Oral Answers to Questions

Debate between Caroline Dinenage and Julie Cooper

Tuesday 29th October 2019 Commons Chamber

[Caroline Dinenage]

I simply say to the hon. Lady that people over the age of 60 qualify for free prescriptions.

[Julie Cooper (Burnley) (Lab)]

Too many patients cut back on their prescribed medicines or go without them altogether because they simply cannot afford to pay prescription charges. Research by University College London indicates that this non-adherence to prescribing regimes costs the NHS £500 million more in complex treatments and hospitalisation. Prescription charges are a tax on sickness that disproportionately burdens those who have chronic illnesses and those on low incomes. Does the Minister agree that it is high time we brought an end to these charges, which fly in the face of the principle of an NHS free at the point of delivery?

[Caroline Dinenage]

I suppose I should probably have declared an interest in this issue, because I am severely asthmatic and I do not get free prescriptions, but then again I do not think I should. There is a prescription exemption system designed specifically to assist people who are most likely to need support in paying for prescriptions: people on low incomes or in full-time education; the over-60s; people living with many long-term conditions; and people with an increased risk of illness, such as pregnant women. That is why 89% of prescriptions are dispensed without charge.

Oral Answers to Questions

Debate between Caroline Dinenage and Julie Cooper

Tuesday 26th March 2019 Commons Chamber

[Caroline Dinenage]

Almost 90% of prescription items dispensed in the community in England are free of charge. That includes medicines for the treatment of asthma. The fact is that people who, like me, suffer from asthma and need those prescriptions have to decide, as taxpayers—as the people funding our NHS—whether we would rather contribute to those prescriptions or see the underfunding we have seen in Scotland, where GPs have been underfunded by almost £660 million over the last four years. It is a case of priorities.

[Julie Cooper (Burnley) (Lab)]

I miss the former Minister, the hon. Member for Winchester (Steve Brine), but commend him for his principled stance.

The Minister is missing the point on prescription charges. It is now more than 50 years since the eligibility criteria for medical exemption charges were reviewed, and next week prescription charges will rise again, placing a financial burden on many who require regular medication for long-term conditions. Does she agree that it is high time the Government moved to address the very many anomalies in the system? How can it be fair that patients with some chronic illnesses get free prescriptions for all their ailments, while asthma sufferers pay for everything? When will she review this unfair system?

[Caroline Dinenage]

We all miss my hon. Friend the Member for Winchester (Steve Brine), so I thank the hon. Lady for her comments.

Since prescription charges were introduced, Governments of all colours have decided that some patients should pay prescription charges to contribute to the cost of running the NHS, but almost 90% of prescription items are dispensed in the community free of charge, which I think the hon. Lady will agree is an enormous amount.

Children with Life-limiting Conditions

Debate between Caroline Dinenage and Julie Cooper

Tuesday 29th January 2019 Westminster Hall

[Caroline Dinenage]

I know that we are planning to meet next month to discuss this issue in more detail, but my understanding from the announcement in the long-term plan is that there will be an increase in funding for children’s hospices. I would not support a move towards anything other than that, so we are certainly in agreement about the value that children’s hospices offer up and down our country.

In July 2016, “Our commitment to you for end of life care” set out what everyone should expect from care at the end of life, and the actions being taken to make high-quality personalised care a reality for all. NHS England is responsible for delivering that commitment in partnership with key stakeholders through its national end of life care programme board. The hon. Member for Strangford mentioned ensuring that sustainability and transformation partnerships and integrated care systems deliver care in a way that supports their local population. NHS England is already working with Public Health England and the Care Quality Commission to provide bespoke end of life care data and support packs to STP and ICS areas, to help plan for and improve end of life services.

NHS England is developing a new indicator for clinical commissioning groups to measure deaths in hospital after three or more emergency admissions in the final 90 days of life. That sounds like a technical piece of data to collect, but such vital information will help us to understand exactly what care is being delivered, and ensure that we spread best practice and identify areas for improvement.

The hon. Gentleman rightly highlighted the crucial role that leadership and accountability play in commissioning those vital services, and NHS England has and is seeking to improve support for commissioners when funding and delivering children’s end of life care. In April 2017 it made available a new specialist palliative care currency—one for adults and one for children—to support local areas in planning and delivering services, including hospice services. The currency can help local services better understand complexity of care and the investment needed to deliver it. It can be difficult for some commissioners to develop suitable models to meet children’s needs, given that in some geographical areas relatively small numbers are involved. That is why NHS England has established an expert group, which includes Together for Short Lives, to bring together knowledge and expertise in children’s end of life care, consider developing models that are suitable for that incredibly vulnerable group of patients, and set up pilot models of care that will be implemented later this year.

