Care: Older People

Baroness Wheeler Excerpts

Wednesday 7th May 2014 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what response they intend to make to the findings of the Age UK report Care in Crisis on the impact of cuts to care for older people.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, social care is a priority for this Government, which is why we have allocated an extra £1.1 billion to councils this year to protect services. We are building on this by creating a £3.8 billion fund next year to join up NHS and social care services. Both health and social care need to work differently to respond to the needs of our ageing population, focusing on keeping people well and living independently for as long as possible.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. Age UK’s report found that social care cuts between 2010 and 2013 have resulted in 168,000 older people no longer receiving help with essential tasks such as eating, washing and getting dressed. The Nuffield Trust recently put the figure over four years at 250,000 people who have lost state funding support. In the light of today’s developments, can the Minister please comment on what is now happening to the Better Care Fund and when does he expect to update the House fully on why the launch of the fund has been delayed? The Minister knows that the fund basically uses resources already committed to shoring up the existing reduced level of services and that there is no new money in it. We now learn that the Cabinet Office says that the fund lacks financial credibility, in particular as to how on earth local hospitals are to save money to move care into the community in the current climate of substantial cuts. How does the Minister think progress can be made on the transfer to community care amidst the chaos and confusion into which this policy has now fallen?

[Earl Howe]

My Lords, I can assure the noble Baroness that there is no chaos and confusion. As regards reduced numbers, which was where the noble Baroness started, the transformation in the service model that we are promoting focuses above all on prevention and is designed to enable people to live independently for longer, as I said earlier, so as to reduce the number of people who are dependent on formal care. Councils have told us that lower social care user numbers are partly due to the success of their core prevention work, but also due to increased use of re-ablement services for people who leave hospital to help them get back on their feet. As regards the Better Care Fund, there has been no delay there. We wanted to set aside enough time to make sure that all areas of the country have developed comprehensive plans for joined-up care. The better care plans start from April next year, as the noble Baroness is aware, and we have asked for early versions to be completed a year in advance so that we can review them, check their level of ambition and test how they will be delivered. That is what is happening now and we are broadly on track with the programme.

Care Bill [HL]

Baroness Wheeler Excerpts

Wednesday 7th May 2014 Lords Chamber

The Better Care Fund is a crucial part of the wider change needed in the way in which the health and care systems work together to secure better care for people. Work is well under way with the development of local plans and this legislation will support those plans to become a reality. With that lengthy explanation, for which I apologise, I beg to move.

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his full and thorough explanation of the Government’s changes to the Bill since it left this House. We will deal with each issue as it comes up. I will deal with Amendments 1 to 10, 44 and 46 to 51 on the Better Care Fund, and Amendments 12 to 39 on the care and support appeals process.

In light of today’s revelations about the Government’s problems with the aims and operations of the Better Care Fund, perhaps I might ask a couple more questions that follow on from the earlier exchange with the Minister on this matter. The Government’s technical amendments—Amendments 1 to 10, 44 and 46 to 51 —on the fund and achieving integration of care and support between the NHS and local authorities are straightforward. Of course, whether the fund can ever achieve what it set out to achieve looks like a very different matter.

The Cabinet Office review has found that the £3.8 billion fund lacks financial credibility. The Nuffield Trust says that it is based on “flawed logic”. The King’s Fund says that the aim stressed by the Minister earlier to get spending plans in place for the fund in time for the 2015-16 Budget is “completely unrealistic”. Its chief executive, Chris Ham, points out in today’s Guardian what many of us have been stressing all along, despite supporting the principle of and need for the fund; namely, that hospital budgets can be reduced only if much more care is already being provided in the community by GPs, community nurses and staff who are supporting patients in their homes. He says that just cutting NHS hospital budgets now would place,

“additional stress on an NHS already struggling to balance the books and maintain acceptable standards of patient care”.

Surely that is the point. Taken with the huge underfunding of local authority social care highlighted by the Age UK report Care in Crisis that was referred to earlier, this is the underlying problem that has still to be addressed. The fund does nothing to address the huge social care funding gap that has led to the cuts in social care support that Age UK’s report has highlighted, particularly the ending of help with essential tasks for older people, such as eating, washing and getting dressed. Those are the very services that help them remain independent and living in their own homes with a good quality of life.

