Adult Social Care Funding
Steve Brine Excerpts(7 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Steve Brine)
Thank you, Mr Speaker—take two.
There are few things more important to any of us than the way in which the oldest and most vulnerable are cared for in our society. First, let me pay tribute to the 1.4 million people who work in the country’s social care sector. They support many of the most vulnerable people in our communities, often in the most difficult of circumstances. I am proud that we have done more than any Government before to improve the quality of social care, introducing a tough system of CQC ratings, new qualifications for care workers, and new standards to ensure that everyone receives the highest-quality support. I am heartened that today’s CQC report shows that even in a time of acute fiscal pressure, 79% of adult social care services are now providing good or outstanding care.
However, it is impossible to ignore the pressure that our ageing population and advances in medicine are putting on the system. We have seen the number of over-65s increase by nearly 1.2 million, or about 14%, over the past five years. Today’s CQC report shows that in some areas, it is completely unacceptable that standards in some settings are below those rightly expected by care users and their families. This Government view social care as a priority, which is why in the spring Budget this year we announced an additional £2 billion over the next three years for councils in England to spend on adult social care services. That means that, in total, councils will have access to £9.25 billion more dedicated funding for social care over the next three years—enough to increase social care spending in real terms. We have also been clear that later this year we will be consulting widely on the future of social care in this country to put it on a stable footing.
My right hon. Friend the Health Secretary updated the House on Monday about action he is taking to address delayed discharges from hospital in advance of this winter. Last year there were 2.25 million delayed discharges, up by 24.5% from 1.81 million in the previous year. The Government are clear that no one should stay in a hospital bed longer than necessary—it removes people’s dignity, reduces their quality of life, leads to poorer health and care outcomes for people and is more expensive, ultimately, for the taxpayer. Since February, there have been significant improvements in the health and care system, with a record decrease in month-on-month delayed discharges in April of this year.
However, we must make much faster and more significant progress well in advance of next winter to help free up hospital beds for the sickest patients and reduce pressures on accident and emergency departments. That is why we have introduced a further package of measures to support the NHS and local government in reducing delays. That package includes guidance, a performance dashboard, plans for local government and the NHS to deliver an equal share of the expectation to free up 2,500 hospital beds, and of course CQC reviews. We have also been clear that we will consider a review in November of the 2018-19 allocations of the social care funding provided at spring Budget 2017 for poorly performing areas. We have been clear that the Budget funding will all remain with local government, to be used for adult social care.
Barbara Keeley
I thank the Minister for that response, but I really must ask him whether he shares my deep concern about the state of adult social care, as highlighted by today’s report by the Care Quality Commission. Some 3,200 care services were rated as “requires improvement”, with more than 340 rated as “inadequate”. That means that some 92,000 vulnerable people are receiving poor care and some 10,000 people are receiving inadequate care. The picture is even worse in nursing homes, with one in three receiving the poorest ratings.
Does the Minister share my concern about safety, with one in four care locations failing on protecting people from abuse or avoidable harm? That means thousands of vulnerable people not getting prescribed medicines, being ignored when they ask for help and not having enough time for their home care visits.
The Labour party has repeatedly raised the damaging impacts of budget cuts, with more than £5 billion having been cut from social care since 2010. Does the Minister now accept that that has caused the crisis in care staffing, which is at the heart of the poor care that is being reported? Poor staffing levels and staff training are key factors in those providers with the poorest ratings.
In his written ministerial statement earlier this week, the Secretary of State suggested that the £2 billion allocated in the spring Budget to local councils for social care, to which the Minister has just referred, will now be dependent on performance against targets for delayed transfer of care. That means that some councils could lose funding that they have already planned to spend. Does the Minister accept that threatening local councils with the loss of planned funding could lead to a worsening of the quality and safety issues highlighted today? With social care in crisis, this is not the time to be threatening joint working with local councils, so will he reverse that threat and match the Labour pledge of an extra £8 billion for social care, including an extra £1 billion this year?
Steve Brine
I thank the hon. Lady for that response. This subject was much discussed during the general election, and I think it will be greatly discussed during this Parliament.
Nobody is making any threats. The Government are very supportive of the best-performing systems, where local government and the NHS work together to tackle the challenge of delayed transfers of care. We have said that, depending on performance, we will consider a review in November of the 2018-19 allocations of social care funding provided in the spring Budget for areas that are poorly performing. As I have said, that funding will all remain with local government, to be used for social care.
Obviously, we recognise that there are real pressures in the system. That was why we responded—I think the hon. Lady’s party was pleased with this at the time—with an additional £2 billion for social care in this year’s Budget. We have also given councils the chance to raise the council tax precept. My authority, Hampshire, has done that, and I think that has been well received.
Turning to the actual report, it would be easy to duck all of this. Dare I say that I hope we can conduct this debate in a sensible spirit? People out there working in the system who want to pass the mum test, as was said this morning, want us to do that and are watching things closely. Of course, it would be easy to bury our heads in the sand, but let us remember that had we had the rigorous inspection regime that the Secretary of State put in place earlier, a lot of problems, including those in the hospital sector when the hon. Lady’s party was in government, would not have been heard of. We know about the current situation only because of the inspection regime that has been put in place.
The CQC report found a number of things, and obviously we will digest it over the days and weeks ahead. It found that the adult social care sector performed best in how caring its services are: 92% of services were rated good and 3% outstanding. We can kick this issue around all we like, but today’s report shows exactly why we introduced the inspection regime. It is uncovering the care that is good—the vast majority of it—and it is also uncovering the care that is not, which is where we want to help and support local authorities to make sure that improvements are made for the people we represent.
Dr Sarah Wollaston (Totnes) (Con)
It is concerning to note from the CQC’s state of adult care report that staff turnover rates have risen from 22.7% to 27.3% in the three years to 2015-16. Will the Minister meet me to discuss the important role that supporting skills and opportunities for career progression can play in reducing turnover, improving morale and, most importantly, improving the quality of care that people receive? Will he visit my constituency to see the excellent joint working that has been done by the trust and South Devon College towards just that?
Steve Brine
I thank my hon. Friend for that. I think she knows that I will be in the vicinity of her constituency at some point over the next few months, and I would like to take her up on her offer. I wish her well in her current campaign.
