Social Care

Mike Hill Excerpts

Wednesday 25th April 2018 Commons Chamber

[Dr Whitford]

I thank the hon. Lady for her intervention. In my years of working particularly as a breast cancer surgeon, where I was involved in the palliative care of my own patients, we often met that as a barrier. We started to have the fast response teams who could get hold of hospital beds and commodes and get the changes done, particularly for somebody who actually might not have very long to live.

Since 2015, those who are defined by their medical care team as being in the terminal phase of an illness, whether it is cancer, motor neurone disease or another condition, have not been charged for personal care or nursing care at home. This means that they are not delayed by means-testing, which is another thing that can end up keeping a terminal patient stuck in hospital for weeks and weeks that frankly they just cannot spare.

Younger people with disability have been mentioned. In England, approximately half of local authority spend, and in Scotland approximately 40%, is for the working-age disabled. However, Scope, a charity involved with those with disability, says that two thirds of those who applied to local authorities for care were offered no help and were simply signposted to other charities. The 83% who were given some care felt that they did not get enough hours for it to support them sufficiently.

When we discussed social care in October, I mentioned that in Scotland we were hoping to pass Frank’s law, which is in honour of Frank Kopel—a footballer who played for Man Utd and Dundee Utd and who, possibly related to heading the ball, developed dementia at a very young age. I am glad to report that this law has now been passed. Starting from April next year, those under 65 with degenerative, chronic and eventually terminal illnesses will also be able to have personal care, and this will simply be needs-based, as it is for those over 65. I pay tribute to his widow, Amanda, who fought for a very long time to raise the issue of people who are being excluded from care based on precisely when their date of birth is. However, the Scottish Government are trying to clarify with the Department for Work and Pensions whether providing this additional free personal care to someone under 65 will not result in cuts to their disability benefits, because to give with one hand and have it taken away with the other would be tragic.

The UK Government’s Green Paper provides a chance to step back and rethink care. Obviously, the aim is to achieve sustainable care—as I say, perhaps to look at more radical considerations such as combining it with health and not having it as an utterly separate system.

On those who are younger with disability, the Minister talked about a parallel workstream for the under-65s. What are the terms of reference for that? What can people with disability expect?

After the complete shambles of the 2017 manifesto, it is crucial that there are no sudden changes or things that catch people out, with no notice to prepare for what they might have to pay for care. This is something that will affect people in the future. We have all debated the WASPI women in this place. Let us not create a new tragedy of people who are trapped by some sudden change in how social care works.

As the Minister said, the workforce are absolutely key to the care service. This is a service that is utterly delivered by people. It is not high-technology or machines, and by and large, it is not hospitals. In Scotland, the homecare workforce has risen by 11% over the last three years, but all care providers are reporting that they are struggling to recruit, and all of them see that Brexit will make that much worse, because colleagues who have come from Europe, and particularly eastern Europe, make up a significant proportion of our social care workforce.

We need to value carers. They have often been treated far too much as a cheap workforce, and that says to people, “This is not a profession or a job to stay in long term. This is until you get something better.”

[Mike Hill (Hartlepool) (Lab)]

There are of course also carers who are not employed. I came across kinship carers in Hartlepool. Does the hon. Lady agree that kinship carers, and in particular those who receive no benefits, should also feature in this debate?

[Dr Whitford]

I thank the hon. Gentleman for his intervention. There are all sorts of aspects to the provision of care, for whichever age group or needs, and the Green Paper will fail if it does not result in us stepping back and taking a wider view.

It is important to pay the real living wage, which the Scottish Government already support and fund, and not the national living wage. All hours should be paid—that commitment is being consulted on in Scotland at the moment—and that should include travel as well as overnight care.

For local authorities that have social care within their service, this is the biggest driver of the gender pay gap. Men who empty the bins are paid considerably more than the women who are caring for our grandparents. We should think of job satisfaction and give them the time to care, not 15 minutes. We should think of continuity for both the patient and the carer, but particularly we need to think of the career structure and the training. Caring needs to be a profession, and a profession that is respected.

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[Anna Turley]

My hon. Friend is absolutely right. This is a regressive form of taxation. Every time the precept or local council tax is raised, people pay twice: they see less of a service, but they are still paying through their income tax and through council tax.

