Social Care (Liverpool)

Maria Eagle Excerpts

Tuesday 7th March 2017 Westminster Hall

[Maria Eagle (Garston and Halewood) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I congratulate my hon. Friend the Member for Liverpool, Riverside (Mrs Ellman) on obtaining this crucial and timely debate. She set out in full and with great clarity the situation facing Liverpool and other local authorities in the city region, as the council seeks to set a lawful budget while desperately trying to keep going the public services on which so many of our constituents depend. She set out in great detail and with pertinent facts and figures many of the things that I was going to say about Liverpool. I endorse her speech fully—it was excellent.

Liverpool has had £420 million cut from the city budget since the Lib Dem-Tory coalition imposed cuts in 2010. There has also been the never-ending slashing of public services provision by this Government and their predecessor, and another £90 million has to be found. To illustrate that, Liverpool raised £147 million in council tax in the last financial year, but it spent £151 million on adult social care. I will emphasise that: Liverpool is having to spend more on adult social care alone than it can raise in council tax.

My hon. Friend set out some of the other concerns and problems. The demand for social care assessments is rising. Despite the cuts she described to the money that can be spent on adult social care, the demand for help of those depleted services from our citizens and constituents has increased by 15%. The demand for social care assessments in Liverpool has gone up from 18,000 a year in 2020 to 21,000 a year now. As she set out, Liverpool supports 9,000 people annually to some degree with a care package at home. That is fewer than half of the people who have asked to be assessed, so it is clear that only those with the highest needs get help, and they may well not get a level of support from which they benefit and which might keep them out of more acute services for longer with a better quality of life.

Liverpool City Council announced in its budget proposal that it intends to increase council tax. It will of course do so reluctantly, because many of our fellow citizens will find it difficult to afford an increase, but that course of action must be taken. I say in all sincerity to the Minister that it is not credible to claim that the shortfall that results from resources being cut by 70% can be made up by efficiency savings. I could not lose 70% of my resources and make up the difference in efficiency savings.

My constituency of Garston and Halewood also covers part of the Knowsley metropolitan borough, which is a smaller authority but, thanks to this Government and the Lib Dem-Tory coalition Government that preceded it, it faces financial challenges that are just as severe. Its revenue is currently £148 million. It has had to make cuts of £86 million since 2010 and will have to find a further £17 million over the next three years. That is a total loss for a small authority of more than £100 million. Both Liverpool and Knowsley are among the top five hardest hit local authorities. Knowsley’s income will have gone down by 56% by the end of this process.

Knowsley raised £43.2 million in council tax in the last financial year, yet it spent £47.1 million on adult social care alone. Are we seeing a pattern here? Just like Liverpool, Knowsley had to spend more on adult social care alone than it was able to raise in council tax this year. The pressures on the social care budget are huge. Because the population is ageing and people are living for longer—something we should all celebrate—Knowsley expects to face additional pressures of £10 million in the next three years for adult social care alone.

[Mr George Howarth (Knowsley) (Lab)]

Does my hon. Friend agree that the picture she paints is grim, particularly for Knowsley? Does she, like me, envisage a time in the not-too-distant future when Knowsley simply will not be able to meet its legal responsibilities unless additional funds are found to ensure that adult social care is available?

[Maria Eagle]

I well understand my right hon. Friend’s concerns. Indeed, the fear is that it will simply be impossible. Knowsley has not had 56% of its statutory obligations removed—just 56% of the money with which it is supposed to meet them. Knowsley, too, is looking at a council tax increase of 4.99%, with 3% ring-fenced for adult social care. This will be the first time that it has increased council tax in five years, and it will do so reluctantly, but that will generate just £1.9 million a year—a total of £3.8 million over the three-year period. That will pay for only just over a third of the pressures that are expected in adult social care alone.

Some additional money will come through the improved better care fund, and there will be one-off allocations—albeit of less than £1 million—through the adult social care fund, but none of that will meet the pressures that are apparent now. I say again to the Minister in all sincerity that one-off payments cannot deal with permanent pressures that are increasing relentlessly day by day when budgets have been cut so drastically.

Unfortunately, Government actions elsewhere mean that those pressures could easily increase rather than decrease because of what is happing in the health service, as my hon. Friend the Member for Liverpool, Riverside mentioned. Greater pressures on our NHS hospitals and acute services, which have financial problems, the Government’s never-ending austerity mania and real-terms reductions in resources for the NHS over the next few years mean that our NHS services, too, are under enormous pressure. That is where the Merseyside and Cheshire sustainability and transformation plan comes in, but that aims to offset £908 million of financial pressures on the local NHS. It has changed from something that was welcome as a way of improving co-operation and transforming our services into something that is simply about saving money over the next few years. I am afraid that that will not make things easier.

There has been a lack of consultation between the STP leaders and the councils. Neither of the councils that I have mentioned feels like they have been consulted at all about the proposals that are supposed to be going ahead for the NHS, despite the fact that they will face pressure from hospitals that want to get people back into the community—but to what? There is ever-decreasing resource in the community to help look after them.

Tomorrow’s Budget is a chance for the Chancellor to tackle some of those problems with vigour. We hope that he will, but if the Government’s briefing in the newspapers is to be believed, it looks like he will not. It is reported that he will announce an emergency fund of £1.3 billion to tackle the social care crisis. That is only half of the £2.6 billion that the Local Government Association estimates the spending gap will reach by 2020, and it appears that the Chancellor will direct it at schemes that aim to tackle bed-blocking. Knowsley will not benefit from such money, because it has tackled that problem already. Indeed, the Minister always prays Knowsley in aid when he tries to say that bed-blocking is not a problem in some authorities. Knowsley has lost 56% of its resource, and it now looks like it will be punished for being efficient while less efficient local authorities get a slice of the money that the Chancellor will give out tomorrow.