The workforce is critical. Adult social care is a rapidly growing sector, and there are about 165,000 more adult social care jobs than there were in 2010. It is imperative that we get the right people into the right jobs, to deliver the improved quality of care and services that we all want to see. We are working closely with our delivery partner Skills for Care to improve the level of skills in the adult social care workforce, and we are making the profession more attractive with the introduction of the national living wage, from which up to 1.5 million people in the social care sector are expected to benefit. I might point out that that policy has come in only as a result of this Prime Minister and this Government.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I want to point out that the report rates 92% of services as good and 3% as outstanding on caring. That comes from the commitment of staff, who, sadly, have not been given a breaking of the 1% cap. The issue of safety has been raised, with one in four providers failing to provide safe care. That comes down to workforce and funding. Brexit threatens the workforce; as the hon. Member for Totnes (Dr Wollaston) said, there is a turnover of one in four. Funding has been reduced by 9%, and that has to be tackled.
Does the Minister recognise that one in five emergency admissions could be avoided if alternatives were provided? Although the measures are different in Scotland, delayed discharges are falling in Scotland while they are rising in England. Will he get rid of fragmentation and look at real integration of health and social care in the sustainability and transformation plan reorganisation?
Steve Brine
I said at the very start of my response, did I not, that we should salute the 1.4 million people who work in this country’s social care sector? We should also salute the families who support people who are in and out of care settings all the time. I did also say—I am grateful that the hon. Lady responded to this—that it does not surprise me that the caring side of the sector came out as one of the good bits in the report.
The hon. Lady spoke about keeping people out of the emergency setting, and that is absolutely what the STP process is about. We are one NHS, and there is one public sector. This is about the NHS getting delayed transfers of care right, but it is also about the work of local government. The STP process works at upper tier authority level as well as across the NHS—in my area of Hampshire, the NHS is working closely with Hampshire County Council—to deliver a one-system response. She is absolutely right, as usual, to point that out.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
It is absolutely vital that we improve adult services that are failing and falling behind, but let us not lose sight of the fact that most adult social services are of high quality and many are improving. Nearly four out of five of our adult services are good or outstanding. We all know that there is a looming crisis in social care, which is why the Chancellor announced further investment of £2 billion in this area. Is that investment starting to show some results?
Steve Brine
Yes, we believe it is. The CQC has completed its ratings, and the proportion of providers rated good or outstanding increased to 79% by July 2016; the previous figure was 72%. It is also worth noting the CQC’s statement that 81% of services rated inadequate improved their overall rating following re-inspection. Obviously, there is a challenging element to the report. As I have said, we do not hide from that or shirk it—nor should we—and that is why we set up the inspection regime. It would not be right or fair to people who work in or rely on the sector to say that everything is going to hell in a handcart, because I do not believe that it is.
Norman Lamb (North Norfolk) (LD)
I hope the Minister will agree that these widespread failures of care are intolerable in a civilised society. Does he share my view that we will have to confront the need to increase taxes to ensure that we have an efficient, effective and compassionate system, and will he embrace a cross-party approach to come up with a long-term settlement?
Steve Brine
Of course I want to work—as will the current Care Minister, the Under-Secretary of State for Health, my hon. Friend the Member for Thurrock (Jackie Doyle-Price)—with the respected former Care Minister, and with any other Members who have any sensible suggestions. Taxation is of course a matter for the Chancellor at financial events, and there will obviously be a Budget later in the year.
On the areas where there are care challenges, we have picked up 12 local areas for review, as the Secretary of State said earlier this week. We have published the details that are suitable for the review, which we have developed from the dashboard criteria. We will give those involved every possible support, as we do with the inspection regime for hospitals, for instance. Such inspections are to get hospitals out of special measures and get them to a better place, and we will do the same for those areas. I will be very happy to meet the right hon. Gentleman. In fact, if he had not asked me, I would have offered to meet him.
Mr Christopher Chope (Christchurch) (Con)
If the Government’s plan is to reduce the pressures on adult social care, will my hon. Friend explain why the Dorset clinical commissioning group is proposing to close down the St Leonard’s community hospital, which provides really good services at the moment and is approved of by the community?
Steve Brine
No, I cannot go into the detail of why that is, as I suspect my right hon. Friend realises. There will be a one-NHS STP process in his area, and it will have to come up with proposals that meet the five criteria for any reconfiguration. As he will know, there were previously four criteria that had to be met, but there are now five; Simon Stevens, the chief executive of the NHS, has added a fifth on patient safety. My right hon. Friend mentioned St Leonard’s hospital, and any reconfiguration or change of service in relation to it will have to be considered in that context.
Mr Speaker
The Minister has just elevated the hon. Member for Christchurch (Mr Chope) to the Privy Council, of which he is not currently a member. Whether that was inadvertent on the part of the Minister or a gentle hint to the powers that be remains to be seen. It would be only a very modest elevation for somebody of the hon. Gentleman’s experience.
Thelma Walker (Colne Valley) (Lab)
Does the Minister agree that it is time we considered bringing the social care sector back into public ownership to remove the profit-making aspect of looking after the most vulnerable in our society?
Steve Brine
Mr Speaker, I have no advance knowledge of the future career prospects of my hon. Friend the Member for Christchurch (Mr Chope), but I am sure it is only a matter of time before he becomes a Dorset knight.
I do not agree with the hon. Member for Colne Valley (Thelma Walker), whom I welcome to her place. I do not think that what the sector needs right now is nationalisation. I would gently say once again that public ownership is not the answer to every challenge in our public services.
Jeremy Lefroy (Stafford) (Con)
When visiting a constituent at home last week, I discovered that he has had dozens of carers. Many of them have delivered excellent care, but he was really concerned about the sheer number of different carers that he had had. What does my hon. Friend have to say about proposals or plans to ensure that people receive consistent care from as few carers as possible, which benefits both the patients and the carers?
Steve Brine
As ever, my hon. Friend is on the money. Across primary care, the named GP policy is a huge step forward, and that idea is absolutely something we should aim for in this sector. That may come out during the consultation later this year, and I feel certain that my hon. Friend will respond to that consultation.
