Breast Cancer Screening

Maria Caulfield Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

We have not had conversations at ministerial level, but we have had conversations at official level. The Welsh Administration do not believe this problem has affected them, even though Wales was using the same IT system we were using in England. Our concern is about people living in England who are registered with a Welsh GP or people living in Wales registered with an English GP. That is why we are having constructive discussions to share IT information and make sure everyone in England or Wales registered with a GP will get that letter.

To respond to the earlier question about what people should do now, anyone is free to call the helpline number, which will be made public today, but we are hoping to get the letters out as quickly as possible over the next four weeks, during the month of May, so that everyone can be pretty confident that they are okay if they have not received one of those letters.

[Maria Caulfield (Lewes) (Con)]

I welcome the Secretary of State’s announcement today that there will be an independent review; it is important that women have confidence in the screening programme. As someone who worked in breast cancer for over 10 years before being elected, I gently say to women that the screening mammogram is just one tool in the early detection of breast cancer and that if they notice a change in the interval of three years between mammograms they must seek medical advice. Also, not all mammograms pick up breast cancers, so they must not just rely on screening mammograms.

[Mr Hunt]

I thank my hon. Friend for her excellent advice, which gives me the opportunity to repeat that the advice for women about looking after their breasts and making sure they are alert to potential breast cancer remains unchanged. All women should take great care over this and should always come forward to see their GP or local cancer service if they have any concerns or doubts.

Social Care

Maria Caulfield Excerpts

Wednesday 25th April 2018 Commons Chamber

[Barbara Keeley]

I will indeed, because given the cuts that many councils have been facing—I am sure Bristol is the same—these efforts to protect care services are really excellent.

I was talking about those London boroughs that have committed to pay care staff the London living wage, which, at £10.20 an hour, is way above the Government’s so-called living wage of £7.83—a commitment that is no small undertaking. That is a further example of the good that Labour-run councils are doing for the most vulnerable people in their communities. We on this side of the House—this ties in very much with the point that my hon. Friend has just made—see the need for social care to be valued as a career. At last year’s general election, Labour pledged to implement the real living wage for all care staff and to ensure that care staff were paid for travel time, that 15-minute care visits were scrapped and that zero-hours contracts were ended for care staff. Those are important steps, but we know that we have to go much further if we are to improve care quality.

It is clear from the reports of the Care Quality Commission that staffing levels are still a major issue in those care services rated as inadequate or requiring improvement. Much of the care workforce are underpaid, undervalued and overworked, which leads to high turnover and vacancy rates in the sector among care staff and, more importantly, the registered managers who are responsible for overseeing care quality. Improving pay for care staff will help with that, but we also need to commit to improving care staffing levels to reduce the workload pressure and offer better training and career paths.

The National Audit Office has criticised the Government for failing to have an up-to-date workforce strategy for the care sector and for their lack of oversight of workforce planning in local areas. Indeed, the Government have no major workforce strategy for social care. It was the Labour Government who produced the last strategy, in 2009. The head of the National Audit Office has said:

“Social care cannot continue as a Cinderella service—without a valued and rewarded workforce, adult social care cannot fulfil its crucial role of supporting elderly and vulnerable people in society.”

Skills for Care has a budget of only £21 million for care staff training, whereas Health Education England has a budget of £4.7 billion. That disparity in budgets between health and social care says it all about the Government’s lack of priority for improving the quality of social care.

At the 2017 election, Labour pledged an extra £8 billion for social care across this Parliament, with an extra £1 billion to ease the crisis in social care this year. That aimed to relieve the pressure on the social care system. It would have been enough to begin paying care staff the real living wage and would have sought to offer more publicly funded care packages for people with different levels of need. Today’s debate is not primarily about the long-term funding of social care, but Labour has made it clear that maintaining the current funding system is not an option in the long term. Recently, polling by the Alzheimer’s Society has shown that paying for social care is a growing public concern and that there is overwhelming public support for a cap on care costs. The next Labour Government will implement a lower cap on care costs than the cap set under the Care Act 2014. We will also raise the asset threshold to a higher level than under the current system.

[Maria Caulfield (Lewes) (Con)]

I am listening with interest to the hon. Lady’s opening remarks. I am obviously interested in the cap, in paying care workers more and in raising the threshold, but how would a Labour Government pay for that?

