Social Care (Local Sufficiency) and Identification of Carers Bill

Kerry McCarthy Excerpts

Friday 7th September 2012 Commons Chamber

[Barbara Keeley]

I have not followed that as closely as I might have done, so I hope that we will hear from my hon. Friend later about the practice in Wales. However, we have much to learn from other countries.

It is important that we bear in mind the shrinking provision of social care because we know that demand is growing. Since 2010, local councils’ adult social care budgets have been cut by more than £1 billion, and a further £1 billion of cuts is expected. The number of vulnerable older and disabled people who have their home care services fully paid for by their local authority has fallen by 11% over the past two years. According to a survey by the Care and Support Alliance, services have been cut to 24% of disabled adults. Research by Age UK shows that cuts to council budgets mean increased fees for services—in fact, service fees have increased by 13% over two years. Almost half of all local councils are charging more, or making new charges, for home help or day care. One in six councils has reduced personal budgets for care packages, and almost half of all councils have frozen the rates that they pay for residential care. In addition, the fees for both residential care and nursing home care have increased by 5% on average during the past year.

Those are important statistics, but sadly they are not routinely gathered so that they can be scrutinised by, for example, the Health Committee. They were mainly gathered through freedom of information requests by my hon. Friend the Member for Leicester West (Liz Kendall) and various organisations. Local authorities do not have a full picture of local care provision, particularly that needed by the 80% of care users who are self-funding. Those self-funders—people whose assets exceed the means test for local authority support—spend £5.5 billion a year on care, with top-ups to statutory services costing them another £1.15 billion. It is vital that we have a better and more complete picture of social care provision, including that very large amount for self-funders.

Clauses 1 and 2 introduce a strategic duty on local authorities in England to ensure that sufficient social care services exist in their local area to meet the care needs of disabled people and carers. They seek to move towards local authorities having a total and accurate picture of what is purchased and provided in their area. Existing duties on local authorities relate only to those for whom the local authority has a statutory responsibility—disabled people and carers who meet eligibility criteria and who do not exceed means-testing thresholds.

It might be argued that the Government’s draft Care and Support Bill introduces a duty on local authorities to establish and maintain the provision of information and advice relating to care and support for adults and carers. The draft Bill says that a local authority must promote the efficient and effective operation in its area of a market in services for meeting care and support needs. However, that duty does not cover an assessment of local sufficiency, and it is that picture that can truly help carers and disabled people, particularly in terms of working, as we have just discussed.

Andrew Dilnot, in his 2011 report, set out the need to place duties on local authorities to provide information, advice and assistance services in their area, and to stimulate and shape the market for services. Moving to embrace a duty to develop a full picture of care and support services, and to assess the sufficiency of those services, will assist local authorities in developing their role as market shapers.

Clause 2 includes a duty to promote sufficiency of the supply of care, which, as we have discussed, would bring a new focus on the importance of social care in promoting and enabling work for disabled people and unpaid family carers. Carers UK has analysed local authority joint strategic needs assessments, which is really the only assessment that we have, but this analysis has shown that the majority of those assessments do not link care provision with work, so clause 2 would link well with Government strategies around work for carers and people with disabilities.

[Kerry McCarthy (Bristol East) (Lab)]

A couple of weeks ago in my constituency, I met a group of young adult carers aged from 18 to 24 who, for the most part, look after disabled parents, but sometimes siblings as well. They have particular needs because they are at the stage when they want to get on with their careers and perhaps go to university, and they have to make the choice between that and putting their life on hold to care. Does my hon. Friend agree that we need particularly to look at the needs of that group, who do not fall into the same category as other adult carers?

[Barbara Keeley]

I do, and I will come on to the issue of student carers. The Bill explores student carers for the first time. I do not know why the issue has not been discussed more in the House, but it is vital that we, as constituency Members, take note of it.