Apparently, the Chancellor will also establish another long-term review of social care funding. Although that is welcome, because this needs to be tackled in the end as a proper long-term policy issue, it will not tackle the problems that Liverpool and Knowsley face now. I must also observe that both Governments the Minister has been a member of have done the same, and they simply ignored the proposals that ended up emerging. The shadow Cabinet of which he was a prominent member before 2010 sabotaged the attempts by my right hon. Friend the Member for Leigh (Andy Burnham) to have cross-party talks about a solution seven years ago for a cheap election poster alleging that Labour was proposing a death tax. So we will see.

Meanwhile, the social care crisis in Liverpool and Knowsley worsens and the Government simply pass the buck, play politics and offer zero leadership—I am afraid we have come to expect that from them. Those who lose out are the elderly and the vulnerable, who rely most on the services that this Government’s actions decimate the most.

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[David Mowat]

Indeed. On Thursday, I am going to Liverpool to give a talk at a care conference. I would be very happy during that visit to come along and talk to the council about some of the issues raised here today. As the hon. Gentleman rightly said, I am sure that the Government can learn from Liverpool. Frankly, we can all learn from each other. When I went to Whiston hospital and saw discharges to St Helens and to Liverpool, I saw some wonderful things happening there. Anyway, the offer stands.

[Maria Eagle]

I am sure that all councils in Merseyside would be happy—I know that Knowsley would—to see the Minister on Thursday if he has a bit of spare time. Does he agree that it will be a bit of a blow if the Chancellor’s reported actions tomorrow reward those with a poorer record with smaller cuts to their resources than Knowsley’s? Knowsley has a good record on delayed discharges, but according to the formulation listed in some of today’s newspapers, it will end up getting very little, if anything.

[David Mowat]

I thought that I had said that I agree with the hon. Lady that it would be wrong to punish those that are doing better. She mentioned that Knowsley is one of the stronger councils in that regard; St Helens is even stronger. It would be completely wrong if that were the basis of the allocation. Frankly, that is not my understanding.

I want to talk a little about what the Government plan to do on social care. Part of that involves recognising the pressures that exist. One thing that we get into quickly in social care discussions is a debate about adult social care and frail people—people on the borderline between being ill and being old. If they are ill, they are in hospital under the NHS, and if they are not, they are old, and care is either means-tested or provided by the council. That is a difficult area.

One third of the pressure on councils such as Liverpool arises not from older people but from people with severe learning difficulties, autism and disabilities more generally. Over the past decade, thankfully, the health inequality from which that cohort suffers has decreased considerably, and the life expectancy of people in those categories has increased. The cost to local authorities is clearly severe. In addition, the Government are determined to press ahead with a programme called Transforming Care, which came out of the Winterbourne View case. Too many people with severe learning difficulties were in institutions and long-term hospitals, with all that goes with that. We are moving them into communities with the help of local authorities. There is a plan to move some 3,000 people out of institutions—places hopefully much better than Winterbourne View—and into care. All of that creates pressures of the sort that we have been hearing about in this debate, but that does not mean that it is not the right thing to do.

Defibrillators in Public Areas

Maria Eagle Excerpts

Monday 16th January 2017 Commons Chamber

[Maria Eagle (Garston and Halewood) (Lab)]

Defibrillators save lives. That is the truth that drives the work of the Oliver King Foundation, a charity that campaigns to ensure that defibrillators are available in public places and that people are trained to use them. Every year, ambulance services in the UK treat about 30,000 people for a non-hospital cardiac arrest, but fewer than 10% of them survive—fewer than one in 10. Of the average 82 people who suffer cardiac arrest outside hospital every day in the UK, just eight live.

Cardio pulmonary resuscitation is often championed as the best way to treat cardiac arrest before the emergency services arrive. Indeed, in some cases it can double the likelihood of survival. But even then the chances of resuscitation are still as low as 20%, and that is only in some cases. Clearly CPR alone is not enough.

[Craig Whittaker (Calder Valley) (Con)]

A little over a year ago, on 7 December 2015, my 28-year-old son had a cardiac arrest. He is one of the few lucky ones who got to hospital in time and survived. He has his own defibrillator, but does the hon. Lady agree that, in conjunction with defibrillator training, it is incredibly important that people are trained in CPR? In my son’s case, his girlfriend was trained in CPR and saw him through the process until the paramedics arrived.

[Maria Eagle]

The hon. Gentleman has had a frightening experience in his family, and also learnt the incredible importance of not only having defibrillators available, but having people who know how to use them. I could hardly better his family’s example of how important that is.

A study by the British Heart Foundation found that for every single minute without defibrillation, chances of survival fall by between 7% and 10%. The Care Quality Commission sets a response target of eight minutes for emergency ambulance services, but we know that ambulances cannot possibly arrive within that time in every case. Even if they did, the chances of survival without immediate defibrillation and CPR will have already plummeted to 20% or lower. Access to a defibrillator can therefore make a huge difference. If cardiac arrest is recognised, basic first aid is given, 999 is called and CPR is applied, in combination with rapid and effective defibrillation, the chances of survival can exceed 50%. In fact, in some cases it can be as high as 80%. However, immediate action is vital. A defibrillator must be at hand for those survival rates to be realised.

Three people who know that better than most are my constituents Mark, Joanne and Ben King. In 2011, Mark and Joanne King lost their son Oliver, and Ben lost his brother. Oliver tragically died following a sudden cardiac arrest while racing in, and winning, a school swimming competition. He was just 12 years old. He had a hidden heart condition, and without access to a defibrillator at school his chances of survival on that day were dramatically reduced. Had he lived, this Saturday would have been his 18th birthday.

I never met Oliver, but I have been struck by talking to those who knew him well. He was clearly a very happy and popular boy, judging by the tributes that poured in from those who knew him following the shock of that terrible day. He was known as a big character at King David High School. His teachers recall his “uncompromising zest for life” and how he was loved and respected by boys and girls and teachers alike. His best friend David recalls Oliver’s charm and how it was deployed on more than one occasion to get them out of a tricky situation. This year is particularly difficult for David, as he will be celebrating the milestone of turning 18 without his best friend.

Everyone mentions Oliver’s love of football—he was a staunch Evertonian. His family and friends all recall his great talent and potential on the pitch. One of his teachers describes him as

“a sportsman at heart and a natural at whatever he turned his hand to”.