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[Caroline Dinenage]

I am happy to answer the hon. Lady’s questions, which she is right to ask. Although we are very hopeful that this procedure will have a positive result, we are taking steps to ensure we are prepared for all eventualities. The Care Quality Commission and my Department are monitoring the situation, and the CQC will notify local authorities in the event it considers it likely that services will be disrupted as a result of business failure. The law means that local authorities will step in to meet individuals’ care and support needs if a care provider business fails and its services are disrupted. The relevant local authorities are working up contingency plans to ensure individuals’ care and support needs continue to be met.

While the long-term options are being resolved, it is right that funding for social care comes from a variety of sources, including business rates, general taxation and the social care precept. Delayed transfers of care is one area where that money is clearly making a difference. This Government are clear that no one should stay in a hospital bed for longer than is necessary; doing this removes people’s dignity, reduces their quality of life and leads to poorer health and care outcomes.

[Maria Caulfield]

My local East Sussex County Council is a rural authority, so for decades it has had 49% less funding per head of population, yet it has had the same pressures as the areas represented by Opposition Members. By working together with health services, my council has reduced delayed discharges by 38%. Will the Minister welcome the hard work of East Sussex County Council?

[Caroline Dinenage]

I do welcome it. I recognise the very hard work of local councils that have managed to reduce delayed transfers of care. Indeed, I also recognise the very hard-working NHS staff, such as my hon. Friend, who have also helped to make that a reality.

We know that the NHS is busier than ever before, with hospital admissions rising by 33% since 2007, yet we have set clear expectations for reducing delayed discharges. Despite these challenging circumstances, both the NHS and social care have been working hard to free up beds. Since February 2017, more than 1,600 beds per day have been freed up nationally. I need slightly to take exception to the way the hon. Member for Worsley and Eccles South described people being discharged before they are medically fit. If someone is experiencing a transfer of care that has been delayed, it is because a multi-agency team have already assessed them as being medically fit for discharge.

NHS Staff Pay

Maria Caulfield Excerpts

Wednesday 21st March 2018 Commons Chamber

[Mr Hunt]

What led to the mushrooming agency fee was the realisation, post Mid Staffs, that we needed a lot more nurses. Nursing staff numbers were going down until the Francis report was published, but the report created huge demand among hospitals, which realised they needed to improve patient safety by recruiting more staff. The hon. Gentleman will be pleased to know, however, that we are bringing down the agency bill, and I expect it to be significantly lower this year.

[Maria Caulfield (Lewes) (Con)]

It is disappointing to see the lack of welcome from Labour Members for this pay rise for NHS staff in England—one day after the announcement of five new medical schools across the country. Has the Secretary of State had discussions with the Labour Government in Wales to see if they will be replicating this pay rise for NHS staff in Wales?

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 20th March 2018 Commons Chamber

[Steve Brine]

Obviously, everybody in the House is aware of this case, and our thoughts are with Alfie and his family. The policing Minister has met Alfie’s family and discussed options that may assist him. No decisions have been made, and any proposal would need to be led by Alfie’s clinicians using sufficient and rigorous evidence.

[Maria Caulfield (Lewes) (Con)]

Despite not hearing it from Opposition Members, I am sure that all Members in this House welcome the five new medical schools announced today. Will the Minister also welcome the extra medical school places in Brighton and Sussex Universities, supporting my constituents, and the launch last week of the new nursing apprenticeship scheme by the University of Brighton, which will enable more nurses to enter the profession?

NHS Winter Crisis

Maria Caulfield Excerpts

Wednesday 10th January 2018 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

I regret that Opposition Members have continued to politicise this issue. I speak as someone who has worked in the health service for more than 20 years. I worked in A&E under the previous Labour Government and coped with the winter pressures—when there were ambulances queuing round the block, when major incidents were declared because we could not take in any more patients, and when patients were cared for in corridors, including cupboards, and left lying on floors on makeshift mattresses. To continue to blame one Government or the other does nothing for patients or staff. If we continue down that route, we will be here not just next year or the year after, but in five, 10 or 15 years’ time.

This is not just about throwing money at the problem. We have heard today that Wales gets 8% more funding per person than the rest of the UK, yet it is also facing pressures this winter. Hospitals there are also cancelling operations and appointments, so this is clearly about not just funding, but what is done with the money.

I pay tribute to my local health service. In a debate at this time last year, I asked why the two trusts in my constituency were not coping when a neighbouring trust in Worthing was able to cope with virtually all its patients. A year later, after the imposition of special measures, after the CQC put in extra resources, and after a new management team were put in place, I am proud that both my local hospitals have coped with not just a 6% increase during non-winter periods, but an 11% increase in the number of patients not just visiting A&E but being admitted to A&E. They have not had to cancel hospital appointments, they have not had patients waiting in corridors and they have not had ambulances queueing round the block.

