NHS Services (Access)

Gary Streeter Excerpts

Wednesday 15th October 2014 Commons Chamber

[Mr Gary Streeter (South West Devon) (Con)]

Thank you, Madam Deputy Speaker. I love your husky voice.

In June, I spoke to a conference of orthopaedic surgeons from the south-west, including the NHS consultant who carried out my own hip replacement very successfully in 2012. They had asked me to speak about the future of the NHS and to be as bold and as honest as I could be. When we came to questions, I was amazed at how all the doctors said basically the same thing. It might be paraphrased thus: “When will you politicians realise that the NHS is creaking at the seams and come up with new, more radical policies and a brand-new model more suitable to the 21st century that is able to cope with the demands we now face?” They said they were grateful for the extra money this Government have put in and they recognised the competing pressures on the public purse, but they believed passionately that it was not just about money going in at the top. They wanted us to be more radical in addressing the problems now facing the NHS and, in particular, in finding new service delivery vehicles.

I explained that one of the weaknesses of modern-day politics is that as soon as anyone starts to grapple with innovation and change in the NHS, we hear the voices Opposition Members—we have just heard them—who immediately shriek privatisation, and the debate grinds to a halt, especially in the run-up to an election. I find it extremely disappointing that this has all happened again today. The audience of doctors recognised this depressing reality, but none the less urged us to be bolder in addressing the pressure under which they work day in, day out in an institution that was designed 70 years ago.

I listened to the shadow Secretary of State this evening and the complaint seems to be that doctors are now under an obligation, in their commissioning groups, to buy in the best services to provide the very best health care for our constituents. That is surely a good thing. The motion before us today is an example of this immature debate. It seeks to lay the blame for the pressure under which the NHS operates today on the reorganisation that took place earlier in this Parliament. That is an absurd claim. Let us look at some of the statistics.

Between 2009 and 2013, the number of general and acute in-patient admissions rose by more than 10%. In 2003, there were just over 77,000 hip operations. By 2013, these had increased by 43% to 110,000 hip operations, of which mine was one. In 2003, there were approximately 46,000 knee replacements. That number rose sharply by 71% by 2013 to more than 79,500 knee replacements. All this has to be funded. Total attendance at accident and emergency departments in 2013 was almost 22 million, representing an increase of 11% since 2003. There were around 9.1 million emergency calls in 2013, up from 4.9 million in 2003—an increase of 85% in just 10 years.

In Derriford hospital in Plymouth, every day 75% of the patients are over 65. In the 10 years between 2003 and 2013, the actual number of people over 75 who completed episodes of admitted patient care in NHS hospitals rose by 61%. Life expectancy in the UK is increasing significantly. One in three children born today is expected to celebrate their 100th birthday. The fact that people are living longer is a wonderful success story, but it is having a significant impact on the NHS. Average NHS spend on retired households is nearly double that for non-retired households.

As everybody in the country knows, the primary source of NHS pressure today is the demographic success we have seen in recent years of people living longer—more of us getting older and needing more health care. That is why we were right to ring-fence the health budget in 2010, which has resulted in an £12.7 billion extra pumped in in this Parliament. That is why it is right that the Prime Minister has committed the next Conservative Government to continuing to increase health spending over and above inflation every year for the next Parliament. I hope we will also be bold and find new models of delivering health care, still free at the point of use, to meet the demands of a growing and ageing population.

On the subject of new models and structures, I see signs that the new commissioning groups in my area are having a positive impact. My constituency is part of the West Devon clinical commissioning group, and my discussions with the GPs who serve on it give me great hope that they are beginning to improve the nature and scope of their commissioning, helping better to meet the health care needs of my constituents. It is right that doctors, not bureaucrats, be in charge of commissioning, and we were right to deconstruct the bloated PCTs. Our PCT in Plymouth was so cumbersome that I gave up attending the regular MP briefing meetings because I could not cope with the bureaucratic culture. I am glad it has been replaced by a more streamlined, doctor-led commissioning group. This is a step in the right direction. I do not suppose for a second that the reforms were perfect—nothing ever is that Governments do—but I can see progress in the commissioning of acute services.

I say one thing to my colleagues on the Front Bench: in the west country, it used to be extremely easy to recruit GPs, but it is getting tougher by the year. I hope in the winding-up speech to hear some reassurance that in places such as Devon—a splendid place to live and work—which are having difficulty recruiting GPs of the highest quality, steps and policies will be put in place to set this right over the next two years. Nevertheless, I support the reforms; the NHS is improving all the time.

Oral Answers to Questions

Gary Streeter Excerpts

Tuesday 14th January 2014 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I am sympathetic to the point that the hon. Gentleman raises, and I am happy to meet him to discuss it further so that we can see whether the matter needs to be addressed.

[Mr Gary Streeter (South West Devon) (Con)]

T6. On any given day in the Derriford hospital in Plymouth, 75% of patients are over 65 years of age and rising. Does that not demonstrate the demographic pressures that face our acute hospitals, and what more can this Government do to ensure that people, especially elderly people, are treated in the community?

[Mr Jeremy Hunt]

We are doing a huge amount, but the first thing is to ensure that there is someone in the NHS who is accountable and responsible for all vulnerable older people outside hospital, because out-of-hospital care is where we need to have the big revolution. There will be a big change in April with named GPs for the over-75s. The integration of the health and social care systems is the next step. I hope that my hon. Friend will see real progress for his constituents.

Roaccutane

Gary Streeter Excerpts

Tuesday 3rd December 2013 Westminster Hall

[Mr Gary Streeter (in the Chair)]

We are ready to move on to our next debate. The protagonist has entered the Chamber. There is a lot of interest in this extremely serious health matter. As the Minister takes his place, I am delighted to welcome the hon. Member for North Devon.