Above all, Oliver was caring, loving and incredibly close to his family:

“family was everything to Oliver.”

It goes without saying that Oliver’s death left many who knew and loved him with a great sense of loss. His family and friends are sadly not alone in going through this terrible ordeal. As well as the thousands of people who die every year following sudden cardiac arrest, there are thousands more who are now faced with the agonising reality of living without their loved one.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I pay tribute to the hon. Lady for bringing this important subject to the House and for her good fortune in having, potentially, three and a half hours in which to debate it. She has given an emotional case of somebody for whom, for the sake of a relatively simple and inexpensive bit of kit, the outcome might have been different. Does she agree that public buildings—certainly places such as schools—should automatically be fitted with a defibrillator?

Will the hon. Lady pay tribute to Sompting Big Local in my constituency, which has a lottery grant for the enhancement of the village? Its first priority was to install four defibrillators in every corner of the village, including one outside the local pharmacy, because it saw it as a worthwhile thing to do. Many other people have imaginatively used things such as redundant telephone boxes by replacing them with defibrillators as an obvious help point for local people. Should not we just be doing those things automatically?

[Maria Eagle]

I agree very much with the hon. Gentleman. He has set out an example from his constituency. Around the country, there are many ways in which communities are starting to ensure that they have access to defibrillators so that, if needed, they are there. I welcome that. We should try to ensure that defibrillators are available throughout our land—up and down, north and south, and east and west. What happened to Oliver is not as rare as we might hope. In the UK, some 270 young people tragically die every year of sudden cardiac arrest while at school. That furthers the hon. Gentleman’s point that having defibrillators routinely available in schools seems to be a no-brainer.

In 2012, Oliver’s parents, Mark and Joanne, set up the Oliver King Foundation in memory of their son. It aims to raise awareness of the conditions that lead to sudden cardiac arrest, which is vital as the family did not know that Oliver had any condition that might have led to what happened. If they had known, probably with the diagnosis of a simple electrocardiogram test, they may well have been able to take steps that could have avoided what happened. Other aims of the foundation are to purchase and place defibrillators in schools and sports centres, to train staff how to use them and to hold screening events to enable simple, painless ECG testing to help diagnose such conditions and ensure that what happened to Oliver does not happen to the children of other families.

Mark and Joanne have done an incredible job. Their aim is simple: to ensure that no more families have to go through what they did, knowing that the death of a son, daughter, mother, father or friend may have been prevented. They campaign tirelessly and effectively to ensure that every school in the country is equipped with an automated external defibrillator. They have the support of more than 200 hon. and right hon. Members of this House, across parties.

Automated external defibrillators are specifically designed for use by non-medically trained people. They are remarkable, life-saving machines that are not difficult to use. The machine will apply an electrical pulse only when it detects an irregular heart rate and it talks the user through the process, step by step. However, at about £1,200, AEDs are not cheap and, even if provided, some people are often afraid of using them. As a result, many schools and high-risk public areas in the UK are still not equipped with them. As a direct result of the work of the Oliver King Foundation, more than 800 schools and public places now have this life-saving kit and people who are confident to use it. In Liverpool, Oliver’s home city, not a single school is now without one thanks to the work of the foundation and Liverpool City Council.

The foundation has also managed to train 15,000 people around the country in how to use an AED, thus making sure that in sudden difficult circumstances the confidence is there to use this life-saving kit. As a direct result, 11 lives have been saved that would otherwise have been lost, including an elderly gentleman who suffered a heart attack at his local gym. Thanks to the staff’s quick thinking and use of the gym’s defibrillator, he was sat up and talking by the time the emergency services arrived. In Woolton in my constituency, where Oliver used to live, an AED provided by the foundation was deployed three times this December alone. If the defibrillator is available and training is provided, people will use one: it is as simple as that.

However, we cannot and should not be reliant on charities to do all the heavy lifting and work in this policy area. In November, the hon. Member for Lewes (Maria Caulfield) introduced the Defibrillators (Availability) Bill under the 10-minute rule procedure, with the purpose being to

“increase the rates of survival rates from non-hospital cardiac arrests across the UK”.

Its objective is basically to do for the nation what the OK Foundation has done for Liverpool and is continuing to do in its work in other places: providing defibrillators in public places and training people to use them.

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

I am not sure whether the hon. Lady is aware of the impact that these defibrillators have in cardiac ambulances. When I qualified, an ambulance just picked someone up and took them to a hospital, but the big, boxy ambulances have more equipment in them than was in a casualty unit in those days. Even in professional hands, this technology has transformed out-of-hospital cardiac arrest.

[Maria Eagle]

I thank the hon. Lady for that very useful information, from her own experience as a doctor. It is important that the availability of this kit is widened across our society in order to save lives.

Current legislation surrounding public access to defibrillators is practically non-existent. Last year, the Government produced a guide for schools recommending the purchase of AEDs. While I welcome that move to highlight the issue, the Government should do more. Will the Minister undertake to meet Mark and Joanne and the OK Foundation to discuss a realistic programme of providing AEDs in public places and training for people such that they feel confident to use them? Will he facilitate a meeting with the Prime Minister? I know that the OK Foundation would welcome an opportunity to argue its case at the highest possible level of Government.

[Maria Caulfield (Lewes) (Con)]

I thank the hon. Lady for raising such an important issue in this Adjournment debate. I, too, pay tribute to the Oliver King Foundation for all its hard work. This is one of those rare occasions when there is cross-party agreement. We agree on the need for these defibrillators, but the Bill that will come here for its Second Reading on 27 January is unlikely to make progress simply because of its nature as a ten-minute rule Bill. Does she agree that it would be good if the Government adopted the Bill, because this procedure does save lives, it is relatively cheap to introduce, and it would make a difference to young people? As she eloquently explained, 12 young lives are lost each week through these incidents.

[Maria Eagle]

I congratulate the hon. Lady on bringing forward her Bill. Yes, it was done under the 10-minute rule procedure, but it is now there, and I echo her call for the Government to adopt it. As she realistically observed, the only reason it may not progress in this Session is that there is no time given its position on the list for private Member’s Bill Fridays. The Government could transform that in an instant by taking on board aspects of the Bill—or the whole Bill, preferably—and putting them into some of their own legislation. The Minister might have something to say about that.

