Social Care Funding

Charles Walker Excerpts

Tuesday 1st October 2019 Westminster Hall

[Sir Charles Walker (in the Chair)]

Order. There are plenty of speakers, so we will have a time limit of four minutes, perhaps dropping to three as the debate develops.

[Sir Vince Cable (Twickenham) (LD)]

I beg to move,

That this House has considered social care funding.

I should like to introduce a discussion on the funding of social care and narrow that to adult social care and the specific areas covered in the admirable Library briefing around the Green Paper in its absence.

It is a relief to debate something that is not about Brexit, although there is probably some indirect connection. Attempts have been made to blame the delays on Brexit, but the Secretary of State was candid enough to acknowledge that deep-seated disagreements going back 20 years explain why we are at an impasse on the basic principles.

There are a couple of contradictions or paradoxes that we must try to unravel. We all say that the only way forward is to have an all-party consensus, but at the same time the issue is increasingly weaponised. We all say that this is an incredibly urgent problem, but it stays for longer and longer in the long grass. Until we get to the root of those problems, we are not going to make any headway.

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[Several hon. Members rose—]

[Sir Charles Walker (in the Chair)]

Order. We have lots of people. I am going to start with a time limit of four minutes, but do not be surprised when I drop it to three.

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[Several hon. Members rose—]

[Sir Charles Walker (in the Chair)]

Everybody is being so disciplined about interventions, which is great. Faisal Rashid, you, too, can have four minutes, but nobody else will.

[Faisal Rashid (Warrington South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Charles. Making sure that the sick and elderly are treated with care is the measure of any civilised society. I believe that we should not be judged by our personal wealth, but by our compassion for those in most need. Clearly, however, that ethos is not shared by our Government.

As we speak, 1.4 million older people are going without the care they need, which is totally unacceptable. We are faced with the huge challenge of meeting the increasingly complex care needs of an ageing population, yet as those needs have increased and intensified, state funding for those services has nosedived. Council budgets have been reduced by an average of nearly 50% since the Tories came to power. Those cuts have taken a staggering £7.7 billion out of social care funding since 2010.

In my constituency, Warrington Borough Council has had £137 million cut from its budget with another at least £22 million of savings to find by 2020. As a former new town, we are seeing a significant increase in our vulnerable older population—those who were drawn to Warrington for work and a better life in the 1970s and 1980s. Nationally, there are 8,000 fewer care home beds than in 2015, despite the kind of rising demand seen in my constituency. Reports indicate that, last year, almost 90 people a day died while waiting for care to be arranged for them at home. That is absolutely shameful. How can the Minister justify those figures?

The crisis in social care is felt by not just those in need of care, but their families and friends who must step in where the state has failed and where money is short. More than 5 million unpaid carers look after loved ones. Skills for Care has found an 8% vacancy rate in the social care sector, which is equal to 110,000 empty roles at any one time. Many who work in the social care sector are overworked and underpaid. Unison has documented at length the injustices faced by those who do such vital work: sleep-ins, impossible rotas, zero-hours contracts and unpaid travel time, to name just a few.

Make no mistake: this policy area is crippled by Government inaction and market failure, causing immense hardship and misery for those who need care and for those who provide it. It is high time our political leaders showed the courage necessary to rise to the challenge and fix this mess, ensured the safety and security of older generations and treated care workers with the respect they deserve. I am proud that my party has recently announced bold, radical plans to do just that.

Labour will introduce personal care free at the point of use in England funded through general taxation. Providing free personal care to older people will ensure that they will be able to live in their own homes for longer, providing them with dignity and the support to lead independent lives for as long as possible. I have seen at first hand from my mum, who passed away last year, how that is absolutely crucial.

[Sir Charles Walker (in the Chair)]

Speeches are now limited to three minutes.

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[Dr Sarah Wollaston (Totnes) (LD)]

I begin by paying tribute to all the family carers and the care workforce, including those who looked after my mother-in-law Mary. It was only with their support that she was able to die where she wished: at home, surrounded by her loved ones. That support is not available to everybody, but it should be. For the want of good social care, far too many people unnecessarily end up in far more expensive hospital settings. We must act quickly, and I hope that the Minister will update us on when the Government will come forward with their consultative social care Green Paper, because it was promised two and a half years ago. Five publication deadlines have been missed, so when will we see that Green Paper?

I also hope that the Minister will confirm that she has looked at the Joint Select Committee inquiry by the Health and Social Care Committee and the Housing, Communities and Local Government Committee, because the proposals provide a blueprint for how to move things forward. It contains practical suggestions that have been road-tested for their acceptability through a citizens assembly. I hope that she will also confirm that the principles set out in the document will form part of the Green Paper.