Joint strategic needs assessments done at local level do not link care provision with work, and that is why the clause is important. The Department of Health has an upcoming event on developing care markets, the invitation to which we received yesterday. It says:

“the ability to choose from a variety of high-quality services should be available to all people in a local area, regardless of who pays for their care.”

Age UK, in its support for my Bill, commented on that Government aim to give people who need care and support a greater choice. It said:

“this cannot become a reality unless local care markets work effectively to provide people, including those with specialised needs, with appropriate services. Whilst we welcome proposed duties in the draft Care and Support Bill that would require local authorities to take steps to ensure that appropriate services are available this falls a long way short of a requirement to ensure sufficiency. We will certainly be advocating for a Bill or subsequent regulations that will include more specific duties on local authorities.”

People with Learning Disabilities (Abuse)

Kerry McCarthy Excerpts

Monday 3rd September 2012 Commons Chamber

[Mr Clarke]

I am grateful to my hon. Friend. On these matters she shows a great humanitarian understanding, and the very point that she raises was raised with me today by families who came down to London from all over the UK because of this debate. My hon. Friend should know that she has considerable support.

The harrowing examples that are given, and there are many more, of depraved activity that some will inflict on the most vulnerable among us are almost impossible to comprehend. My hon. Friend outlines some of the reasons for that. The courts will deal with those responsible, and that is how it should be. Families of the victims may find solace when the guilty are sentenced, but what of those who seek no vengeance? What of those who take the view that such abuse should never have happened and want to know why it did happen? It is fair to say that we all want to know who was responsible for presiding over this human crisis. How far and how wide does culpability spread?

We cannot erase the evidence of abuse, where and when it happened. We cannot undo the pain, the suffering and humiliating experience endured by people with learning disabilities, and we most certainly cannot leave it to the monolithic bureaucratic machine to ensure that such abuses never occur again. We have completely and unmistakably failed to protect adults in many aspects of their character where we see that their mental capacity is that of a child.

Winterbourne View was operated by a company called Castlebeck Care Ltd, which charged the public purse an average of £3,500 per patient per week for the services that it provided. For that amount of money, a person could stay in the Ritz hotel. For that amount of money, Castlebeck Care Ltd saw a turnover of £3.7 million per year from Winterbourne View. We should know what that money was spent on. We do not know, but the Department of Health should be able to solicit this information and put it into the public domain—again, a point that the parents whom I met today made loudly and clearly. It is only then that a proper, informed judgment can be made of whether the reason for being of those who are providing such services is the pursuit of profit or patient care.

As I said, I met today families who related their own experience. What they told me is that questions and challenges must be addressed to local councils and local health authorities, which have a crucial role. The Improving Health and Lives organisation published a report written by Professor Emerson of Lancaster university, which analysed the Care Quality Commission’s investigations into 150 care providers. Professor Emerson established that only one in seven patients were being supported in an environment that was fully compliant with statutory regulations. He also established that units operated directly by the NHS were more likely to be compliant than those that were out to make a profit. Half the units investigated did not meet those important statutory levels of care.

The Care Quality Commission knew exactly what was going on. Reading through the material, it is impossible not to conclude that its inaction was simply shocking. It presided over the shambolic and chaotic delivery of vital care services. It was appalling when not even lip service was paid to the adherence to statutory regulations or the basic minimum levels of care. Prior to the abuses at Winterbourne View, there were months and months when the commission carried out no inspections at all. Its self-described “light-touch regulation” is part of the reason these abuses occurred. Winterbourne View was inspected only once every two years in the absence of any complaints. Clearly, that is profoundly unacceptable. The commission was also affected by the coalition Government’s civil service recruitment freeze, which resulted in it having fewer inspectors than it clearly required.