The Minister says the fund has not been suspended, but there are clearly problems. Can the Minister give us any further details about the Cabinet Office review findings, and in particular the concern about the lack of detail about how the savings will be achieved? What is the timescale for the further review referred to by several newspapers and the specialist press today? Can the Minister explain how progress is to be made in enabling older people to remain active and independent at home or in the community when there is just not the funding or support available to help them?

Finally, on the technical amendments to the care and support appeals process, we welcome the Government’s announcement accepting the two recommendations from the Delegated Powers Committee and fully support these government amendments.

[Baroness Brinton (LD)]

My Lords, I have just one issue to raise, on Amendment 32 and the Government’s amendments in light of the Delegated Powers Committee report. I speak on behalf of a number of people who are grateful that the Government have been able to respond very quickly to this. It is much more sensible for this to be an affirmative instrument rather than a negative one.

--- Later in debate ---

[Lord Rix (CB)]

My Lords, on behalf of learning disabled people and other vulnerable people I should like to thank the Government for making this amendment, which certainly ensures that their care will be greatly attended to in the future.

[Baroness Wheeler]

My Lords, briefly, I also support the Government’s amendment on this long-running but vital issue. As the House knows, we strongly supported the need for the amendment. We, too, warmly congratulate the noble Lord, Lord Low, on his dogged determination and efforts to achieve this outcome. We also thank noble Lords from across the House who have helped to bring this about. On these Benches, we recognise that this was very much unfinished business from the Labour Government. We congratulate the Minister on the hard work he has put into finding a way forward and to getting cross-government departmental agreement, which has been important. We recognise that the amendment is a very significant step. I was going to ask for clarification on a couple of issues, but they have been raised in the debate so I shall leave it there.

Health: Liver Disease

Baroness Wheeler Excerpts

Tuesday 6th May 2014 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords—

[Lord McConnell of Glenscorrodale]

I was up three times before.

[Noble Lords]

Front Bench.

[Baroness Wheeler]

My Lords, I, too, pay tribute to Elena Baltacha, who was a truly remarkable and very brave woman. One in five people in the UK is at serious risk of liver damage, but a recent government response shows that the Secretary of State has not met any external organisations to discuss liver disease since May 2010, and current Ministers have not met representatives of people living with liver disease since September 2012. Can the Minister commit urgently to remedying this situation, particularly as it is in such stark contrast to the 130-plus meetings the Government have had with the drinks industry?

[Earl Howe]

My Lords, liver disease is very much in the sights of my honourable friend the Minister for Public Health, as is evidenced by the document we published last week, Living Well for Longer, in which there is a whole section on alcohol and liver disease, and by what NHS England and Public Health England are doing to tackle them.

Mental Health: Young People

Baroness Wheeler Excerpts

Monday 7th April 2014 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, a recent survey found that more than half of young carers reported having a mental health problem, including feelings of stress, anxiety and depression, eating and sleeping problems and risk of self-harm. What are the Government doing to support these dedicated young people? What guidance will be given in the Children and Families Act and the Care Bill on how local authorities should work with mental health services to ensure that young carers get the support they so clearly need and deserve?

[Earl Howe]

The noble Baroness is absolutely right and the pressures and strains on young carers have been well recorded. It is fair to say that compared with a few years ago, not least thanks to the efforts of the previous Government but also the work that we have continued, GPs and others working with families are much more alert now to the needs of young carers and can signpost them to appropriate support. The CYP IAPT programme is designed no less for young carers than it is for others.

Tobacco: Packaging

Baroness Wheeler Excerpts

Thursday 3rd April 2014 Lords Chamber

[Baroness Wheeler (Lab)]

I thank the Minister for repeating the Statement. I also take this opportunity to place on record the Opposition’s thanks to Sir Cyril Chantler and our congratulations on his excellent review of the public health evidence. We welcome much of what the Minister said, but I am sure that we share with other noble Lords who have long campaigned on this issue our frustration at the prospect of yet another consultation—albeit on regulations—especially when Sir Cyril's review is so clear and unequivocal about the impact that standardised packaging would have.

