. He will be aware that the people who raise such concerns are protected under the Public Interest Disclosure Act 1998.

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

Last week I visited Salford Royal hospital, which has the lowest death and weekend mortality rates in the north-west, and the seventh lowest in the country. It is interesting to note that Salford also has higher ratios of nurses per in-patient bed, and that individual wards in the hospital publish data on their rates of MRSA, ulcers and falls. Does the Minister accept that good practice at hospitals such as Salford Royal should be investigated alongside the poor practice and high mortality rates in other hospitals?

[Dr Poulter]

The hon. Lady is absolutely right. That is exactly what the review is about. It is going into the 14 hospitals in which concern has arisen over mortality data, looking at the practices there and commissioning a peer review of them from leading clinicians and patient groups. That will help to raise standards of practice where required.

Social Care Funding

Baroness Keeley Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

I absolutely agree with my right hon. Friend’s points; he speaks wisely, as ever. I, too, want to pay tribute to the work that my predecessor, our right hon. Friend the Leader of the House, did in laying the ground and making the big call that we needed to have the Dilnot commission, and in last year publishing the care and support White Paper, which moved this agenda much further forward than in any of the 13 years of the previous Labour Government. My right hon. Friend is also right about the fundamental randomness and unfairness. Of course, we are not saying that the Government will pay for all the social care costs we encounter—public finances could not possibly be in a state to allow that to happen. However, this provides certainty and allows people to plan, so that they can cope with the randomness and unfairness of the current system and know that it will not put their precious inheritance at risk.

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

At £75,000 the cap on social care is far too high to help people in an area such as Salford. The Secretary of State has talked about insurance products developing to help people meet the costs of the cap. In our inquiry into social care, we on the Select Committee on Health were told that this country has no market at all in long-term care insurance—not only that, but no country in the world has a working market in pre-funded long-term care insurance. Is it not wishful thinking of the highest order to talk about people being able to rely on products that do not exist either here or anywhere else in the world?

[Several hon. Members]

rose—

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

I am happy to do so, and I commend my hon. Friend for her campaigning, because if we invest properly in community health services, we can allow the frail elderly, who are among the biggest users of the NHS, to stay at home happily, healthily and for much longer. That must be a key priority for us all.

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

At the last Health questions, the Secretary of State told me:

“Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.”—[Official Report, 27 November 2012; Vol. 554, c. 122.]

Quoting national average nurse-patient ratios does not help to improve the patient experience, but cutting 7,000 nurses sure does affect it. We have unsafe levels of care in 17 hospitals. Will he treat this issue a bit more seriously and do something about those unsafe levels?

[Mr Hunt]

With respect to the hon. Lady, she cannot talk about alleged cuts in the NHS while her Front-Bench team support a policy of real cuts in the NHS budget. In the last Opposition day debate, the right hon. Member for Leigh (Andy Burnham) said that he thought it was irresponsible of the Government to increase the NHS budget in real terms. That means he wants a real cut in the NHS budget, which would make the staffing issues to which she referred much, much worse.

Dementia

Baroness Keeley Excerpts

Thursday 10th January 2013 Commons Chamber

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

It is a pleasure to speak in this Back-Bench debate on dementia. I congratulate my right hon. Friend the Member for Salford and Eccles (Hazel Blears), the right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Chatham and Aylesford (Tracey Crouch) on securing the debate and on their excellent contributions. I join others in saying how much I appreciated the moving and personal contributions from right hon. and hon. Members this afternoon. It must have been very difficult for them to talk about their personal experiences, but they did it very well.

My right hon. Friend the Member for Salford and Eccles has worked unstintingly on this issue, locally and nationally. Like her, I want Salford to become a dementia-friendly community. I share her pride that Salford contains one of the 10 national demonstration sites, in the Humphrey Booth centre in Swinton, which has its own day centre, the Poppy centre. I also agree with her that more needs to be done to improve our community services, to reduce hospital stays, to increase rates of diagnosis of the condition—many Members have mentioned that today—and to end the stigma that is so often associated with it.