Inspectors must increase the pressure in care units that are underperforming. Inspections must occur more regularly and without warning. There must be stiffer penalties for care providers for non-compliance with their statutory obligations. The commission must be relentless when it comes to investigating care providers that cause concern. Of course, as we all know, Winterbourne View was closed down, but how many people know that Castlebeck Care Ltd had two other units closed down as a result of serious concerns about the level of care? The “Panorama” documentary not only exposed Winterbourne View; it laid bare the unbelievable ineptitude of the commission, which was utterly incapable of taking action in all three units before the scandal was exposed. In my view, the new mantra should be, “Inspections will occur anywhere at any time and without prior notice.”

[Kerry McCarthy (Bristol East) (Lab)]

My right hon. Friend talked about meeting the parents of the patients in the care homes. One of the concerns that have been raised with me is that of elderly parents who care for children with learning disabilities. In particular, my constituent Ivor Needs has a son who is vaccine damaged. Because Winterbourne View is in the vicinity of my constituency, they are really concerned because they have no confidence that the system will be able to look after their child when they are no longer around to do so. Does my right hon. Friend agree that we need some system in place to ensure that people such as Ivor’s son, Matthew, are looked after when their parents are no longer around to do so?

[Mr Clarke]

My hon. Friend makes an excellent point and, yes, she is correct. That point was raised with me today several times. Over the years I have certainly had many letters from parents who simply ask, “What will happen to our children when we are no longer here?” I am sorry to say that, on this evidence, I worry very much indeed.

There must also be a review to ensure that the current funding system does not incentivise the keeping of patients for long periods at assessment centres. If adults with learning disabilities are better treated and cared for in their own communities, there has to be a support network. Having local care units that are integrated into local treatment centres is a better model than dispatching patients for assessment hundreds of miles away from their friends, families and communities.

We cannot ignore the voices of the 86 leading figures and charities in the care sector who have stated that the current model poses a real risk that similar abuses will occur in future. Enhanced sentences rightly already exist for those found guilty of racism and homophobia. To begin the process of moving to local integrated units, the Government should begin closing large assessment centres and set a time scale. Local commissioners should develop local services that meet the care requirements of those with learning disabilities.

Sadly, those issues were identified long before the scandal emerged. The late Professor Mansell’s report “Services for People with Learning Disabilities and Challenging Behaviour or Mental Health Needs” was clear in its analysis and prescribed remedy.

The current care model, and the regulation of it, led to these abuses. It is the system that we are challenging. Simon spent 15 months at Winterbourne View and was hit, pushed, abused and tormented. When he cried for help, we collectively let him down. Then there is the experience of James, a child with a learning disability and autism who suffered abuse and neglect. When James needed help, we collectively let him down. Chrissy suffers from various conditions such as autism and epilepsy as well as from challenging behaviour. When Chrissy needed help, we collectively let her down. There is also Victoria, whose father died before she was nine years old. She suffered a lot of family stress. When Victoria needed care, we collectively let her down. Emmanuel, only six months out of school, was sent away to a unit far away from his family, where he remained for 18 months. All those people, and many more, have been collectively let down.

The scandal, highlighted so bravely by Terry Bryan, is predicated on the notion that if people want to abuse someone, they will, under the present system. The status quo is no longer a tenable option. I trust that the Minister will recognise that we need Government intervention to tackle and cure the cause of abuse. We never want a repeat of Winterbourne View or any similar home in today’s or tomorrow’s Britain. We want public support for our efforts in caring for and protecting people with learning disabilities. We must never collectively let them down again.

Oral Answers to Questions

Kerry McCarthy Excerpts

Tuesday 17th July 2012 Commons Chamber

[Paul Burstow]

I am grateful to my hon. Friend for asking that question. The NHS Commissioning Board is currently conducting a review of the effectiveness of clinical networks, and the scope for expanding them. It includes examining the case for neurological clinical networks, and a report should be published very soon.

[Kerry McCarthy (Bristol East) (Lab)]

T4. In yesterday’s debate, when talking about the south-west consortium, the Minister of State, the right hon. Member for Chelmsford (Mr Burns) emphasised the need for negotiations and agreement with staff. Does the Secretary of State not think it was shocking that staff found out only through a series of freedom of information requests that the consortium existed, and can he tell me when the Department of Health first found out about the consortium?

