Social Care

Debate between Alex Cunningham and Jackie Doyle-Price

Tuesday 25th February 2020 Commons Chamber

[Jackie Doyle-Price (Thurrock) (Con)]

I feel like I am in groundhog day. It is approximately two years since I responded to a very similar debate secured by the hon. Member for Worsley and Eccles South (Barbara Keeley). It is disappointing that we are still debating the very same issues that we were then. Of course, there has been much water under the bridge since then in our broader politics in that time, but in respect of social care, to coin a phrase, nothing has changed. The questions we need to settle are exactly the same as they were then. I say very gently that with Brexit done and with a majority Government, there is no excuse for continuing to kick this can down the road. It is time that we genuinely took action.

At the heart of this question, we need to establish to what extent the cost of care should be met by the individual and by taxpayers. We need to establish a consensus on the balance between those two. From my perspective, it is not fair that at the moment that cost is met almost entirely by individuals. Equally, it would be unfair for it all to be met by taxpayers when people have some assets. We therefore need to settle that question properly. I would also gently say that our politics has not been entirely honest about that. It is worth reminding the House that at the moment only £14,250 of capital is protected. As the hon. Member for Worsley and Eccles South mentioned, that means those with very long-term care costs, particularly those who suffer from dementia, can face catastrophically high bills. There are, therefore, very strong arguments for a cap.

There are other reasons why we have to grip this issue now. As the hon. Lady mentioned, local authorities cannot plan their long-term finances. That also brings a real threat to financial stability within local councils. It is fair to acknowledge the challenges within the care sector, too. Many providers are finding the marketplace challenging, not least because of workforce challenges, but also because local authorities are insisting on paying low rates for residential care. That brings with it an additional injustice—people who are deemed able to pay for their care find themselves paying higher rates for the same product than local authorities do for those who do not pay for their care. I think that is a major injustice in the system.

[Alex Cunningham]

Would the hon. Lady support the Government funding local authorities so that they can pay the proper living wage to careworkers?

[Jackie Doyle-Price]

The issue is that local authorities are commissioning care from local care providers and paying the rate that the individual resident is incurring. It is about what they are prepared to pay for that bill and not the local authorities paying living wages directly to employees. However, that is pushing the risk on to care providers, and we need to acknowledge that there will be workforce challenges for those providers. They will be competing more and more for people. While there is that downward pressure from local authorities on what they are prepared to pay and the upward pressure on wages, the risk is being borne by providers.

Part of the solution is also not just about who pays. We need to be a lot more imaginative about this. We all know that we will live longer—beyond 70—and that we will have more years in life in retirement. Just as we make plans for our pensions, we need to make provision for our homes and how we are going to live in old age. The simple fact is that our housing requirements when we are in our 40s and are raising a family are rather different from what we might require in our 90s. We know that falls are one of the biggest burdens on the NHS, so the fact that we are not encouraging people to make sensible lifestyle decisions about their homes is causing additional cost to the NHS, as well as, potentially, the need for more long-term residential care. One reason why we have that issue is that we have allowed, collectively over decades, so much wealth to be stored in our housing stock that we have encouraged people to behave in a way that makes them want to cling to it. I would like us to look more imaginatively at incentives through the tax system to encourage people to downsize and look at different ways of living. We want to use the planning system to encourage the development of retirement villages where people can purchase extra care.

[Jackie Doyle-Price]

I completely agree. That is exactly the kind of incentive that we should encourage. The longer that we can encourage people to live independently, the better their quality of life and the better it is for the taxpayer, because there will not be those ongoing bills. The point is exactly that as we live longer, we will spend many years in a condition of frailty, and that needs to be properly managed through the system.

Every parent, with the best will in the world, will wish to hand on as much of their assets to their offspring as possible, but that could also encourage behaviours that are bad for their health. I want my parents to realise the value of their assets rather than protect their inheritance for me. I am sure that most people would think that about their parents, but there is a lot we can do on the tax system and incentives to encourage families to manage those issues collectively and in a way that is good for people’s welfare as they become elderly and enables them to do more for their children.

It is high time that we tackled this issue. We should also not look at this entirely in isolation from the issues regarding working-age adults, which are also a major challenge for local authorities as they manage their finances in this area. We must look at the issue of people with learning disabilities and autism being increasingly placed in areas of long-term care. The issue is that, although we have been broadly successful in moving out people with learning disabilities through the transforming care programme, sadly the pipeline afforded by those people moving out has been filled by people with autism. The Government have to give a much clearer challenge to commissioners. When faced with people with complex needs, the first instinct should not be to put them in residential care. Too often we have seen how those kinds of placements do harm. We need to challenge local CCGs and NHS England to put much better care upstream by providing early diagnoses for people with autism and giving them the tools to protect themselves.