[Mr George Howarth (Knowsley) (Lab)]

I congratulate my hon. Friend on the eloquent and forceful speech she is making. She has already paid tribute to the King family. May I add my tribute to them for their great dignity and the constructive way in which they have taken the issue forward? I agree with the hon. Member for Lewes (Maria Caulfield) that the ten-minute rule Bill has virtually no chance of getting on to the statute book, but the Government could, if they had a mind to, adopt it and turn it into a Government Bill. Of course, if it is defective in any way, it could be amended, but nevertheless the spirit of it could be carried forward.

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[Maria Eagle]

My right hon. Friend is completely correct on both those things. I know that he knows the King family, as many of us on Merseyside do. Many colleagues from across the House have met either the family or the campaigners associated with the Oliver King Foundation, which does a stunning job of getting across its campaigning efforts and its ask to Members across the House.

Losing Oliver was devastating for Mark, Joanne and Ben, and for Oliver’s friends and his local community. Who knows what he would have been capable of achieving, had he lived? It would have been something remarkable, I have no doubt, given the way in which he had started off in life.

I would like to finish by saying how much I admire the positive and successful way in which Oliver King’s family and friends have channelled their grief into ensuring that no other family has to endure what they did. They have done such good work in Liverpool and elsewhere, and they are moving on to other places to start installing AEDs in schools, sports centres and other public places. Only the Government can help them to achieve their goal nationwide, and I very much hope that the Minister, in his reply, will want to take the opportunity to announce a Government initiative to make that dream a reality. I think it would be a fitting tribute to Oliver King.

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[David Mowat]

I accept that. Also, a number of sports governing bodies offer screening for people who participate in their sports, but of course that is not the national screening of all 12 to 39-year-olds, which was the issue that was looked at.

Let me finish by reiterating my willingness to meet the hon. Member for Garston and Halewood, other Members and people from the Oliver King Foundation.

[Maria Eagle]

I conveyed a request for the Prime Minister to meet the Oliver King Foundation and Oliver’s parents. Could the Minister help me to facilitate that?

[David Mowat]

I can do many things, but I cannot answer for the Prime Minister. I think I am right in saying that those people met the Secretary of State a couple of years ago. Perhaps when we meet, however, they can start at the bottom end of the food chain before working their way upwards.

When the Government invest in any aspect of health, whether it be cancer drugs or access to GPs, efficacy and cost-effectiveness must be evaluated. The National Institute for Health and Care Excellence uses the criterion “quality-adjusted life years”. Investment in defibrillators must be judged against investment in other necessities, such as cancer drugs, but it is clear from what has been said in a debate that has attracted interest on both sides of the House and the border that defibrillators save money as we start to save lives. The Government accept that, and I want us to make progress in this regard.

Question put and agreed to.

Social Care Funding

Maria Eagle Excerpts

Monday 12th December 2016 Commons Chamber

[Mr Speaker]

I call an Eagle—Maria Eagle.

[Maria Eagle (Garston and Halewood) (Lab)]

Liverpool City Council has seen £330 million cut from its budget since 2010—58% of all its money. A further £90 million has to be found by 2020. In those circumstances, how will it be possible for the council to increase, as we all wish it could, the money it spends on adult social services, when it already spends more on them— £146 million—than it can raise in council tax?

[David Mowat]

It is not my role to lecture Liverpool City Council on how to deliver adult social care. I make the point, though, that Knowsley and St Helens, which are very close to Liverpool, have virtually no delayed transfers of care, and so possibly some best-practice sharing would be in order.

National Health Service Funding

Maria Eagle Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Maria Eagle (Garston and Halewood) (Lab)]

I want to talk about the Cheshire and Merseyside sustainability and transformation plan and the documents relating to it, which were finally published last Wednesday, although details had been repeatedly leaked. The plans are every bit as full of unrealistic proposals and management newspeak as many of us feared. They amount to a catastrophic financially driven plan drawn up by managers in secrecy under pressure from the Secretary of State for Health. They are already being implemented, without any of the affected stakeholders or the people of Cheshire and Merseyside ever being asked what they think.

If fully implemented, the STP would involve the merging of the Royal Liverpool, Broadgreen and Aintree hospitals, with the Liverpool Women’s hospital being “reconfigured” and merged into the new organisation at a later date. It is planned to be rebuilt nearer the Royal, but there is no NHS money available for the new hospital building. The plans entail the downgrading of hospital A&E services at Whiston hospital, where many of my constituents go, or at Warrington or Southport hospitals, or some combination of all three. Details are not provided.

These shocking cuts and mergers have very little chance of being accepted by the people of Garston and Halewood, for a number of reasons. First and foremost, it is clear that the Cheshire and Merseyside STP is financially driven. This has been admitted by those who have drawn it up. Katherine Sheerin, chief officer of Liverpool clinical commissioning group, accepted this in an interview that she gave in the Liverpool Echo. When asked what would happen if these changes were not made, she said:

“If we did nothing, we would not have enough money to run the services. This is about managing that, rather than letting it happen.”

When asked if these changes were being driven by cuts, she replied:

“The financial component has been a strong driver”.

The King’s Fund agrees with her. In its report entitled “Sustainability and Transformation Plans in the NHS”, it says:

“The original purpose of STPs was to support local areas to improve care quality and efficiency of services . . . The emphasis from national NHS bodies has shifted over time to focus more heavily on how STPs can bring the NHS into financial balance (quickly).”

Quite so, and we can see this in Katherine Sheerin’s answers.

The Cheshire and Merseyside STP has to deal with the pressure of almost a £1 billion gap in its funding by 2021, so making cuts in spending to meet the Government’s financial requirement is at the core of these plans. The people of Merseyside are not daft— they can see this. The Cheshire and Merseyside STP requires £755 million of capital funding, which is now no longer available. In Liverpool alone, our hospitals’ deficit is estimated to be £276.5 million. In her Liverpool Echo interview, Katherine Sheerin suggested that Liverpool City Council would provide the missing capital funding.