That tells me that this is not just about how much money people put into the service; it is about what they do with that money. Let us look briefly at what my local trust has done to stop the crisis which seems to have happened in other parts of the country. NHS staff, including doctors, nurses, porters and ambulance staff, have worked tirelessly throughout, and I pay tribute to them. It is also about the management, and the new management teams in Eastbourne and Brighton have done tremendously well to turn those services around.

It is also about better planning. My local community health trust has seen a 38% reduction in delayed discharges, so going into the winter period, it had an occupancy rate of about 84% in acute hospitals. That was achieved by working together with community services. A major Government or departmental reorganisation is not needed; change can be achieved by working locally, which is what the trust is doing.

This is also about working with social services on social care. Opening up 40 community beds in Newhaven has taken a huge amount of pressure off local hospitals, and both my trusts say that the emergency money provided this winter—nearly £2 million to each hospital trust—has enabled them to keep those beds open. It has enabled patients to be admitted to the acute centre for treatment, and then moved to the community hospital and be discharged safely and securely.

We need to look at capacity. If there is going to be an 11% increase year on year in the number of patients coming through the door, the solution is not just providing more money; it is about looking at the service and how it is delivered. My local trusts have done it, and there is no reason why that cannot happen in the rest of the country. Once again, I pay huge tribute to Brighton and Eastbourne Hospitals.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

I am afraid that the hon. Gentleman will have to wait until the result of that consultation is published. I visited the trust last week, although I went to the Romford end of it, and I think that it is making great strides in improving the quality of care. I congratulate all the staff at the trust on what they are achieving.

[Maria Caulfield (Lewes) (Con)]

13. What steps his Department is taking to reduce suicide rates.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

We remain committed to reducing the national suicide rate by 10% by 2020, and our record investment in mental health will ensure that we can achieve that ambition. Local suicide prevention plans now cover 98% of the country, and we updated the cross-government suicide prevention strategy in January to strengthen key areas for action, including by focusing on self-harm as an area in its own right.

[Maria Caulfield]

My constituent Justin Bartholomew, a young man of just 25, recently committed suicide by hanging himself. His family are convinced that the high-energy drinks that he was taking—more than 15 cans a day—increased his anxiety and contributed to his suicide. As there is growing concern about the safety of such energy drinks, may I ask the Minister what assessment of that the Department is undertaking?

[Jackie Doyle-Price]

I thank my hon. Friend for sharing that very moving case. We have no evidence at this stage that those drinks cause such outcomes, but we know that all stimulants, whether alcohol or caffeine, have consequences that can affect people’s mental health. That is something that bears examination.

King’s College Hospital Foundation Trust

Maria Caulfield Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

I share the hon. Gentleman’s support for the staff, and I have already paid tribute to the hard work and commitment that they are showing to their local population. His question regarding a royal commission is rather beyond the scope of this urgent question and rather above my paygrade.

[Maria Caulfield (Lewes) (Con)]

We do have a problem with NHS managers; not only are there too many of them, but many lack clinical skills, which is probably why they make so many bizarre decisions. On Lord Kerslake’s watch, £715,000 was spent off payroll last year on an interim director, and £30,000 a month was spent on temporary managers. There is a problem with this scandalous waste of taxpayers’ money.

[Mr Dunne]

My hon. Friend takes a close interest in what is happening in London’s hospitals, where she regularly works shifts. From time to time, there is a need for some interim managers to fill vacancies and gaps, but she is absolutely right that we have taken significant action to limit the excessive amounts that some have been paid. The amounts have now been capped and are being driven out of the service, and the interim mangers are being encouraged to take up substantive positions.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

Let us be clear: we took the difficult decision on nurse bursaries precisely so that we could have the biggest expansion in nurse training places we have ever had. When we had the higher education reforms in 2011, which the right hon. Gentleman’s party opposed, we also saw a drop in initial applications, but then we saw them soaring to record levels. That is what we want to happen with nurses, because we need more nurses for the Royal Devon and Exeter, and all the hospitals that serve our constituents.

[Maria Caulfield (Lewes) (Con)]

I welcome the apprenticeship route and the associate nurse route into nursing because living on a bursary of £400 a month is no fun, believe me. However, will the Secretary of State look at nurse training so that when nurses qualify they are able to take on courses such as venepuncture and cannulation as soon as possible? Many student nurses and newly qualified nurses are frustrated that they cannot be used in those roles.