[Alex Cunningham]

On the workforce issues, surely the answer to the dilemma the hon. Member is describing is to have a professional, well-paid, well-trained workforce that can deal with people with the most complex needs in their homes and allow them to remain there as long as possible.

[Jackie Doyle-Price]

The key words the hon. Member just used were “in their home”. There is no public policy challenge that does not come back to having the right kind of housing solutions. Many of these issues arise from our not investing in the right kind of supported housing environments that would enable more people to live independently. That has to be part of the solution. Local authorities and the local NHS need to come together to commission the right kind of service.

As we are short of time, Mr Deputy Speaker, I will end there, but it is high time we gripped this once and for all.

Mental Health Act 1983

Debate between Alex Cunningham and Jackie Doyle-Price

Thursday 25th July 2019 Westminster Hall

[Jackie Doyle-Price]

I partly agree with the hon. Lady. The answer is better help within the community, but I come back to the point that the right hon. Member for North Durham (Mr Jones) made so well. It should not be about beds or in-patient care. The fact that we still have that, and that it is increasing, is a mark of failure. I do not think it should be addressed by reinvestment in in-patient care in the community. The key is putting the support in earlier, and that is what we must aim toward.

The hon. Lady mentions that many of the providers are private, and she is right. One of the challenges I am setting NHS providers is how we can be more innovative, co-commissioning with local authorities to ensure that we have more supported accommodation available in the community, recognising that there will be a saving across the system. I am very clear; I will take it on the chin that local authorities have had more financial challenges than the NHS has as we have tackled public spending, but ultimately, we must think about that person and ensuring that they have holistic care. Silo-based decision making is not doing the people who need our help any good. That is still a work in progress.

The hon. Member for Stockton North (Alex Cunningham) is right about the role of social workers here. I have regularly debated with hon. Members about the workforce challenges that we face in delivering improved mental health services. NHS England is very clear that that will be developed only through new multidisciplinary models of care, in which social workers will play a part. We can also make much better use of people with lived experience in delivering care for people with mental ill health, not least because engaging with mental health professionals can be very intimidating and threatening, particularly for somebody going through a crisis, and someone with lived experience can bring a very different perspective to that relationship. Much more can be done about that. That underlines the point that hon. Members made a number of times about the need for appropriate support services.

[Alex Cunningham]

I wonder whether I can prise from the Minister a commitment to look at the fact that there has been a deterioration in the number of authorities that are working with our health partners. Integration is deteriorating, rather than increasing. The model must be better, and all professionals must work together.

[Jackie Doyle-Price]

That is a fair challenge. We certainly will. One of the difficulties when there is a financial challenge arrangement is that people retreat into their silos and say, “This bill is your problem.” That is not good enough. We have to be better at challenging them when that happens.

I am very clear that commissioners need to be much more imaginative. There is often a tendency to over-medicalise some of these issues. We have heard today that wrap-around services can be delivered much better by the voluntary sector, with better value for money and in a less intimidating way. That can often be more reliable than relying on in-NHS services.

There are two aspects to homelessness. It can often be symptomatic of a mental health issue or addiction; it is symptomatic of the fact that the person needs help. Equally, it exacerbates the issues that those people have. We have made resource available to tackle the holistic needs of rough sleepers, but again we are treating the problem at the crisis end. People struggling with their housing situation will be more likely to need help, so we need to look at what else we can do to support people at that stage.

I was challenged on when we will end the use of police cells to detain people under the Mental Health Act. I want that to be written on the face of the Act, so that there is a clear binding commitment to do that. We have reduced it by 95% so far with places of safety, so I am confident in saying that detention in a police cell is a rarity these days; nevertheless, we need to guarantee that.

On in-patient care and out-of-area placements, it is clear that people recover more quickly if they are closer to their family and friends. As the hon. Member for Bristol East said, there is sometimes a need for specialist support. We need to look at how that interaction happens with NHS England. Specialised commissioning and delivering a very narrow service will inevitably lead to out-of-area placements, but are we doing more harm than good? Should the best be the enemy of the good? NHS England commissions a quantum; it does not scrutinise individual commissioning decisions. That is more likely to happen if it takes place locally. That is still work in progress.

[Alex Cunningham]

Recognising that specialist provision might be 150 miles away, will the Minister accept the recommendation from the APPG inquiry that families who do not have the means should be funded so they can visit and spend time with their loved one?

[Jackie Doyle-Price]

I cannot commit to delivering that, but I can commit to looking at it. I hope that is good enough for the hon. Gentleman.

Autism Diagnosis

Debate between Alex Cunningham and Jackie Doyle-Price

Wednesday 13th September 2017 Westminster Hall

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

It is a pleasure to serve under your chairmanship this morning, Mr Howarth. Thank you for giving so many Members the opportunity to speak, because the debate has been extremely valuable. I congratulate the hon. Member for Enfield, Southgate (Bambos Charalambous) on securing it. The discussion was highly informed and showed how important Members consider the issue to be. That is to be celebrated, given the 2009 starting point that my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) mentioned.