I want to talk about the people who are the backbone of our care system: those who work in the care sector. In my local authority area, just over 170 social care staff are employed to support about 5,750 people. That is an average of 33 to 34 cases per member of staff, with all the challenges and safeguarding issues that come with that. The more experienced staff often deal with many more cases than that. As people live longer, with multiple and increasingly complex health conditions, the time and effort required from staff becomes greater. Currently, about 22% of residents in Redcar and Cleveland are over the age of 65. That is expected to increase to 27% by 2030. There are also many working-age disabled or vulnerable adults who have long-term care needs.

The needs of the individuals who need care vary hugely, from those who are frail and need physical support to those with learning disabilities or mental health problems. Mental health poses a particularly difficult challenge, with one in 14 people over the age of 65 developing symptoms of dementia in their lifetime. The care demands required of staff to support these people are ever more complex.

[Mike Hill]

I praise Redcar and Cleveland Borough Council for being the first council in the north-east to adopt Unison’s ethical care charter, which promotes staff training and pay and quality care. It has also been adopted in Hartlepool. Will my hon. Friend join me in supporting the further ambition to establish local care academies to guarantee that such training and care packages are written into employment contracts?

[Anna Turley]

My hon. Friend raises an important point. Much has been said today about the prestige of the sector and that suggestion would go a long way to addressing that.

Privatisation of NHS Services

Mike Hill Excerpts

Monday 23rd April 2018 Westminster Hall

[Mike Hill (Hartlepool) (Lab)]

I beg to move,

That this House has considered e-petition 205106 relating to the privatisation of NHS services.

It is an honour to serve under your chairmanship, Sir Graham. I pay tribute to a young constituent of mine, Connor McDade, whose father, John, is a friend and a former work colleague. Connor was run over in Newcastle last weekend, but despite the most excellent care provided by NHS staff in the critical care unit at the Royal Victoria Infirmary in Newcastle, his life support was switched off yesterday. On 14 May, he would have been 22. He passed in the early hours of this morning. The standard of care delivered by staff at the RVI was second to none, so it is fitting that I pay tribute to them and all hard-working NHS staff at the beginning of my speech.

Privatisation in the NHS is not new. When the NHS was founded in 1948, agreements had to be thrashed out with GPs, doctors and consultants to allow private practice to continue and sit alongside the new national health service. Private healthcare insurance has been around for longer than the NHS. The British United Provident Association—BUPA—was founded in 1947, and it currently has about 15.5 million health insurance customers and 14.5 million people in its private clinics and hospitals.

The NHS itself has always had a private treatment offer, although between 1974 and 1976, Barbara Castle, the Labour Secretary of State for Social Services, campaigned to abolish pay beds in the NHS. That was achieved after her tenure in 1977, but the Tories repealed it three years later in the Health Services Act 1980. On abolishing pay beds and separating out private and NHS facilities, Mrs Castle said:

“The existence of pay beds, with the opportunity it gives to a few senior doctors to make private gain and the opportunity it gives to patients with money to jump the queue, is seen as a bitter affront to those thousands of other staff who are dedicated to the principle of a free Health Service.”—[Official Report, 21 November 1975; Vol. 901, c. 355.]

Tens of thousands of health workers, citizens and patients would echo that opinion today. It is also the opinion of the British Medical Association, which believes that the NHS should always be free at the point of use and has campaigned for many years to halt the spread of privatisation. Its focus is not just on private practice, but on private provision—the privatisation of services, commissioning and procurement.

It is worth noting that, on private practice or healthcare provision, an update to the BMA’s 2016 report entitled “Privatisation and independent sector provision in the NHS” shows that in recent years, the number of NHS patients treated in private hospitals has increased substantially. In 2015-16 alone there were 557,200 admissions—an increase of 8%—and in the same period 5% of NHS-funded elective surgical admissions were to independent sector facilities.

[Thelma Walker (Colne Valley) (Lab)]

We are witnessing the fundamental dismantling of the NHS and creeping privatisation, which is undermining its dedicated, hard-working staff. Does my hon. Friend agree that we need to halt all privatisation and legislate against the selling-off of our world-renowned health service?

[Mike Hill]

As a member of the Petitions Committee, I am independent; as a Labour MP, I agree. I will come to that point later.

Private practice is only one aspect of the worrying trend towards the increased privatisation of NHS services. As the BMA points out, the recent legal action that Virgin Care brought against several clinical commissioning groups should serve as a stark reminder of what can happen when the relationship between the NHS and the private sector sours.

