Children’s Palliative Care

Steve McCabe Excerpts

Tuesday 3rd March 2015 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I am grateful to have secured this debate and glad to have the opportunity to serve under your chairmanship, Mrs Main. I first became interested in this area through the work of Acorns children’s hospice in my constituency, which provides a valuable service to children and families from all over Birmingham. I cannot praise its work too highly.

I begin by acknowledging that I believe the Government are genuine in trying to establish a clear funding path for children’s palliative care and hospice services. I understand that the major change envisaged by the Government is the new per-patient funding system. It would be helpful if the Minister said more about how it will work and how he plans to ensure that it is properly monitored and reviewed. I also want to raise the issue of short breaks and bereavement care, as these elements are not included in the per-patient funding strategy.

The children’s hospice movement supports the principle of per-patient funding for children’s palliative care as a means of providing more sustainable, transparent funding through an NHS currency, commissioned by clinical commissioning groups and designed to complement NHS England’s commissioning of specialised children’s palliative care services.

I understand that the third strand of Government thinking is that local authorities should continue to be responsible for commissioning necessary elements of social care and that together this should create an overarching system where all elements of the care—clinical and non-clinical aspects, short breaks and bereavement support—are all provided for.

My purpose in seeking this debate is to address a genuine fear that the impending general election and uncertainty over the new system could lead to a funding hiatus that could have a damaging effect on the children’s hospice movement. If I have understood it correctly, the per-patient system is designed to reimburse providers according to the activity they undertake, and to incentivise both commissioners and providers to deliver palliative care in a child’s home, community or hospice setting, if that is consistent with the wishes of the child and the family, and clinically appropriate.

The idea of the currency is set out in NHS England’s 2014 document, “Developing a new approach to palliative care funding: A revised draft for discussion”, in which it is argued that the currency should make it easy for clinical commissioning groups to understand the specific needs of children with life-limiting conditions. It should also be possible for clinical commissioning groups to have a better understanding of what constitutes palliative care and of the potential cost drivers for commissioning.

What steps have the Government planned to ensure that those elements of palliative care not covered by the new per-patient funding system will be properly funded by local authorities and clinical commissioning groups? This new system is the product of hard work and, as I have indicated, the sector is generally favourable towards it, but it is worried about a number of aspects. For example, how will the costs incurred by providers during the transition be met, including costs of setting up new systems to record activity and of ongoing data collection demands?

The Government-commissioned palliative care funding review by Hughes-Hallett, Craft and Davies in 2011, was clear that introducing and implementing the new system should be cost-neutral to the sector. What support does the Minister envisage for the voluntary sector providers to enable them to implement this new approach?

It would be useful if the Minister outlined any plans to provide models of practice that show how the currency will work, especially in situations for children and young people subject to continuing care packages and personal budgets, as introduced by the Children and Families Act 2014. It would also be useful to understand how the data quality will be monitored and how comparisons of models of care and outcomes will be assessed.

It is not clear to me how the new system will deal with the issue of transition from child to teenager to young adult.

[Mr Robin Walker (Worcester) (Con)]

I congratulate the hon. Gentleman on securing this important debate. Acorns children’s hospice serves my constituency as it serves his. It has a fantastic hospice in Worcester. It has done some important work on transition space and supporting the many people who, because of advances in medicine, are living longer. Does he agree that it is vital that the Government engage with it on this work, to make sure that transition is properly supported by the future funding system?

[Steve McCabe]

Yes, I agree. That is exactly the point. It is fantastic that so many children now survive for so much longer. That creates new demands and service needs that have to be considered. I should be grateful if the Minister said what work is being undertaken, both within Government and the NHS, to ensure that these transition issues are being considered in any new funding plans. I concur with the hon. Gentleman on that. The Care Quality Commission report, “From the pond into the sea: children’s transition to adult health services”—that is its title, I kid you not—also indicated that this focus is important.

We are moving towards the election, so it would help if the Minister clarified where we are with all these plans. As I have said, I acknowledge that the intention is to create a fair and sustainable framework, but we are now in March—the projected launch date for the introduction of the new non-mandatory currency is March—and as yet, unless I have missed something, we do not know the Government’s intention. What I would really like to know, and what I think the hospices would like to know, is what is going to happen with the hospice grant? Is the intention that it should continue during 2015-16 and beyond? I am sure that the Minister appreciates that not knowing is a real source of anxiety and a blow to any attempts at long-term planning.