Several hon. Members rose—
Melanie Onn (Great Grimsby) (Lab)
One among many, Mr Speaker.
This Government have pushed a national crisis on to hard-pressed local councils and hard-up local residents, forcing council tax rises that will barely cover the minimum-wage salaries paid to carers. The Minister says that the precept has been welcomed, but I would ask: by whom?
Steve Brine
The precept is welcomed by local authorities that want to get extra money into their social care system.
Steve Brine
I understand that the hon. Lady wants to play politics with this issue, but as I said in my response to the urgent question, I honestly think that we can do better than that.
Nigel Mills (Amber Valley) (Con)
I have found the CQC’s inspections of struggling care homes in Amber Valley to be a very useful way of making sure that they improve care for local people. Is the Minister confident that the CQC is sufficiently resourced and skilled to carry out those inspections in a timely fashion and to a sufficient quality?
Steve Brine
Yes, I think that the CQC does a fantastic job. Andrea Sutcliffe, its chief inspector of adult social care, whom Members will have heard on the media this morning, was absolutely right when she talked about services needing to meet the mum test or the dad test. Ultimately, we are all affected—I have ageing parents, like many Members of this House. The mum test or the dad test is what we want, because when people go into adult social care settings we want to feel that they are as well looked after as we could manage ourselves.
Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)
Loneliness can be extreme in housebound adults and the level of mental health issues such as depression is often high but unrecorded. Will the Government ensure that there is a holistic approach to social care that includes key indicators of mental health and wellbeing?
Steve Brine
Yes, the hon. Lady makes a very good point. Those are exactly the issues that will be discussed in the consultation later this year, in which she will, of course, be very welcome to take part.
Sir Desmond Swayne (New Forest West) (Con)
What is the status of the announced Government policy that the Dilnot cap will be implemented in the financial year 2021-22?
Steve Brine
Okay. The Prime Minister has been very clear about the importance of tackling this issue. As she said, we will look after 2 million more over-75s in the next 10 years and we have to find a sustainable way of caring for older people. As I have said, we will consult on detailed proposals, which will include a capital floor and an absolute limit on the amount people can be asked to pay. Our objective will be to get the widest possible consensus.
Mr Speaker
Whether the right hon. Gentleman regards that as a satisfactory answer is for him to decide, but it is the answer that he is getting.
Christian Matheson (City of Chester) (Lab)
Did the Minister see the recent “Dispatches” programme featuring Bupa’s Crawfords Walk care home in my constituency, which had shocking levels of care? If large, well-known providers such as Bupa are caught putting profits before patient care, what can the Minister do to ensure that smaller, less high-profile providers are not doing the same?
Steve Brine
I am sorry, but I did not see that programme. I shall look out for it on “watch again”. What we can do is put in place the toughest, most rigorous assessment and inspection regime, and that is what we have. That has come from this Secretary of State, not from the previous Government, who ducked the issue. What we can do is ensure that there is rigorous inspection to root out poorly performing services. That is the same in the hon. Gentleman’s constituency as it is in mine.
Dr Matthew Offord (Hendon) (Con)
With an increasingly ageing population, does the Minister agree that it is deeply cynical to pretend that there is some financial solution to this issue that does not involve very difficult decisions both within and across generations?
Steve Brine
Yes, I do. There were many disappointing things for me about the recent general election—[Laughter.] To be serious, one of the more disappointing things was that the debate around the future of adult social care was reduced to the use of the words “dementia tax”, which did the sector, our constituents, our public life and this Parliament an enormous disservice. We do need to have a grown-up debate in this country about this issue, and that is why we will bring forward proposals for consultation.
Faisal Rashid (Warrington South) (Lab)
This week marks the sixth anniversary of the Dilnot commission report on social care, yet the Government are no closer to finding a solution on funding social care. Will the Minister tell the House why his Government have wasted six years and failed to take any action to solve the social care crisis?
Steve Brine
Honestly, now I am being tempted into politics. The bottom line is that the Labour party had 13 years in government to sort out the social care system, and it never did. It was in the Labour manifesto in ’97, there was a royal commission in ’99, there was a Green Paper in 2005, there was the Wanless review in 2006, the Labour Government said it would be solved in the 2007 comprehensive spending review and then there was another Green Paper in 2009. I honestly think that lectures from Labour Members about wasting time on this subject are for the birds.
Robert Courts (Witney) (Con)
The Minister has made an excellent point about the years of failed opportunities and failed promises under Labour. During that period, were not 40,000 people per year forced to sell their homes in their lifetimes to fund their care?
Steve Brine
Yes, and my hon. Friend is absolutely right that one of the most disappointing aspects of the discussion over the past few months is that the current situation is hardly perfect. If it was, we would not be debating it, and if it had been easy to solve we would have solved it years ago—and the last Labour Governments would have done so as well.
Several hon. Members rose—
Liz McInnes (Heywood and Middleton) (Lab)
We have an appalling case of abuse in a small private care home in my constituency that resulted in prison sentences for the two people involved. What is the Minister going to do to raise standards in small private care homes?
Steve Brine
I cannot comment on that individual case, but if the hon. Lady writes to me about it I will be more than happy to look into it and meet her.
Mrs Maria Miller (Basingstoke) (Con)
I welcome the Care Quality Commission inspections of care homes in my constituency as it is helping to drive up standards and highlight problems, but many older residents tell me that they want to stay in their own homes for longer. What is the Minister doing to help make that happen?
Steve Brine
That is exactly why I said that this has to be a one-system solution. We need the NHS to work on delayed transfers of care, but we need local authorities to work with us as well, which is what the better care fund is all about. We know that it is better for people to be cared for in their own home, but that is not always possible, which is why we need a long-term solution to the funding of adult social care that deals with not only residential but domiciliary, care—and that is why we tried to introduce that debate during the election.
Maria Eagle (Garston and Halewood) (Lab)
Liverpool City Council spends more on adult social care than it is able to raise in council tax, yet still has more of a cut to make, and pays a very low level of fees as a consequence. Can the Minister give an assurance that councils such as Liverpool will not be further disadvantaged when he rolls out the extra funding he is promising to try to improve this situation?