I want to talk specifically about carers for people with dementia. As others have pointed out, about 10% of our 6.5 million carers are caring for a person with dementia, which means that at least 2,000 of our 22,000 carers in Salford must be in that position. The nature of the symptoms of dementia clearly makes providing such care particularly difficult. People with dementia can grow agitated, and they may wander at night and call out when asleep, which means that the carers themselves get little sleep. The personal care needs of those with dementia can be very great, as has also been mentioned today. Many people are performing a caring function for more than 100 hours a week. As we have heard, family members caring for a person with dementia must cope with personality change and loss of memory. Those very serious changes cause them to suffer feelings of grief and loss, similar to the experience of bereavement but before bereavement.

Dealing with that heavy caring work load also means that shortcomings in the provision of appropriate care services will be keenly felt. If carers do not have confidence in the quality or appropriateness of care, they will not have the confidence to take the respite breaks they so badly need. In 2007, when I was parliamentary champion for carers week, I visited some local carers and talked to them about our local services. One of them, a remarkable woman, was caring for her husband, who had vascular dementia. When she and I introduced ourselves, she told me “I am his nurse.” That was the change that had come about in her relationship with her husband.

The woman also told me how impossible it was proving to be to find adequate respite care locally. On one occasion, a week’s respite care had been arranged, with her husband staying at a local nursing home. Owing to a catalogue of problems at the start of the week, she then had no confidence that the home would manage her husband’s care properly, and she began to visit him there every day. By Wednesday, when family members found him lying unshaven in a soiled bed, she said that enough was enough, and brought him home. The end result of all her worries during those four days was that she developed eczema and had to visit her GP. That was her one week’s respite care.

One aspect of that woman’s life that she did praise was the support given by Crossroads Care, which is now part of the Carers Trust. Twice a week it provided two hours of respite care that she trusted. During one two-hour slot, she did her shopping at the local supermarket; during the other, she went to play bingo. When I asked her what we politicians could do for her and what changes she wanted to see, she told me that she wanted regulators who inspected care or nursing homes to ask carers for feedback about their experiences, and that, for herself, she wanted occasionally to have respite care lasting longer than two hours, so that she could wander around the shops rather than racing to get back home.

That was more than five years ago. I wish I could record that the situation for carers for people with dementia had improved radically in that time, but, given the increasing number of people with dementia and the crisis in the funding of social care—which has been touched on by several Members—the amount of respite care per individual carer cannot be stepped up dramatically, which is a pity. Crossroads Care told me that in 2008 it had provided 9,000 hours of respite care for 398 carers. This year it will provide some 13,800 hours of respite care for 567 carers. As I said earlier, we probably have some 2,000 carers for people with dementia, so the support is reaching only just over a quarter of the people who might need it.

The Health Committee’s recent report on our accountability hearing with the Care Quality Commission concluded that the regulator inspecting our care homes still did not have the confidence of carers, families and residents. It recommended that feedback from carers and other members of the public should start to be regarded by the commission as “free intelligence”, and that the regulator should act swiftly when complaints were brought to light.

In 2007 I introduced a ten-minute rule Bill, the Carers (Identification and Support) Bill, which required health bodies

“to identify patients who are carers or who have a carer”

and take steps to promote their health. I have introduced similar Bills subsequently, including, on 7 September this year, the Social Care (Local Sufficiency) and Identification of Carers Bill. I am still convinced of the need for health bodies—hospitals or, in primary care, GPs and their teams—to identify carers and ensure they receive information, advice and health checks. That would help avoid the isolation carers feel, which my hon. Friend the Member for Bridgend (Mrs Moon) talked about. They would be connected with professionals and other carers.