Almost 96% of children’s hospice organisations are worried, according to the Together for Short Lives survey, that CCG funding will be less than their existing grant and harder to access. That grant covered about 13% of the care costs incurred by children’s hospices and existing clinical commissioning group funding represents about another 12%. Uncertainty over almost 25% of previously guaranteed funding is a difficult basis from which to operate.

I am sure the Minister knows that these bodies rely massively on public generosity and fund-raising efforts, but they also need some core guaranteed funding. If the grant ceases and is not matched by equal funding elsewhere, 89% of children’s hospice organisations could be forced to reduce their services. Areas at risk include short-break services for 60% of users.

[Stuart Andrew (Pudsey) (Con)]

As someone who has spent 14 years working for the children’s hospice movement as a fundraiser, I am completely aware of the point that the hon. Gentleman is making. Short breaks are incredibly important, because they are not only a break for the child, but for the whole family. Often people arrive on a Friday looking utterly exhausted. Just being able to have some normal family time until Monday is a great relief for them. Is that not the importance of these short breaks?

[Steve McCabe]

I do not think we can in any way overestimate the importance of short breaks to families and to children. Both need space at times, and the hon. Gentleman is absolutely right. The survey suggests that more than 60% of users could lose that service. There is also a risk of a 35% reduction in family support work, which is connected with short breaks and enables many families to keep going in stressful situations. There is also a risk of a 23% reduction in the amount of end-of-life care support provided.

Short breaks provide respite for carers and families and should be funded by local authorities and the NHS under their respective legal short-break duties. Despite being key providers of short breaks, a third of children’s hospices are not recognised by local authorities as being short-break providers. Some 42% of children’s hospice organisations receive no funding from local authorities. Page 56 of the palliative care funding review report states that

“pre-bereavement support is an absolutely essential part of palliative care and should be fully funded by the state.”

The review goes on to state, however, that far from being universal, only 65% to 70% of local authorities have open access services. Without the children’s hospice movement, there will be a gaping hole in end-of-life care.

I am not here to criticise the Government’s intentions, but the combination of the election and a new system with many unanswered questions risks significant funding problems. As organisations try to tighten their belts and take on new responsibilities, there is a danger that they will fall back on what they know or believe they know. It will not help the children or families of children with life-limiting conditions if clinical commissioning groups fall back on a narrow, clinical model that focuses on the child’s health needs as defined by doctors. The currency should not be used as a top-up for the acute sector providers, who can access other tariffs to fund care for children with life-limiting conditions.

Palliative care for children with a life-limiting or life-threatening condition is an active and total approach to care, from the point of recognition or diagnosis through the child’s life to death. It embraces emotional, social and spiritual elements and focuses on enhancing quality of life. It also supports the family and includes managing distressing symptoms, providing short breaks and care right through to the point of death and bereavement. That more holistic understanding of palliative care is reflected in national policy documents such as NHS England’s “Actions for End of Life Care: 2014-16” and the 2014 Care Quality Commission handbook. I welcome the interest that the Government have shown in an often neglected area, but we now need some clear messages, actions and signals to ensure that valuable work is not wasted and that an easily avoidable funding crisis is not allowed to develop. Local authorities under significant financial pressures are highly unlikely to fund what they might see as additional services unless required to do so. NHS England’s draft currency for children’s palliative care should be accompanied by clear guidance to local authorities on funding short breaks and bereavement care.

I would like the Minister to give an assurance that the structure is clear and that the intention is to have a three-source funding arrangement, with NHS England commissioning specialised children’s palliative care and utilising the experience of the children’s hospice movement, with CCGs commissioning general children’s palliative care using the new per-patient funding system and working closely with children’s hospices and with local authorities required to commission social elements of palliative care, such as short breaks, bereavement care and support for siblings and other family members, and seeing it as their duty to work with children’s hospices. It is vital that all three funding sources complement one another. If not, there is a risk that local authorities will regard those services included within per-patient funding as the entirety of palliative care and avoid playing their part. NHS England’s specialised care could fall prey to a narrow medical model and never leave the acute hospitals.

The Government need to provide some specific distinctions between specialised and general palliative care, so that one side is not tempted to avoid its responsibilities by relying on the funding of the other. We also need to know that NHS and local authorities are clear about their duties under the Children and Families Act 2014. It places a duty on them to jointly commission care for children and young people with special educational needs and disabilities up to the age of 25. I urge the Minister to provide what answers he can today to a valuable sector, which eagerly awaits his response.