[Mr Lansley]

I will gladly write to the hon. Lady about when we were first aware of the consortium. I think it was several weeks ago; indeed, the document referred to prominently in the press on Sunday had been on websites for some weeks, so there is nothing new about that. We knew about it. I reiterate the point that I and my right hon. Friend made yesterday: even though under a Labour Government, in the 2006 legislation, powers were given to trusts to take their own decisions on the employment of staff, they must do so in negotiation with the staff side. We would expect that. From my point of view, the South West Pay Consortium is rightly looking to maximise flexibility, but I have made it clear to the pay review body that we believe that the flexibility it needs can be delivered through negotiations and “Agenda for Change”. It will not and should not require the reduction of pay for staff.

National Health Service

Kerry McCarthy Excerpts

Monday 16th July 2012 Commons Chamber

[Kerry McCarthy (Bristol East) (Lab)]

rose—

[Mr Burns]

The hon. Lady only recently walked in. She has not been here from the beginning.

I call on the unions to respond positively to the issue and the national discussions on “Agenda for Change”. I also hope that the Opposition will support the policies that they put in place when in government.

The Opposition have used this debate to make yet another sorry attempt to paint a distorted picture of the NHS. That is wrong. The shadow Secretary of State pours scorn on the performance of the NHS, while we admire the excellence of the staff; he belittles their achievement while we laud them; he scaremongers, while we present the truth more transparently than at any other time in the history of the NHS.

The accusations in the motion are simply wrong, and I ask my right hon. and hon. Friends to join me in the Division Lobby at the end of the debate to defeat the motion.

NHS Risk Register

Kerry McCarthy Excerpts

Wednesday 22nd February 2012 Commons Chamber

[The Minister of State, Department of Health (Mr Simon Burns)]

We have had an interesting debate. The number of right hon. and hon. Members taking part has shown the interest in it. I congratulate Opposition Members who have made speeches—unfortunately, so many spoke that I cannot go through all their speeches—on sticking meticulously to the line in the parliamentary Labour party briefing. They repeated meticulously the mistakes and wrong information in it.

I have a degree of sympathy for the right hon. Member for Leigh (Andy Burnham), because very early in the debate his predecessor as Secretary of State for Health, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), seemed to hole his argument below the line when he came out with what was a rather surprising statement at the time, although having listened to the winding-up speech of the hon. Member for Leicester West (Liz Kendall) it does not seem that surprising. He said that the risk register was a second-order issue. Given that the debate is about the risk register, that struck me as rather odd.

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer) on an excellent speech. As we listened to more Opposition speeches, his speech began to strike a strong chord that risk registers could be misinterpreted and become a charter for shroud-waving.

I congratulate my hon. Friend the Member for Kingswood (Chris Skidmore), who with great logic and clarity argued an overwhelming case, and I was delighted to hear yet again a speech from the hon. Member for Easington (Grahame M. Morris). A health debate without a contribution from him would be a severe loss. No doubt the news editor of the Morning Star will be fascinated with his comments. I also congratulate my hon. Friends the Members for Boston and Skegness (Mark Simmonds) and for Gillingham and Rainham (Rehman Chishti).

I am disappointed that the right hon. Member for Leigh has decided to politicise a topic that, at its core, is not really about health. The question of publishing risk registers has implications that will be felt across the Government. For the reasons I shall outline, risk registers have implications for the successful running of a parliamentary democracy.

The right hon. Gentleman knows that by heart already, but let me tell him again, in plain English, one last time. The reason why risk registers are not released is the same now as it was when he was in government: if their contents are taken out of context, they could be misleading for parliament and the public.