I am afraid that I am going to disappoint my right hon. Friend the Member for Twickenham (Sir Vince Cable), who said that this debate provided an opportunity not to talk about Brexit, because Brexit poses a grave threat to a fragile sector. The Yellowhammer documents make it clear that smaller providers face going to the wall within two to three months and larger providers within four to six months. I hope that the Minister will be able to comment on what action will be taken to mitigate that.

The effects include not only the impact of an increase in inflation on a fragile sector, but the impact on the workforce. As the Minister knows, the vacancy rate is already at 8%, which amounts to around 110,000 positions across social care. Some 8% of the workforce come from our partner EU27 nations, and many workers are deciding that it is no longer economically viable for them to remain in the UK due to changes in the exchange rate. Several careworkers have told me in tears that they no longer feel welcome in this country, which is horrific and should make us all feel a sense of great shame, but that is the reality. People face racist remarks in our country today despite decades of service to the most vulnerable in society. We cannot afford to lose them. We need to set out what will happen to ensure that the people in this workforce, many of whom will not meet the income thresholds, will be able to come here, share their skills with us and be welcomed.

[Sir Charles Walker (in the Chair)]

Thank you, colleagues. We now move to the Front-Bench speeches.

[Martyn Day (Linlithgow and East Falkirk) (SNP)]

It is a pleasure to serve under your chairmanship, Sir Charles. I am grateful to the right hon. Member for Twickenham (Sir Vince Cable) for securing what has been a well attended and thoughtful debate.

The Office for Budget Responsibility assessed the UK’s public finances as potentially £30 billion worse off each year in a no-deal Brexit scenario of medium disruptiveness. That sum is significant because it is more than the entire sum spent on adult social care, plus investment in NHS buildings and equipment, across the United Kingdom in 2017-18. Much of the responsibility for social care is, of course, devolved, with respect to Scotland. The Scottish National party Scottish Government are currently working with a range of partners to take forward a national programme to support local reform of adult social care support. Scotland continues to be the only country in the UK that delivers free personal care. That currently benefits more than 77,000 older and disabled people in Scotland.

In England since 2010 the number of people receiving publicly funded social care has decreased by 600,000, because of funding cuts. In 2019-20 the SNP Scottish Government are increasing their package of investment and social care support and integration to exceed £700 million, up from £550 million in the previous year. In England a boundary has always existed between the NHS and social care, contributing to fragmented and unco-ordinated care. In Scotland the SNP Scottish Government successfully integrated health and social care, which is the most significant change to health and social care since the creation of the NHS in 1948. Last month the First Minister announced that everyone diagnosed with cancer will have a dedicated support worker, provided through a new £18 million partnership fund.

Of course, the devolved Administrations do not operate in isolation. Policy decisions from Westminster continue to have an impact on social care. The independent expert advisory group in Scotland deems that changes set out in the UK Government’s immigration White Paper would reduce net migration to Scotland by between 30% and 50% in the coming two decades. That is extremely significant. It states that social care would be severely affected as fewer than 10% of those in caring personal service occupations in Scotland earn above £25,000, and almost no one earns over the £30,000 immigration threshold. Average earnings of adult social care workers are higher in Scotland than they are elsewhere in the UK, coming in at about £18,400 as opposed to £17,300. Yet people are thinking about a £30,000 immigration limit. Just let those figures sink in. Thanks to Scottish Government funding, staff can be paid at least the real living wage, but it is still nowhere near the immigration threshold. That is a serious worry in respect of future provision throughout the UK, not just Scotland.

The number of Scots over 80 with social care needs is set to increase by 68% by 2036. That is probably an even faster rate than the English figures that we have heard from some hon. Members. My hon. Friend the Member for Argyll and Bute (Brendan O'Hara) called for an independent evaluation of the impact of Brexit on the health and social care sector, through his private Member’s Bill, the European Union Withdrawal (Evaluation of Effects on Health and Social Care Sectors) Bill. The Bill was supported across the House and by 102 organisations, but I wonder whether the UK Government are listening.

On 18 August The Sunday Times, citing UK Government planning assumptions under Yellowhammer, stated:

“An already ‘fragile’ social care system is expected to be tipped over the edge by a no-deal, with providers starting to go bust by the new year”.