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 24th February 2015 Commons Chamber

[Norman Lamb]

This Government have absolutely not made any decision to cut children’s mental health services, and the hon. Lady knows it is misleading to suggest otherwise. These decisions are taken by local commissioners in local authorities and CCGs. Indeed, we have legislated for parity of esteem for mental health. I urge her to look at the outcome of the work of the children and young people’s mental health and well-being taskforce, which I think gives us a real opportunity to improve the way in which services operate.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

11. How many nurses per million population were working in the NHS in each of the last five years.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The full-time equivalent number of nurses, midwives and health visitors working in the hospital and community health services in England per million population from September 2010 to September 2014 inclusive has remained broadly constant at 5,872, 5,768, 5,703, 5,712 and 5,781 respectively.

[Steve McCabe]

In response to 11 parliamentary questions that I submitted in the past year, the Minister has admitted that he does not know how many part-time, agency and locum GPs are in the health service, the number of agency and part-time nurses, the number of part-time doctors in our hospitals, or how many working nurses and midwives are also drawing their pensions. Given that he has so little detail on staffing, where did today’s figures come from, and what faith can anyone have in them?

[Dr Poulter]

They are in the monthly staff statistics survey. As the hon. Gentleman would like some detailed information, I am sure he will be pleased to hear that in his constituency there are now 386 more nurses than there were in 2010 under the previous Government, and nationally there are 7,500 more nurses, midwives and health visitors working in the NHS.

GP Services

Steve McCabe Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg]

The hon. Gentleman raises an important point and he is absolutely correct. I will refer to that later in my speech.

There can be no doubt that GP recruitment has not kept up with the demands of our population. That is the key problem today. In addition, the pressure on hospitals has increased massively because if people cannot see their GP they often go to A and E. That has been a problem in areas such as mine. There is also the inability of hospitals to discharge frail, elderly people from wards into the community because of the shortage of care in the community. Councils face massive budget cuts, so there are pressures all round. There are pressures on GPs in relation to access and there are pressures on hospitals and elsewhere.

I want to raise a particularly important point with the Minister that I have raised before. The Government are proposing to demand a 3.8% efficiency saving in the national tariff for 2015-16. That will push many hospitals to breaking point and possibly endanger patient safety. I hope that the Minister will look at that again. Members should read the briefing on that from NHS Providers.

There is clearly a view among many that general practice is heading for some sort of crisis. One GP in Halton told me recently:

“The overwhelming problem is the manpower crisis and the rock bottom morale of the Profession, which are interlinked. We are unable to recruit new GPs into practice or medical students into our specialty, training places are left unfilled and there are vacancies all over the country with very few applicants.”

It is hardly surprising we have that problem when we consider what the RCGP has said:

“Funding for general practice has fallen to an all-time low of only 8.3% of the overall NHS budget…GP surgeries are now seeing 372 million patients a day, compared to 300 million a day in 2008.”

Some family doctors are seeing 40 to 60 patients a day. That is unsustainable in the long term. Some 49% of GPs say that they can no longer guarantee safe care to their patients.

The RCGP tells me that the average coverage is 6.9 GPs per 10,000 of population. That is the lowest level of coverage since 2011. The RCGP estimates that up to 543 practices in England could face closure due to the fact that 90% of GPs working in those practices are 60 or over or are likely to retire soon. The hon. Member for Kettering (Mr Hollobone) made that point.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I certainly agree with my hon. Friend’s point, but does he also agree that the constant stop-go policies and the changes in contracts and the confusion over NHS England and clinical commissioning groups is adding to that problem? In my constituency we have the Bournbrook Varsity practice. It expanded and did everything that was asked of it by the primary care trust to create a broader health service. It now finds itself about to be penalised, have its funding cut and have to reduce staff in an area where there is a huge student population. Those students will inevitably gravitate to A and E if this service goes.

NHS Major Incidents

Steve McCabe Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

That is absolutely right, but Members on the two sides of the House hold different views. We believe in devolving power locally and we want local decision-making. We accept that that might mean that sometimes services are slightly different in one part of the country compared with another, but the benefit is that we do get that local knowledge. In the past few weeks, I have spoken to South Western ambulance service, which had particular pressures over Christmas, to ask whether there is anything we can do from the centre. What I want to ensure is that the decisions that keep my hon. Friend’s constituents safe are made locally, because they are likely to be better than any that I could make in Whitehall.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State is very reassuring when he says that, under him, the NHS is free from political news management. If that is the case, why does he not free it from the constraints of election purdah, and allow these officials to get on with their jobs without having to second-guess the consequences of some of the decisions?