[Mr Hunt]

I will certainly look into that. Of course, my hon. Friend understands this issue better than many in this House. The really exciting change is that it will now be possible for healthcare assistants who could make fantastic nurses to progress to being nurses without needing to take out student loans because they will be able to carry on earning while they learn. That will open up big opportunities for many people.

NHS Pay

Maria Caulfield Excerpts

Wednesday 13th September 2017 Commons Chamber

[Chris Philp]

rose—

[Maria Caulfield (Lewes) (Con)]

rose—

[Jonathan Ashworth]

The hon. Lady has often spoken out on this matter, so I feel I should take her intervention, but then I will make progress, if the House will indulge me.

[Maria Caulfield]

It is generous of the hon. Gentleman to give way. As he says, I support the lifting of the pay cap and I am pleased that the Government are moving on this. My concern about supporting this motion is that Labour do not seem to have learned the lessons from crashing the economy in the first place. Could he outline what level of pay rise the Labour party is proposing for public sector workers—1.5%, 2% or 3%—and how it will be paid for? That is crucial to influencing the voting intentions of Members like me.

[Jonathan Ashworth]

I have a huge amount of respect for the hon. Lady; we have had conversations outside the rough and tumble of this Chamber, and I know she takes these matters extremely seriously. I would ever so gently say to her that she has been telling newspapers that she supports getting rid of the cap; she has been hosting nurses in Parliament, saying that she would get rid of the cap; well, this evening she has an opportunity to take a stance, ignore the Tory Whips and vote for getting rid of the cap.

[Maria Caulfield]

In this debate, we must be honest with the British public about how we are going pay for the lifting of the pay cap. If Labour wants to lift the pay cap, can the hon. Gentleman explain how the Labour party will pay for it? Will it be through increased taxation or more public borrowing, or will Labour shift spending priorities? We need to know the detail in order to be able to support this policy.

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[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). I pay tribute to her for her work on the Select Committee on Health in the previous Parliament. That work was inevitably full of expertise and always constructive; I thank her for that. I agree with her that the NHS is a team, but that team should also include the wider social care staff because we cannot continue to look at the two systems in isolation. I echo her point, thanking all our NHS and care staff for the contribution they make not just to our wider economy, but—most importantly—to patients. Those are the people we should keep at the heart of this debate.

I welcome this debate. I also welcome the relaxation of the cap because we need to give the NHS Pay Review Body greater flexibility to make recommendations about what we need to put in place for our NHS staff. I agree with the hon. Member for Central Ayrshire that we should look at the impact of pay on morale, recruitment and retention—this is an international workforce, as well as a national one—but we also need to look at pay across regions and within specialties because there is great variation. We should focus our efforts on ensuring that we are looking at the situation from the patients’ perspective by, for example, looking at the greatest areas of deprivation, which very often have the lowest ratios of NHS and care staff and who are under the greater pressure.

Seven years of sustained pressure on NHS pay is taking a toll. Nobody anticipated that it would go on for this long, so it is time to relax the cap. We should look not just at the issue of pay, but at the wider pressures within the NHS. I am delighted to announce that the Health Committee, which held its first meeting just before Prime Minister’s Question Time, has agreed that its first inquiry of the Parliament will be on the nursing workforce. We will look not just at pay, but at the wider workforce pressures, including the increased workload that comes from increasing demand across the system, morale and all the other non-pay issues that contribute to the pressures on nurses. We will also look at bursaries and the new routes into nursing, and at their impact on people entering the nursing workforce. We have heard about that already today. For example, we know that those who drop out of nursing courses are more likely to be in the younger age groups, whereas those who go into nursing as mature students are much more likely to stay. We need to look at all those wider impacts.

[Maria Caulfield]

I really welcome the news that the Select Committee is going to do a review of nursing. Will the Committee look into pay structure? The current Agenda for Change structure is being used by some trusts, in hospitals and communities, as a way of downgrading nursing roles. For example, a senior sister in one place may be paid a band 7 salary, whereas someone in the same role somewhere not too far down the road may be paid a band 5 salary. There is inequity in the current system.

[Dr Wollaston]

That is an important point. I very much hope that my hon. Friend will contribute to the Committee’s inquiry. As well as looking at the new routes into nursing, we will look at the skills mix, roles within health and social care more widely, the impact of Brexit and language testing, workload and morale. We will be seeking contributions from hon. Members across the House and from people outside.

As I said, we will miss something if we just look at the issue as one of pay. Pay restraint is estimated to contribute between £3.3 billion and £3.5 billion of the five year forward view efficiency savings up to 2019-20. If that goes, what will fill the gap? We have to be careful that there is no loss of services or losses in the workforce, because workforce pressures—probably more than any other issue—contribute to nursing staff leaving the profession. We have to look at the bigger picture.