Steve Brine
As I said, councils have access to a total of just over £9.25 billion more in dedicated funding for social care over the next three years as a result of measures introduced by this Government since 2015. That is enough to increase social care spending in real terms. And let me just put this on the record for the House: the UK spends more as a share of GDP on long-term care than other industrialised countries, including much-vaunted Germany, Canada and the United States.
Mr Peter Bone (Wellingborough) (Con)
I gently say to the Minister that the only reason the Labour party was able to mention the “dementia tax” was that the Conservative party had put something stupid in its manifesto. This matter is far too important for party politics. Does the Minister agree that the social care system is broken and that we need a cross-party agreement on how to move forward?
Steve Brine
I do think we need a cross-party, cross-country solution to the long-term funding of adult social care, which is why we started a debate during the recent election campaign, and why we need a proper consultation, which will be coming online later this year. My hon. Friend is absolutely right: this is far too important for the knockabout of party politics.
Rachael Maskell (York Central) (Lab/Co-op)
On the question of care homes requiring improvement, on inspection 38% still require improvement and 5% have deteriorated. What action is the Minister taking, beyond just inspections, to improve standards?
Steve Brine
That is an absolutely fair question. This is why I said in my statement that, through the dashboard, we have picked the 12 most challenged local areas for review. The reviews will cover providers and commissioners of services, looking at the interface between social care and general primary care and acute and community health services. It will include an assessment of the governance in place for the management of resources. I am sorry to have had to read that out, but I wanted to get it absolutely clear for the record. That is why those reviews are being put in place. We are not just pointing the finger and saying, “You’re bad.” We want to support those areas to deliver the care we are getting in the vast majority of other areas.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
Improvements in medicine have enabled people to live longer, but we also want them to live more healthily. We know that investment in reducing loneliness, in improving activity and in treating conditions such as macular degeneration, which causes blindness, will help to reduce the need for social care. What is the Minister doing in this regard?
Steve Brine
Although I am not specifically the Minister with responsibility for care, I am the public health Minister and the primary care Minister. We have brought those two subjects together because we want to see a healthy population across the board. I am pleased that my hon. Friend has mentioned the Commission on Loneliness. It was probably set up before she entered this House; it was started by the late Member Jo Cox, who did some really good work that is rightly being taken forward in this Parliament.
Jim Shannon (Strangford) (DUP)
Carers in Northern Ireland who provide for elderly and disabled loved ones save the NHS some £4.6 billion, and that figure rises to £132 billion across the whole of the United Kingdom. How does the Minister intend to ease the pressure on them by funding more respite places, to allow families to have the much-needed breaks that enable them to carry on caring in the long term?
Steve Brine
I will look into that. The hon. Gentleman makes an important point. I am sure that Members across the House take part in carers week events every year. I certainly do that in my constituency. It is at those events that we meet not only the staff who work in the system but the people who, day in and day out, do not have the life that they would like to have because they have caring responsibilities. We also meet young carers who do incredible work. The hon. Gentleman is right, and we should all say a clear thank you to those people for the work that they do.
Helen Whately (Faversham and Mid Kent) (Con)
The extra money in the last Budget for social care is helping Kent County Council to provide more people with access to care, particularly at home, but the cost of social care is going to keep rising. Does my hon. Friend agree that we as a society need to have an honest conversation about how we fund those growing costs fairly across the generations?
Steve Brine
Yes. This is no different from the conversation that we are having about the funding of every other public service. It is very easy to take to the streets with placards saying “Spend more!” Indeed, I think the Leader of the Opposition spent the national debt several times over just in his response to the Queen’s Speech. This is why we need a proper debate and a consultation on long-term funding. Ultimately, it could come out of general taxation, but we have to have a debate as a country on how much we can afford to do while funding all the other public services. I have not noticed us being short of requests to increase funding in other areas as well. We have to have that honest debate as a country.
Diana Johnson (Kingston upon Hull North) (Lab)
If we are going to have that honest debate, the Minister, whom I welcome to his place, has to accept that the decisions of his Government have fuelled the social care crisis. My council, the third most deprived in the country, has had the 17th highest cuts to its budget, including having £40 million taken out of social care by 2020. The social care precept that the Minister has introduced does not raise the amount of money in my area that it could in wealthier areas. Will he please accept some political responsibility for the mess we are in?
Steve Brine
Of course Governments of all colours have delivered us to the place where we are at this very moment, but have this Government put more money into the social care system? Yes. Did we provide more money in the Budget this year? Yes. Are we allowing councils to raise more money? Yes. As I said earlier, we spend more on long-term care as a share of GDP than other industrialised countries, including Germany and Canada and the massive economy of the United States.
Wendy Morton (Aldridge-Brownhills) (Con)
As the Minister knows, about 2.8 million adults over the age of 65 are currently in receipt of formal or informal social care. Can he confirm that a recent Care Quality Commission report showed that, despite the pressures, the proportion of care services rated good or outstanding is actually increasing?
Steve Brine
Indeed I can. We introduced the new, tougher system of CQC inspections, for the reasons I set out. We introduced a care certificate for support workers and healthcare assistants, and we introduced the new quality standards to clarify what excellence actually looks like in care. We brought in new criminal offences of ill treatment and wilful neglect, and we introduced a fit and proper person test to hold directors to account for care. Those are all things that have happened under this Secretary of State that never happened before.
Karin Smyth (Bristol South) (Lab)
The care sector is a significant employer in my Bristol South constituency, but people are being lost to other sectors. I listened carefully to the Minister’s response to the hon. Member for Totnes (Dr Wollaston), but I urge him to be much more ambitious in supporting the sector to recruit more people and build on career pathways between health and social care to encourage people who want to do those jobs.
Steve Brine
They have not all been sensible, but yours was marginally more sensible.
As I said earlier, this is a rapidly growing sector and it is imperative that we get the right people into the right jobs. That is why it is so important to work with organisations such as Skills for Care to improve the level of skills, and people in this sector are expected to benefit from the national living wage.