[Mr Hunt]

We are not in election purdah. The point is that during election purdah we will continue to publish the weekly A and E performances and other figures from the Office for National Statistics, and that has always been the system. But there is a difference between what is happening in the run-up to this election and what happened in the run-up to the previous election. This time, the CQC is free to speak up, without fear or favour, about the quality of care in every single hospital in this country, and it will continue to do so.

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I have met the doctors in Chippenham and been personally lobbied on that plan. I thought it sounded very promising, so I am happy to take it away and look at it again, and hopefully at some stage they can get some of the funding.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

T4. The Bournbrook Varsity medical centre is about to face a double-whammy financial crisis, as NHS England scraps its minimum practice income guarantee and forces it to switch from a personal medical services contract to a general medical services contract. Why should that excellent practice, which has done all that could be asked of it, and its patients be victimised because a high proportion of the patients are young students? Will the Secretary of State agree to look at this disaster immediately?

[Mr Hunt]

I am very happy to look at that issue.

NHS Investigations (Jimmy Savile)

Steve McCabe Excerpts

Thursday 26th June 2014 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. Today’s report is about the NHS and the BBC report is ongoing, as is the report being done by the Department for Education and the work being done by other Departments. We have to wait for the BBC to make its own statement on the matter, but my priority now is NHS patients, and the reason that I wanted to go at speed on this was to make sure that any changes we need to make now, we do so.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Secretary of State says, quite understandably, that we cannot undo the past, but there are several people culpable in this affair who are still drawing substantial NHS pensions. Why does he not consider docking their pensions, as a consequence for their behaviour and as a clear warning to others?

[Mr Hunt]

I do not rule that out at all. If someone has behaved in a way that is in breach of either the law or the regulations that were in place at the hospital in which they worked, and there is a way to have legal redress such that things like pensions can be docked, I think that they should face the full consequences of that.

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Hunt]

Well, I must say that that sounds like a pretty irresistible offer, and I will give it careful consideration. Local community hospitals have an important role to play in our NHS because of the high standard of compassionate care that they deliver, and because they are easy for relatives to get to. I am delighted to see my hon. Friend campaigning for his local hospital, and delighted that it is doing so well.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

T2. A Birmingham trust has recently announced that it will be possible to cut 1,000 beds across the city by setting a maximum stay of seven days for most patients. Not surprisingly, this has caused some alarm. Are Ministers aware of that proposal? What guidance, if any, can they offer in regard to such proposals?

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

As the hon. Gentleman will be aware, patients need to be treated according to clinical need, and bed stays should not be determined by anything other than that. So if what he describes is actually the case, it would be very disturbing. If he would like to raise the issue further with me, I would be happy to look into it for him.

Health

Steve McCabe Excerpts

Monday 9th June 2014 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

It is great to address the packed Benches on the Government side of the Chamber. This Queen’s Speech ought to be remembered as the last Queen’s Speech of the first coalition Government since 1945. I confess I am one of those who thought that it might never happen, but to their credit the coalition Government have put aside their differences and come up with a plan for a Bill to levy a 5p charge on poly bags. That would normally earn them a place in history, but this Queen’s Speech has been overshadowed, as we saw again today, by the row between the Home Secretary and the Education Secretary. Since the theme of today’s debate is health, let me say to the Education Secretary that trying to humiliate that lady could be very bad for his health—ask the Police Federation! Perhaps he should try to recruit a retired counter-terrorism officer to mind his back.

This has always been a Government built on hype. It has been there from the beginning, when they claimed that trebling tuition fees and slashing public spending were all for our benefit and would eliminate the deficit within five years. That much heralded and rebranded long-term economic plan aims to cut the deficit by the same amount as my right hon. Friend the Member for Edinburgh South West (Mr Darling) would have achieved. What has become long term is the prospect of continuing cuts and a deficit stretching years into the future.

We were led to expect a Bill to regulate health and social care professionals, but that is absent, despite Winterbourne, the Francis report and the latest Anglia Retirement Homes scandal. I regret that, because there is little doubt that we need to regulate those professions and provide greater assurance and security to patients, residents and relatives. I want to be able to tell my constituent whose elderly relative was induced to give a loan of several thousand pounds to her carer to buy a car that something will be done and that such crooks will not get away with it. I want to be able to tell the family of Ms Jones that, if they see the call button by the bedside disabled or find their elderly relative naked from the waist down and covered in excrement, something will be done. I want to know that the people who are doing the caring have been properly vetted and have suitable qualifications and training, are supervised and will be given the time to provide the care that their patients need.