We know that the case for the introduction of standardised packaging is, as ever, urgent. The cost to the NHS of treating diseases caused by smoking is approximately £2.7 billion a year. Two-thirds of adult smokers took up smoking as children. One in two long-term smokers dies prematurely as a result of smoking-related diseases, and more than 200,000 children take up smoking every year in the UK. As Sir Cyril says, if we can reduce that figure by even 2%, that is 4,000 fewer children taking up smoking every year. For that reason, we strongly welcome the confirmation in Sir Cyril’s review of what public health experts have been arguing for some time—namely, that standardised packaging makes cigarettes less attractive to young people and could help save lives.

Sir Cyril's remit was to consider whether standardised packaging would lead to a decrease in tobacco consumption. Does the Minister not accept his clear conclusion that,

“standardised packaging would serve to reduce the rate of children taking up smoking”,

and that it could lead to,

“an important reduction … on the uptake and prevalence of smoking and … have a positive impact on public health”?

Of course, this is something that all the previous evidence reviews showed. Indeed, Sir Cyril states:

“My overall findings are not dissimilar to those of previous reviews”.

Did not the Government’s own systematic review in 2012, which Sir Cyril describes as “extensive and authoritative”, conclude that standardised packaging is less appealing than branded packaging, that it makes the health warnings more prominent and that it refutes the utter falsehood that some brands are healthier than others?

All the royal colleges and health experts, including the Royal College of Paediatrics and Child Health, the BMA and the campaigning health charities are united on this. The majority of responses to the Government’s own consultation also favoured it. Does the Minister therefore finally accept that there is an overwhelming body of evidence in favour of standardised packaging and that there can be no excuse for further delay?

The House will know that Labour has long called for the immediate introduction of standardised packaging. However, for every step we took in government on smoking and tobacco, the tobacco industry fought us all the way and then took a new approach. As my noble friend Lady Thornton put it when we recently pressed for amendments introducing standardised packaging to be included in the Children and Families Bill,

“we are talking about whether we are prepared to allow the over-powerful and wealthy tobacco companies to gain their next market for the profits they need to make from tobacco products … They can exist only if they continue to recruit young people to tobacco addiction so that they have their next generation of smokers”.—[Official Report, 20/11/13; col. GC 404-05.]

Do the Government not accept that the failure to take action on this issue under the Children and Families Bill was yet another missed opportunity? After Labour banned tobacco advertising, manufacturers developed increasingly sophisticated marketing devices for their packaging. We know that they spend millions every year on design testing to lure in new, young smokers. The question is: why have we had to wait so long for action on standardised packaging? Does the Minister accept the impact that further delay will have? More than 70,000 children will have taken up smoking since the Minister announced the review, and today he announced yet another consultation. The Government have already had a consultation, which reported less than a year ago. What do they expect to change?

At the time of announcing Sir Cyril’s review last November, the Government promised to issue regulations if they could be persuaded by the case made by Sir Cyril. Now they say that they are persuaded that he has made a “compelling case”—so why the further consultation and inevitable delay? Is this another attempt to kick the matter into the long grass, and can we be reassured that there will not be another government U-turn on this issue? How many more children will take up smoking before the Government make a decision and act? Does the Minister not accept that it is the clear will of both Houses of this Parliament to proceed with standardised packaging without further delay?

NHS: Midwives

Baroness Wheeler Excerpts

Monday 17th March 2014 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, does the Minister accept that the Public Accounts Committee report on maternity services was pretty damning, not just in terms of midwife shortages but on the lack of overall government accountability and strategy for maternity services, the increasing clinical negligence bill and substantial regional and demographic inequalities and variations in maternity care? What are the Government doing about this and when can we expect a coherent plan in response to these issues?

[Earl Howe]

The noble Baroness is right: the PAC raised a number of very important issues, many of which we agree need close attention. I have already mentioned the work that we are doing to improve recruitment and to reduce variation in the quality of services around the country. This requires more than just government; it requires all the arm’s-length bodies with an interest to pull together and, of course, local commissioners to do their bit as well.

Mesothelioma: Research Funding

Baroness Wheeler Excerpts

Thursday 16th January 2014 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I also commend the noble Lord, Lord Alton, for securing this debate and for ensuring that we keep the focus on the Government’s pledge on a package of measures to stimulate and build high-quality research into mesothelioma. There is optimism that progress is slowly being made but we are a long way from getting the secure and guaranteed funding on the scale we all want to see and which we recognise is vitally needed to offer hope to mesothelioma sufferers and to find a cure.