[Ms Angela Eagle]

I thank my hon. Friend for giving way. The Wirral Borough Council was not asked to participate at all. Was the Liverpool authority asked to participate?

[Maria Eagle]

Neither Liverpool City Council nor Knowsley Borough Council has been consulted at all about the plans. However, when asked where she was going to get the money for the new hospital, Katherine Sheerin said:

“There’s limited capital available but there are options to explore. Councils tend to be able to access borrowing at a very cheap rate.”

There we have it: Liverpool City Council is expected to stump up the money to implement what is supposed to be a key part of the strategy—building a new women’s hospital. However, this is the same Liverpool City Council that has had 58% of its money from central Government removed—first by the Lib Dem-Tory coalition and then by the Tory Governments after 2010—and that relies for almost three quarters of its income on that Government grant. This is the same Liverpool City Council that already spends £151 million on adult social services for its ageing population, but that can raise only £147 million in council tax. This is the same Liverpool City Council that is expected to find another £90 million of savings over the next three years and that is facing some extremely invidious choices to balance its budget.

My second point is this: these plans have been drawn up in near secrecy by NHS managers, and without consultation with those who are now being exhorted to help. Neither Knowsley Metropolitan Borough Council nor Liverpool City Council has been asked what it thinks. Consequently, both say, unsurprisingly, that they are opposed to the plans. In Liverpool, the ruling Labour group has made it clear that it will oppose any STP that proposes cuts, and the Mayor of Liverpool has said publicly that he opposes the proposed closure of the Women’s hospital and will campaign to keep a women’s hospital in Liverpool. I agree with him. Labour in Liverpool will support any change to existing provision only if it improves services to women in Liverpool.

The current plans are already being implemented, and that is another thing we cannot allow to go ahead without proper consultation.

Community Pharmacies

Maria Eagle Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Jonathan Ashworth]

I know that the hon. Gentleman works tirelessly as a champion for pharmacies, but he knows that these proposals will mean cuts in many services.

[Maria Eagle (Garston and Halewood) (Lab)]

Many pharmacies in Halewood deliver medication, up to 8.30 pm, to elderly and vulnerable people who cannot get out of the house, and to care homes. What does my hon. Friend think will happen if those pharmacies have to close?

[Jonathan Ashworth]

I do not need to say what I think; I need to say what the sector thinks, and the sector has made it clear today that it will have to cut services such as the delivery of medicines to some of the most elderly and vulnerable members of society.

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[David Mowat]

I want to make some progress.

Secondly, we want to see an enhanced role for the community pharmacy network in providing value-added services. This is an aspiration that we share with the network and its representatives. To that end, NHS England has commissioned Richard Murray of the King’s Fund to produce an evidence-based report to determine which types of primary care services are best done by pharmacists over the next two or three years. The report, which will be published later this year, will inform NHS England’s decisions on how to use the integration fund of £42 million that I announced two weeks ago. There are many candidate areas, including long-term conditions, minor ailments, better care home support and more medicine reviews, as well as the work that pharmacists do in public health.

[Maria Eagle]

Many of the pharmacies in my constituency already provide such services, but they are now threatened by the Government’s proposals. Does the Minister not realise that, according to research carried out by Pharmacy Voice, in a constituency such as mine, which is No. 20 on the list of deprived areas, four in five people who cannot see a pharmacist will end up going to their GP? Does he not agree that that will achieve exactly the opposite of what he wants?

[David Mowat]

The impact review, which was published at the same time as my statement two weeks ago, estimated that the amount of extra time that people would have to spend going to a pharmacy would be a matter of seconds, even if we had, say, 100 closures. The impact review sets that out in some detail. Did someone sitting behind me wish to intervene?

Hormone Pregnancy Tests

Maria Eagle Excerpts

Thursday 13th October 2016 Commons Chamber

[Maria Eagle (Garston and Halewood) (Lab)]

I congratulate my hon. Friend the Member for Bolton South East (Yasmin Qureshi) on her work in this area and on securing today’s debate. I am here to speak on behalf of my constituents: Pamela Mawdsley from Garston and her daughter Louise; a constituent who lost a baby son; and Sonia Fitzpatrick from Halewood. All of them believe—I think correctly—that the disabilities with which they or their children live and the losses they have had to face were caused by Primodos being administered in pregnancy. This was not for any therapeutic reason, but simply as a test to determine whether or not there was a pregnancy.

Pamela’s daughter, Louise, is now 42. In 1973, Pamela visited her doctor to find out whether she was pregnant, and she was given Primodos. Her daughter was born in November that year with many severe disabilities. She has extensive brain damage, cerebral palsy, a right leg two inches shorter than the left and a right foot four sizes smaller than her left foot, spina bifida, scoliosis, partial deafness and significant special needs. She nevertheless lives a good life with her family at the age of 42, and her family obviously value her tremendously, but she has ongoing medical problems. My constituent Pamela had her medical records go missing when she became one of the people who tried, with other families, to sue in the early 1980s. The hon. Member for Livingston (Hannah Bardell) also raised that issue in respect of her constituent.

Sonia Fitzpatrick from Halewood is also 42, and in common with Louise Mawdsley, she believes—again, I think, correctly—that the disabilities with which she was born that affect her every day were caused by the Primodos given to her mother to see whether or not she was pregnant. She has spina bifida and other significant medical problems. Since being a young child, she has had a colostomy and a urostomy. She has significant ongoing difficulties with her feet, her hands and other joints. She, too, has lived for 42 years with the effects of that day when her mother went to find out whether she was pregnant.

I first met Pamela Mawdsley in 2011, and I had never heard of Primodos at that time. As a former lawyer who used to conduct product liability litigation and medical negligence cases, however, I rather wondered why I had not. I practised from 1990 to 1996, specialising in this field among others. Products that cause harm, especially medical products, were one of my focuses at that time; and seeking the truth and, where appropriate, compensation for those adversely affected was what I sought to achieve. Yet I had still never heard of Primodos, which is why I am participating in today’s debate.

