Health Service Medical Supplies (Costs) Bill

Jim Cunningham Excerpts

Tuesday 25th April 2017 Commons Chamber

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Like the hon. Member for Ellesmere Port and Neston (Justin Madders), this will be my last time speaking in the Chamber before Dissolution, and as a newbie I also want to pay tribute to the staff of the House, who made coming here much easier than we had expected it to be. I am also glad that my final speech before Dissolution is on a Bill that, despite some of our disagreements, we have worked on on a cross-party basis to produce a piece of work that we all agreed needed to be done.

I, too, welcome Government amendment (b), although I would have laid out the three paragraphs the other way around, because the whole point of the NHS, and the whole reason we are discussing this, is patient access: that is the No. 1 concern. I would have put patients first, not third. The fear of not getting access to drugs is a great issue for patients. As the hon. Gentleman mentioned, we have a significant delay that is measurable in comparison with other countries. For certain types of cancer, our performance in relation to patients with early disease is as good as anywhere, but we fall down in dealing with people with difficult or advanced disease. That is because of the delay.

I want briefly to mention the interaction of the budget impact assessment with our no longer being part of the European Medicines Agency. I am not talking about the United Kingdom losing the agency itself; I am talking about our no longer being part of the scheme. We know that there is a danger that drugs are presented for licensing in the United Kingdom at a later date than in the United States and the European Union, which are major markets. It is likely that we could also be behind Japan. I am not suggesting that we should simply hand over any amount of money, but if we were also seen as a hostile market in which there was an expected delay of three years for expensive drugs, there would be a danger that international pharma would simply say, “You know what? We’ll license everywhere else, then we’ll come back to the UK in a few years.” That could result in significant delayed access for our patients.

We need to think about how all this feeds into trials and research, and into the life sciences system. If we are not using what is considered to be the gold standard drug at the time of a new international trial, we will not be able to take part in the comparison of the gold standard with the new drug. The UK has led the EU research network, which is the biggest research network in the world. We have been a major player in that, and it is important to realise how building in this delay from NHS England could undermine that. Surely this should be part of the NICE process. It should be clear to pharma, when it comes with a drug at a price, what process it will have to go through, what evidence it will have to bring forward and how it will have to negotiate a price. I fear that there will be delays in drugs being licensed.

This will affect us in Scotland even though NICE decisions do not apply to us. If a drug were simply not licensed here, it would be irrelevant that the Scottish Medicines Consortium chose to fund it—as it did the other week with Kadcyla—because it would still be an unlicensed medicine. We need to look at how the loss of the European Medicines Agency will work in this regard. There should not be a separate procedure after NICE that could suddenly hit pharma with another barrier to jump over. This will hit new cancer drugs, because they are expensive. It will particularly hit drugs for rare diseases, which the EMA has led on, because they are bespoke and therefore inevitably expensive. The £20 million limit would mean that if someone came up with a fabulous cure for dementia, for example, a budget impact assessment would be triggered.

[Mr Jim Cunningham (Coventry South) (Lab)]

I agree with what the hon. Lady says about the European Medicines Agency. I have had a lot of letters from people who are very concerned about that issue. There is another factor involved in the delays that can occur in the Government agreeing a price. I think that the drugs companies often take the Government to the cleaners.

[Dr Whitford]

I thank the hon. Gentleman for his intervention. That is obviously why the Government are introducing the Bill. They are trying to achieve a degree of control and to prevent runaway drugs costs. Of course we agree with that objective, which is visible in the Bill. The Government are trying to establish a predictable system of licensing in the UK, so that a pharmaceutical company knows what it has to bring to the table. That might mean a bit more flexibility during the NICE process, because we could appear hostile if a drug goes through that process and is defined as cost- effective, only to be hit with another, less predictable, barrier. The danger is that that will affect Scotland just as much as England, regardless of our drug funding decisions, because licensing is a reserved matter. The Government need to take that into account, because patients come third in the order set out in the amendment, and I believe that they should come first.