--- Later in debate ---

[Caroline Nokes]

Does my hon. Friend agree that Roaccutane can only be prescribed by a dermatologist, so the vast majority of patients would have gone through products prescribed by their GP before they ever get to a dermatologist and have the possibility of having Roaccutane prescribed?

[Mr Gary Streeter (in the Chair)]

Order. Before the hon. Gentleman responds, can we make sure the Minister has time to respond to the debate?

Health and Social Care

Gary Streeter Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Gary Streeter (South West Devon) (Con)]

It is a real joy to follow the hon. Member for Plymouth, Moor View (Alison Seabeck), my next-door neighbour—you are being extremely skilful in your selection of speakers today, Mr Deputy Speaker. I very much enjoyed her contribution; she spoke in her usual trenchant and passionate style. I also enjoyed hearing about the work that her late father was involved in, and I can say with some confidence that he would be extremely proud of her and all that she has done in her time as a Member of Parliament.

I liked the Queen’s Speech, but it was a little long for my liking. I was looking forward to the Queen sitting on the throne and saying, “My Government have decided to introduce no new laws this year, but to concentrate on implementing and overseeing well the policies that we have already passed and the laws that we have already put in place.” As we all know, coming to the House and taking legislation through involves a huge time commitment for Ministers, and there is a huge case to be made for Ministers to focus on implementing well the things that we have already decided. We have been radical in the past three years in this Parliament, so let us make sure that the policies now work in practice on the ground—let us set our Ministers free to do that. Interestingly, the key areas our constituents are most concerned about—getting the deficit down, getting the economy moving and cracking down on immigration—do not require any legislation at all. They simply require us to do well the things we have already decided.

I welcome the Queen’s Speech and, despite having said what I just said, the increased attention on immigration, which is what our constituents want. The reaction of my constituents to some of the tough measures we have introduced so far on immigration and on welfare changes is, “It’s about time. We have been waiting for this for many years.” So I support the broad direction of travel of the Government, and I have full confidence in the Health Secretary.

I want to make two points in a brief contribution about health issues, the first of which is about the challenge of urgent care. Our parliamentary system has many strengths, but one weakness is that every Government Member is inclined to say that everything we are doing is wonderful, while the Opposition are inclined to say that everything we are doing is rubbish. We all know that the truth lies somewhere in between. I support and pay tribute to the fact that we continue to pump fresh money into the health system year after year. The shadow Health Secretary is convinced that we are not meeting our commitment to increase health spending above inflation every year—I think we are, but of course there is a debate to be had. I do know that there are pressure points in the health system that need to be tackled, and urgent care is one of them.

[Andy Burnham]

The hon. Gentleman’s association with the detail seemed to be loose there; Andrew Dilnot wrote to the Government to say that health spending was lower in real terms in 2010-11 than it was when Labour left government. It is important to point out that the promise the hon. Gentleman stood on was for real-terms increases in every year of this Parliament and that that has not been honoured.

[Mr Streeter]

That is Andrew Dilnot’s opinion, but it is not mine—that is the point I am seeking to make. [Interruption.] The right hon. Gentleman’s speech was riddled with references to spending—more spending on health and on local councils—but is he not aware that this year the deficit in this country will still be, even after three years of austerity, £110 billion? If he comes to the Dispatch Box to make speeches about extra spending for health and local councils, he is obliged to tell us where that money will come from. At the moment, I can see no signs of it whatever.

[Andy Burnham]

rose—

[Mr Streeter]

I will not take any further interventions, but let us not hear any further speeches calling for extra spending unless we know where the money is coming from.

As I was saying, before I was so rudely interrupted, there are pressure points in the health system, and urgent care is one of them. This is about not only accident and emergency departments, but GP and out-of-hours services, community nursing, social care, ambulance services and hospital beds—there is pressure on all those points.

The hon. Member for Plymouth, Moor View and I are fortunate to go to Derriford hospital in Plymouth for briefings. I have been going slightly longer than she has—21 years—and I can tell the House that in good times and in bad times Derriford hospital is under pressure. It has a running capacity of about 95%, which means that when there are spikes, as there have been this winter, it can be running at 103% capacity, which puts the hard-working staff under enormous pressure. Even when the Labour Government were spending money as though it were going out of fashion, I have never gone to Derriford hospital and had the staff tell me, “It’s fine. There are no pressure points. Everything is working in our health service. It’s all working well and waiting lists are coming down.” That has not happened once in 21 years.

[Stephen Phillips (Sleaford and North Hykeham) (Con)]

Does my hon. Friend agree that perhaps one problem with the Queen’s Speech, and one of the issues with which neither Ministers nor shadow Ministers tend to grapple, is that there is a real problem in this country with demand? Unless and until we grapple with that, the national health service will always be under pressure.

[Mr Streeter]

I completely agree with my hon. and learned Friend, and I might come on to deal with that point in a moment.

The point I wanted to raise with Ministers is that the funding formula for emergency work needs to be reviewed. As I understand the system, the formula is based on the 2008-09 baseline, and any extra patients who come into an acute hospital over and above that baseline are paid at 30% of the tariff. It costs hospitals 100% to meet the needs of those people coming in, yet they are paid at 30%; the extra 70% is supposed to be spent by other health care agencies in providing alternative centres of treatment, which are intended to divert people away from acute hospitals. I am pretty well plugged into what is going on in my constituency, and I have not seen anything since 2008 that looks vaguely capable of diverting pressure away from Derriford hospital. The system of allocating 30% to the hospital and 70% elsewhere is simply not working. I ask our Ministers to look urgently at that formula and to find out why, if it is not working, we are still using it and to address that. I am not calling for extra money; I am calling for money to be diverted to the acute hospitals, because they are where the pressure points are. In my constituency, there have been no realistic options for treatment other than to go to Derriford hospital. So, such hospitals should be receiving not 30% but 100% of the tariff.