The stories my constituents and others tell me are familiar to anyone who has practised as a lawyer in product liability litigation. From Thalidomide to Primodos and vaccine damage, there are some common themes: a lack of warnings about possible side-effects; being called a fussy mother when disabilities of a young baby are first noticed and raised with medical practitioners; denial of causality when there are reports of adverse effects; the sudden and inexplicable loss of medical records that indicated what was prescribed and when—often “just for the week” or “just for the month”. I have come across that many times in litigation. Then there are overt hostility and lack of transparency when doubts are finally expressed; no acceptance of liability by drug company or regulatory agency or prescriber, even after the withdrawal of the product in question; and a legal battle—it also happened in this case—usually with gross inequality of arms, when those at fault are utterly unwilling to concede any kind of liability or causation or to co-operate at all in finding some way through the difficulties that the victims have to suffer for many years.

The results are always the same. There are years of denial and agony for those affected, and a subsequent failure to help to alleviate the consequences or to understand the motives of the people who come forward. There is agony for parents, who invariably blame themselves for what has happened to their children, particularly in cases such as these in which there is no therapeutic reason for taking the drug. There are also extremely long, frustrating and often fruitless campaigns for truth and justice, many of which involve failed litigation, as in this case. The litigation usually fails on the basis of causation, or, effectively, because there is no real co-operation or willingness to discover the truth but merely a defensive attitude on the part of medical authorities, scientists, and frequently—I hesitate to say it—Governments. That is what I see going on here.

I think there is little doubt that hormonal pregnancy tests caused the birth defects about which many of the families affected have complained. There was significant disquiet, and evidence from the 1960s, that there were adverse effects that led to the kind of disabilities that Louise and Sonia now live with, but there were no warnings. Obviously proving causation in individual cases is difficult, particularly when the medical records have gone missing, but why should these families have to prove it? Drugs containing such hormones in such doses were banned elsewhere. The fact that existing drugs contain them in much smaller doses does not mean that the large-dose versions could not cause the problems that we are discussing now.

Survivors such as Louise and Sonia have significant and ongoing serious health problems, and they and their families deserve the truth about what happened, in addition to the further help that they need. We have the so-called independent review that the Government established in October 2014, and I think that they were right to establish it, but it does not seem to be going well. I am not sure that it has the confidence of the families, or the confidence of those who have been fighting for so long to get to the bottom of what happened. There seems to be a failure to work with the families who are affected by this scandal.

I have seen independent reviews that work. The Hillsborough independent panel springs to mind: I had a long association with that campaign, and I know what works and what does not. Independent reviews that work are not based on expecting campaigners to sign confidentiality agreements before they can even observe proceedings. They are not based on appointing experts who are suspected by some families—rightly or wrongly—to have a conflict of interests. They are not based on proceedings being so slow and opaque, with so little information emerging, that those affected become suspicious, or do not know what is going on behind the closed doors of the review. They are based on proper consultation and obtaining the full confidence of those affected.

If that does not happen, the end result, whatever it is, will make matters worse. It will make the affected families feel that there has been another establishment whitewash, that their hopes have been raised only to be dashed, that things have been swept under the carpet, and that the authorities, whoever they are, do not really want to find out what happened because it is inconvenient.

In view of the debate and in view of the concern that many of the families are expressing, the Minister must get a grip on the process and ensure that it works. He must take steps to secure the confidence of the families. He must be much more transparent about what is going on, and he must have a proper understanding of what the process is seeking to achieve. I can tell him that if there is another whitewash—if the review does not work—those families and their Members of Parliament, whether that means us or our successors, will not go away. We will be coming back to the Minister and to the Government, and we will make sure that our constituents— those families—are given the truth, the information, and the acknowledgement and help that they deserve.

--- Later in debate ---

[David Mowat]

There is nothing in that intervention with which I disagree. We all want the inquiry to work. The Government have not established an inquiry in order for it to fail. We have not established an inquiry for it not to have the confidence of the association. We need to get to the truth, but that is a scientific process, and because it is a scientific process, it can be frustrating and long-winded; it can take a long time.

I want to talk about some of the concerns that have been raised. There were three types of concerns. The first was that the independent group of experts is not reviewing the regulatory concerns or the delays that took place at the time, in particular the failures of the then Committee on Safety of Medicines and the five or eight-year delay, which we have heard about. The UK was not the first country to ban the drug, but it was not the last either. The second concern, which I will talk about at some length, was that members of the expert group might not be independent and might not have fully declared their conflicts of interest. We have heard words like “colluding” and “cover-up” from some Members. The third concern was that not all the available evidence is being considered by the group, and we heard about the German material not being translated. I will address all three points.

On the first issue, we have heard that there was a regulatory failure and that the inquiry should look at it. I say to the House that if, when the expert group reports next spring, it finds a clear causal link, that will be the time to take further action on issues such as regulation and liability, and everything that goes with that. The first step we are taking is to establish the science. The group that has been set up is an expert group. It is science-led. It is important to make it clear in the House that we are not criticising individual members, because they are striving to get to the truth. It is a group of eminent people.

It would be quite wrong if we conflated the possible eventual need to look at the regulatory actions that were taken, the legal liabilities and everything that goes with that, with the first step of the process, which is to establish whether the science leads us to that link. In spite of some of the comments that have been made today, that has not been done yet in any country. The first serious attempt to do it is the one that is going on now.

The second concern is that the expert working group is not impartial. The MHRA has taken a vigorous approach to evaluating and handling potential conflicts of interest. No member of the expert working group can have any interest in any of the companies that were involved or their predecessors. Members should not have publicly expressed a strong opinion, favourable or unfavourable, about the possibility of birth defects arising from these drugs. We heard that one of the members had tweeted. If there is evidence of that, we will follow it up. It is true that one member not of the expert group, but of the advisory group was removed because it was felt that he had a conflict of interest that was not properly declared. Action was taken very quickly in respect of that.

The inquiry is chaired by a consultant gynaecologist from the Chalmers centre in Edinburgh. The group has 14 scientists drawn from some of the best universities in the UK. We have no reason to believe that any of them have any more reason not to want to get to the truth than Members on both sides of this House.