Contaminated Blood

Jim Cunningham Excerpts

Tuesday 25th April 2017 Commons Chamber

[Andy Burnham]

I fear that my hon. Friend is right once again. I am aware that individuals received Crown immunity to protect the Government from litigation at the time. That paints a strong picture, and that is why we need to see the papers and find out what happened. I do not want to stand here and accuse Ministers in that Government of anything—that is not my aim—but let us have a look at the papers, so that we can at least see whether any misleading statements were made.

The cases that I have brought before the House provide evidence of several things. First, people were used as guinea pigs. Secondly, people were given inappropriate treatment, as Stuart was. Thirdly, tests were done without people’s knowledge or consent. Fourthly, the results of tests, even when they were positive, were withheld for years—decades, in some cases—from individuals. It has even been suggested that those individuals, who were simply living their lives and did not know that they were HIV-positive or hepatitis C-positive, subsequently infected others who were close to them. Fifthly, as we saw in the case of Ken Bullock, medical records were falsified with slurs and smears to suggest that liver disease was self-inflicted. These are criminal acts.

[Mr Jim Cunningham (Coventry South) (Lab)]

I pay tribute to the work that my right hon. Friend did when he was Secretary of State for Health. I was in the Department with him as a Parliamentary Private Secretary. Are we saying that the information is immune from the Data Protection Act and the Freedom of Information Act? Have they ever applied in this situation?

[Andy Burnham]

I think people have applied for documents, but many of those documents have been withheld. I will come on to that in a moment.

I was a Minister in the Department of Health just after the publication of the Archer report and the Government’s response to it. At the instigation of the late Paul Goggins, I sought to reopen the whole issue, and I encountered a lot of institutional resistance, if I may put it that way. I am myself standing here out of a sense of guilt—I wish that I had done more over the years—but having looked at it all and having pieced it all together, I think the documents that have been withheld would fill in some of the gaps I have described.

Preventing Avoidable Sight Loss

Jim Cunningham Excerpts

Tuesday 28th March 2017 Westminster Hall

[Mr Jim Cunningham (Coventry South) (Lab)]

Does the hon. Lady agree that one of the most important features of this situation is that at least half a million schoolchildren are affected, one way or another, by sight problems, if I may use that expression? Some 100,000 people in the west midlands, of which my constituency is a part, are probably also affected.

[Nusrat Ghani]

Of course. I will go on to mention children and the fact that it is necessary for them to be tested earlier than we previously believed they should be.

Wet age-related macular degeneration affects the retina and causes changes to central vision. In October last year, Jean Rugg’s eye clinic consultant told her that she needed follow-up treatment. She was told by the receptionist to expect the appointment in the post, but nothing arrived. By December, Jean was continually contacting the booking department and being turned away. She was told that she would not be booked in because the department was just too busy. Time passed. Jean noticed changes in her vision and was extremely worried about permanent damage to her sight. She was getting nowhere, so she contacted her consultant’s secretary and, after much urging, managed to secure an appointment with him to discuss her sight.

By that time, three months had passed. Jean’s consultant was alarmed that she had not received treatment sooner and explained that her vision could well have deteriorated due to the delay, as there had been further leakage of fluid into her eye. Jean needed an urgent course of injections, so the consultant took her to the booking department to try to secure an appointment that same week. They were both told that there were simply no spaces in the injection clinic. After repeatedly explaining the urgency of the matter, the consultant was eventually able to obtain an appointment for Jean the following week.

I am sure that the Minister agrees that that is just not good enough. That delay and lack of responsibility and urgency is just not acceptable. There are many more Jeans across the country. A 2014 survey by the Royal National Institute of Blind People showed that 86.5% of the public were more fearful of losing their sight than any other sense. As I said, 50% of all sight loss is potentially avoidable if treated early, yet NHS England does not give eye health the profile it deserves. There is no overarching NHS England-led strategy to govern it and push for more prevention of avoidable sight loss. There are equivalent strategies for hearing loss and dementia.

[Nusrat Ghani]

I agree. We most definitely need to prioritise sight loss for all vulnerable people, including older people, who might also have mental health illnesses.

There are eye health strategies in place in Scotland, Wales and Northern Ireland; England is an anomaly. I therefore ask the Government to consider developing and implementing a national strategy for eye health in England. That would not require additional funding, but would be a commitment to improving the efficiency of eye care services and ensuring consistency across the country. It would enable the development of improved clinical leadership at clinical commissioning group level to prevent eye health from slipping down local commissioning agendas, enable closer partnerships between CCGs and local eye health networks, and aid commissioners to identify eye health priorities that respond to the needs of local populations.