[Paula Sherriff (Dewsbury) (Lab)]

My hon. Friend is being very generous in giving way. Many Members know that I worked in the NHS for more than 10 years. That service was privatised and taken on by Virgin Care, which destroyed it. What concerns me is that I have given Conservative Health Ministers, including the Secretary of State, the opportunity to talk to me on a number of occasions about Virgin Care’s many failings, some of which were very dangerous, but they have never taken up that opportunity. Does my hon. Friend share my concern?

[Mike Hill]

I certainly do share my hon. Friend’s concern. Ironically, in my patch, sexual health services are delivered by Virgin doctors.

[John Spellar (Warley) (Lab)]

Is it not the case, as the two previous examples show, that we are not comparing like with like? The supposed savings are actually achieved by an immediate reduction in service or by the service becoming unviable, which means that the Government have to pick up the pieces. If anything goes wrong with a private healthcare operation, the patient has to go into the national health service, which has to bear the burden.

[Mike Hill]

I entirely agree. The forecasts for the next three years indicate that £10 billion-worth of NHS work will go to the private sector.

A settlement reported to be in the region of £330,000 was paid to Virgin Care in December 2017, following a procurement process in which an alliance between a foundation trust and local social enterprises won a contract to provide children’s services across Surrey. Such interventions and the ability of private companies to challenge NHS procurement provisions are precisely why there are fears about the transatlantic trade and investment partnership—a proposed trade agreement between the European Union and the United States. Many fear that our separate post-Brexit trade agreements with the United States will mean that NHS services will be exposed to the competition and might of the American private care market.

[Laura Smith (Crewe and Nantwich) (Lab)]

Hundreds of my constituents in Crewe and Nantwich signed this petition because they want their Government to put people before profit. Fourteen hospital trusts have had to trigger emergency contingency plans and delay hospital building because of the collapse of Carillion earlier this year. Given that Capita’s annual losses are rocketing, does my hon. Friend agree that the Government’s response shows that they remain dangerously obsessed with privatisation in our NHS?

[Mike Hill]

I agree. As I said, it is estimated that, over the next three years, up to £10 billion-worth of NHS contracts will go to the private sector, including the provider that my hon. Friend mentions.

Are such fears irrational or are people right to be concerned about the privatisation of NHS services, given the fact that the influence of private healthcare providers has risen sharply in recent decades? The use of the private sector has been progressed by successive Governments over many years. The present Government blame Labour for introducing private finance initiatives, which they say have burdened the NHS with eye-watering debts, but the Government compounded the problem through PF2. They also blame Labour for opening up the NHS to marketisation by splitting primary care trusts into commissioning and provider arms, and introducing the concept of “any preferred provider” in its transforming community services programme, even though the Secretary of State at the time, Andy Burnham, expressly stated that the NHS would always be the preferred provider of services. Yet from 2010 onwards this Government extended that model, creating clinical commissioning groups and pursuing competition and commercialisation with renewed vigour. Today, therefore, many traditional public health services are run by private providers such as Virgin Care and GP consortiums in their own right—services such as out-of-hours urgent care, sexual health and mental health residential care.

The Health and Social Care Act 2012 was designed to bring in a far greater private sector element to the NHS through expansion of the internal market. Since then, the privatisation picture has been more mixed than had been feared, not only as a result of campaigns by Unison, the GMB and others, but because various Government initiatives to boost privatisation fell flat. However, there is still significant evidence of increasing privatisation, with companies such as Virgin, Serco and Spire continuing to prosper.

[John Spellar]

My hon. Friend mentioned the care sector. Is there not a fundamental flaw in that sector, because it is based on offshore location of ownership of the assets and on heavy leveraging and gearing of the companies? That has meant that many of them are on the brink of bankruptcy, and they seek either to be bailed out or to throw many thousands of very vulnerable and elderly people straight back to the Department of Health and Social Care. The Government have no real plan, as far as we can see, to deal with such a contingency.

[Mike Hill]

My right hon. Friend makes an important point about social care. In fact, some private providers have drifted away from healthcare contracts because of the losses that they might make on them.

[Paula Sherriff]

Will my hon. Friend give way one more time?

[Mike Hill]

One more time.

[Paula Sherriff]

I want to be clear about some of the dangers of privatisation. When Virgin Care took over our dermatology service, it would not subscribe to the SystmOne computer system, so we had to use another system, which was not operable for more than a year. Patients were coming in, but we had no idea what they were coming in for—we had to ask them questions such as, “Is the lesion on your left or right arm, or on your leg?” That is particularly difficult with patients who have dementia or learning difficulties, for example, and it represents a significant hazard to patient safety.