[Maria Eagle]

Does the Minister not realise how important it is that, whatever the rights and wrongs of this and whatever the qualities of the members of the panel, the families need to have confidence in it? There is no point in saying that they are all wonderful people. The families have concerns and if they are not assuaged, in one way or another, the outcome will not have their confidence.

[David Mowat]

I said at the start of my remarks that the learning point I have taken from this debate is that, whatever we think about the truth, the science and whether we are doing the right thing, the families are not happy. I also said that we will do what we can to amend that.

As well as that, Members on both sides of the House need to accept that we need to get to the scientific truth. In order to do that, there needs to be a scientific process. That has to happen and that is why some of this is time-consuming and difficult, even though we wish that it was not.

NHS Sustainability and Transformation Plans

Maria Eagle Excerpts

Wednesday 14th September 2016 Commons Chamber

[Sir Simon Burns (Chelmsford) (Con)]

Will the hon. Lady give way?

[Maria Eagle (Garston and Halewood) (Lab)]

Will my hon. Friend give way?

[Ms Abbott]

I give way to my hon. Friend.

[Maria Eagle]

I am grateful to my hon. Friend for giving way. We have a leak of the STP for Merseyside and Cheshire, which states that there is an “appetite for hospital re-configuration” because the existing set-up is “currently unaffordable”. Given that it also says that almost a £1 billion gap is to be expected by 2021, and that the public have not yet been consulted, does my hon. Friend agree that when the public are consulted, there will be an absolute outcry?

[Ms Abbott]

That is the reason for the secrecy thus far. The Government know that if the public understood what STPs meant, there would be an outcry.

--- Later in debate ---

[Mr Dunne]

I am going to continue my remarks, as I have already been quite generous in taking interventions.

As part of its annual planning round in 2015, NHS England published planning guidance last December—nine months ago—calling for clinical commissioning groups to come together with their providers across entire health economies to develop a collective strategy for addressing the challenges in their area. Those are the sustainability and transformation plans. There are 44 areas, which were agreed six months ago in March. They cover the whole of England, bringing together multiple commissioners and providers in a unique exercise in collaboration. Their geographies have been determined not by central diktat but by what commissioners and providers felt made the most sense locally.

Each area has also identified a strong senior leader who has agreed to chair and lead the STP process on behalf of their peers. They are well respected, credible figures in their local health economies, and we and NHS England are committed to supporting them to bring people together to agree a shared plan for how best to improve and sustain health services for their local populations. Local authorities, too, are fully engaged in the development of the plans. In some cases, local NHS organisations have agreed with local authorities that a senior council leader will lead the STP for their area. I think that is happening in Birmingham—I see a number of Birmingham Members present.

[Maria Eagle]

It is clear from the leaked document that Merseyside and Cheshire are looking to save £1 billion by 2021. In that context, does the Minister not agree that there will be an outcry when the secret proposals—which have now been leaked—to merge much-loved hospitals and cut services in Liverpool, for example, are finally consulted on? Does he acknowledge that they will have no chance of receiving any support?

[Mr Dunne]

The hon. Lady is leaping much too far ahead. There are no proposals at this point—[Interruption.] I will explain the exact state of the STPs shortly. There are a number of draft ideas to try to improve the services that are delivered to patients. Looking to the future and the efficiencies that need to be provided, as part of the five-year forward view the NHS leadership asked the Government to fund £8 billion of additional cash for the NHS. We provided £10 billion; the Labour party refused to provide anything like it. In return, the NHS agreed to look for £22 billion of efficiencies up to 2020. We have assisted it through the efforts of Lord Carter, whom we asked to undertake a review of efficiencies across the NHS. He has identified 10 work streams in which clear efficiencies can be found—many of which, incidentally, have been identified by Opposition Members. The hon. Member for Hackney North and Stoke Newington herself has referred in the past to areas of the NHS in which there is waste, and a newspaper article this week by the former Chair of the Public Accounts Committee, the right hon. Member for Barking (Dame Margaret Hodge), referred to “absurdities” in the spending practices in the NHS. We are trying to put right some of the practices that have been swept under the carpet for too long.

Defending Public Services

Maria Eagle Excerpts

Monday 23rd May 2016 Commons Chamber

[Maria Eagle (Garston and Halewood) (Lab)]

I welcome the Minister for Culture and the Digital Economy to his place and look forward to hearing what he has to say, but it is extraordinary that the Secretary of State for Culture, Media and Sport could not be bothered to turn up to wind up his part of the debate on the Gracious Speech at the very beginning of this new parliamentary Session. What a dereliction of duty. Who knows whether he is otherwise engaged—no doubt on the vote leave battle bus—or whether the Prime Minister simply does not trust him enough to let him out of the Cabinet dog house to which he has no doubt been confined on the shortest of leashes because of his support for the leave campaign.

We have had a broad-ranging and excellent debate. We have heard from 31 Back-Bench colleagues, one of whom, my hon. Friend the Member for Sheffield, Brightside and Hillsborough (Gill Furniss), made an excellent and well received maiden speech. It showed quite clearly what a great MP she is going to be, rooted as she is in the community that she now represents. Sad though the circumstances are that have brought her to this place, it is quite clear from her remarks that she will do an excellent job.

This was the Queen’s Speech that was not supposed to happen ahead of the EU referendum, and it showed. As my right hon. Friend the Member for Leicester East (Keith Vaz) and my hon. Friend the Member for Stoke-on-Trent Central (Tristram Hunt) said, we were told in Government briefings in March that the Queen’s Speech was to be postponed until after the EU referendum, but the Prime Minister then changed his mind. Perhaps that explains the ill thought out programme, with a small number of Bills, many of which seek to do things that everyone agrees with, being cobbled together to give an impression that all is well with this relatively newly elected Government—except that it is not.

We can see clearly that the Prime Minister is not focused on this legislative programme because he is otherwise engaged. It is no wonder, given that his fractious, warring Cabinet members seem to have lost all mutual respect, denouncing each other in language more suited to bitter political enemies. I will give two examples. The erstwhile Welfare Secretary thinks that the Chancellor tells fibs—he has said today that Pinocchio,

“with his nose just getting longer and longer and longer”,

is

“very similar to the Chancellor. With every fib you tell, it gets longer. Who am I to judge how many there have been?”