The Department of Health and NHS England already do great work to support the voluntary sector-led England Vision strategy, but that is, by definition, limited in its ability to bring together all the relevant organisations in a joined-up way. In response to a written question that I tabled last week, the Department rightly explained that England’s size

“and the diversity of the health needs of different communities”

mean that commissioning is best “owned and managed locally”. I completely agree, but that should not be incompatible with strategic thinking from above by people who see the bigger picture, or establishing principles that local areas can fit to their circumstances.

Local commissioning must be coupled with national leadership. Leaving things to local commissioners is not working as well as it should. There is significant variation in the quality and quantity of services. For example, someone in Luton will wait for 15 days between their first attendance at a hospital out-patient clinic and their cataract surgery, but if they were in Swindon, they would wait not 15, 50 or even 150 days, but 180 days. That is a shocking difference. No doubt the Minister agrees that, again, that is just not good enough.

Small changes to guidelines and legislation would streamline the process for many patients. For example—my hon. Friend the Member for Twickenham (Dr Mathias) may have to help me out with my pronunciation—allowing orthoptists to sign hospital eye service spectacle prescriptions, rather than requiring ophthalmologists to sign them, would allow the delivery of effective patient care and reduce the number of appointments required to access spectacles.

[Mr Jim Cunningham]

rose—

[Nusrat Ghani]

I hope that the hon. Gentleman does not intend to make a quip about my pronunciation.

[Mr Cunningham]

The hon. Lady’s pronunciation is not as bad as mine. I would support a national strategy. More importantly, however, the cost of drugs for treatment is an area that creates difficulties. In 2014-15, the cost of two drugs alone to treat age-related macular degeneration was £287 million. There is room for discussion between the Government and the drug companies on the cost of drugs to treat people with eye problems.

[Mrs Cheryl Gillan (in the Chair)]

Order. I gently remind Members that interventions are supposed to be short. We seem to have plenty of time, but we have quite a few speakers, so I would like interventions to be short.

Health and Social Care

Jim Cunningham Excerpts

Monday 27th February 2017 Commons Chamber

[Dr Wollaston]

I have seen the study to which the hon. Lady refers, and I think the Department of Health needs to look at it very carefully.

[Mr Jim Cunningham (Coventry South) (Lab)]

We should look at it in general terms. For example, a local authority cannot deal with bed-blocking because it does not have the resources to provide social workers. The NHS as a whole in Coventry and Warwickshire has to find cuts of £250 billion, which is a tremendous amount of money. If we are not careful, we will create an insoluble problem.

[Dr Wollaston]

I thank the hon. Gentleman for making that point, although I think we should use the term “delayed discharges” rather than “bed-blocking”, because the latter can make older people who are in that position feel as if somehow they might be to blame. Nevertheless, I take his point.

The estimates memorandum seeks a transfer from the capital departmental expenditure limit of £1.2 billion to prop up revenue. It also seeks a £23 million transfer from Her Majesty’s Treasury reserve, a £58.5 million transfer from other Government Departments, and a £6 million transfer to capital from other Departments. Again, we see an unsustainable position, as pointed out by the Comptroller and Auditor General.

--- Later in debate ---

[Meg Hillier]

My hon. Friend makes her point well. It is important to protect staff. I echo the comments of the Chair of the Health Committee that staff cost more than anything else in the NHS and provide the direct patient care that is so important to its long-term sustainability. I will touch on workforce planning in a moment.

[Mr Jim Cunningham]

There is another dimension, which is that some people with mental health problems turn up at A&E units because there is no other place for them to go and they cannot get any other accommodation. The views and voices of the carers who look after these people are very often not listened to. I get many complaints about that.

[Meg Hillier]

That is one reason that we need to be really clear that we are looking at a long-term integrated health and social care system. Social services support should be there for people—whether they are a frail older person, someone with a particular disability and need, or someone with a mental health challenge—when they need it to prevent them from going to A&E in the first place.