[Mike Hill]

I am glad that my hon. Friend mentioned such issues, and dementia in particular—mental health care needs to be looked at for investment.

[Mr George Howarth (Knowsley) (Lab)]

Will my hon. Friend give way? I know he has just said, “One more time”, but perhaps he will make it two.

[Mike Hill]

I am on my last two paragraphs, but I will give way to my right hon. Friend.

[Mr Howarth]

I am grateful to my hon. Friend. He has made a powerful case for how it is wrong in principle to privatise the national health service, and he has alluded to comparisons with the social care sector. Is not one of the major risks the fact that private sector provision sometimes fails—the business fails—so there is a complete and, in the short term, irreplaceable loss of capacity in the healthcare categories catered for by such a company?

[Mike Hill]

I cannot disagree with such a well made point.

The impact of austerity has been a double-edged sword, according to the union Unison. On one hand, less money can be made from the NHS, so some firms have shrunk away. On the other hand, the NHS has opted increasingly for short-term fixes as it struggles with insufficient funding, and that has created opportunities for the private sector. For example, the Carter review includes the threat that hospitals that cannot make sufficient savings in their support services or pathology functions might have to use outsourcing instead. Most recently, the development of wholly owned subsidiary companies has brought a whole new set of fears for the NHS, and for health staff in particular.

The old fears from the 1980s and 1990s are beginning to resurface. When we add social care into the mix, those fears multiply. The NHS is one of our proudest achievements, and we need to protect it, not privatise it. To do so, we need to revoke section 75 of the Health and Social Care Act.

--- Later in debate ---

[Mike Hill]

I thank all hon. Members for their powerful contributions, and I thank the petitioners, whose numbers helped to secure this important debate.

Question put and agreed to.

Resolved,

That this House has considered e-petition 205106 relating to the privatisation of NHS services.

Sitting adjourned.

Austerity: Life Expectancy

Mike Hill Excerpts

Wednesday 18th April 2018 Westminster Hall

[Jackie Doyle-Price]

I am grateful for that point, which consideration is being given to in the Department. There are any number of tools that we could use to tackle alcohol. Probably the most important thing is to give the message that unsafe drinking is bad for the health. It is always interesting to learn from Scotland’s experience, and we will keep an eye on that.

Tobacco is a major cause of poor health. It is worth noting how much progress we have made over decades to reduce the prevalence of smoking. That should lead to better health outcomes, but that has yet to be seen.

[Mike Hill (Hartlepool) (Lab)]

Rates of premature deaths in Hartlepool and the north-east are among the highest in the country. Other issues such as poor-quality housing, food poverty, fuel poverty and unemployment are also factors. Does the Minister agree that those factors also need to be taken into consideration?

[Jackie Doyle-Price]

I agree. That is exactly the point made by the hon. Member for Central Ayrshire (Dr Whitford). Housing is probably the single most important ingredient in good health. We often talk in this place about there being a housing crisis and about the need to fix the broken housing market and get more supply. Amen. The fact that we have failed to manage the supply of housing effectively for decades is bringing bigger health challenges. We really need to crack that if we are to tackle some of these issues.

I could go on, but we are running short of time. We are seeing very good rates of improvement in health for things such as cancer, and much better outcomes for people. The direction of travel means that there are good things to report. I am grateful to all hon. Members who have approached this debate with real thought about the very serious issue of the decline in life expectancy. I am sure that we will revisit the issue, but my lasting message is that we see the method of tackling this being tackling inequalities. That is what I pledge to do.

Question put and agreed to.

Resolved,

That this House has considered austerity and changes in life expectancy.

NHS Wholly Owned Subsidiary Companies

Mike Hill Excerpts

Tuesday 6th March 2018 Westminster Hall

[Liz Twist]

I most certainly do agree, and I will expand on that point shortly.

I want to speak about the impact on staff—some of the same staff we have all been praising in recent days for turning up to work in the snow and coping when we have the only too frequent crises. They are an integral part of the NHS team, as the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) said, making it possible for nursing and medical staff and other allied health professionals to do their bit in caring for patients.

On transfer to a wholly owned subsidiary company, staff already employed by the trust will be transferred on their existing terms and conditions. That is, on “Agenda for Change” terms and conditions and pay rates, negotiated nationally and checked to ensure equal pay for work of equal value. They will retain their membership of the NHS pension scheme and a set of decent terms and conditions applying to all NHS staff. The main way that trusts can make savings through these companies is by employing new staff on different, and worse, terms and conditions.