Noble Lords, and supporters of the Bill across all parties in the other place during last week’s Third Reading, have stressed our moral obligation on this issue in this country and internationally, as my noble friend Lord Giddens has underlined today. I also pay tribute to the vital contribution and role of Paul Goggins. I did not know him personally but certainly was fully aware of his work and reputation in my party, and of the respect in which he was held across Parliament. Now that the Bill has passed, I also pay tribute to the work of the British Lung Foundation and the campaigners, trade unions, MPs and Peers who have been lobbying for many years for justice for victims of this terrible disease. The BLF carer support project, in conjunction with Carers UK, is also developing vital support networks for carers and their families. It deserves special mention and recognition.

The Government have agreed that the scheme regulations will provide for a review of the operation and effectiveness of the scheme in four years’ time, which we welcome. On research funding, we must ensure that considerable progress has been made by then. The noble Lord, Lord Kakkar, again has ably underlined the need for a strategic, defined national initiative on mesothelioma research. I look forward to hearing from the Minister what actions are being taken on this. How will the current initiatives his department and the DWP are rightly pursuing be developed and built into a coherent strategy which will lead to real progress being made?

There is no doubt that the mesothelioma research programmes funded by the BLF itself, as well as jointly with the four insurance companies, and by other charities, have played an important role in kick-starting research and academic interest and laying the foundations for future developments. The meso-bank which is collecting tissue and blood samples from sufferers will provide the opportunity for fundamental and translational research. There are important projects too on palliative care and pain relief. I notice on the BLF website that it has recently awarded a further tranche of grants which will help to improve understanding of how the disease develops and progresses, and how our genes contribute to the disease.

We strongly supported the amendment in the name of the noble Lord, Lord Alton, for the 1% levy on the insurance companies, which would have provided secured and guaranteed research funding, and could have led to major advances and breakthroughs. It was sad to see this amendment again defeated in the Commons last week. As our shadow Minister, Kate Green, said, the levy,

“is very modest in the context of the overall scheme … a very modest sum for a multibillion pound insurance industry to afford, but a sum that could make an exponential difference to the scale of research that is possible into the disease”.—[Official Report, Commons, 7/1/14; col. 201.]

As we have heard, the DWP Minister of State, Mike Penning, cited the quality of research issue—on which there are clearly differing views among medical and research experts—but also rejected the amendment on the basis that it would “break the deal” with the insurance industry on the whole compensation scheme. It will be interesting to get further insight from the Minister today on why the insurance industry saw this issue in this way. I, too, look forward to the update on the ABI discussions that was promised by the Minister.

We know that the terrible reach of mesothelioma extends across all occupations and is not just an industrial disease. Indeed, it is anticipated that in the coming years more people will be diagnosed from all occupational backgrounds who have come into contact with asbestos or who contracted it via secondary exposure, such as wives who washed their partners’ overalls.

I was particularly concerned to learn of the huge problem of asbestos in schools, to which the noble Lord, Lord Wigley, referred. The risk or impact is not just on teachers but on children and ancillary and office workers. More than 70% of schools still contain significant amounts of asbestos. I am sure the Minister will agree that this frightening situation underlines the importance of making real and substantial progress on mesothelioma research, not just into treatment and cure but also into how the workplace can be protected.

Like other noble Lords, I look forward to hearing from the Minister what progress is being made on the joint DWP and Department of Health initiatives, and on the Government’s plans and timescales for developing the full-scale strategy for mesothelioma research that is so desperately needed.

NHS: Essential Services

Baroness Wheeler Excerpts

Tuesday 14th January 2014 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government, in the light of the Dr Foster Hospital Guide 2013, how NHS England is monitoring access to essential services and how it intends to address variations in access to and provision of services at clinical commissioning group level.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, to help reduce variations in access to health services, Professor Sir Bruce Keogh, the medical director of NHS England, is working with the medical royal colleges and others to ensure that the NHS is clear about the evidence base for common types of surgical interventions. For example, it will produce guidance for commissioners to help ensure that consistent eligibility criteria are used to access surgical services and so minimise the scope for variation at a local level.