My hon. and learned Friend the Member for Sleaford and North Hykeham (Stephen Phillips) is absolutely right about demand growing exponentially. In 1979, if a man reached the age of 65, they could expect to live until they were 77. If a man reaches the age of 65 now, they can expect to live until they are 88, and of course that age is rising year on year, so the demand is going up.

One thing that we are noticing is that although the number of people admitted to the emergency department at Derriford hospital in the last 12 months has been stable, there is much higher acuteness—in other words, people are much sicker and therefore it requires a lot more effort to treat them. Please, nice Ministers on the Front Bench, may we have a look at that formula for the funding for people accessing acute hospitals on an emergency basis?

My final point, in the one minute of my time that remains, is that 20 years ago or so I made a speech in this House saying that the health service had lots of challenges, issues and problems, but that one of the things we did not need to touch was primary care as it was working fine. I cannot make that speech today. I will not hammer the Opposition again about the GP contract, but in the past few years constituents have been complaining to me in a way that they never did in the previous 15 years to say that accessing their GP is becoming extremely difficult. For someone—whether they are a mum with a young baby, or a senior citizen—to get a surgery appointment when they want it has become a serious issue in the past few years. Addressing that issue does not necessarily require legislation, but may I ask Ministers whether we can please put in place a system whereby GPs give the seven o’clock in the morning to seven o’clock at night, seven days a week service that this country so desperately deserves?

Oral Answers to Questions

Gary Streeter Excerpts

Tuesday 16th April 2013 Commons Chamber

[Norman Lamb]

I am certainly willing to meet the all-party group, but I think that significant new opportunities are emerging. For example, from this month the National Institute for Health and Clinical Excellence will be responsible for the evaluation of new drugs for the treatment of rare conditions, and I think that that is a very good thing.

[Mr Gary Streeter (South West Devon) (Con)]

One of my constituents, a seven-year-old boy, has Duchenne muscular dystrophy. His family are pinning their hopes on a new drug called ataluren, which has not yet completed its trials. Can the Minister give me any idea when it might become available?

[Norman Lamb]

I understand that the manufacturer of ataluren has applied for conditional approval from the regulatory authorities. We await the outcome of that process, but I am afraid that I cannot give a time scale for it.

Sudden Adult Death Syndrome

Gary Streeter Excerpts

Monday 25th March 2013 Westminster Hall

[Anna Soubry]

My hon. Friend’s point is another well made point.

I will return to where this debate started—the subject of sudden adult death syndrome. Starting with screening, often when there has been a case of a sudden cardiac arrest, many people say, “Screening will have a big impact in the future.” As the right hon. Member for Leigh will know, the UK National Screening Committee, an independent expert body that advises Ministers about all aspects of screening, assesses the evidence for screening against a set of internationally recognised criteria. No doubt that is why the right hon. Gentleman listened to and followed its advice, which is that, while screening has a potential to save lives, it is not a foolproof process. The footballer Fabrice Muamba suffered cardiac arrest, and many of us will remember what happened to him at the game. We have heard many people describe the amazing medical assistance that he was given—I cannot remember for how long he was unconscious, but it was an incredibly long time—and that young man has made a remarkable recovery. However, I am told that he had received several screening tests throughout his career.

In 2008, the UK NSC reviewed the evidence for screening for the most common cause of sudden death in those under the age of 30, hypertrophic cardiomyopathy, including looking at athletes and young people who participated in sport. A number of the cases that we have heard today involved, invariably, young men or boys who died while playing sport, notably football. The UK NSC concluded that the evidence did not support the introduction of screening. Sudden cardiac death is a complex condition and is difficult to detect through screening; there is no single test that can detect all the conditions, nor is it possible to say which abnormalities will lead to sudden cardiac death. However, in line with its three-yearly review policy, the UK NSC is again reviewing the evidence. This time the review will go further than only looking at the evidence for screening for HCM and will cover screening for the major causes of sudden cardiac death in young people between the ages of 12 and 39. The review will take into account the most up-to-date international evidence, including evidence from Italy, where screening is currently offered to athletes between the ages of 12 and 35.

There will be an opportunity to participate in the review process later this year, when a copy of the latest review will be open for public consultation on the UK NSC’s website. No doubt, a number of the organisations and charities that we have heard about today will take part in that consultation. I am told that although screening is not routinely available in England, work to prevent premature death from cardiovascular disease is a priority, as it should be.

On 5 March, the cardiovascular disease outcomes strategy—not exactly words that trip off the tongue—was published. It sets out a range of actions to reduce premature mortality for those with, or at risk of, cardiovascular disease. The NHS Commissioning Board will work with the Resuscitation Council, the British Heart Foundation and others to promote the site mapping and registration of defibrillators, and to look at ways of increasing the numbers trained in using them. I pay tribute to the foundation, which a number of hon. Members have mentioned, and rightly so, as we are all grateful for its work in, for example, placing defibrillators in Liverpool primary schools. That is, no doubt, because of the outstanding work of the Oliver King Foundation.

Ambulance trusts have had responsibility for the provision of defibrillators since 2005, and in my view they are best placed to know what is needed in their local area. However, it is important to recognise that defibrillators help only in a minority of cases. The majority of out-of-hospital heart attacks—up to 80%—happen in the home. Bystander CPR doubles survival rates, but it is only attempted in 20% to 30% of cases. It is clear that although defibrillators play an important part, we have to bear in mind, as I said, that 80% of heart attacks, if they do not happen in hospital, happen at home, and I absolutely concede that there is a real need for an increase in the amount of people trained in CPR, because we know that that also plays a hugely important part in ensuring that people who have a heart attack survive it.