Tim Loughton (East Worthing and Shoreham) (Con)
Worthing has the highest proportion of over 85-year-olds in the country. They tend to be not particularly well off, and their major asset is their property; so can the Minister ensure that, in welcoming the fact that we will have a grown-up debate at last, any sustainable solution recognises that people who have worked hard, paid their dues, looked after their family and done the right thing should be appreciated, not penalised, for having done so?
Steve Brine
I have said that we will consult on detailed proposals later this year, which will include a capital floor and an absolute limit on the amount that people can be asked to pay. Those two critical pillars must go together.
Mrs Madeleine Moon (Bridgend) (Lab)
More care homes may face closure if they cannot access migrant workforces. What steps will the Government take to ensure that migrant workers, who are happy to work in our care homes and who provide excellent standards of care, will still be able to come to the UK after Brexit?
Steve Brine
The Secretary of State has been absolutely clear, including at oral questions earlier this week, that we see the migrant workforce as critical to the NHS, by which we mean in-patient care as well as the social care system—we want to see those protected.
Mims Davies (Eastleigh) (Con)
Adult social care funding has been raised with me across Eastleigh. Delayed discharge is also being prioritised by the clinical commissioning group, but Eastleigh’s Lib Dems on Hampshire County Council chose back in February not to support a further £27 million for the county’s social care budget. Will the Minister highlight the fact that some parties talk about action but simply fail to make a difference locally?
Steve Brine
My hon. Friend is a doughty champion for her Eastleigh constituency, and I also represent part of the borough. What she says surprises me, but I am sure she will raise it in the national debate in the months leading up to next May’s borough council elections.
Mr Clive Betts (Sheffield South East) (Lab)
In March, the Select Committee on Communities and Local Government agreed a report on adult social care. We called for significant extra funds in the short and medium term, but we said that, in the long term, a lasting solution will be found only through cross-party working. The Minister seems to agree in principle, but will he confirm: that he will engage with Opposition Front Benchers and other parties on the consultation’s terms of reference; that he will fully involve them in the consultation; that he will approach the consultation with an open mind, and not rule out any alternatives; and that the Select Committee will be involved in the consultation?
Steve Brine
I confirm that there will be the widest possible engagement across the House and across the sector, including with the Select Committee that the hon. Gentleman may or may not be in charge of in the next few weeks.
Ms Nusrat Ghani (Wealden) (Con)
I have visited many nursing and care homes in my constituency of Wealden and have met committed and caring care staff. Does the Minister agree it is the inspection system introduced by this Government that is finally shining a light on poor care and driving up standards?
Steve Brine
Yes, I do. As I said, this inspection regime is a good thing. It is important for families and for people in the system, but it is also important for the staff—they want to know that they are benchmarked as giving the best possible care. It is as important for the staff as it is for the punters, for want of a better word.
Paula Sherriff
You finally spotted me, Mr Speaker. Worryingly, Age UK recently described choosing a care home as “Russian roulette”. Does the Minister believe it is acceptable to force people to take these risks with their most loved ones?
Steve Brine
I did not quite catch the question, but I do not think the hon. Lady is easily overlooked in any forum. If she would like to write to me or speak to me afterwards, we will be able pick up that point.
Mr Speaker
There is somebody after the hon. Lady and so she need not develop a complex about the matter. Somebody has to be last, and on this occasion, nevertheless with a cheery disposition, it is Mr Tom Pursglove.
Tom Pursglove
Thank you, Mr Speaker. Some local authority areas are undoubtedly better than others at joining up social care departments with the NHS. Does my hon. Friend therefore agree that we need to see a greater focus on sharing best practice where it exists?
Steve Brine
Yes, I agree with my cheery hon. Friend, and this is a good place to finish. There is so much good practice in the sector, and the report highlights that today. We should celebrate that, as we do, and learn from it, as we will, while ruthlessly picking out those areas that need support in order to improve the care they are giving.
Southend Hospital
Steve Brine Excerpts(7 years, 5 months ago)
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The Parliamentary Under-Secretary of State for Health (Steve Brine)
I very much enjoyed the speech by my hon. Friend the Member for Southend West (Sir David Amess). I congratulate him on securing this debate and commend the fire in his belly that always shines through when he speaks in this House, or anywhere else, on behalf of his constituents. They are lucky to have him. I congratulate him on his re-election once again last month.
It is a strange that there is nobody in front of me and everybody I am talking to is behind me, but such is the layout of the House of Commons—and I am of course talking to you, Madam Deputy Speaker.
I understood before I came into the Chamber, and I certainly understand now, that there is significant local concern about the future of the A&E at Southend University Hospital NHS Foundation Trust. My understanding is that Southend A&E will continue to provide substantial emergency services 24 hours a day, 7 days a week, and any change—I underline, any change —to this position would need to meet the four tests of service change. For clarity, let me outline those tests, because they really are the bottom line of any proposed service change in the health service in England. First, proposed service changes must have support from commissioners; secondly, they must be based on clinical evidence; thirdly, they must be able to demonstrate public engagement; and fourthly, they must consider patient choice. An additional NHS England guidance has been added—that proposed service reconfigurations should be tested for their impact on overall bed numbers in the area, and the impact thereof on safety. It is important to set that out very clearly.
The work of the success regime has now fed into the Mid and South Essex success regime sustainability and transformation plan.
Vicky Ford (Chelmsford) (Con)
I would like to introduce Broomfield hospital in Chelmsford into the discussion as one of the hospitals in the mid-Essex area along with the three in Southend and those in Basildon. I congratulate my hon. Friend the Member for Southend West (Sir David Amess) on bringing so much experience to this debate. Broomfield is deeply loved. It serves our newest city. We too need our 24-hour consultant-led A&E. NHS England made it clear to me on Monday that it is not only 24-hour, but consultant-led. Can the Minister confirm that? Can he also confirm that any decisions made will put patient safety first? The future of our NHS relies on first-class training and innovation in Chelmsford. As part of the mid-Essex area, we have the country’s first new medical centre. Will the Minister confirm that he supports that medical centre?
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. The hon. Lady’s question is slightly tangential to the subject of the debate, but I appreciate that she has made a connection. The Minister might be able to make the connection between the subject of the debate and her question, but I know that he will concentrate on the subject of the debate introduced by the hon. Member for Southend West (Sir David Amess).