The report quoted the document as saying that “smaller providers” would be

“impacted within two-three months and large providers four-six months”

after Brexit. The negative economic impact of a disorderly Brexit, including an increase in inflation and an economic recession, will augment the pressure on providers and will shift the burden of care work on to unpaid family carers, the majority of whom are women. I look forward to hearing the Minister address those points, particularly on the issue of migrant staff and the £30,000 immigration limit.

[Sir Charles Walker (in the Chair)]

I want to give Sir Vince Cable two minutes at the end, so if the other Front-Bench colleagues could maintain a 12-minute discipline, or just under, that would be great.

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[Sir Charles Walker (in the Chair)]

Thank you. Minister, if you could leave two minutes at the end for Sir Vincent Cable to wind up the debate, that would be hugely appreciated.

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[Sir Vince Cable]

Sir Charles, thank you for safeguarding the last 10 minutes. I tried to approach this whole subject in a non-tribal way. I thank all the Members, including the Minister, who participated in that spirit. The debate was enriched by people drawing on professional experience, such as the hon. Member for Lincoln (Karen Lee), and those drawing powerfully on personal case experience, such as the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard), the hon. Member for York Central (Rachael Maskell), the hon. Member for Eastbourne (Stephen Lloyd), the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) and others.

The title of this debate included the ugly word, “funding”. However good our intentions, we do have to pay for this, and I commend the hon. Member for Thirsk and Malton (Kevin Hollinrake) for setting out clearly and succinctly the financial constraints and a good solution through social insurance for many of these problems. I also commend the hon. Member for Sefton Central (Bill Esterson) and the hon. Member for Newton Abbot (Anne Marie Morris) for pointing out that we are trying to reconcile two fundamentally different systems of funding and organisation. As we integrate the system, bringing them together is not an easy task.

Perhaps I tried too hard to be non-tribal. I thought we were trying to get a bit of respite from Brexit. However, as my hon. Friend the Member for Totnes, the hon. Member for Linlithgow and East Falkirk (Martyn Day), and others pointed out, unfortunately we cannot get away from it. It has a major impact on resource availability and the labour market.

In conclusion, I wish to thank the Minister for her reply. She pointed out—and I should have acknowledged this at the beginning—that the Government have put in a little bit more in resource. However, that is growing at 2.5% while the demand is growing at 4% and the cruelty of compound interest is, I am afraid, rather powerful and painful over time.

[Sir Charles Walker (in the Chair)]

Colleagues, thank you for sharing out the time so well.

Question put and agreed to.

Resolved,

That this House has considered social care funding.

Heated Tobacco

Charles Walker Excerpts

Wednesday 26th June 2019 Westminster Hall

[Mr Jones]

I do indeed. I will also comment on my hon. Friend’s point about other people having to endure smokers’ smoke. One point that the Government make in their response to the Science and Technology Committee’s report is that heated cigarettes are far less offensive to other people than combustible cigarettes.

Consumers’ principal reason for using e-cigarettes is to give up smoking. According to Action on Smoking and Health, 62% of ex-smokers use e-cigarettes for that purpose, and the majority of users have successfully quit smoking. However, it might well be that we have now passed the apogee of the e-cigarette effect. According to the Office for National Statistics, the number of new e-cigarette users peaked at 800,000 in 2013-14. Since then, the number has approximately halved every year, down to 100,000 in 2016-17. It is not the case that the remaining smokers do not want to quit; the ONS reports that nearly 60% do. For some, however, the experience of using e-cigarettes does not come sufficiently close to that of smoking to be an adequate substitute. In this context, I urge the Government to consider the alternatives.

In Japan, heated tobacco is proving very successful in helping smokers to quit. Evidence there shows that 70% of heated tobacco users give up smoking altogether. That is a better conversion rate than for any other alternative nicotine-containing product on the market.

[Mr Charles Walker (Broxbourne) (Con)]

I have been a smoke-free person for 15 years, but it took me 12 years to get there. I had various failed attempts to give up smoking because it was a choice between smoking and chewing gum, which really was not a successful pathway—it took me 12 years before I could finally give up. Any method that helps the process has to be a good idea.

[Mr Jones]

I am very pleased to hear that. Of course, it is debatable whether chewing gum is more or less antisocial than smoking—particularly in its effect on pavements.

The heated cigarette process uses an electronic device that heats tobacco, producing an aerosol that tastes like tobacco, and it delivers nicotine in a similar way to a cigarette. Importantly, however, it is not a product of combustion. Tests on heated tobacco carried out by the tobacco industry and scrutinised by the Committees on Toxicity, Mutagenicity and Carcinogenicity of Chemicals in Food, Consumer Products and the Environment found a reduction of up to 90% in the number of toxic chemicals emitted by heated tobacco compared with combustible cigarettes. That is not greatly dissimilar to Public Health England’s finding that e-cigarettes are up to 95% safer than combustible cigarettes.