When there is a sudden cardiac death, we need to take action to ensure that potentially affected family members are identified and offered counselling and testing to see if they are also at risk. We know that that does not always happen. There are continuing discussions with the chief coroner for England to determine how coroners’ services might help in the identification of potentially affected family members, so that more lives can be saved. The national clinical director for heart disease, Professor Gray, will work with all relevant stakeholders to develop and spread good practice around sudden cardiac death.

In conclusion, I will wait to see the latest recommendation from the UK NSC, following its latest review of evidence. The national clinical director for heart disease will continue to promote good practice and awareness around sudden cardiac death. However, as I have said before—forgive me for repeating myself—I will ensure that I speak to the relevant Minister at the Department for Education about all the arguments that have been advanced today for training in CPR and life-saving techniques to be part of the national curriculum. It is my understanding that that particular part of it is under review, and I will impress on him or her how strongly Members have spoken today.

Again, I thank everybody, especially those who signed the petition, for bringing the debate into this place and, effectively, for shining a spotlight on the matter. I hope that hon. Members will take the issue to their local press, as I am sure they will, and that the national press might also look at it. It is absolutely right that the more we ventilate it, the better the situation will be.

[Mr Gary Streeter (in the Chair)]

In debates of this kind, the mover of the motion may have a few moments to summarise or respond at the end.

NHS (Foreign Nationals)

Gary Streeter Excerpts

Tuesday 22nd May 2012 Westminster Hall

[Mr Virendra Sharma]

I apologise; I should have congratulated the hon. Gentleman earlier on securing this debate, which is important not only to his constituents but to people all over the country, who take the issue seriously. It is also important in my constituency, where it is discussed every day.

I am a bit confused; I hope that the hon. Gentleman will clarify. He is mixing foreign nationals and those who have been here for many years. As I see it, in this debate, foreign nationals are those who come especially to register themselves for a few days, who receive treatment and who disappear without paying, due to system failures, although I will not get into that debate. For those already here, if GPs act as immigration officers or work on behalf of the UK Border Agency, that will mean health problems.

[Mr Gary Streeter (in the Chair)]

Order. Interventions should be brief.

[Chris Skidmore]

I certainly do not mean to confuse or mislead. When I say foreign nationals, I mean those who come to this country requiring care who are not defined as ordinarily resident under the current regulations. Personally, I think that we should consider the definition of “ordinarily resident”. I have no problem with people’s nationality, whether they are British or a citizen of whatever country. If they work in this country and are contributing to society, it is right that they should receive the free care towards which they have contributed.

Equally, exemptions apply for matters of public health and vulnerable groups. As the hon. Gentleman mentioned, if denying access to treatment could worsen the health of the community, let alone the individual, it is right that we should act responsibly. However, that should not preclude the creation of a clear definition of who is and is not eligible for care. One reason why we are having this exchange is that there is no clear, black and white definition. There will, obviously, be shades of grey, as there always are in health care. Health care professionals have a moral obligation to treat people in need, the sick and the vulnerable. I do not deny that, but we also have a moral obligation to our taxpayers to ensure that NHS money is spent as well as it can be.

A few people have come to me and said, “Mr Skidmore, it’s only £60 million out of a budget of £110 billion. Surely you’ve got to factor in debt. We should be able to expect that amount of debt to be written off.” I do not accept that argument. My local community hospital, Cossham hospital, is undergoing a £20 million refurbishment at the moment, and my constituents are so excited that it is taking place. That £60 million is a lot of money; it could have paid for the refurbishment of Cossham hospital three times over. We must count millions in order to save billions. During this efficiency drive, when we are trying to reinvest 15% to 20% of NHS resources in front-line care, it is a key aspect of the Nicholson challenge that we look for waste in the system and for instances where regulations are not being applied effectively.

I agree with the hon. Gentleman that we must be careful about how we define a foreign national. I do not want this to be seen as a xenophobic campaign, because it certainly is not. It is based on the conviction that the NHS is a national health service that provides free care at the point of use, but should not be abused; it should be free at the point of use, but not at the point of abuse.

The GP situation includes the lawyers at Deighton Pierce Glynn, who have been contacting GPs, and the Minister of State’s answer to the right hon. Member for Birkenhead about the issue of visas and documentation, which raises an issue that I think GPs would welcome.

Part of the consultation involves clarity about what GPs must look for when patients register in their practices, and whether they can say, “I’m afraid I cannot register you, because you don’t have the necessary data documentation.” As far as I understand it, the lawyers have been writing to GPs saying that by not registering patients, they are applying a discriminatory process. However, I was interested to read that paragraph 5.16 of the guidance on charging, in the section on GPs in primary care, says:

“It is important to see that all patients are treated the same way, to avoid allegations of discrimination.”

That is also clear in the Minister’s answer. The guidance goes on to say:

“It is not racist to ask someone if they have lived lawfully in the UK for the last 12 months as long as you can show that all patients—regardless of their address, appearance or accent—are asked the same question when beginning a course of treatment. The answer to that question may result in others needing to be asked, but again you will not be breaking any laws as long as those questions are asked solely in order to apply the Charging Regulations consistently.”

It is in the guidance that GPs have the right to ask, as long as they ask everybody. They will not be applying a discriminatory process.

As I said, in 2004—they reported in 2009—the previous Government began to consider whether we should extend charging to primary care and how eligibility criteria should be tightened. The review suggested that charging would not be extended to primary care. I hope that we as a Government might be able to reconsider. I know that this Government are committed to ensuring that national health care resources are spent in the right way. My constituents appreciate that, as I have said.