Steve Brine
I will, Madam Deputy Speaker. I could feel you bristling at the length of the intervention. I can assure my hon. Friend that none of the options being considered includes the closure of any of the three A&Es, and all will continue to provide emergency care 24 hours a day, seven days a week.
I was mentioning the work of the Mid and South Essex STP, which was published in November 2016 as part of the work to ensure that there are sustainable services in mid and south Essex. There is now a major workstream looking at service configuration across the three hospital sites. Work led by clinicians in 2016 arrived at five possible future configurations for consolidated specialist services across the three hospitals. As well as providing the majority of routine hospital care for its local population, each hospital site would provide some centralised specialist services.
Let me briefly outline the current thinking as it has been set out to me. Southend hospital will continue, as I have said, to provide substantial emergency services 24 hours a day, seven days a week. In addition, it will be a centre of excellence, as my hon. Friend the Member for Southend West rightly said, for planned care, alongside its already well-established cancer centre and radiotherapy services. Basildon hospital will provide enhanced specialist emergency care—for example, specialising in the total management of major life-threatening illness. Broomfield Hospital in Chelmsford will provide a combination of specialist emergency and planned care, with the potential to provide a specialist centre for children. I have to emphasise that these ideas are being further developed by the clinical groups as we speak. No single preferred option for consultation has been arrived at.
Let me now turn to the proposals for emergency care. It is important to note, and I wish to reiterate, that in all potential options for hospital reconfiguration currently being discussed, Southend hospital would continue to provide emergency services 24/7. An options appraisal process was held earlier this year involving clinicians, stakeholders and local people. The higher-scoring options listed one hospital as the provider of specialist emergency care. Basildon was identified as the better location for that. Southend and Chelmsford would continue to provide emergency services, but they would be less specialised than Basildon. Southend would instead specialise in planned care, cancer and radiotherapy, building on the excellent work already being done at the hospital. There would be separate units specially designed to give fast access to assessment and care for older and frail people, children and people who may need emergency surgery. In some cases, that could include an overnight stay, if necessary. Those units would involve both health and social care so that patients could return home as quickly as possible with any continuing support and treatment that they may need.
The potential services in the A&E and assessment units at Southend would be able to respond to a range of emergency needs, some of which could be initiated by a 999 call and may involve an ambulance. The possibility of Basildon hospital being the provider of specialist and complex emergency care has benefits for local patients. It would have several teams of specialists ready to provide immediate access to state-of-the art scans and treatments around the clock, which is not always possible in the current three general hospital A&Es.
I also understand that the practice of taking patients by ambulance from Southend to a specialist centre is already established. For example, people who suffer an acute heart attack in Southend are currently taken by ambulance to the Essex cardiothoracic centre—that was easy for me to say—in Basildon. I have been advised that that arrangement has been in place for many years. Separating some of the major emergency work in that way releases capacity and resources for planned surgery and other treatments.
For the local NHS, new centres of excellence across the hospital group in both planned and emergency care have the potential to compete with the best in the country to attract high-calibre staff and bring the best of modern and world healthcare to mid and south Essex. I emphasise that in all options currently under discussion, about 95% of hospital visits would remain local at each hospital.
As I have stated previously, the programme is currently under discussion and I am advised that the aim is to launch a full public consultation at the end of the year at the earliest, centring on a single preferred option. The public consultation will explore in detail the benefits and implications of the proposals and will inform plans for implementation. Engagement with staff and local people will continue to influence and refine plans at every stage. That is a key principle, as I have said, in local reconfiguration of services, and it has to be right that the process is guided by those who know and understand the local area best.
In conclusion, as a constituency MP I completely appreciate the concerns of my hon. Friend the Member for Southend West, whom I again commend for his work.
Sir David Amess
I should have said in my speech that all my literature had headlines such as, “David pledges support for 24/7 A&E service”. I felt that I was not believed, so it is good that my hon. Friend has repeated that we will have 24/7 care. Finally, given that morale at the hospital has been ruined over the past few weeks, it would be great if we could have a ministerial visit at some stage, perhaps even from the Secretary of State.
Steve Brine
I thank my hon. Friend for that offer and will pass it on to the Secretary of State, although I am not entirely sure whether he or any of his Ministers can compete with royalty.
In the 30 seconds I have left, I commend my hon. Friend for his work on those issues affecting his constituents. He is a doughty champion for them. I think they do believe him, because they re-elected him admirably just a few weeks ago. I encourage both him and his constituents to maintain an open dialogue with the local NHS, as I know they will, especially during the pre-consultation and consultation phase, and reassure him that Southend A&E will continue to provide substantial A&E services.
Question put and agreed to.
Oral Answers to Questions
Steve Brine Excerpts(7 years, 5 months ago)
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Bridget Phillipson (Houghton and Sunderland South) (Lab)
5. What assessment he has made of the adequacy of the number of GPs.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
In answering my first Health question, may I thank the cardiac intensive care unit team at Barts hospital in London, where my father-in-law, the just retired Supreme Court Justice Lord Toulson, sadly passed away last week? They did absolutely everything they could and showed the very best of the NHS.
We have committed to there being an extra 5,000 doctors in general practice by 2020 as part of a wider increase in the total workforce in general practice. NHS England and Health Education England are working together with the profession to increase the GP workforce. We believe that that is an essential part of creating a strong and sustainable general practice, and indeed NHS, for the future.
Bridget Phillipson
In recent years, the number of family doctors in Sunderland has plummeted. All the evidence shows that doctors are more likely to stay in the areas where they have trained. Does the Minister accept that new medical school places should be created in areas such as Sunderland, where there is the greatest need to recruit and retain general practitioners?
Steve Brine
I thank the hon. Lady for her question. Since 2016, Sunderland’s GP Career Start scheme has recruited 10 newly qualified GPs. A further five newly qualified GPs will be recruited each year over the next three years. I understand her point about medical school provision. Undergraduate medical education is delivered in the north-east in partnership between Newcastle and Durham universities. There are currently 25 medical schools in England offering just over 6,000 Government-funded medical school places. We are funding 1,500 additional places each year. Five hundred have already been allocated, with 24 of them in Newcastle.