As many hon. Members have mentioned, the right hon. Gentleman cleared the line in a letter sent from the Department of Health on 1 October 2009, when refusing to publish a departmental risk register. He rightly said that there was a

“public interest in preserving the ability of officials to engage in discussions of policy options and risks without apprehension that suggested courses of action may be held up to public or media scrutiny before they have been fully developed.”

Releasing the risk register is directly contrary to the public interest he described. As he knows, risk registers outline any conceivable situation, however improbable, on the subject they are evaluating. Any risk at all, even the most minuscule or unlikely thing, is included. They help the Department to see the possible pitfalls and to ensure that they do not happen.

This case has implications not only for the Department and Whitehall, but across all levels of government. As hon. Members will know from the debate, risk registers are essential because they are records of frank discussions between Ministers and civil servants on policy formulation. If a precedent were set for those records to be made public, it follows that such discussions and conversations would be a lot less open and a lot more guarded. That would mean that policies might develop with a lot less candid thought and debate than they do now. That might have been the argument under the previous Government, but the reason prevails and the argument is the same today.

The right hon. Gentleman understood that argument when he was Secretary of State for Health. Similarly, the right hon. Member for Wentworth and Dearne (John Healey), who made an interesting speech, understands it. That is why, regardless of what he said in interventions today, during his time in the Treasury—

[Kerry McCarthy (Bristol East) (Lab)]

Will the Minister give way?

Oral Answers to Questions

Kerry McCarthy Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Lansley]

My hon. Friend will know that it is the policy of the NHS not to use compensation agreements in order to suppress information that is in the public interest, and I will certainly write to him about the case that he raises.

[Kerry McCarthy (Bristol East) (Lab)]

T4. Before the election, the Conservative party and the then shadow Health Secretary received substantial donations from the chairman of the private health company Care UK and his wife. Does he agree with the then Liberal Democrat health spokesman, the hon. Member for North Norfolk (Norman Lamb)—who has now been promoted to Minister—when he said:“This is a staggering conflict of interest which completely undermines the Tories’ claim that the NHS would be safe in their hands”?

[Mr Lansley]

If not abuse, then smear. I never received any money personally from the chief executive of Care UK. The Conservative party solicited and received donations that were declared in the normal way. They had no influence, and we would never permit any such influence over our party’s policies.

Oral Answers to Questions

Kerry McCarthy Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

I am interested to hear my hon. Friend’s experience. I certainly look forward to hearing more from him about it, and to taking it on board in considering how we respond to those obviously tragic victims.

[Kerry McCarthy (Bristol East) (Lab)]

19. What assessment he has made of the effects of publishing his Department’s strategic risk register on his restructuring of the NHS.

[The Minister of State, Department of Health (Mr Simon Burns)]

Publishing the Department’s risk register would have implications beyond the Department of Health, and we are taking the time granted to us by the Information Commissioner before deciding whether to appeal against his decision requiring its release.

[Kerry McCarthy]

I think I thank the Minister for that response, which at least gives some indication of where the Government are coming from. But, given the widespread concern among the public about the risks posed by the Health and Social Care Bill, and given that the Information Commission has ruled that the register should be published, does the Minister not think that it should be published before Report stage in the House of Lords, so that at the very least the findings can be used to inform the amendments being tabled to rescue the Bill even at this late stage?

Oral Answers to Questions

Kerry McCarthy Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Lansley]

Happily, I can entirely confirm that.

[Kerry McCarthy (Bristol East) (Lab)]

This review came about as a result of the tragic Bristol heart babies scandal in the 1990s, and it is a measure of the quality of services at Bristol children’s hospital that it is now being considered for all four options under the consultation. A few weeks ago, I abseiled down the children’s hospital for Wallace & Gromit’s Grand Appeal, which is an excellent charity. However, will the Secretary of State assure me that, with the move to fewer and larger specialised units, they will be properly funded and will not rely on MPs throwing themselves off tall buildings?