The Home Office has introduced measures so that anyone owing the NHS £1,000 or more will not be allowed to enter or stay in the UK unless the debt is paid. When that is implemented, the Home Office hopes to capture 94% of outstanding charges owed to the NHS; hopefully, it will have a significant impact. Encouragingly, the review commissioned on 18 March 2011 suggested:

“The existing system is still too complex, generous and inconsistently applied. While the NHS remains committed to providing immediate or necessary care, it is important that a balance of fairness and affordability is also struck.”

I agree entirely.

The review taking place will now consider

“qualifying residency criteria for free treatment; the full range of other current criteria that exempt particular services or visitors from charges for their treatment; whether visitors should be charged for GP services and other NHS services outside of hospitals”,

as I suggested; and

“establishing more effective and efficient processes across the NHS to screen for eligibility and to make and recover charges”.

I suggest that as part of the consultation, they consider West Middlesex University hospital and the good work being done there. Finally, the review will consider

“whether to introduce a requirement for health insurance tied to visas.”

I was encouraged when the Minister said:

“The NHS has a duty to anyone whose life or long-term health is at immediate risk, but we cannot afford to become an international health service, providing free treatment for all. These changes will begin the process of developing a clearer, robust and fairer system of access to free NHS services which our review of the charging system will complete. I want to see a system which maintains the confidence of the public while preventing inappropriate free access and continuing our commitment to human rights and protecting vulnerable groups.”

I agree with all those words.

I initiated this debate to ensure that Members have an opportunity to put their views as part of the consultation, which, hopefully, will report later this year. To reiterate, the NHS is a national health service, not an international one. Although we all believe that health care treatment must be free at the point of use, it cannot be free at the point of abuse. I urge the Minister to consider carefully what I have said and what other Members will say in this debate. We care passionately about the NHS. We want the NHS to continue as it has for six decades now. This issue is one that I know all our constituents and everyone in the House, regardless of party politics, will wish to ensure is solved.

Care (Older People)

Gary Streeter Excerpts

Tuesday 6th September 2011 Westminster Hall

[Tracey Crouch]

Is the hon. Gentleman aware of the report by the all-party group on dementia that highlights that issue specifically? Dementia patients are extending their stays on hospital wards because they cannot go straight back to their residential care homes, and it is costing the NHS about £20 billion a year. It is a massive issue. Intermediate provision must be considered more closely to alleviate that financial pressure on the NHS.

[Mr Gary Streeter (in the Chair)]

Order. Before the hon. Gentleman responds to that point, I would like to say that five other colleagues are seeking to catch my eye and the wind-ups will begin at 12.10 pm. If colleagues can moderate their speeches, I would be most grateful.

[Jack Dromey]

Thank you, Mr Streeter.

The work that the hon. Member for Chatham and Aylesford has done, together with the all-party group, is admirable. She is absolutely right to highlight the dilemma. Before I conclude, I will give one other example of the impact of what is happening in Birmingham. It is a combination of the cuts to big society organisations on the one hand and the impact on carers on the other. On big society organisations, the budget of Age Concern Kingstanding—my constituency is one of the 10 poorest in Britain, and Kingstanding is the poorest area in Erdington—is being cut. A particularly heart-breaking case concerns a group called Elders with Attitude. It has one co-ordinator and a range of volunteers. I remember the first time that I met them. They are inspirational. People were brought together around a table and told their story. One individual—another Frank—said he had had a terrible stroke and had thought that his life was over. The group meets twice a week and, in his words, it brought him back to life. His granddaughter, who was sitting alongside him, burst into tears and said, “My granddad used to just sit at home, looking at the wall. This has given him a fresh lease of life.” This is essentially a voluntary initiative and initiatives of that kind should be supported, not least because, as the hon. Lady has said, stimulating people is of the highest importance to their quality of life and, ultimately, to their not having to go back into a hospital.

I want to give one other example of the impact on carers. In Birmingham, thousands of carers are employed directly by the council. I remember meeting a group of 20 of them in July. They were women who had worked for 10, 15, 20 or 25 years. They were the kind of women who go the extra mile in the job that they do. I remember meeting one of them coming out of Sainsbury’s in Castle Vale the Easter before last. She had a bag of Easter eggs. I asked, “Who are those for?” She said, “Half a dozen people I care for.” I asked, “Who’s paying for it?” She said, “Oh, I am of course.” She was buying Easter eggs for people who would not otherwise get them. Such was her bond of love and affection for the people for whom she cared. Sadly, she and all the people like her are now going to see cuts. They earn typically £14,000 a year. They will see, under the proposed Birmingham contract, a cut of £4,000. That is absolutely devastating.

What I hope unites us here is the focus on the need for the new dawn to be realised and for all parties to work together to put in place Dilnot’s recommendations, and to do so as quickly as we possibly can. Crucially, however, it is about what happens in the meantime, because the hallmark of a civilised society is whether we care for the most vulnerable in our ranks.

Caring Responsibilities

Gary Streeter Excerpts

Wednesday 15th June 2011 Westminster Hall

[Barbara Keeley]

I very much agree. I have a point to make later about that topic, because the staff who work on the young carers project in my constituency have said that they are very concerned about carers losing their education maintenance allowance. That is the one support that the state gave young carers and it is going, which is a worry.

To return to the testimony from Parkinson’s UK, the final points were about more carers contacting the staff member to ask for help finding respite because they are struggling to cope; financially, they cannot now afford a break, a treat or a holiday. I am glad that the hon. Member for Banbury raised that point. The staff member said:

“I know of one carer who has had to take on a part time cleaning job in the early evening because money is so tight. She puts her husband to bed before she leaves”—

for work—

“at 4pm so that he is safer and so she won’t worry that he will fall while she is out.”

I think that we would agree that we would rail at care agencies that put a person to bed at 6 or 8 o’clock, yet this carer has to put her husband to bed at 4 o’clock because that is the only way that she can do the cleaning job that she has to do.