Alex Chalk (Cheltenham) (Con)
Recruiting more GPs in Cheltenham is vital to share the growing workload they face, but rising indemnity costs, particularly for out-of-hours care, can act as a disincentive. Does my hon. Friend agree that this must be addressed decisively?
Steve Brine
Indeed we do. We recognise the role that GPs play in the delivery of NHS care. Following the GP indemnity review, additional money was included in the contract last year to address indemnity inflation. We said in our manifesto that we will ensure appropriate funding for GPs to meet rising costs in the short term and work with the industry to produce a longer term solution.
Mrs Madeleine Moon (Bridgend) (Lab)
17. As the number of GPs goes down, there is increasing pressure on the time they have with their patients. One area being missed is that of suicide and self-harm. We now know there is an increased risk of suicidal behaviour for those on unstable and irregular zero-hour contracts, and that those on employment and support allowance are more than two thirds more likely to take their own life. What are we doing to advise GPs on that?
Steve Brine
The hon. Lady, who chairs the all-party group on suicide and self-harm prevention, does a huge amount of work in this area. The GP patient survey last year showed that 85% of respondents rated their GP experience as good. We are investing about £30 million of taxpayers’ money in the releasing time for care programme, which we hope will increase the time GPs can spend with patients on issues such as those she raises, but in my new role I am very happy to meet her.
Kevin Hollinrake (Thirsk and Malton) (Con)
GPs are the first line of defence against antibiotic resistance, which has the potential to be an uncontrollable global new black death. Will the Minister confirm that the UK will retain its position as a world leader on this issue, and will he tell us when the global antimicrobial resistance innovation fund will open for applications and when the pilot reimbursement model for drug development will begin operating?
Steve Brine
The Government have committed £50 million of official development assistance towards setting up the global antimicrobial resistance innovation fund. We are one of the world leaders on this subject. I am meeting my hon. Friend and my hon. Friends the Members for Stafford (Jeremy Lefroy) and for York Outer (Julian Sturdy) shortly, when we can take this forward.
Julie Cooper (Burnley) (Lab)
I spoke to one GP last week who told me that because he has been unable to recruit help he has only been able to take one week’s leave in three years. That is clearly not sustainable. The morale of GPs is at an all-time low, the number of GPs continues to fall, surgeries are closing, and patients are finding it harder and harder to get an appointment. The Secretary of State promised an extra 5,000 GPs by 2020, but given that it takes 10 years to train a GP will the Minister tell the House how exactly he is going to deliver on that promise?
Steve Brine
I thank the hon. Lady for her question and I look forward to engaging with her on such matters. The “General Practice Forward View” is a landmark document, which was published in April last year. As she knows, it sets out extra investment that GPs have been calling for for years: £2.5 billion a year for GP services. That means investment is rising. The good news, as the Secretary of State said, is that more people are coming into general practice. We want to continue to encourage that, but we also have to take action to prevent early retirements and to bring people back to general practice. We are indeed doing that.
Mr Marcus Fysh (Yeovil) (Con)
6. What steps are being taken to broaden routes into nursing.
Daniel Kawczynski (Shrewsbury and Atcham) (Con)
9. What guidance he provides to clinical commissioning groups on decision-making processes to improve healthcare provision.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
Clinical commissioning groups, as statutory organisations, have a duty to deliver the best possible services and outcomes for patients within their financial allocation. NHS England supports them in this by providing several sets of guidance, as do the National Institute for Health and Care Excellence and other arm’s length bodies.
Daniel Kawczynski
I thank the Minister for that answer. He will know that the clinically driven Future Fit process in Shropshire could lead to hundreds of millions of pounds of investment in our local hospital. That is being jeopardised by Telford CCG and Labour-controlled Telford council. When there is this gridlock and impasse between two local CCGs over a long period of time, what more can the Government do to break the deadlock?
Steve Brine
I am aware that my hon. Friend has been concerned about this for a long time. An independent review of Future Fit is taking place, and he will know that Professor Simon Brake has been appointed as the independent chair of the joint committee of CCGs, agreed between them both. The review will report in July and be considered by the local CCGs before next steps, including on public consultation, are decided. Clear rules apply to any significant reconfigurations and I expect these to be followed in Shropshire as anywhere else.
Lucy Powell (Manchester Central) (Lab/Co-op)
Patients at the Manchester Royal infirmary with serious congenital heart problems found out last week that the services will now no longer be provided in Manchester, or in fact anywhere in the north-west, due to a Government review of services which means that staff cannot be retained and recruited. What has the Minister got to say to those patients who now have to go to Leeds or Newcastle to get the lifesaving surgery that they need?
Steve Brine
I understand that this is an independent review of services, and it will report in due course.
Lucy Allan (Telford) (Con)
Does my hon. Friend agree that, when political activists mislead and misinform my constituents about the future of our Princess Royal hospital, the CCG should communicate directly and clearly with residents so that they can be reassured that our A&E and our women’s and children’s services are safe?
Steve Brine
Yes, I do. The CCG should communicate directly with patients, and that should be clinically led when making the clinical case for any service reconfigurations. As I said to my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski), there are clear guidelines that the CCGs must follow. There are now five tests that must be met before any reconfigurations are brought forward, and that should be the same for my hon. Friend’s area as for everywhere else in England.
Layla Moran (Oxford West and Abingdon) (LD)
The Abingdon community hospital is a treasured asset in my constituency, but in trying to find savings of £176 million, the local clinical commissioning group is launching a consultation on its future imminently. May I seek reassurance, on behalf of my constituents, that the hospital will not close and that, as part of the consultation, their voices will be not only heard but acted upon?
Steve Brine
Clinical commissioning groups have a statutory responsibility to consult the public, and Members of Parliament have a key role in ensuring that members of the public engage with those consultations, as I do in my area. I will be following the hon. Lady’s case closely, and she is welcome to come and see me about it if she likes.
Sandy Martin (Ipswich) (Lab)
10. When the Government plan to publish a tobacco control plan.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
The UK is a world leader in tobacco control, and we will publish a new tobacco control plan shortly, building on our success. That plan will set out new national ambitions to further reduce smoking prevalence, particularly among disadvantaged groups.