[Mike Hill (Hartlepool) (Lab)]

On the point made by my hon. Friend the Member for Stockton North (Alex Cunningham) about North Tees and Hartlepool Solutions, as the LLP is called, does my hon. Friend agree that its immediate intention to introduce worse terms for new starters sets a dangerous precedent?

[Liz Twist]

I very much agree. It is a very dangerous precedent that does not respect the rights of those staff.

NHS Blood Cancer Care

Mike Hill Excerpts

Wednesday 17th January 2018 Westminster Hall

[Henry Smith]

The hon. Gentleman has a fine excuse for leaving the debate early, and I endorse everything he says. Future stem cell research is critical; this country has made a good start, but we cannot be complacent in any way, shape or form.

The APPG’s work focuses on blood cancer—as my hon. Friend the Member for Henley (John Howell) said, it is a hidden cancer—on the differences between blood cancer and solid tumour cancers such as breast cancer and prostate cancer, and on the ways in which patient outcomes can be improved with Government, medical professionals and local healthcare bodies working in partnership.

It is not an exaggeration to say that blood cancer is one of the great public health challenges of our time. We know it is the third biggest cancer killer in the UK, the fifth most common cancer overall, and by far the most common cancer among people under the age of 30, as we heard from an intervention earlier.

[Mike Hill (Hartlepool) (Lab)]

I congratulate the hon. Gentleman on securing the debate. On the point of cure, will he celebrate with me the fact that one of my young constituents, Elly-Mae Waugh, aged 12, was confirmed cancer-free in November 2017, having been treated for two years for lymphoblastic leukaemia? Does he agree that there is hope and that there is a need to better finance research into blood cancer developments?

[Henry Smith]

I am delighted by the news that the hon. Gentleman’s young constituent is cancer-free; that is wonderful to hear. There are positive stories that we can draw on. Antonio, the son of our former colleague Sir Nick Clegg, the former Deputy Prime Minister, was fortunately given the all-clear from the blood cancer he was being treated for. I thank the hon. Gentleman for highlighting those positives.

A key factor in ensuring early diagnosis is a greater knowledge and understanding of the symptoms of blood cancer. Diagnosing one of the 137 different types of blood cancer can be complex because symptoms such as back pain or tiredness can, of course, easily be misunderstood or misdiagnosed. Other symptoms of blood cancer include night sweats, weight loss and bruising, and in the first instance can often appear similar to feeling “run down” or having the flu, as was the case with my mother. We thought she had flu for a couple of weeks beforehand, and then she sadly passed away in a very short time.

NHS Winter Crisis

Mike Hill Excerpts

Wednesday 10th January 2018 Commons Chamber

[Mike Hill (Hartlepool) (Lab)]

It is a pleasure to follow that thorough speech by the hon. Member for Henley (John Howell).

On Monday, I asked the then Minister of State, the hon. Member for Ludlow (Mr Dunne), what the Government were doing about the crisis in the ambulance service. He responded by saying that a new ambulance response programme has been introduced to try to deal with category 1 calls more rapidly. The reality is that two months after so-called improvements were put in place in the north-east, an elderly constituency of mine who collapsed in his own home on new year’s day had to wait 14 hours for an ambulance.

Last week, in the intensive care unit at the University Hospital of North Tees in Stockton, two people died from influenza on the same day. One of them was a constituent of mine. On new year’s eve, I attended the urgent care centre at the University Hospital of Hartlepool and then the ambulatory care unit at Stockton with my son. The car parks were crammed full, the sick were presenting themselves thick and fast, and the ambulances were once again backed up. When will the Government admit that this is not just a winter crisis, but a crisis in our NHS full stop—a crisis of their own making?

NHS Winter Crisis

Mike Hill Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

I absolutely agree with my hon. Friend that improving out-of-hospital capacity in our communities is vital. That includes capacity in medical centres and community hospital settings wherever they are outside the acute hospitals, which are inevitably under the most pressure at this time.

[Mike Hill (Hartlepool) (Lab)]

Constituents of mine recently waited several hours for an ambulance, owing to the North East Ambulance Service running at a high state of alert. What are the Government doing about the crisis in the ambulance service?

[Mr Dunne]

This financial year we have introduced the new ambulance response programme precisely in order to try to direct category 1 calls more rapidly, with conveyance by ambulance for those people who need it most. It is in the early stages of introduction in many areas, and we have yet to be able to analyse its impact. If my hon. Friend would like to write to me about the specific case he mentions, I would be happy to look into it for him.