I also had some input from a branch of Age Concern in Greater Manchester about how cuts to grants are affecting its dementia support service, which is important because it is another line of support. Cuts to grants of 40% over the next three years are affecting its capacity to deliver individual and group support. That goes against objectives 5 and 7 of the national dementia strategy. The staff member told me:

“Carer support groups have had to close. These are groups where carers can get a break, have a chat to other carers and get advice and information from staff. These groups help to maintain morale and prevent carers from becoming socially isolated.”

Even though there are personal budgets, which will come in in Greater Manchester, carers of people with dementia often find it hard to mix in other social groups because of the “different” behaviour of the person with dementia. Carers have described the groups as a “lifeline” and something “to look forward to”. The fact that they are being cut back is important.

The proactive support to carers of phoning them every few weeks is another aspect of Age Concern’s work that is being cut. The staff member said:

“We now have to wait for them to contact us for time-limited intervention. We know that many older people are proud and longsuffering and will often suffer in silence rather than ask for help.”

Before the cuts, branches of Age Concern in Greater Manchester ran special events for carers such as a carers day each year, parties and trips. The reduction in funding means that it can no longer offer the extras that it knows give people a better quality of life. I am very concerned to hear that carers in my area in Greater Manchester are starting to suffer.

I want to return to the two sides to the debate—values and choices. We are fortunate in Salford because, due to the way in which the cuts and the organisational turmoil in the NHS are being managed, we are not suffering as much as other areas. There are choices. Labour-run Salford city council is now one of only 15% of local councils still providing support to people with moderate care needs, as well as to those with substantial or critical needs. We are fortunate to have an excellent carers’ centre run by the Princess Royal Trust for Carers. Salford has tried to ensure that carers continue to be supported through these difficult times. As I mentioned earlier, however much the council and our local NHS bodies support carers and try to maintain what they are providing, the national changes and cuts affect our carers.

The young carers project will be affected when the young carers lose their education maintenance allowance. The centre manager told me of two other concerns: the changes to benefits and disabled people being called in to take work capability assessments. The extra worry of having to take them and of having benefits curtailed are starting to affect carers.

The centre manager also said that a major concern for her organisation was that although the carers’ centre was very well established, the service has to go out to tender through the joint commissioning process next year. She said:

“We are aware of a number of carers’ services which have gone out to tender in other areas, and bids have come in from organizations and agencies which have no experience, knowledge or expertise in carers and carer issues, including organizations from abroad.”

What reassurance can the Minister give to staff of the carers’ centre that an established, trusted and effective organisation such as theirs will not be undercut in the tendering process by organisations with no local knowledge and no experience or expertise with carers or in carers’ issues? Our carers in Salford would lose out if they lost the valuable support that they get from their carers’ centre.

The Government’s economic policies are damaging support to carers. Government cuts to local council budgets have gone too far, too fast. Councils pleaded not to have their budget cuts front-loaded. We have lost £1 billion from adult care services at a time of rising need, and we have lost billions in grants to the voluntary sector, but the worst thing is that we are only a few months into the first year of cuts, and we can already see the impact on carers. Carers are fearful about the cuts and distressed that they cannot manage financially. People with serious conditions such as Parkinson’s are being turned down for attendance allowance and made to feel like beggars if they appeal. Young carers are losing their education maintenance allowance. Carers are now unable to afford a break or holiday. It is shameful that a carer should have to take a part-time cleaning job and put her husband to bed at 4 pm.

That is not a record of which the coalition Government can be proud, and it is so early in this Parliament. I hope that carers week gives Ministers time to rethink the impact of the cuts that they are making.

[Mr Gary Streeter (in the Chair)]

Colleagues, three Members have sought to catch my eye, and we have 19 minutes before winding-up speeches begin, so can we regulate ourselves to about six or seven minutes each?

--- Later in debate ---

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter, for the first time in a Westminster Hall debate. I echo the tributes to my hon. Friend the Member for Edinburgh East (Sheila Gilmore), whom I congratulate on securing this important debate on the effects of spending reductions on families with caring responsibilities, not least because of the important changes being made in the House of Commons in the Welfare Reform Bill.

I want to confine my remarks to a couple of issues, because of the shortage of time. A survey of more than 2,000 carers was recently carried out for carers week. It shows that 80% of unpaid carers are worried about cuts to services and that about 50% are unsure how they will be able to cope without the vital support that they currently receive. For the record and for anyone who is not involved directly as a carer, it is worth stating that three out of every five people will be an unpaid carer at some point during their lives. To respond to the point made by the hon. Member for Banbury (Tony Baldry), those unpaid carers save the economy a huge sum. It is difficult to quantify it, but it may be more than the total NHS budget—£103 billion each year.

We have done some research in County Durham. I am proud to speak up for the vulnerable, the disabled and for carers. My county alone has 61,000 carers and the estimated moneys saved to the public purse by the very important work that these unpaid carers carry out are £1 billion a year. We should not be dismissive of their needs and requirements. Each carer who works for nothing saves the Government, the taxpayer and the Exchequer the cost of a care worker, which is about £18,000 a year.

My own constituency of Easington is characterised by long-term ill health. As the hon. Member for East Londonderry (Mr Campbell) has mentioned, many carers, particularly in my area, are themselves victims of ill health. That was highlighted by a recent report by Carers UK. The legacy of coal mining and heavy industry has left many thousands of people debilitated in later life by long-term disabilities and in need of care, which is often provided not by the state, but by close family members.

I shall speak briefly about a number of issues. In particular, I want to draw Members’ attention towards, and place on the record, the effects being felt by some of my constituents as a result of the transport costs they now face due to local government cuts, and towards respite care, which has been mentioned. I also want to ask the Minister a couple of questions—I hope that she will answer them—about carer’s allowance and the provisions in the Welfare Reform Bill.