Agenda for Change: NHS Pay Restraint

Jim Cunningham Excerpts

Monday 30th January 2017 Westminster Hall

[Mark Durkan (Foyle) (SDLP)]

It is a pleasure to serve under your chairmanship, Mr Evans. It is a particular pleasure to follow the excellent contribution from the hon. Member for Newcastle upon Tyne North (Catherine McKinnell). She set out the compelling case for why the pay regime for nurses, midwives and associated health service professionals across our health services is becoming increasingly exploitative.

The hon. Lady spoke of the particular experience in England; I obviously speak from the experience of Northern Ireland. Unfortunately, the Administration in Northern Ireland have chosen to void the clear recommendations from an independent pay review body, as in England, and have not taken the more constructive approach followed in Scotland to pay recommendations and to meeting the proper pay needs and aspirations of hardworking professional staff. As other hon. Members have said, those staff provide such a valuable service day in, day out. They work long hours with huge responsibilities, but with less and less of a sense of reward and with ever more inadequate remuneration.

We now have the situation in which many things have been brought forward. People were promised that Agenda for Change would ensure greater equity and transparency on pay, that they would see salary paths improving naturally—with more than just token increments—and that it would reward people’s sense of vocation. Of course, it does nothing of the sort, because people have found themselves locked into highly contested bands. Certainly in Northern Ireland, people doing the exact same work in different trusts are paid differently, which is causing huge frustration and a grave sense of grievance and injustice for many people.

The health and social care system in Northern Ireland is supposed to be operating increasingly as a single employer, with the commissioning role of Health and Social Care Board moving to the Department and the Minister. However, we have the bizarre situation in which people who are doing the same job and delivering on the same targets set by Ministers and the Executive are supposedly employed by different trusts and are paid differently—not because their working terms are different, but because the terminology on their contracts might be different here or there. The slightest difference in terminology in job descriptions is being used to keep people in lower pay bands than their counterparts in a neighbouring trust who are doing the exact same job. Of course, not being able to address those issues absolutely suffocates people with frustration.

This has happened in the context of those staff being locked into the 1% pay rise cap that has endured for a number of years. It is one thing to ask people to take a pay freeze in the name of austerity and managing public financial pressures for a year or two, but it is another to be locked into such a pay freeze while seeing other people, including on the public sector payroll, being able to escape those constraints. Again, it adds to the sense of injustice.

[Mr Jim Cunningham (Coventry South) (Lab)]

On the pay freeze, over the past five or six years it has worked out to roughly the equivalent of between a 6% and 8% wage cut. That is the reality that those people face. The Government say they value people in the health service, but the only way to demonstrate that is through their wage packets at the end of the day. The other issue, which will certainly affect mature students who want to be either a nurse or a midwife, is that the education maintenance grant has also been cut. So much for valuing people who work in the national health service.

[Mark Durkan]

I agree with all of the hon. Gentleman’s points; they touch on points made in interventions by other hon. Members. Let us be clear: the long-standing freeze is, in essence, a long-term pay cut in real terms. People are left feeling frustrated and aggrieved by that. People are leaving the profession; they feel they are being driven out—we heard references to the number of people who are switching to agency roles, but many people do not want to do that, and their sense of vocation is being exploited in a way that now probably more than borders on the cynical. A better response is needed.

I have made points particularly on Northern Ireland. On Agenda for Change, we know, as other hon. Members have mentioned, that pay in the lower bands actually falls below living wage standards. One appalling vista—which will bite this year in Northern Ireland, where these adjustments are being made—is that the money for that 1% pay rise will be used to bring people in the lower wage bands up to the living wage. In other words, if the 1% envelope is to be used to cover that, other people will lose out; there will be a trade-off between nurses and health service professionals in different grades, with that 1% being prioritised towards bringing people up to the living wage. Nobody should be asked to endure inadequacy as the price of affording a micro-concession to equality for those who are locked into the lower bands that pay below the living wage. That is going to bite in Northern Ireland this year.

It should not, because as part of the Stormont House agreement and other things, Northern Ireland has a voluntary exit scheme that was meant to reduce the cost of the public service payroll. If that overall voluntary exit scheme saves money on the public service payroll, my party made the point that, rather than those savings being used to pay for a cut in corporation tax in future years, they should be used for restorative pay measures—starting first in the national health service for those staff who have suffered as a result of freezes and who are stuck on inadequate and unfair pay bands under Agenda for Change. Their case could be met because public sector payroll savings are on the way.