A number of hon. Members mentioned short break services, and access to respite and short breaks is fundamental for many families and carers. Local authorities have a legal duty to commission short breaks, and although the NHS’s role is not statutory but a matter for local commissioners, it may also provide clinical support. Having the reassurance of clinical oversight can often mean the difference between carers taking those much-needed breaks and feeling unable to do so, and it is important that such work is collaborative. A recent report from Together for Short Lives found that 84% of clinical commissioning groups said that they commission short breaks for children who need palliative care—an increase from 77% in 2018. We want to ensure that 100% of clinical commissioning groups make such a contribution so that carers have access to the breaks they need. NHS England provides bespoke data and commissioning support to STP and ICS areas to enable them to plan and deliver effective services, such as short breaks, for children and young people.

Access to and quality of palliative and end of life care goes beyond funding for hospices, and through the long-term plan we are accelerating the roll-out of personal health budgets to give people greater control and choice. We want 200,000 people to benefit from a personal health budget by 2023-24, and that will include things such as provision of bespoke wheelchairs and community-based packages for personal and domestic support. NHS England is expanding the offer of mental health services to people receiving social care support and those receiving specialist or end of life care.

[Julie Cooper]

Does the Minister agree that the 49,000 babies, children and young people who have been diagnosed with life-threatening or life-limiting conditions would all benefit from a personal finance plan?

[Caroline Dinenage]

That is right. The system has to be rolled out carefully because we must get it 100% right. It is a jointly funded and collaborative system, but at the end of 2018 it covered 32,000 people, and by 2023-24 it will cover 200,000 people. That shows enormous progress and commitment, and it will give those who want it more choice and control over what kind of care and support they need to meet their needs.

NHS England is developing a refreshed end of life care core skills education and training framework to standardise training, and the NHS now employs more staff than at any other time in its history. The data does not identify nursing specialities, such as palliative care, but the hon. Member for Eastbourne (Stephen Lloyd) may be interested to know that 648 full-time equivalent doctors are working in palliative medicine, which is 202 more than in May 2010—an increase of 45.2%. NHS England’s long-term plan sets out how it will work with patients, families, local authorities and voluntary sector partners to personalise and improve end of life care.

I will write to the hon. Member for Strangford about NHS pensions and hospices. I was going to mention “Agenda for Change”, but I do not have much time and I wish to leave him time to conclude the debate. I thank all hon. Members who have taken part in this debate. We know there is more to be done to meet our ambition to reduce variation at the end of life and ensure proper support for children with life-limiting conditions and their families.

Hospice Funding and the NHS Pay Award

Debate between Caroline Dinenage and Julie Cooper

Wednesday 31st October 2018 Westminster Hall

[Caroline Dinenage]

The hon. Lady makes an excellent point. She is right: there are services up and down the country delivering first-class care, but there are also areas where we know we need to do more. NHS England is firmly focused on providing both the support and the challenge to achieve that, and the hon. Lady is right to mention the incredible efforts of the imaginative and resourceful volunteers who do incredible work to raise much-needed funds for those vital hospices.

A key objective in delivering our commitment to strengthening the provision of end of life services out of hospital and in the community is that people should have that level of choice, and a quality choice, up and down the country. Work is ongoing nationally to provide sustainability and transformation partnerships with tailored information to assess and enhance end of life care services in their areas. We talked earlier about commissioning; NHS England has commissioned Hospice UK to undertake an evaluation of the cost-effectiveness of hospice-led interventions in the community. Historically, hospices have struggled to demonstrate strong evidence of the services they provide and the fabulous care that we all know they offer.

The hon. Member for Burnley (Julie Cooper) mentioned currency. NHS England is working to support local use of the specialist palliative care currency, which can help local areas to plan and deliver services, including hospice services. The currency can help local services better understand the complexity of palliative care and the investment needed to deliver it properly. It is also essential that we can assess how effectively commissioners are working to improve end of life care services. My hon. Friend the Member for St Ives hit the nail on the head when he spoke about that. This year we have a new indicator in place designed to help measure how well patients needing end of life care are supported in the community. Going forward, we are planning to do more work to develop indicators that will enable NHS England to further scrutinise the effectiveness of local health economies in delivering choice in end of life care and securing the progress we all want to see.

[Julie Cooper]

Can the Minister give some idea of the timescales? The point has been made that not only are these organisations at risk of closing, but the people who need the care have not got time. Timescales that indicate the urgency with which the Government are treating the matter would be welcome.