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[Maria Caulfield (Lewes) (Con)]

I declare an interest as a nurse who has worked for over 20 years in the NHS, and who still works as a nurse on my hospital bank. I worked through 2010 to 2015, when the pay freeze and then the pay cap was introduced, so I know exactly how difficult it is to manage on a nurse’s wage and not see an increase. Inflation is now close to 3%, so it is becoming increasingly difficult. Seven years is enough for anyone to have lived with a pay cap or a pay freeze, so I support the RCN’s campaign to scrap the cap.

No political party comes out of this unscathed. There was a recognition among colleagues back in 2010 that we in the public sector had to tighten our belt if we were to protect jobs and frontline services. We recognised that we had to step up to the plate and play our part, and we did. However, we were promised by those on the Government Benches that that would be for roughly a five-year period. The Government have to take responsibility for not having tackled the deficit completely and for keeping the pay cap going. It is not fair on frontline staff that they are the ones still picking up the pieces of the mess the last Labour Government left the country in.

It is time now to scrap the cap. Nursing has changed dramatically over the last 20 years. It is now a graduate-only-entry profession. Nurses are taking more advanced roles, including nurse prescribing, and extended roles, such as biopsies and minor ops. Today is National Sepsis day. In A&E, it is often a nurse who sees a patient and, if they suspect sepsis, cannulates, takes blood, does the blood cultures and, if they have done their prescribing course, starts the first line antibiotics. That is done long before the doctor ever sees the patient. That is not because nurses are becoming mini-doctors; it is because they are extending their role, improving outcomes for patients and improving patient experience.

I want to send a message to Ministers: there are two myths doing the rounds at the moment about nurses’ wages. The first is that nurses are on an average of £43,000 or even £37,000. That is completely untrue. Most nurses are in bands 5 or 6, the average wage for which is £27,000—for an experienced nurse—and the starting salary roughly £21,000. The banding system is used to downgrade nurses and pay them as little as possible. When I do a hospital bank shift, I am on the lowest band 5 wage—after 20 years of working as an experienced cancer nurse who is chemo and intravenous-trained.

The incremental rise we hear about is also a myth. The banding system is used to start nurses on the lowest-possible salary. They have to wait seven years—each year going up a little bit—till they reach the top of their banding. In no other profession would that happen. We do not see MPs in the 2017 intake being paid less than those in the 2015 intake because they are less experienced or new to the role, but that is exactly what we do to nurses, and then we tell them they should be grateful for that incremental rise. They should be paid what is due for that job, not wait seven years to get the actual pay the job is worth. We do not say to the editor of the Evening Standard, “You’ve never been a journalist before, so you should be paid less than any other journalist in this country.”

This is about fair pay for a fair day’s work. We are asking people to save lives or put their own lives on the line to save the lives of others. The time has come to end the public sector pay cap, and I welcome the moves by the Government. As for the motion, I hear that the Labour party wants to scrap the cap, but there is not the money to do it across the board, although there are ways to give nurses, public sector workers and other NHS staff a pay rise. If we focus that pay rise on bands 1 to 7 and help those in high-cost areas with high-cost living allowances, we can make a difference, but using this as a political football will not score any goals. It is incumbent on all of us from all parties to work together.

When Ministers stand up at the Dispatch Box and say, “More schools than ever are good or outstanding”, “More patients are being treated than ever before” or “There is less crime than ever before”, they should remember it is because of the hard work of public sector workers. We need to reward them for their hard work and effort.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

The capped expenditure process is an NHS England initiative to meet its statutory duty to live within its budget, and I support the principle that in a period where real expenditure on the NHS is going up by £5 billion, those benefits should be spread fairly among patients in all parts of the country.

[Maria Caulfield (Lewes) (Con)]

8. What progress is being made on improving end-of-life care.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

In July 2016 the Government published “Our commitment to you for end of life care”. This set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality and personalisation in care a reality for everyone. By 2020 we want to significantly improve patient choice, including ensuring an increase in the number of people able to die in the place of their choice, including at home.

[Maria Caulfield]

I thank the Minister for her reply, and it is welcome news that there is such a focus on end-of-life care. Will she meet me to discuss the Access to Palliative Care Bill presented in the other place, to look at how we can improve access to palliative care across the whole of the UK?

[Jackie Doyle-Price]

I will be delighted to meet my hon. Friend, who is a committed and passionate campaigner in this area. I am keen to explore anything that improves care and choice for all patients at the end of their life.