[Martin Horwood (Cheltenham) (LD)]

I agree with what the hon. Lady is saying, and, indeed, we might mention institutions such as the National Institute for Health and Clinical Excellence in this context. When I worked for the Alzheimer’s Society, we had the experience of trying to persuade NICE that evidence from carers about some quite difficult-to-research things such as behaviour and daily living skills was valid evidence when collected systematically and at scale—and, indeed, just as valid in its way as the evidence from things such as clinical trials and cognitive scales?

[Barbara Keeley]

Yes, and probably more so. The key concept here is that of the expert carer. Reference has been made to the professional carer, but I think expert carer is the right term. I shall talk about NICE shortly.

My Bill stated that health bodies should promote and safeguard the health and well-being of carers. They should ensure that effective procedures exist to identify patients who are carers or who are about to become carers, and ensure systems are in place to make sure that carers receive information and advice and that general medical services are rendered to patients who are carers. The reason for that is that carers will ignore their own health. They will entirely put the person they are caring for first, and put their own health to the back of the queue.

I was interested to see that this week NICE started a consultation on the topics prioritised for development in the quality and outcomes framework for 2014-15. The hon. Member for Banbury (Sir Tony Baldry) discussed the three indicators, the first of which is:

“The percentage of patients with dementia with the contact details of a named carer on their record.”

The second indicator is:

“The practice has a register of patients who are carers of a person with dementia.”

The third indicator is:

“The percentage of carers (of a person with dementia) who have had an assessment of their health and support needs in the preceding 12 months.”

I would have welcomed this development, as the identification and support of carers is a crucial issue, but I have some comments to make on the indicators. I doubt whether the QOF is the best way to achieve progress, and in some respects this issue is a higher priority. We currently give three QOF points to GP practices that keep a register of carers, but they could, in fact, have a small and static register of carers that they did not consult on, improve and develop. They would still get three points, however. The task of properly identifying carers and making sure they get the advice and support and the health checks they need is certainly worth more than the £400 that these three QOF points averages out as being worth. Is that what we think these tasks are worth? They surely must be worth more than that.

I have taken advice on this matter and I suggest that a better solution would be to tier the indicator payment based on the percentage of carers identified. Sufficient QOF points should be given properly to recognise the achievement of the task as well. It will take a number of people quite a bit of time to perform it, particularly if it is performed at the higher levels of achievement. Carers trusts tell me it is hard to find GP practices where more than 3% of carers are identified. The figure should be about 10%.

I fully support the indicator measuring the percentage of carers who have had an assessment of their health and support needs in the preceding 12 months, as that is a very important development, but why does it cover only carers of people with dementia? In my constituency there are carers of people who have had a stroke who have a very heavy, and very similar, work load to carers of those with dementia. It would be better to specify a small range of long-term conditions that lead to carers having a heavy caring work load, and they should be identified and receive assessments.

I want to record my thanks to organisations in Salford and elsewhere that do a wonderful job in supporting carers of people with dementia. I have mentioned the Humphrey Booth centre, and Age UK in Salford has a dementia support service. Those services are very important. They provide buddy cafés that support both people with dementia with activities and carers with respite. A buddy café lasts for five hours. That is a welcome period of respite for carers. There is a drop-in café at the HBC as well as a carers training programme, and it offers vital information, advice and advocacy services. It is a key partner in Salford, providing better quality services to people with dementia.

Last, but definitely not least, I should mention Salford Carers Centre, which plays a key role in identifying carers and helping them with information, advice and support. I believe that our practice in identifying carers, both in primary care and acute settings, is making a real and vital difference to helping our carers to care. I have invited the Minister, just as I invited his predecessor, to come to Salford to see what we do. The key other part of that now is Crossroads Care, which provides vital respite care.