Health service staff in Northern Ireland will be asked to manage yet more change. People already work long hours in heavy-demand services, but more structural changes will be made to health services following the Bengoa review and others. If people are being asked to manage all of those changes and keep those services going during those transitions, the one thing they are entitled to is some long overdue consideration of the inadequate pay they have been asked to endure.

--- Later in debate ---

[Andy Burnham]

I am glad to hear the intervention of the former Minister, whom I worked well with in the previous Parliament. I want to take this opportunity to say that he did listen on regional pay. We made an argument about that issue, backed up by the RCN and others, and, to be fair, it did not go any further than the experiment in the south-west. I give credit to him for that. I also give credit to him for consistently showing a real regard for the pressures faced on the frontline.

The hon. Gentleman makes an important point that the Minister would do well to reflect on. There is a huge false economy here. It makes sense to have fairness in terms of headline pay for staff, to maintain good will, but on top of that, it makes sense to provide them with incentives to give any additional shifts or time to the in-house bank, rather than private staffing agencies. The Government have lost sight of that in recent times.

[Mr Jim Cunningham]

My right hon. Friend makes an interesting point. It can be a false economy to rely on agencies to staff hospitals, whether it be nurses or doctors. At the end of the day, training suffers. That makes it difficult for the NHS to recruit, so it is a false economy in a number of ways.

[Andy Burnham]

It is not only a false economy; it directly damages the quality of patient care. When people arrive on the ward who do not know the team or the environment and have to be told everything, it builds in confusion and delays because staff have to take them through things. It does not make sense to use private staffing agencies to the extent that they are being used in the NHS. The cost is exorbitant—that is No. 1—but it also damages morale, because it leads to staff in the permanent employ of the trust working on the ward alongside people who are being paid significantly more than them for the same shift, despite having just arrived on that ward. That does not build a sense of team on the ward; it builds a sense of resentment.

Breast Cancer Drugs

Jim Cunningham Excerpts

Thursday 26th January 2017 Commons Chamber

[Iain Stewart]

I am grateful to my right hon. Friend for that question. My answer is pretty much the same as that of the hon. Member for Mitcham and Morden. In this specific case, I hope that there is scope for NICE and Roche, the manufacturer of Kadcyla, to sit down and agree some compromise. I received a briefing note from Roche this morning stating that it was willing to do that, so I hope that NICE will respond in kind. Its consultation ended last week. As the hon. Lady said, and as my right hon. Friend rightly points out, there is a broader issue for other drugs. Perhaps it is time to look again at the appraisal system and the cost mechanisms so that we do not keep returning to this debate every time a new drug is identified and there is a question about its affordability under the cancer drugs fund.

[Mr Jim Cunningham (Coventry South) (Lab)]

I agree, because it is not only about the drugs we are debating today; we have had problems before in relation to NICE. In answer to the question from the right hon. Member for New Forest West (Sir Desmond Swayne), I think that the Minister should look at the procedures and at NICE itself, because otherwise we will keep coming back to this issue time and again. The years I have spent listening to the same issues with different drugs is nobody’s business, to use an expression.

[Iain Stewart]

The hon. Gentleman makes an important point. I do not pretend to be an expert on how NICE works, but I hope to bring to the debate the personal experience of my constituent and underline the human effect of these issues. I do not necessarily have a solution, but I hope that the outcome of the debate will be that we not only consider Kadcyla, but take a fresh look at the whole process.

NHS and Social Care Funding

Jim Cunningham Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Wollaston]

I am afraid that that intervention is exactly not the kind of debate we want to be having. Let us look to the future. We are in a different part of the electoral cycle. I accept the hon. Lady’s comments—I was still an NHS clinician when that happened and, like many of those working in health or social care, I looked at the yah-boo debate in this place and thought that surely there had to be a better way—but I ask her to put them aside and to look to the future rather than backwards, otherwise we will not get anywhere. I think our constituents want us, as politicians, to recognise the scale of the challenge and to get to grips with it.