[Mr Lansley]

I am grateful to the hon. Lady. All the representations that we have received in the debates in this House are ample evidence of the high regard and support that Members have for their children’s heart surgery services. None of this is about saving money or resources. It is entirely about what delivers the best quality surgical services for children with cardiac problems. To that extent, the intention is that those services—once the decision has been made—are fully funded.

--- Later in debate ---

[Mr Lansley]

Yes, my hon. Friend is absolutely right; indeed, we are extending the range and frequency of the publication of data relating to infections to support the NHS in that work. With his commendable consistency, my hon. Friend asked a question on exactly this subject on 8 March, when he raised the issue of the Barking, Havering and Redbridge trust. I am pleased to be able to report that in the past five months C. difficile infections in the trust have fallen by 57% in comparison with the same five months of 2010, while MRSA bloodstream infections have been reduced by 25%. I expect the trust to continue to bear down on those and other infections in future.

[Kerry McCarthy (Bristol East) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improved health outcomes in England; to lead a public health service that improves the health of the nation and reduces health inequalities; and to lead the reform of adult social care which supports and protects vulnerable people.

[Kerry McCarthy]

In the wake of the former Defence Secretary’s resignation and the fact that 40 peers who voted on the Health and Social Care Bill have private sector health interests, and given the Secretary of State’s known connections with private health care companies, can he assure the House that he has been as transparent as possible about the influence of private health care companies on the passage of the Bill?

Oral Answers to Questions

Kerry McCarthy Excerpts

Tuesday 12th July 2011 Commons Chamber

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

I am happy to join my hon. Friend in congratulating those who are making efforts locally. As he will be aware, public health services will move to local authorities, and I am sure those efforts will continue. Some 80,000 people a year die of smoking-related disease, and 320,000 young people are taking up smoking each year. We must not only help those who are smoking to stop but prevent young people from taking it up.

[Kerry McCarthy (Bristol East) (Lab)]

The number of patients waiting more than four hours in A and E went up by 76% in the past year, which is an extra 200,000 people. I think we all know what a hellish experience waiting in A and E can be. Does the Secretary of State agree that that is a backward step, and that he ought to take steps to rectify it?

[Mr Lansley]

Shortly after the election we took clinical and expert advice that made it very clear that the expectation that 98% of patients should be seen within four hours was not clinically appropriate in some cases, so we relaxed the 98% limit to 95%. As it happens, I believe that according to the latest data, between 97% and 97.5% of patients are being seen in under four hours.

Winterbourne View Care Home

Kerry McCarthy Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

I mentioned in my statement that each of the individuals who have been affected in this terrible way have advocates. The hon. Lady makes an important point about the role that advocacy plays for those who lack capacity or the ability in certain circumstances to advocate on their own behalf. We are looking at that as part of the overall reforms of health and social care, but as for a precise sum of money, I do not have a figure in my head that I can give her now. I will write to her on that point.

[Kerry McCarthy (Bristol East) (Lab)]

My elderly constituent, Mr Ivor Needs, has been looking after his vaccine-damaged son, Matthew, for many, many years. Ever since I became an MP, he has been expressing concern to me about what will eventually happen to Matthew when he is no longer able to look after him. How can we reassure people such as Mr Needs that the Government are pulling out all the stops and doing all they can to ensure that care homes in the Bristol and south Gloucestershire area will be fit for purpose and a fit place for him to entrust the care of his son?

[Paul Burstow]

I entirely understand that question. I suspect the hon. Lady speaks for many who saw the programme and therefore fear for their loved ones who may be in other institutions. That is why we have to act in a thorough and thoughtful way, why we have to act quickly, and why the various processes that I described today are the best way to reach conclusions quickly. Because of the separate criminal inquiry, a separate independent inquiry would not be able to start until those judicial processes had been completed. That is why we want the internal processes to go forward. We have provided external scrutiny to make sure that they deliver what we all want—greater assurance that the system will deliver the best quality care for our loved ones.