I will finish on the issue about the funding of care, as many hon. Members have done. The right hon. Member for Sutton and Cheam referred to the moving speech made by a carer at the meeting earlier in the week to launch a pamphlet he wrote. In her contribution, that carer described the difficulty of managing catastrophic care costs for a person with dementia. She said:

“A £35,000 cap, as proposed by Dilnot (or even £50,000 or £60,000) could give me back my life. Our liabilities would be over. I could concentrate on my frail mum instead of the practical and emotional burden of single-handedly selling our family home. My mother has an incurable disease that has robbed us both of our lives; must it rob us of our assets too?”

I could not put it better than that, so I will not try to do so. As other hon. Members have said, we must consider setting the cap, up and down the country, at a lower level than £75,000, which will help people such as this carer. I have outlined a number of ways to support the carers of people with dementia, and I hope we give them the priority they deserve.

NHS Funding

Baroness Keeley Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

They are certainly sheepish today; they need to get back to their offices pretty sharpish to amend their websites in light of the letter from the chair of the UK Statistics Authority.

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

The website of the Conservatives in Salford says, on the budget that was going to increase,

“we would see more investment in our local NHS”

under a Conservative Government, but in Salford Royal hospital, 750 jobs have been cut. Between them, all our local hospitals have had 3,100 jobs cut in the past couple of years, and two walk-in centres have closed. If the budget is the same, why all these cuts?

[Andy Burnham]

This is the reality on the ground, as my hon. Friend says. There is also the mental health budget cut. There has been a mismatch; people see all those things, yet they hear the statements from the Government, and it does not make any sense, but now the truth and the facts about our NHS are being told, and things will begin to make sense to people.

What I find most troubling about all this, and most revealing about the Government’s style and the way that they work, is that even when they are warned by an official watchdog, they just carry on—as they are doing today—as if nothing had happened. When they admitted cutting the NHS in 2011-12 by amending their website, what was the excuse that they offered to Sir Andrew? Labour left plans for a cut; that is what the Prime Minister said at the Dispatch Box last week. It is what the Secretary of State said in a letter replying to Mr Dilnot. Again, that is simply untrue.

According to Treasury statistics, Labour left plans for a 0.7% real-terms increase in the NHS in 2011-12. From then on, we had a spending settlement giving real-terms protection to the NHS budget. It was this Government who slowed spending in 2010-11, who allowed the resulting £1.9 billion underspend to be swiped back by the Treasury, contrary to the Secretary of State’s promise that all savings would be reinvested, and who still have published plans, issued by Her Majesty’s Treasury, for a further 0.3% cut to the NHS in 2013-14 and 2014-15, contrary to the new statement that the Conservatives have just put on their website. The Secretary of State has a lot of explaining to do.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 27th November 2012 Commons Chamber

The Secretary of State was asked—

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

1. How many (a) health visitors and (b) nurses there were in the NHS in May 2010 and the latest month for which figures are available.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The number of full-time equivalent qualified nurses and midwives employed in the national health service in England in May 2010 was 310,793, and in August 2012 it was 304,566. The number of full-time equivalent health visitors in May 2010 was 8,092 and in August 2012 it was 8,067, with an additional 226 health visitors employed by organisations not using the electronic staff record.

[Barbara Keeley]

I thank the Secretary of State for that answer. The recent Care Quality Commission report found that 10% of NHS hospitals did not meet the standard of treating people with respect and dignity, and underpinning that poor care were high vacancy rates and hospitals that have struggled to make sure they have enough qualified staff on duty at all times. That shows us the real impact of losing those thousands of nurses. So does he agree that it is urgent that this Government take action when understaffing in the NHS results in poor care?

[Mr Hunt]

I absolutely agree with the hon. Lady that nowhere in the NHS should allow low staff numbers to lead to poor care. What was interesting about the CQC report, which was a wake-up call for the whole NHS, was that institutions under financial pressure, as the whole NHS is, are delivering excellent care in some places and delivering care that is unsatisfactory and not good enough in other places. On her specific question about nurses and nurse numbers, it is important to recognise that across the NHS as a whole the nurse-to-bed ratio has increased. Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.