Meanwhile, the Employment Minister has accused the Prime Minister of “concocting Armageddon scenarios”, calling some of his claims about what will happen if we leave the EU “fantastical”, “hysterical” and “incredible”. It was clear from the context that she did not mean it in a positive sense.

We have heard an echo of those debates on the Government Back Benches today, with the right hon. Members for Hitchin and Harpenden (Mr Lilley) and for Wokingham (John Redwood) being opposed by the right hon. Member for Arundel and South Downs (Nick Herbert) on EU issues. My hon. Friend the Member for West Ham (Lyn Brown) called it a Tory “Game of Thrones”, and the hon. Member for Glasgow South West (Chris Stephens) even went so far as to offer parallels with individual characters from that drama. It makes for an interesting spectacle, but not for good governance or an ambitious legislative programme.

[John Redwood]

Could the hon. Lady give us an up-to-date view on how the Labour party is getting on with the arguments on unilateralism and the nuclear deterrent?

[Maria Eagle]

Certainly not in 10 minutes.

The Government’s extraordinary decision to announce that they will accept an amendment to the Humble Address if necessary, clarifying that the NHS will be exempt from arrangements in the Transatlantic Trade and Investment Partnership, is highly unusual, not to say humiliating for them. That major concession before we have even got to the end of the debate on the Gracious Speech shows how desperate the Prime Minister is to avoid being defeated on the Floor of the House by his own Brexit-driven rebel Back Benchers, at least 25 of whom have signed the amendment—enough, along with all the rest of us, to defeat the Government. Without that retreat, this would have been the first vote on a Gracious Speech lost by a Government since 1924.

That also shows how willing Tory Brexit rebels are to inflict such a defeat on their own Prime Minister. Indeed, some reports over the weekend suggested that it would be followed by the rebels going on strike to block Government legislation after the referendum unless some of their number were promoted—an extraordinary state of affairs. Meanwhile, one pro-remain Minister is reported to be demanding that the rebels should all be kicked out of the Tory party; a Tory “Game of Thrones” indeed. No wonder this legislative programme is so slim. The Prime Minister will be spending all his time after 23 June on party management. I can only congratulate the right hon. Member for Hitchin and Harpenden, who spoke to his amendment with great cogency, and my hon. Friend the Member for Dewsbury (Paula Sherriff) on causing such Government turmoil. My hon. Friend has now secured Government concessions on both the Budget and the Queen’s Speech—she is really getting the hang of how this place operates.

I am sure the hon. Member for Blackpool North and Cleveleys (Paul Maynard) will be glad to hear that the Opposition agree with the aims behind some of the legislation that has been announced. In the case of the Department for Culture, Media and Sport, how could one object to the Cultural Property (Armed Conflicts) Bill, which will implement The Hague convention to which the UK has been a signatory for many years? We support it wholeheartedly. We also welcome the aims behind the digital economy Bill, as did the right hon. Member for Arundel and South Downs, the right hon. Member for Basingstoke (Mrs Miller) and the hon. Members for Harrow East (Bob Blackman), for High Peak (Andrew Bingham), for Mid Worcestershire (Nigel Huddleston) and for Rossendale and Darwen (Jake Berry).

We particularly welcome the proposed introduction of the universal service obligation for broadband, automatic compensation for customers deprived of good service, and enhanced transparency for consumers to make an informed choice. We will look carefully at proposals to introduce a new electronic communications code, protect intellectual property rights online, and introduce age verification for pornographic websites. It is extremely disappointing that the Government will break their promise to automatically roll-out broadband to all households, so perhaps the Minister will spell out the additional costs that many households and businesses will need to bear to get connected, and give us the total number that he expects will be adversely affected.

Despite their desperate efforts to appear uncontroversial in this legislative programme, the Government pose an underlying threat to all our public services—many of my hon. Friends referred to that during the debate. The Government seem to know the price of everything and the value of nothing, and their obsession with marketisation as a prelude to privatisation leaves them with a tin ear to the value of the public service ethos. As my hon. Friend the Member for Huddersfield (Mr Sheerman) said, they seem to believe that the public sector is automatically bad, and the private sector automatically good.

Unfortunately, the Government are developing that theme across Departments. As my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson), for Manchester, Withington (Jeff Smith), for Sheffield Central (Paul Blomfield), for West Ham (Lyn Brown), and for Merthyr Tydfil and Rhymney (Gerald Jones) said, the Government seem unable to accept the fact that public service broadcasting and the public service ethos—as exemplified by the BBC—makes a hugely positive contribution to our society, boosts the UK creative industries and creative economy, and is successful and massively popular, providing great value for money for licence fee payers and high-quality broadcasting for us all. Channel 4 fulfils its remit without any input from the taxpayer or licence fee payer.

However, the Secretary of State for Culture, Media and Sport has shown himself to be utterly committed to denigrating and diminishing the BBC, which he recently described as no more than

“a market intervention of around £4 billion by Government”.

He wants to privatise Channel 4—he said so just last month, although I notice that there is no Bill for that in this legislative programme.

The constant assumption that the private sector is better, and that the public sector should be diminished or sold off, is based on ideology, not evidence, and is out of step with public opinion. Just last week the BBC announced that it would start to do what the Secretary of State said he wants, which is to cease activity that duplicates what can be done in the private sector—something he calls “distinctiveness”. The BBC announced that it would remove its online recipes. The huge public outcry was instructive, and the Government should take note. So far 195,000 people have signed the petition asking the BBC to keep that trusted resource. The Secretary of State immediately said that the plan was nothing to do with him, but we all know that it was.

Some of our debate has been about the national health service—our most loved public service—and I tell this House and the Government that the Labour party will not stand by and watch the health service be denigrated, reduced or cut. This legislative programme will do nothing to deal with the real challenges facing our public services, whether our NHS or the BBC. We know the value of our public services, and we will make it our business to speak up for and defend them.