There have been significant advances in the treatment of people with autism, notwithstanding the serious issues raised today. I will not pretend that things are as they should be, because clearly they are not. Our ambition is for people to receive a timely autism diagnosis, but the cases that hon. Members have raised today make it clear that the standards that families deserve, and that they have a right to expect, are not being met. All Members who said that we need to do more are right. I give the House an assurance that I am determined about our need to do better.

I look forward to cross-party work with the all-party parliamentary group, and to the review of where we have reached since the Autism Act 2009. I welcome the input of all Members, because only by understanding the real-life experiences can we make everything work better. In Government we tend to work through such things as targets and processes, which ignore the fact that we are dealing with real people. When we are dealing with people who have conditions such as autism, the processes can leave them behind. It is down to all of us to be the conscience and to ensure that all our public services work better in this field. We do have a sense of urgency on this.

I want to deal with some of the common points that have been raised. Many Members wished to know when the autism data will be published. Our intention is that the data will start to be collected from next April, with a view to publication in 2019. That is hugely important, because it will enable us to see which local areas are doing the job and which are not. There is nothing like transparency to hold people to account and to ensure that we get the consistency and delivery of service so that nobody is left behind.

The Care Quality Commission and Ofsted are currently undertaking a five-year rolling programme of inspections, looking at how things are being implemented in local areas, how health services are working and how education authorities are dealing with education, health and care plans, which were mentioned in earlier contributions. We all know, and have witnessed, that so much is dependent on local leadership. If we can highlight good practice and where things are going well, as well as where things are not, we will be able to generate the pressure to increase performance across the board.

My right hon. Friend the Member for Chesham and Amersham mentioned mortality rates for people with autism. I know that the Minister for Disabled People, Health and Work, my hon. Friend the Member for Portsmouth North (Penny Mordaunt), shares my concern that people with autism and learning disabilities tend to get left behind when it comes to employment and access to health, which has an impact on mortality rates. She and I are very much prioritising that. I look forward to engaging with the all-party parliamentary group on those issues too, because we will have much to learn from its expertise.

The hon. Member for Worsley and Eccles South (Barbara Keeley) specifically asked whether we would commit to including autism in the primary care register. We have said that we expect GPs to do that and that we want to spread that good practice. We will be working with NHS Digital to do exactly that. Again, I am open to any suggestions in that space.

With regard to access to further services following a diagnosis, that is very much the space of local commissioners, but the inspections by the Care Quality Commission will enable us to hold local commissioners to account on exactly that.

[Alex Cunningham]

The Minister knows how frustrated parents are by the delay in getting an official diagnosis, but it is the knock-on effect on other assessments, such as education support plans, that really adds to their burden. Will she give any advice to local authorities and CCGs to look beyond the official diagnosis, to make some of those other things happen?

[Jackie Doyle-Price]

We very much send the message that parents of children with autism are entitled to good services and that is what they should expect. We need to spread that good practice and collect those data, in order to highlight exactly where it is not happening. When we look at the work that the Care Quality Commission has done to highlight good practice, we should be able to get some messages. We are looking for transparency to drive performance and to have those conversations. The NHS mandate for 2017-18 sets a priority for the NHS to reduce health inequalities for autistic people, so that is very much part of NHS England’s conversations with local CCGs.

Health

Debate between Alex Cunningham and Jackie Doyle-Price

Monday 9th June 2014 Commons Chamber

[Jackie Doyle-Price]

I cannot agree with the hon. Lady. The important thing is that Government Members make it clear to the NHS that we expect it to put the interests of patients at its heart. I want again to draw attention to what has happened in Basildon and Thurrock university hospitals trust because it is perhaps the best example of the profound change we have had in NHS culture over the last five years. We now have a Government, and leaders within the NHS, who are finally prepared to face up to what is going wrong and to deal with it, rather than to cover up, be complacent and say, “We’re no worse than anyone else.”

I have to say that it has been a turbulent journey for those of us involved in Basildon hospital over those five years. The shadow Health Secretary, who is not in his place, will recall coming to this House in 2009, at the same time as he spoke about Mid Staffordshire, to highlight exactly what was going wrong at Basildon. Since then I have had a number of conversations with senior managers in which I was told, “Well, we’re no worse than anyone else. You’ll find this everywhere.” That was not good enough, but after two and a half years of not making any progress at all, Members of this House had very robust discussions with Monitor and said, “This needs proper intervention.” That led to a complete change in the leadership. A new board was appointed that was more inclined to give challenge where it was due. We had a leadership team that put stronger emphasis on good clinical leadership, and a chief executive was appointed who was determined to make sure that Basildon hospital delivered the standards of care that all patients deserve. What we have had is cultural change, and cultural change comes from leadership; it does not come from legislation. As I have said in many contexts, any organisation is a creature of the person at its top, so when we get good leadership in individual hospitals we get a step change in performance.