A constituent who came to see me recently is a full-time carer for her husband. She has one day a week of respite care. Her husband attends a day-care centre in Grampian House, in Peterlee in my constituency, once a week for four and a half hours. That is the only break she has. It is an excellent facility and I pay tribute to its care staff. I have visited it myself and a close relative of mine is in there. They do tremendous work in terms of physiotherapy and rehabilitation. However, from September, due to the front-loading of cuts of £67 million this year to my local authority of Durham county council, transport to the centre will be cut. It will cost my constituent £72 for specialist transport, which means that she will not be able to take her break and take advantage of the respite care.

The issue of transport has been raised by many of my constituents. They understand that cuts to social care by local authorities are due almost entirely to the swingeing, front-loaded cuts that the Government have imposed. Councils are struggling to cope with massive funding reductions from central Government.

People are also aware of the impact that the Government’s £18 billion package of cuts to the benefits system will have on carers in particular. The Government accuse Labour of rejecting welfare reform, but I am proud to say that we stand firm on the principle that the most vulnerable should not be paying that £18 billion when some of the richest in society—most notably, the bankers and the banking sector—contribute only between £2 billion and £5 billion to the cost of the deficit.

I shall conclude my remarks, because time is short. Another big issue that has been raised is that of ring-fencing moneys for social services, with a distinctive sum identified for carers’ services—the carer’s grant. Although it was not ring-fenced under the previous Government, councils at least knew how much money they were receiving for that purpose. The Minister has responsibility for public health and I would like to congratulate my own soon-to-disappear primary care trust, County Durham PCT, on clearly ring-fencing, identifying and spending its allocation from the Department of Health on the provision of respite care for people with disabilities and their carers.

How will the Government fulfil their pledges to improve the support for carers in the face of massive cuts to local government? How will the Government ensure that the proposed reforms, outlined in the Welfare Reform Bill, do not result in carers losing their carer’s allowance? The Government could give two promises that would give confidence to those who are most vulnerable and most in need. First, budget cuts should not result in carers losing the services that they rely on. Secondly, carers should not lose out under changes to the benefits system.

[Mr Gary Streeter (in the Chair)]

I call Rosie Cooper, who has four minutes.

--- Later in debate ---

[Emily Thornberry (Islington South and Finsbury) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. The debate could clearly have gone on for twice or perhaps three times as long. A feature of it has been the number of people who wanted to speak and have not been able to. My hon. Friend the Member for Newport East (Jessica Morden) wanted to speak, as did my hon. Friend the Member for Birmingham, Erdington (Jack Dromey). My hon. Friend the Member for Glasgow Central (Anas Sarwar) had also prepared something, and my right hon. Friend the Member for Croydon North (Malcolm Wicks) had told me that he wanted to make a contribution. The fact that many people have shown an interest in the matter demonstrates its huge importance.

I congratulate my hon. Friend the Member for Edinburgh East (Sheila Gilmore) on securing the debate. It is very easy to come out with a number of platitudes about carers, but carers want to hear what we will do to help them. Carers probably save this country more in money than is spent on the national health service. By 2017, it is likely that the UK will reach a tipping point, as the number of older people needing care will exceed the number of people of working age with families. There will be a crisis and we need to ensure that we are up to dealing with it. We must be able to support those people on whom we rely entirely. As has been said, if anyone is demonstrating the Prime Minister’s big society, it is carers up and down the country, so we need to look after them.

Where is the good news? There is some good news, which has come from the Law Commission. It has published a report that has largely received broad support from social care groups. A number of proposals are well thought out and will be well received, for example, rather than the carer needing to request an assessment, the local authority will have a duty to provide one. In addition, those assessments should be made for people who provide some care, rather than being restricted to those providing substantial care. Both those proposals are sensible. The third proposal is to ensure that a national system of eligibility assessments will provide some consistency across the country and allow people to move from one local authority to another without there being a huge time lag, which causes great distress to families. That will allow some portability of care.

The Under-Secretary’s brother Minister who is responsible for care, the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), has so far welcomed the Law Commission’s report. In his pre-coalition past, he expressed support for many of the ideas it recommends. However, many of the issues will not come within the Department of Health’s ambit, but within that of the Department for Communities and Local Government. Given that the Secretary of State for Communities and Local Government has indicated that he wants to conduct a review of local authority duties, there is some concern that he may be resistant to a new duty being put on local authorities to ensure that carers are assessed as well as the person needing care. I hope that that is not the case and that people are speaking strongly in his ear, so that the Law Commission’s recommendations can be implemented in full because they are to carers’ advantage.

The other piece of good news may be the Dilnot inquiry. I met Mr Dilnot again today. He is very generous with his time and is meeting a broad range of people. The meeting he had with me and my right hon. Friend the Member for Wentworth and Dearne (John Healey) was the first of eight meetings that he is holding today. Of course, we all agree that we need to make fundamental changes, that the status quo will not do and that we must have a fundamentally reformed care system. The Opposition believe that there should be high-quality care for those who need it and that care needs to be funded in a fair way, with proper accountability for those who deliver it.

We repeat the Leader of the Opposition’s invitation, which was made on Tuesday 7 June. We welcome cross-party talks and we would like them to happen as soon as possible. We will come with an open mind because we want to be able to work together for the best way forward. I understand that the Prime Minister has welcomed that approach, but we still have an empty diary and we want to be able to get on with it. If the failures of the past are repeated, we will not be forgiven by those who use the care system or their families. It is important to remember that, even with co-operation and a fair wind, we are unlikely to see any of Dilnot’s suggestions implemented until 2014-15. The current problem for carers is what is happening now to the social care system and their support .