[Mr Jim Cunningham (Coventry South) (Lab)]

Looking to the future, does the hon. Lady not agree that there should be a new funding settlement for the NHS and social care budgets that brings both together? At the moment, there have been cuts of £4.6 billion.

[Dr Wollaston]

That is exactly what I am hoping. We must end the silos of health and social care. We should stop thinking about money as a social care pound or a health pound, and instead think about a patient pound and a taxpayer pound, and how we get the very best from that.

That brings me on to a point I would like to raise directly with the Secretary of State. There is an example of where this has happened: in my constituency, Torbay and South Devon NHS Foundation Trust has formed an ICO—an integrated care organisation. Across health and care, passionate people recognised the benefits and sweated blood to get the organisation off the ground. Torbay’s integration is talked about not just nationally but internationally as a recognised way of doing this better. I regret to say, however, that because of the scale of the financial pressure on the ICO, we are now hearing that next year the NHS will be pulling out of the risk-sharing agreement.

That is totally unacceptable. I hope the Secretary of State will meet me to discuss the pressures facing the ICO, which has achieved exactly what we are talking about in this debate. It is able to pool finances better through risk sharing and to work together to get people out of hospital who do not need to be there more rapidly than happens in other areas. It can put people from social care into hospitals to see how we can speed up that process. Unfortunately, if that risk-share falls apart, one of the key pillars of how we want to improve the flow through hospitals and out the other end will break down. Part of the reason, as I understand it, is that unless the control totals are met the funding it hopes to use to improve the facilities in the A&E department will be at risk. The challenge for Torbay is not how it works together to get people out of hospital; it is the facilities at the front door, and it could do so much to improve the facilities. We have the odd paradox whereby we could end up improving A&E infrastructure but worsening the ability of the system to respond at the point where we are trying to get people cared for in the community.

A certain degree of financial challenge can have the effect of bringing health and social care organisations to work more closely together because they know it makes sense, but when unrealistic targets are set it can go the other way. It can start to mean that people have to retreat to protect their budget silos. I hope that the Secretary of State will look closely at what is happening and meet me to discuss whether we cannot just get this back on track for next year. I am confident that the local authority and the NHS staff across the CCG and the provider trust will continue to work together—they have an extraordinary tradition of doing so—but there are threats, which I hope can be addressed. This is about the entire flow from the front door right the way through to getting people cared for back at home.

More widely, we now have more than 1 million people in communities who are unable to receive the care they need. Mears, the prime provider in my area, is in special measures. These are financial issues. Yes, there is much that the NHS can do that is not about money—we know there is a lot of variation that cannot be explained by financial challenge and demographic changes alone—but finance and the workforce inevitably are the key challenges we have to face, and we have to work together across all political parties to resolve them.

In closing, I would like to raise with the Secretary of State the front page of today’s Times, which is extraordinarily disappointing. This is the second time a major national newspaper has reported briefing against the chief executive of the NHS, Simon Stevens. I invite the Secretary of State or the Minister closing the debate unequivocally to support the chief executive of the NHS. When the chief executive appears before the Health Committee and I, as the Chair of the Committee, ask him to respond to questions, I expect him to be truthful and transparent in his answers. He should be commended for doing so and not find himself the subject of negative briefings. I therefore invite the Minister unequivocally to support him and ask for this to stop.

Health Service Medical Supplies (Costs) Bill

Jim Cunningham Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 6th December 2016 Commons Chamber

That is the same wording, this time applying to Wales, as in section 260(5) of the NHS Act 2006, which applies to England. Amendment 7 amends the Welsh legislation, very understandably, to clarify the definition of medical supplies. In Committee the Government did not see the need to clarify the definition of medical supplies as it applies to England, but today are seeking to clarify the same definition of medical supplies as it applies to Wales. I am therefore bemused.

[Mr Jim Cunningham (Coventry South) (Lab)]

My hon. Friend’s analysis of medical supplies is very interesting. I would have thought that pharmaceuticals, for example, would be classified as medical supplies, given that they have always been a contentious area of negotiations over costs. I am surprised that they are not included in the definition.

[Rob Marris]

Medical supplies in this part of the Bill seem to be to do with physical equipment. But, again, what is equipment? We can refer to the definitions, which state:

‘medical supplies’ includes surgical, dental and optical materials and equipment”.