Regional Pay (NHS)

Baroness Keeley Excerpts

Wednesday 7th November 2012 Commons Chamber

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

Like many right hon. and hon. Members in this and earlier debates—we are lucky to have two debates today—I am against the Government’s move to regional pay in both the NHS and other parts of the public sector. I am a little less clear about the speech of the hon. and learned Member for Torridge and West Devon (Mr Cox), who talked a lot about the pay bill. If we were not spending £1.6 billion on redundancies or £3 billion on an unnecessary NHS reorganisation, the pay bill would not be quite the worry to the NHS that it is—but let us leave that aside.

One of the most important reasons for opposing regional pay is that, as we have heard—I think the hon. and learned Gentleman was saying something similar—regional or local market-facing pay is bad for the economy not only in the south-west but in the north-east, Yorkshire and the north-west. Public sector workers are already suffering. They have had a two-year pay freeze and have suffered greatly from budget cuts and redundancies. The TUC believes that local or regional pay would effectively mean a further freeze, holding back public sector pay for years. That would take even more demand out of our regional economy, with staff having even less income to spend in the local shops and businesses that the hon. and learned Gentleman mentioned. In the north-west, which has 780,000 public sector employees, a 1% reduction in earnings would take almost £190 million out of the regional economy.

A key point is that any reductions would particularly affect women, who account for around two thirds of public sector jobs on average, although the figure is higher in some parts of the north-west. For instance, the neighbouring authority to my local authority of Salford is Bolton, where female employment in the public sector is over 71%, and a number of my constituents work in Bolton hospitals. Proposals that would cut public sector pay would therefore be a further attack on the living standards of women, who we know are already being hit hardest by the recession and the policies of this coalition Government. Figures from Personnel Today show that since May 2010 the number of qualified nursing, midwifery and health-visiting staff has fallen by 6,588, as my right hon. Friend the shadow Secretary of State said earlier. Indeed, between June and July this year, a further 808 posts were lost, which is serious.

That fall in the number of front-line nurses, midwives and health visitors has been clear in my local area for some time, due to the level of efficiency savings being forced on to the NHS to pay for the reorganisation. Figures in The Guardian show that Central Manchester University Hospitals Foundation Trust has announced that up to 1,400 jobs are to go, with Salford Royal Foundation Trust announcing a reduction of 750 posts—including 146 nursing posts so far—Wrightington, Wigan and Leigh Foundation Trust planning a reduction of 533 posts between 2010 and 2014, and Bolton Royal Foundation Trust planning to make a reduction of 248 posts, with two thirds of the first 61 posts removed being nursing and midwifery posts. Even our regional cancer hospital, the Christie, plans a reduction of 213 posts between 2010 and 2015, including, sadly, 43 posts in nursing. That means a total of more than 3,100 jobs going at just five foundation hospital trusts in the Greater Manchester area over three to five years. These are the jobs and careers of my constituents, and we know that women’s jobs are disproportionately affected, because women account for 80% of the jobs covered by “Agenda for Change”. It is in that context—the attack on women and their standard of living—that regional pay in the NHS is a cause for further concern.

The British Medical Association believes that the move from national terms and conditions for NHS staff would have a significant negative impact on the NHS because, as a number of Members have said, the national pay system in the NHS provides benefits for both staff and employers. It has maintained good industrial relations, prevents the duplication of negotiating efforts and has helped to support the recruitment and retention of staff. The Royal College of Nursing believes that any move towards local and regional pay would lead to damaging competition between trusts for staff, because it would entrench low pay in certain areas. There is great concern that places such as Cheshire, which could perhaps offer higher pay, would attract staff from Greater Manchester. That would entrench low pay in areas that are already deprived, such as parts of the north-west, where it would become difficult to attract and retain staff. Regional pay would therefore be unfair and bad for the economies of regions such as the north-west, as well as hitting women harder than men.