[Baroness Wheeler (Lab)]

I thank the Minister for his response. Dr Foster’s report shows that the number of knee and hip replacements and cataract removals has fallen to its lowest level in four years, meaning that more than 12 million people now live in areas where the number of these operations has substantially declined. This is despite our elderly population continuing to rise over the same period and these common surgical procedures being vital to ensuring that older people can regain their mobility, keep active and stay living in the community. Does the Minister agree that these are essential treatments? What pressures will be placed on NHS England to ensure that CCGs actually provide them and also that they fulfil their legal obligation to issue guidance to local communities, revealing what their policies are on providing medicines, surgeries and therapeutic interventions?

[Earl Howe]

My Lords, I should first tell the noble Baroness that we cannot reconcile our own figures with those of Dr Foster. We believe that there has in fact been a significant increase in the number of cataract and knee and hip replacement operations since 2009-10 and not a drop. Regardless of that, I suggest to her that the absolute numbers of operations taking place do not tell us anything about possible rationing or the absence of it. That question can be answered only with the benefit of fuller data. The key to consistent access to these treatments is a common understanding among commissioners of the evidence base in each case. That is exactly what Sir Bruce Keogh is working towards and will provide guidance on in due course.

World Innovation Summit for Health

Baroness Wheeler Excerpts

Monday 16th December 2013 Lords Chamber

[Earl Howe]

My Lords, in broad terms, dementia falls outside the scope of mental health but it is, of course, closely allied. Many of the principles that apply to good mental health care apply equally to dementia. We are, again, doing our best, in responding to the Prime Minister’s challenge on dementia, to ensure that those who contract this dreadful condition are looked after with dignity and respect in the appropriate setting.

[Baroness Wheeler (Lab)]

My Lords, the WISH report, to which the Government are signed up, recommends key improvements to community care for mental health by 2020. Yet the recent FoI survey of 51 NHS mental health trusts by BBC News and Community Care magazine shows overall budgets shrinking by over 2%, including those for community mental health support teams, despite referrals to them rising by 13%. How is this consistent with pledging to achieve the WISH goal by 2020? What leadership and direction will the Government give to preventing this very disturbing situation from getting worse?

[Earl Howe]

My Lords, we need to hold the NHS to account by reference to the outcomes that it achieves. I do not belittle the need to spend sufficient sums of money. The National Survey of Investment in Adult Mental Health Services has indicated that reported spend on mental health services has continued to hold reasonably steady over time. I reiterate that mental health and well-being is a priority for the Government, as I hope the noble Baroness knows. We have clear indicators in the NHS outcomes framework, which will ensure that NHS England will need to focus on this area very closely.

NHS: Walk-in Centres

Baroness Wheeler Excerpts

Tuesday 10th December 2013 Lords Chamber

Asked by

[Baroness Wheeler]

To ask Her Majesty’s Government what plans they have in respect of the closures of NHS walk-in centres over the past three years, in the light of the preliminary report made by Monitor.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe) (Con)]

My Lords, since 2007, the local NHS has been responsible for NHS walk-in centres. It is for local commissioners to decide on the availability of these services. It is also for local commissioners to determine how walk-in centres fit into plans locally, rather than being governed by a top-down imposition of services. They make such decisions by involving patients and by using their clinical expertise to determine the pattern of local services and where walk-in centres fit in with this.

--- Later in debate ---

[Baroness Wheeler (Lab)]

I thank the Minister for his response. However, 76 NHS walk-in centres have been closed over the past three years and the Monitor report makes clear that this is often without proper consultation locally on alternative provision, leading to increased pressure on A&E and urgent care services. In Monitor’s survey, one in five patients using the centres said that they would have visited the nearest A&E department had the centre not been there. Monitor also finds in a number of cases that the closure decision has been made by CCGs, with member GP practices themselves having a financial interest in whether or not the service continues. What action will the Government take to ensure that, if future closures of walk-in centres are considered, the public will be properly consulted and patients will have access to an equivalent level of service?

[Earl Howe]

My Lords, when any service change is proposed, we expect that the four tests which the Government laid down early on in their term of office should be followed. One of those is a patient and public consultation or involvement in the decision. Another is clinical buy-in. I can give the noble Baroness the assurance that this is what local area teams of NHS England would expect to see in any proposals involving the closure of a walk-in centre.