Drugs are dealt with elsewhere in the legislation.

I think the Minister has got the point, but I will repeat it very briefly. He is seeking clarification for the Wales legislation through amendment 7 when I understood him to say that he did not think such clarification was needed for the same definition contained in the legislation pertaining to England. I would like him to explain that apparent anomaly. If it is not an anomaly, perhaps he could tell the House that he is going to clarify the definition as it relates to England in the later stages of this Bill.

Social Care

Jim Cunningham Excerpts

Wednesday 16th November 2016 Commons Chamber

[Mr Hunt]

With the greatest respect, I do not know whether the hon. Lady heard what I said just a few moments ago, but I answered very directly what the shadow Health Minister said. Do I recognise the scale and seriousness of the issues? Yes, I do, and I am coming on to explain what I think the solutions are. The point I am making is, yes, the budget—the amount spent on social care—was cut in the last Parliament, as a result of the very difficult economic situation we faced after the financial crisis in 2008, but it is starting to go up again in this Parliament. We need to look at what we can do to try to turn that into a sustainable improvement in the care received by all our constituents.

A crucial point was missing from the shadow Health Minister’s opening speech. There was a suggestion that the issues in social care are essentially caused entirely by decisions made by central Government. We need to salute the efforts made by councils of all colours to deal with the pressures in social care, because those are very tough. Middlesbrough Council, for example, increased its social care budget by 11%—it is the most improved council in England. My own council, Surrey, which is an affluent area, but has a large number of elderly people to look after, has battled enormous odds to expand provision.

However, the fact is that there is enormous variation in the way local authorities have responded to these challenges. If we look at the impact on the NHS, and at the delayed transfers of care that are attributable to social care, we can see that the best councils, such as Peterborough, Rutland, Newcastle and Torbay, have virtually no delays in hospital discharges attributable to social care. That can be compared with Birmingham, Manchester, Reading and Southampton where there are between 14 and 21 days of delayed transfers attributable to social care per 10,000 of population every working day. That is a difference of 20 times between the best and the worst councils, and we cannot say that there is a 20-times difference in funding between the best and the worst councils.

[Mr Jim Cunningham (Coventry South) (Lab)]

Members have alluded to the fact that local authority budgets are under the hammer at the moment. More importantly—I have raised this with the Secretary of State before—one of the big problems is having the social workers to get people a care package when they leave hospital to go home, and that creates bed blocking, so we are in a vicious circle. The last Labour Government looked at an offer from the then Conservative Opposition to get together and have a properly funded national care service. Why have we not looked at that?

[Mr Hunt]

The hon. Gentleman is absolutely right to say that the presence of social workers in hospitals is vital in discharging people, but I think he will be quite shocked to know that 50% of all the delayed transfers of care in the entire NHS happen in just 20 local authority areas. There are many places that are doing these things well, even in the current challenging financial circumstances, but there are others that, frankly, could do a lot better.

Overall, what we see is a picture where the best councils have expanded funding and provision. For example, last year, Windsor and Maidenhead increased its spend by 6.4%, and the number of people accessing long-term care is up by 8%. That was a Conservative council, but the Labour council in Doncaster also chose to increase its social care budget by 10%—nearly £8 million—and it is looking after nearly 7% more people.

This is not just about funding; it is also about the speed of health and social care integration and about local leadership. Where such leadership exists, important changes are happening even now. For example, in Cheshire East, dedicated workers are supporting people with early-stage dementia, saving more than £4,000 a year per client in social care costs while improving the service for patients. Milton Keynes is another good example: its innovative pilots have cut delayed days attributable to social care by nearly three quarters.

Others, regrettably, have chosen to cut funding and provision. There are many reasons for that, but the one thing that is difficult to explain to the public is why, at times of such challenge, local authority reserves have increased by nearly £10 billion since 2010. The hon. Member for Worsley and Eccles South made a fair point when she said that there has never been greater financial or operational pressure on all councils. Like the NHS, there is huge pressure, but unlike the NHS, it has not been possible to protect their budget since 2010.

What is the way forward in this very difficult situation? I think that it is a combination of the right financial decisions locally and recognition by local authorities and the NHS that they are part of the same team. That is why, as has been said, the sustainability and transformation plan process is so important.