I am afraid that that takes me to the end of the good news and into the bad news. As has been said very eloquently by my hon. Friends, social care cuts are clearly having a fundamental impact on the lives of carers. I was going to congratulate the Minister of State, Department of Health, the hon. Member for Sutton and Cheam on finally taking his fingers out of his ears, stopping singing, “La la la la la,” and accepting that the cuts to social care will affect front-line services. That is inevitable; there is no other option. Given that social care is top-tier councils’ biggest area of discretionary spending, we simply cannot have 27% cuts to local authorities without there being cuts to social care. It just does not work. Unfortunately, the Government have ignored the advice of the Association of Directors of Adult Social Services and the Local Government Group, who know what they are talking about.

Although no centralised assessment of the impact of the cuts to local government on social care was carried out, several people have done the Government’s job for them. A wealth of evidence has been provided by ADASS, the BBC and my own survey. As has been mentioned, my survey of the directors of social care received 61 replies from councils and shows some very worrying results. I am pleased that the Minister of State, has complimented my survey as being robust, accurate and, indeed, more reliable than that done by the BBC. However, he needs to look at the impact of it and what it means. We will do the survey again next year and the year after, and I am afraid that we will not get good news.

ADASS has shown this year that the shortfall to adult social care spending is £1 billion. The Government have done their best not to affect adult social care, but next year they have to cut again and the year after they have to cut yet again. If things are bad now, as has been so eloquently reported by my hon. Friends, where are we going? Do the Government have any idea of the impact of these cuts on carers? This has already been asked, but I repeat: how many of those who no longer meet councils’ very narrow eligibility criteria will need to rely on the informal care provided by their families? Do the Government know how many carers will have to go without support from their local authorities and will, as a result, be forced to give up work to meet their new obligations?

I was particularly pleased to hear what the hon. Member for Banbury (Tony Baldry) said about respite care—I support him in that. The Government are right—our Government was right—to ensure that money is put aside for respite care. The difficulty is that the mechanics do not work. Primary care trusts have been given that money. It is not ring-fenced. It is not clearly labelled. There is no accountability. The Department of Health is very unclear about which PCTs have spent it, in what way, how much they have worked with local authorities, or how much they have worked with carers—there is no overall picture. Frankly, is that not the sort of thing that the Government should do? It is not just a question of handing out the money. Surely there needs to be some form of accountability.

The Princess Royal Trust for Carers has been doing its best to conduct an audit of that, just as I am doing an audit of local authorities and the impact of the cuts on social care, but surely that should be a job for Government. Surely the Princess Royal Trust for Carers has things to do other than conduct an audit of whether the money given by the Department of Health to PCTs for respite care for carers is actually being spent on carers. That is part of the knock-on effect of the chaos that has been created through the proposed partial abolition of PCTs in the Health and Social Care Bill. What action will the Government take if PCTs do not work with local authorities and carers of organisations to publish plans and budgets?

The other piece of bad news, which has been mentioned, is welfare reform. We welcome the Government’s announcement that carer’s allowance will be outside universal credit. We also welcome the news that disability living allowance will be excluded from the overall benefit cap. However, the bad news is that, when the Government talked about introducing personal independence payments, they said that there would be a 20% cut to DLA. It is not just a 20% cut to DLA. Those people will not be springing from their beds, suddenly well. People with dependants will still be there. Not only will they, but their carers will lose their money, because carer’s allowance will be attached to DLA. There will, therefore, be a huge impact on the families of those people who are losing their DLA. Do the Government have any idea of how many carers will lose out as a result of moving DLA to the personal independence payment and the 20% cut? Are the Government aware that carer’s allowance is not excluded from the proposed benefit cap, while DLA is? I am sure that the Minister would agree that that is, at the very least, not consistent, let alone fair.

[Mr Gary Streeter (in the Chair)]

Order. It may help the hon. Lady to know that the debate ends at 4.10 pm, and I want to give the Minister some time to respond.

[Emily Thornberry]

May I just come back to this last point? It is shocking that, at a time like this, carers suffer in the way that they do. It is a question of priorities and hard choices. As my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) so eloquently put it, it is not right that a woman has to put her husband to bed at 4 o’clock in order to do a part-time cleaning job to pull things together. It makes “We are all in it together” hollow rhetoric.

Oral Answers to Questions

Gary Streeter Excerpts

Tuesday 7th June 2011 Commons Chamber

[Mr Lansley]

The Prime Minister made it clear that we will focus on outcomes for patients, not just on individual targets. In 2010-11, the financial year that has just ended, only 2.6% of people who attended at A and E waited for more than four hours, despite an additional 870,000 people attending A and E departments.

[Mr Gary Streeter (South West Devon) (Con)]

7. What plans he has for access to NHS speech therapy services for children.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

As my hon. Friend knows, speech and language therapy services are critical for children and young people who need help to develop their speech, language and communication skills, and who have conditions such as swallowing difficulties. We have published a Green Paper on special educational needs and disability, which includes proposals to develop a new co-ordinated assessment for education, health and care plans by 2014 and for the option of a personal budget for all families with such plans. That will offer families more choice and ensure that children get the support that they need.

[Mr Streeter]

Does my hon. Friend agree that when a child needs to access speech therapy, often it is to unlock vital early years education and is therefore time critical? The west country has known waiting times of three, six or even nine months. Will she assure me that the coalition Government can do better than that?

[Anne Milton]

We most certainly can do better than that. I agree with my hon. Friend that such problems are often a barrier, and that therapy can unlock so much more. I refer him to service redesigns that have happened, such as at the Cambridgeshire Community Services NHS Trust, which redesigned its clinical pathways with the result that the number of children waiting longer than 18 weeks from referral to treatment fell from 409 in May 2010 to eight at the end of January 2011. That is a fantastic improvement in the service. This is not all about money, but about the way in which services are designed.