Of course I would have liked an admission that section 75 of the Health and Social Care Act 2012 was a disaster. Far from putting GPs at the heart of decision making, it has reduced clinical commissioning staff to second-rate auctioneers. At a time when Simon Stevens is calling for more local and community services to provide care for the elderly, section 75 requires doctors to act like second-hand car salesmen. The way forward is to construct models that bring together statutory and voluntary services. We need the local state working alongside bodies like churches, community groups and even neighbours. Clinical commissioning groups should be creative and imaginative; instead they are stymied by the Government’s market dogma.

As this is carers week, I would have welcomed a law that recognised the rights and needs of the users of health and care services, that empowered them so that joint commissioning bodies were not allowed to close respite care facilities because accountants advised them it was an easy saving. I am battling to protect the Kingswood bungalows in my constituency, a purpose-built facility less than 15 years old, but targeted by those whose priority is to manage the books, not the interests of patients; and my constituent with severe autism who has lived in a specialist autism community for over 17 years. It is his home, but just as we have seen the crass contempt for people’s needs with the bedroom tax, we are seeing people like him threatened with eviction because the accountants and the joint commissioning administrators think they have found a way to save a few quid. I would have liked some legislation to regulate and enforce action against those who look after their own interests while wrecking the lives of others.

I welcome the promise to raise the number of apprenticeships, because if there is one issue that threatens the health and well-being of a generation, it is the spectre of unemployment and the denial of a future for our young people, but how many will be real apprenticeships targeted on the 16-to-19 age range? As with every other bit of hype, too many of the current apprenticeships go to those over 25 and are often just an existing job that has been redesignated. This is, after all, the Government who think they can send a young graduate already engaged in productive voluntary work to Poundland to learn how to stack shelves.

A Bill promising proper training, relevant qualifications, a chance to build a portfolio of skills, real employment opportunities and the full engagement of employers: that is what young people need. If we are living in the age of micro-businesses, and self and portfolio employment, then let us give young people the training that allows them to make a go of these things, rather than leaving them to be ripped off and exploited.

Sadly, this is a Queen’s Speech with none of those relevant interests served.

Care Homes

Steve McCabe Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

My hon. Friend is right. That is why the Government have taken steps to ensure that the Care Quality Commission can prosecute when there are examples of the new fundamental standards of care we are introducing being breached. In future, no one will be able to get away with allowing poor standards of care in their workplace. We will take action through prosecution and the fit-and-proper-person test to drive up standards.

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

The Minister has spoken a fair bit about the extra powers he will give the Care Quality Commission, but staff at that agency gave the Old Deanery home a clean bill of health in November 2013. Two months later after the “Panorama” revelations they found significant failings. What will the Minister do about inspectors who failed to do their job? Will they be free to carry on as if nothing has happened?

[Norman Lamb]

I am grateful to the hon. Gentleman for raising that point. In a way, he makes the case for why the inspection regime needs to be much more robust and not a tick-box exercise. More effective inspection, with inspectors talking to staff and, crucially, relatives of those in the care home, will provide a much better picture of what is going on there. It is for the CQC as the employer to address any concerns it has about the way in which its staff have conducted themselves, but the new tough inspection regime is being introduced, with 1% of care homes already covered. It will be fully implemented by October this year.

Oral Answers to Questions

Steve McCabe Excerpts

Tuesday 14th January 2014 Commons Chamber

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

T7. The Secretary of State has had a letter from 118 specialists about the MenB—meningococcal B— vaccine. It is available to parents who pay privately, but denied to most of our children by the Joint Committee on Vaccine and Immunisation. Will the Secretary of State agree to meet the families of children who have had meningitis B and consider all the points raised by the clinicians before letting the JCVI rule out access to the vaccine?

[Mr Hunt]

I recognise the real concern over the previous advice given by the JCVI. I hope that the hon. Gentleman agrees that, on something as important as this, it is helpful to have an independent body coming to these decisions and making a ruling. When a ruling is made, we are legally bound to accept the advice, which means that there is a measure of independence. I have met families campaigning for the MenB vaccine. We are waiting to hear what the JCVI says in February. We should let it come to its conclusion after re-reviewing all the advice and the literature.