Sandy Martin
I need to declare an interest as a Suffolk county councillor. Given the health responsibilities of local government, will the Minister tell the House what can be done to deal with the situation in which the actuarial advice from local government and other public sector pension schemes is that they are not at liberty to disinvest from tobacco stocks?
Steve Brine
I will have to look into the exact point that the hon. Gentleman raises, but I should like to welcome him to his place. I worked closely with his predecessor, and the hon. Gentleman has a tough act to follow. When we publish the tobacco control plan, there will be clear local tobacco plans as part of it. We in the Government can give the best evidence of what works, but we need to recognise what is needed in each local area. I know that he has specific needs in his local area in relation to tackling this issue.
Bob Blackman (Harrow East) (Con)
I welcome the Minister to his place. Does he agree that it is vital that anyone who approaches the national health service with a smoking-related disease should be pointed towards smoking cessation services? Does he also agree that it is vital that local authorities continue to run those services?
Steve Brine
Yes, absolutely. Local authorities have an obligation to do that, but as I said to the new hon. Member for Ipswich (Sandy Martin), it is important that local plans come forward alongside the new national plan. Local solutions are needed for different areas, and that will be the case in my hon. Friend’s borough just as it is in my area of Hampshire.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
Last week marked the 10th anniversary of the smoking ban across the UK, but sadly the celebration was dampened by the fact that we have yet to see the Government’s new tobacco control plan, which was promised in December 2015. The previous two Health Ministers I have shadowed repeatedly said that we would see the plan shortly, but they failed to set out an updated strategy for working towards a smoke-free society. I welcome the Minister to his new post—we have worked well together in the past on the all-party parliamentary group on breast cancer—and I am hoping that, although he has not yet given us a date for the plan, he will be able to give us an indication. Is it going to be published before Christmas?
Steve Brine
I thank my hon. Friend for her question. I think I can call her that; we have worked closely together in the past. I am new to my ministerial post, but I have been through the plan, and it is I who has to stand up and defend it. I want to be sure that it is right and that I am as happy with it as everyone else in the Government. My intention is that it will be published before the summer recess.
Ms Nusrat Ghani (Wealden) (Con)
Within East Sussex, Wealden has the highest number of smoking-related deaths. I welcome the update on the tobacco control plan, but how will my hon. Friend raise awareness and provide equal access for rural communities?
Steve Brine
Rural communities are as important as any other. It is up to East Sussex County Council to come forward with a local tobacco control plan, and I know my hon. Friend will be taking a close interest in that, as she does in all matters when representing her constituents.
Paula Sherriff (Dewsbury) (Lab)
11. What steps he is taking to reduce the number of children admitted to hospital for dental surgery.
Chi Onwurah (Newcastle upon Tyne Central) (Lab)
13. What assessment he has made of the consistency and quality of GP services in (a) Newcastle and (b) England.
The Parliamentary Under-Secretary of State for Health (Steve Brine)
In 2016, 85% of patients surveyed across England reported a good overall experience of their GP surgery. In the Newcastle Gateshead CCG, patient satisfaction is even higher than the national average at 88%.
Chi Onwurah
Newcastle has fantastic GPs, but many of my poorest and most vulnerable constituents suffer from GP unavailability and a constant change of providers due to the requirement to re-tender every couple of years to a market that, quite frankly, does not want them because they are too poor or too marginalised to make money from. Will the Minister meet me and my local CCG to find out how we can ensure that those people get the quality and consistency of GP services that they deserve?
Mark Pawsey (Rugby) (Con)
Following the closure of their GP surgery, my constituents in Brownsover have had to make do without one over the past few years. Approvals are in place for a new surgery and it is due to open next summer. Will the Minister confirm that the timeline set out by NHS England will be met?
Steve Brine
I will ask NHS England, but if that is what it has told my hon. Friend, that is what will happen.
Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)
14. What plans he has to improve the integration of mental health services for young people and adults.
Mr Simon Clarke (Middlesbrough South and East Cleveland) (Con)
T5. Nothing is more important than that people can access a GP when they need one. With that in mind, will the Minister join me in welcoming the move made by South Tees clinical commissioning group to enable 90,000 more appointments a year to be generated for people in Middlesbrough, Redcar and Cleveland by ensuring that appointments are available on evenings, weekends and bank holidays?
The Parliamentary Under-Secretary of State for Health (Steve Brine)
I do indeed welcome that. Improvements to GP access in the NHS in South Tees have been put in place. Patients in Middlesbrough, Redcar and Cleveland can now benefit from accessing GP appointments at a time that is convenient for them, seven days a week—that is exactly as it should be.
Ronnie Cowan (Inverclyde) (SNP)
T2. With the Scottish Government now committed to a soft opt-out system for organ donation similar to that implemented in Wales in 2015, is it not time that the UK Government followed the lead of the Welsh and Scottish Governments by introducing a similar system south of the border?
Matt Warman (Boston and Skegness) (Con)
T6. One-year cancer survival rates are now at a record high of 70%, but does the Minister agree that we should and can go further by improving early diagnosis and screening?
Steve Brine
Yes. Progress is really encouraging, and I am sure that Members on both sides of the House will have been encouraged to see today’s press coverage about the chief medical officer’s independent report on genomics—the age of precision medicine is truly here. The NHS has always been at the forefront of new technologies, and so it must be with this; we are determined that it will be.
Patrick Grady (Glasgow North) (SNP)
T3. Would a Minister be willing to meet the all-party group on blood donation after it has been reconvened next week and would they be able to provide an update on the work of the Advisory Committee on the Safety of Blood, Tissues and Organs in respect of lifting or easing the deferral period for gay men who want to donate blood?
Maggie Throup (Erewash) (Con)
I was delighted to hear that, in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman), the Minister was positive about the progress of genome screening. On a recent visit to Nottingham University, I saw similar techniques applied to Alzheimer’s research. Will he back using the process for that, as well as for cancer diagnosis and treatment?
Steve Brine
The chief medical officer’s report—I am sure that my hon. Friend will read it in due course—is clear that this is an exciting new innovation in medicine. We will tackle cancer first, but there is real potential for applying it to rare diseases and the other disease that she mentioned.
Several hon. Members rose—