It is easy to knock a process whereby local areas come together to have yet more meetings, which we are pretty good at doing in the NHS and social care system, and it is also easy to characterise those meetings as secret, but the fact is that people do not want to publish their plans until they are ready, and they will all be published by the end of this year. Many Members on both sides of the House criticised the Health and Social Care Act 2012 because they felt that it did not do enough to promote integrated care, but now we have a process to do that. That is massively important for the social care system, as this is the first time that local authorities are properly involved in NHS planning. Indeed, four of the STPs—namely those for Greater Manchester, Norfolk and Waveney, Nottinghamshire, and Birmingham and Solihull—are headed by local authority leads. On Monday, the head of operations at NHS England told me that there was not one STP meeting that he had been to where a local council was not represented. At the moment, it is a planning process and it needs to be delivered, but planning needs to happen collaboratively. It is a significant change for the NHS and social care system, but it is finally happening.

Capita Contract (Coventry)

Jim Cunningham Excerpts

Tuesday 8th November 2016 Commons Chamber

[Mr Jim Cunningham (Coventry South) (Lab)]

I will just make one or two observations because my hon. Friend the Member for Coventry North West (Mr Robinson) has covered the subject very well. Like him, I have received representations. Since the last reorganisation of the NHS, problems such as this seem to be coming to light. There is a pattern. There was the problem with Concentrix and benefits, which of course is nothing to do with the NHS. We had debates about that a couple of weeks ago. Now this problem with Capita and primary care support is emerging.

When the Government look at such companies, they should look at a schedule of terms and conditions for the service they are going to deliver, the people they are going to employ and their qualifications, and whether people will be employed on zero-hours contracts. I have heard all sorts of stories about companies that subcontract out to smaller companies. That is where the problems start to arise.

There was a ruling a couple of weeks ago on taxis after a case was brought by a trade union. It may well mean that there will be a problem with zero-hour contracts, holiday pay and so on. The Government should look at that when they award contracts.

Like my hon. Friend, I have had GPs in Coventry complain to me about the inadequacy of the services, delays across the board and records being lost. Even the British Medical Association has accused Capita of failures. These delays are making it impossible for GPs’ surgeries in my constituency and across the country to do their job properly. For example, a surgery in my constituency faced delays in receiving patients’ notes. As my hon. Friend has mentioned, that can go on for a long time, and if someone is terminally ill, the situation can be life-threatening. Doctors sometimes have to meet patients without records or knowledge of their medical history, so they have to rely on the patient to provide their history. Patients at the end of the day are not doctors; they can only express in layman’s terms what they think is wrong with them. They need qualified doctors.

[Colleen Fletcher]

Does my hon. Friend agree that the difficulties experienced by GP practices are being compounded by the inability of Primary Care Support England service centres to deal with inquiries about ongoing problems either by phone or email? Staff from one practice in Coventry said that any response to emails was unusual, long-awaited and often failed to address the question posed. This type of comment is echoed time and again by exasperated practice staff across the city.

[Mr Cunningham]

My hon. Friend puts it very adequately. I and all my colleagues behind me have all experienced that and the Minister as a constituency MP may well have experienced something like that because it is widespread.

At the end of the day, GPs are having to bear the brunt of the failings of Capita. It is unacceptable that a private company can bid for an NHS contract without the infrastructure in place to deliver. I have already explained to the Minister what that means. Will she allow GPs to be given additional support and help to cope with overstretched services? As I said, a lot of this came about with the last reorganisation of the health service. When people provide a service that is funded on the basis of a policy of cuts, they can expect people to take shortcuts. The patient is important, the GPs are important, but the employment rights of those people who are subcontractors or sub-subcontractors should be upheld.

The Minister should really look into this. I detect a pattern of Government contracting out of services and problems developing with those services. I have already mentioned the problems with the benefit service. Sometimes services are contracted out because Ministers do not want to be answerable at the Dispatch Box. We have had that in the past. The Minister says, “I am not responsible.” We try to get through to the company that is providing the service for the public; we cannot get through to them and the Government pass the buck. I had that last Christmas with Concentrix, but that is another debate. I will end my comments there.