[Caroline Dinenage]

That is a very good point. NHS England will bring forward its report on hospice care very shortly, in November.

I want to talk about staff funding. In common with much of the sector, I know hospices have faced financial challenges. I recognise the concerns of hospices that the recently announced NHS pay rise is putting them under pressure to match the uplift awarded to staff employed on the Agenda for Change contract not only to retain the incredible staff they already have, but to attract the staff they need. We have agreed that for 2018-19, non-NHS organisations that employ existing and new staff on the Agenda for Change contract will be eligible to receive additional funding. Most hospices do not employ their staff on the Agenda for Change contract because of the cost that would entail and so are ineligible.

Care Homes: CCTV

Debate between Caroline Dinenage and Julie Cooper

Wednesday 5th September 2018 Westminster Hall

[Caroline Dinenage]

I thank my right hon. and learned Friend for that legal advice, which would probably have cost me a fortune in the outside world. I am grateful for that clarification. The provider should consult those affected on the use of surveillance wherever it is possible to do so. It would have to meet the cost not simply of the equipment and the monitoring of it if it is done by a third party, but of the training, staff time, legal advice and consultation activity. There is no point in having such a system unless it is monitored and routinely checked.

The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke compellingly about early years settings. I have experience of that, not just as the former early years Minister but as a mother who has been in exactly the situation that she mentioned. It certainly rings bells with me—leaving children screaming their heads off, and five minutes later being told they are all perfectly fine. As she says, that can be very comforting for parents. CCTV is not compulsory in early years settings either, but there are many similarities between the two sectors: they are both predominantly run by private companies. I hope that early years and residential care businesses see the benefits.

I have an apology to make to the hon. Lady. She asked about the letter that we sent, which suggested it might have to be up to the Ministry of Justice to change the law. That was incorrect, and we have subsequently sent her a letter clarifying that. I apologise.

Ultimately, CCTV can have benefits, but it simply cannot be a substitute for well-supported, well-trained staff and excellent management. We have made it clear in statutory guidance to support the implementation of the Care Act 2014 that we expect local authorities to ensure

“the services they commission are safe, effective and of high quality”.

We also expect those providing the service, local authorities and the Care Quality Commission to take swift action where anyone alleges poor care, neglect or abuse. We have backed that up with more than £9 billion of investment in the sector in the past three years,[Official Report, 11 October 2018, Vol. 647, c. 4MC.] which equates to an 8% increase in funding. That incredible amount of money highlights the challenge we face in the sector.

[Julie Cooper]

Does the Minister not accept that, as a result of cuts to local authority funding, there has been a reduction equivalent to £6.3 billion of spending in the sector?

[Caroline Dinenage]

I accept that there were cuts to local government funding during the time of the recession that we all endured. That was incredibly regrettable, but was one of those very difficult decisions that Governments have to take.[Official Report, 11 October 2018, Vol. 647, c. 4MC.] In the last three years, we have increased funding by £9.4 billion, which equates to an 8% increase. It demonstrates the challenge of this ageing population—people are living longer with much more complex needs, and many vulnerable people need an enormous amount of support and care. It is an enormous amount of money, and yet we still see the sector facing great challenges and stress, which is why we have a Green Paper coming out later this year. We hope it will help address the sustainability of the adult social care sector. Successive Governments have wrestled with this incredibly challenging issue, and we need to find a long-term solution.

We expect serious allegations of abuse and neglect to be thoroughly investigated and prosecutions to be brought where that is warranted. The abuse of people who depend on care services is completely unacceptable and we are determined to stamp it out. That is why we introduced the new wilful neglect offence, which came into force in April 2015. The hon. Member for North Ayrshire and Arran said that we must get the very best quality of staff into this demanding and challenging profession. I could not agree with her more. We have made changes to help services recruit people with the right values and skills, and introduced a care certificate for frontline staff to ensure older and vulnerable people receive the high-quality care they deserve.

The Department for Health and Social Care has commissioned and funded Skills for Health, Skills for Care and Health Education England to develop a dementia core skills education and training framework, which is very important to me. There is also a fit-and-proper-person test to hold directors to account for care. Let us not forget that 82% of adult social care providers are rated as good or outstanding as of August 2018, according the Care Quality Commission. That is a testament to the many hundreds of thousands of hard-working and committed professionals working in care, to whom we owe a debt of gratitude. Surely the best way of building on that is not to say to them, “We’re watching you in case you do the job wrong,” but rather to say, “How can we support you to do the job better? How can we invest in skills training, continuous professional development, great management and more staff on better wages?”