I also wish to pay tribute to the Secretary of State for the continued emphasis he places on patients, because when the head of the NHS—the person operationally responsible here in Parliament for performance—is articulating that, it will spread the cultural change which will deliver the real change in performance. I pay tribute to Clare Panniker, Basildon hospital’s current chief executive, who has delivered this significant change in the 18 months she has been in post. She has taken Basildon from being one of the worst performing hospitals to a position where it is coming out of special measures. She has been ably supported by the chairman of the trust, who has also been prepared to give a robust challenge and to stand behind her when she was doing so. Most of all, I wish to pay tribute to all the staff at Basildon. It has not been easy for them—it has not been good for their morale to see in the newspapers regular reports of the latest horror story of poor care within the trust—but they have reacted to the cultural change that Clare Panniker has brought. They have bought into it and given good, honest feedback, and I no longer get whistleblowing letters from staff about the latest incident. They have procedures to act on things and the management then implement that change. It says a lot about the commitment of the staff in that hospital that they have bought into that process and delivered us to where we are now. We all need to learn that sunlight is indeed the best disinfectant. It is not good enough to pretend that there is not a problem when there so clearly is, and it is important that we continue to put patients at the heart of the NHS. Only by doing that will we be able to ensure that the incidents witnessed at Mid Staffs and Basildon will become a thing of the past.

I wish to turn my attention to another issue that was not mentioned in the Queen’s Speech but which is on the Government’s legislative timetable for the coming year: the plan to introduce standardised packaging for tobacco products. I have to say to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) that it is a very bad idea. I fully support the policy objectives of tackling tobacco consumption and, in particular, of dissuading and preventing children from ever taking up smoking, but I have worries that this tool is not effective and that its unintended consequences may bring about worse health outcomes than doing nothing at all. Sir Cyril Chantler is said to have examined that as part of his review, but I am not persuaded of the evidence. In particular, I believe that introducing standardised packaging will worsen the public health outcomes if unregulated illicit tobacco products replace the regulated ones. We all know how toxic regulated cigarettes are, but when unregulated products enter the market the health outcomes will be very much worse.

Sir Cyril Chantler has concluded that Her Majesty’s Revenue and Customs has been very effective in tackling contraband and illicit tobacco, and he has cited figures going back to 2001. Although they show an improvement, the nature of the problem has changed over that period. European Union enlargement took place during that time and there was an immediate rise in the amount of illicit tobacco, but that has been tackled, mainly through co-operation with tobacco manufacturers. That illicit tobacco was also a legal product, whereas the illicit tobacco coming into this country today is not from Europe and it is not from regulated markets; it tends to be made in places such as China and Indonesia. Some of these products are extremely nasty, with tobacco rolled with whatever is available and containing high levels of tar. I commend The Sun for the exposé it ran last week in which an illicit producer from Indonesia explained just how toxic some of his products are and how standardised packaging will help him make money by reducing the costs of production.

[Alex Cunningham]

The Government’s own inquiry showed that there would not be an increase in the amount of illicit tobacco traded in this country. Does the hon. Lady not trust her own Ministers and the report they commissioned?

[Jackie Doyle-Price]

I was quoting that report and challenging its conclusions, which are based on a flawed analysis of the market—that is what I have been trying to explain. No, I do not trust that report. It is superficial and it has been put together with a particular agenda. As I say, it will lead to unintended consequences which will be very bad for public health.

My constituency contains Tilbury docks and the Purfleet ferry terminal. Despite the best efforts of Border Force, Essex police and the port of Tilbury, these products are getting through. Despite large seizures every week, Border Force does not believe that it is getting even 10% of the illicit product that is coming into the marketplace. It is estimated that one in three cigarettes smoked in London are illicit, and a good proportion of them will come through the ports in my constituency. Standardised packs will inevitably reduce costs for illicit manufacturers, who will be able to produce the product without differentiation in brand. I believe this proposal is a charter for a lot of very nasty people to make a lot of money, and if they do, the health outcomes we wish to see will not be achieved.

Let us be frank: we are talking about packets of cigarettes sold from holdalls behind pubs for a couple of pounds. Children do not start smoking by walking into their newsagents and picking a branded product; they are introduced to smoking via that holdall, at the back of the bike sheds or at the back of pubs. When cigarettes become that cheap, because of the proliferation of illicit products in the market, these children will be smoking some very nasty things. I ask Ministers to think again, because this is not the best tool for achieving a reduction in smoking and there will be unintended consequences for public health. I ask this Minister to sit down with Border Force and understand just how difficult the fight is that it is waging against serious organised crime and smuggling.