The TUC also argues that the case for regional pay is not backed up by evidence, and it makes some important points. As we have heard, comparing public and private sector pay is not comparing like with like. Half the employees in the public sector have a degree, compared with only one in three in the private sector. Importantly, the public sector has a smaller gap between top and bottom pay, and a lower gender pay gap, both of which are welcome. We want to hold on to those. The RCN argues that a move to replicate the pay structures of the private sector would also lead to the replication of inequalities in the private sector, which would be a backwards step. Indeed, I want to challenge the notion put by advocates of regional pay that the public sector somehow crowds out the private sector. In my constituency, there are six people chasing every job vacancy, which is more than the national average. In some parts of the country, such as Hull, as many as 30 people are chasing every job vacancy. It is the lack of growth, jobs and demand in our region that is causing the problem. Budget cuts and redundancies in the public sector, which have already hit our local economy, would be made worse by regional pay.

It is argued that local pay is what the private sector does. However, I worked for many years in the IT industry. I worked in London, the west midlands and Manchester, and we did not have different pay arrangements in those places; in fact, my company would not have been able to persuade people to move from place to place if it did. Of course there is London weighting; that has been with us for a long time. Regional pay would be unfair and bad for the economy of our regions. The arguments are not backed up by evidence. Regional pay is not what the private sector does and it would hit women harder than men. There is no reason a nurse in Salford should be paid less than a nurse in another part of the country. As my hon. Friend the Member for York Central (Hugh Bayley) said, it is important that the NHS should have a work force of the same quality in different parts of the country.

Let me make my last two comments. A nurse in my constituency wrote to tell me that she was against the move from national pay because it would

“pit…employers against each other in bidding wars for staff,”

and would also be completely unfair. A midwife in my constituency told me:

“I have, like all other NHS staff, received no annual pay rise for three years now despite the cost of living rising. The cost of raising four children (one of whom has profound disabilities) on one wage is challenging, as my husband provides 24/7 nursing care. Basic pay for a nurse or paramedic should be the same whether they are saving lives in Preston, Peterborough or Plymouth. Anything else is unfair.”

I support the motion tabled in the name of my right hon. Friend the Member for Leigh (Andy Burnham) on behalf of nurses and midwives such as those.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Dr Poulter]

I thank my right hon. Friend for that question. We discussed this issue in the Adjournment debate before the autumn recess. He is a strong advocate for his local maternity services. The concern was that only 13 births take place at his local maternity unit every year, and whether staff can continue to deliver high-quality care with such a low number of births. Of course, his local providers will want to consider the rurality of the area and the potential, as outlined in the Birthplace study, of rotating staff in and out of the hospital to support his local unit.

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

7. What steps he plans to take to ensure that providers of domiciliary care employ staff who are properly qualified and security checked.

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

Providers of services are responsible for the safety and quality of the care they provide. All staff must be properly qualified and vetted, and the Care Quality Commission can and must take action against providers who fail in that regard. Action can range from a warning notice to, ultimately, cancelling a provider’s registration. The commission must be willing to take that action if necessary.

[Barbara Keeley]

But the Minister knows that a recent BBC programme showed that 217 providers of care at home use staff who are not properly qualified, and that dozens of people with criminal records have not been vetted and are working unsupervised in people’s homes. The Care Quality Commission has reached only just over one in four of its target inspections, with 40% of care at home providers never having been inspected by it. What will the Minister do to ensure that we can have more confidence in care provided at home to vulnerable people and that it is up to a better and safer standard?

[Norman Lamb]

I absolutely share the hon. Lady’s concern about this. It is intolerable that people receiving domiciliary care do not get high-quality care and that in some cases people are inappropriately employed. The Care Quality Commission must take action where there is evidence of employers not taking sufficient action to guarantee the quality of their staff. It is essential that the people who run those services are held to account if they fail in that regard.