Heated tobacco is currently sold in the UK, but there is no independent research to validate its use. Members of Parliament have said that research is needed, and the Government have agreed. As I mentioned a few moments ago, the Science and Technology Committee’s July 2018 report highlighted the need for independent research. It identified the opportunity for the Government to

“help fill remaining gaps in the evidence on the relative risks of e-cigarettes and heat-not-burn products”

and support a long-term research campaign that would be overseen by Public Health England and the Committee on Toxicity to ensure that health-related evidence is not dependent solely on the tobacco industry.

The Government’s December 2018 response to the report was favourable. They accepted the recommendation and undertook to

“review and consider where there are gaps in evidence for further independent research”.

They went on to say that they are

“committed to providing the outputs of research to the public on the risks of e-cigarettes and novel tobacco products.”

They also committed to including heated tobacco in their annual review of e-cigarettes. However, this year’s e-cigarette review contained no mention of heated tobacco.

We are falling behind our international peers on this front. The United States Food and Drug Administration recently produced research that concluded that heated tobacco is

“appropriate for the protection of the public health because, among several key considerations, the products contain fewer or lower levels of some toxins than combustible cigarettes.”

It reported up to 95% lower quantities of certain toxins.

My question to the Minister is this: will the Government commit to producing or supervising independent research into heated tobacco this year? We are talking about a matter of personal choice for smokers, but the Government have a duty to inform them about the available alternatives. We have seen the value of e-cigarettes in helping people to quit smoking, and if there is a prospect that heated tobacco could help to bring down smoking rates further, are we serving the interests of public health by not carrying out the promised research? Might not an approach akin to the innovation principle, as opposed to the precautionary principle, ultimately lead to fewer smokers? If it might, should we not, like David Halpern, seize the opportunity?

The research will not happen by itself. The responsibility to produce it lies with the Government, as they have acknowledged. From 1 July, we will be acknowledging heated tobacco in the tax system. Is not now an appropriate time for the Department of Health and Social Care to ensure that the new tax category goes hand in hand with independent research on the efficacy of heated tobacco in bringing down smoking rates and its impact on public health? It may be suggested that the lack of funding is an issue, but I urge the Government to consider requiring tobacco companies to pay for the research to be carried out, thereby circumventing the need to apportion departmental budgets to it.

The reduction of harm from smoking must remain a top priority for this and any other Government. I therefore hope that the Minister will respond positively to my suggestion.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a pleasure to serve under your chairmanship, Mr Gray. I thank my right hon. Friend the Member for Clwyd West (Mr Jones) for raising the important issue of heated tobacco products and their contribution to reducing harm from smoking, and for his lifelong service as a fellow of Cancer Research UK. He put it very well: smoking is still prevalent in certain communities in our country, and still causes over 78,000 deaths a year in England. It is one of the leading causes of preventable illness and premature death. We have made great progress, particularly over the past 10 years. Adult smoking prevalence is now 14.9%—the lowest ever recorded level—but, as he pointed out, we have much further to go, particularly among certain groups and in certain parts of the country.

In the 2017 tobacco control plan, we set out our ambition to reduce smoking and ensure a smoke-free generation. Part of that strategy is about helping people to stop smoking by adopting the use of less harmful nicotine products. They may, for example, take up chewing gum. I have never seen my hon. Friend the Member for Broxbourne (Mr Walker) spit out his gum on the pavement.

[Mr Charles Walker]

I quit 15 years ago, but it took me 12 years because the only choice besides smoking was nicotine gum, and it was simply revolting. I would have quit a lot earlier if we had some of these modern products around 15 years ago.

[Seema Kennedy]

I hear what my hon. Friend is saying. For a lot of people, nicotine substitutes are a good transition to giving up smoking or other things completely. We have seen a dramatic rise in the use of e-cigarettes from 1.6 million users in 2014 to about 2.5 million in 2017. Encouragingly, about half of them in England have quit smoking completely. E-cigarettes are not risk-free, however. The evidence is increasingly clear that they are significantly less harmful to health than smoking tobacco. They can help smokers to quit, particularly when combined with stop smoking services. Recent studies have shown they can be twice as effective as nicotine replacement therapy in helping people quit smoking. As my right hon. Friend the Member for Clwyd West pointed out, the sales of e-cigarettes are plateauing, and we are coming to the stubborn 5% of people who are still smoking.

Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)

Charles Walker Excerpts

Ping Pong: House of Commons
Tuesday 26th March 2019 Commons Chamber

[Dr Whitford]

The right hon. Gentleman probably would not like me to get into the clearances of the 17th and 18th centuries when people were burnt out of their villages and put on boats, or when people were transported for criminal activities. There are all sorts of reasons why Scots have ended up all over the world, and they are not all about the weather.

[Mr Charles Walker (Broxbourne) (Con)]

I just want to say to the hon. Lady that I adore Scotland. I just love the mist, the fog, the rain—it is what I call proper weather, and it is to be celebrated.

[Dr Whitford]

That is why I live there, right beside the sea, but that does not necessarily mean that somebody living in the vineyards of France will think, “You know what? The weather’s a bit boring here. I fancy somewhere with snow, sleet, hail and sunshine all in one day.”

It is a fact that the disparity is because of the number of pensioners. It is often described as if it is the EU somehow tricking the UK—it simply is not. We are obliged to pay for the pensioners from the UK who have settled in Europe. Indeed, we pay a fixed rate per head that is considerably lower than—just over half—what would be charged for a European citizen settling here.

Princess Alexandra Hospital, Harlow

Charles Walker Excerpts

Tuesday 5th June 2018 Commons Chamber

[Robert Halfon (Harlow) (Con)]

It is a pleasure to see you in the Chair, Madam Deputy Speaker. I thank you for your support for a new hospital in Harlow, as my constituency neighbour.

I want to update the House on the desperate need for a new hospital in Harlow that is fit for the 21st century. The hospital would bring together A&E services, GP provision, social care, physiotherapy and a new ambulance hub in state-of-the-art, purpose-built facilities. Success in securing the capital funding, for which there is already a bid in place, could make this a reality for Princess Alexandra staff and patients in Harlow and across the region.

When I debated Harlow’s hospital last October in Westminster Hall, it was in special measures. In March, following the Care Quality Commission inspection, we heard the amazing news that the Princess Alexandra had left special measures. In fact, two thirds of services were on their way to a good or an outstanding rating. I said it then and I will say it again: this is a testament to the extraordinary hard work of all Princess Alexandra Hospital staff, including the cleaners, porters, nurses, doctors, kitchen staff, support staff and, of course, the leadership and management. I would like to give a particular mention to Nancy Fontaine, head of nursing and one of the most remarkable NHS workers I have ever met. Nancy will soon be leaving the Princess Alexandra to help another hospital, but I take this opportunity to thank her for her work. It is people like her who make the NHS what it is.

The Health Secretary congratulated PAH staff in a video—a sentiment seconded by the Prime Minister. In his message, the Health Secretary not only noted the impressive CQC report and the outstanding work in the neonatal department, but made it clear that it is the staff who make a hospital and that good care is the result of their instinct to do the right thing for patients. The Health Secretary and the former Hospitals Minister, my hon. Friend the Member for Ludlow (Mr Dunne), have both visited the Princess Alexandra a number of times, speaking to the staff and the leadership there. I know that the Health Secretary and the current Hospitals Minister—to whom I am hugely grateful for engaging with me regularly on this issue—are aware of the capital funding bid in place.

The leadership team, headed by chief executive Lance McCarthy, have been developing their case for capital funding since the Health Secretary made the request in autumn 2016. The team are due to resubmit the final plans next month. I understand that the trust is one of seven schemes requiring more than £100 million of capital and that funding for some schemes will be announced in the autumn. I ask the Minister, when will we learn of the progress of these capital funding bids?

[Mr Charles Walker (Broxbourne) (Con)]

Does my right hon. Friend agree that Princess Alexandra Hospital has a great future if it is allowed to have that future?

 Orkambi and Cystic Fibrosis

Charles Walker Excerpts

Monday 19th March 2018 Westminster Hall

[Paul Scully]

I understand the hon. Gentleman’s position and concern, especially so when many people in Ireland in particular are cystic fibrosis sufferers, but I remind him that NHS England is the procurer, not the Government—it is done through that independent process.

[Mr Charles Walker (Broxbourne) (Con)]

I discussed this with my hon. Friend the Member for Meon Valley (George Hollingbery), who is in the Chamber. We decided that it is essential for Vertex and NHS England to be reasonable. There is common ground and a deal to be done. Both sides need to work towards that with the encouragement of the Minister and the Department of Health and Social Care.