Health and Social Care Update
Debate between Alison McGovern and Thérèse Coffey(2 years, 2 months ago)
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Dr Coffey
I thank my right hon. Friend, and I agree with her that access to GPs is important. At present, we only publish data at the local NHS level—the integrated care board level—which is why I want to go further in relation to general practices. I know that the Minister responsible for primary care, my hon. Friend the Member for Colchester (Will Quince), wants to try to make it easier for people to change general practices. Of course, where people already have choice that may be possible now, but, understandably, I want to ensure that that fairly basic standard of provision for patients is a high priority across the country.
Alison McGovern (Wirral South) (Lab)
The statement from the new Secretary of State contained three paragraphs on care but not a word about care workers’ pay. I am gobsmacked, Madam Deputy Speaker. I wonder whether the Secretary of State has read the report produced by the Government’s own Migration Advisory Committee, which states:
“Persistent underfunding of the care sector…underlies almost all the workforce problems in social care…Higher pay is a prerequisite to attract and retain social care workers”.
Will she come back to the House with a workforce plan for care workers that will finally give them a decent pay packet?
Dr Coffey
As the hon. Lady will know, people access care, or work in the care industry, in different ways. That is why I am keen to continue the national recruitment programme, working with the Department for Work and Pensions. As for the £500 million that I have announced today, the local NHS, working with local trusts and local councils, will clearly be in a better position to decide, in a more differentiated fashion, on the best way of spending that money through not just buying packages but support for the sector. Let me also remind the hon. Lady that since last year we have changed the universal credit taper rate so that people keep much more of the benefits they may receive. However, I am also conscious of the need for us to continue to try and encourage people to come into the care sector, and that is a joint endeavour.
Oral Answers to Questions
Debate between Alison McGovern and Thérèse Coffey(2 years, 9 months ago)
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Dr Coffey
As my hon. Friend is my neighbour, I am conscious of the opportunities in his constituency thanks to the Government investment, alongside that of private investors, in our progress to net zero. I do not agree with him that we need to reshape student finance in such a way; that is not the purpose of universal credit, and only a limited number of people can undertake that training. I assure him that Train and Progress, which I mentioned, the lifetime skills guarantee and the opening up of access, as well as apprenticeships to get into a sector in the first place, are better ways to make sure that we help people to get on in work.
Alison McGovern (Wirral South) (Lab)
I similarly associate myself and all my colleagues with your remarks before questions, Mr Speaker.
The Government know that, as the hon. Member for Waveney (Peter Aldous) suggests, there is a problem with progression out of low pay, because they commissioned the Ruby McGregor-Smith review, which reported in July last year. In January this year, the Under-Secretary of State for Work and Pensions, the hon. Member for Mid Sussex (Mims Davies), told me that the Government would publish their response “shortly”. Meanwhile, kickstart has failed to deliver and, as the journalist Ed Conway pointed out this afternoon, in the past year the average house has earned more than the average 18 to 29-year-old in this country. That is a disgrace. Will the Secretary of State announce today when she will at last publish the Government’s response to the Ruby McGregor-Smith review of low pay? Will she say how the Government propose to make progress on two key issues that the review identified: public transport and childcare?
Dr Coffey
I reject the hon. Lady’s assertion that kickstart is not working. More than 130,000 young people have now had access to a proper job in which they have gained employability skills, so it has been an effective response. At the same time, she will be aware that there are more people in work on payroll than there were before the pandemic. People are making good progress in that regard.
The review is important. I will be candid and say that I am the person who has held it up, because I want to make sure we have got all the questions answered as best we can. Meanwhile, we continue to work across Government on some of the hurdles that people are trying to get over, such as childcare and similar issues. I hope that the response will be published shortly.
Oral Answers to Questions
Debate between Alison McGovern and Thérèse Coffey(4 years, 1 month ago)
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Dr Coffey
There are multiple questions there. My right hon. Friend the Chancellor has already responded by introducing the new job support scheme, which he updated for particular sectors, thinking of tier 3 in England, to extend even further the furlough scheme. It is clear that this Government are doing what is needed. In terms of the other things that the hon. Gentleman mentions, he will be aware that I continue to have regular discussions with my Treasury colleagues on the best way that we can help to support people during this pandemic.
Alison McGovern (Wirral South) (Lab)
Oral Answers to Questions
Debate between Alison McGovern and Thérèse Coffey(4 years, 8 months ago)
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Alison McGovern (Wirral South) (Lab)
Dr Coffey
The hon. Lady will be aware that the £118 a week is an average over eight weeks, and it will swing about whether people are eligible or not. I have tried to make it clear to the House, reinforcing the comments of my right hon. Friend the Prime Minister, the Chancellor and the Health Secretary, that people who are working will not be penalised because they cannot work in this regard. We continue to work across Government to bring forward the necessary legislation or other changes required.
Rail Fares
Debate between Alison McGovern and Thérèse Coffey(12 years, 2 months ago)
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Alison McGovern
I rarely reject out of hand anybody’s contribution to a debate on so important a subject as the rail industry. I merely make these points as a precursor to what I am about to say. I always feel that we should be cautious in what we say, because I have seen at first hand the complexity of some of the problems we face in running efficiently the kind of extensive rail system we have in Britain.
I want to speak about two things: first, the question of the average fare rise across the fares basket and the restrictions on rises; and secondly, some of the other ticketing issues that rail industry consumers face and what the Government’s ticketing review could consider in order to assist consumers. On the question of the average fare rise versus the cost to travellers of individual fare rises, I have a problem with the Government’s apparent position. The Secretary of State spoke at length only a moment ago about the importance of allowing train companies to raise fares in a way that allows them to maximise yield, but the problem is that that potentially allows significant unfairness. Those whose travel is absolutely necessary for their employment face potentially significant rises, whereas those who have a choice about how they travel are less likely to face those rises. To use an economist’s term, those with an inelastic demand curve—I apologise for my use of jargon, but it may be helpful—are stuck paying ever higher season ticket prices, while those who make up the elastic part of demand can pick and choose, so train companies maximise those yields on what tend to be leisure fares, for journeys that people can choose whether to make. That is the point that many Members across the House are making in different ways.
The problem with allowing average fare rises is that people who cannot choose whether or not to travel by train because they have no practical alternative can be faced with steep rises. The flexibility to do that cannot be allowed. In my view it is not fair. Of course, that is a decision that the Government must make based on the facts. Back in 2009 the then Transport Secretary took a decision, and I support it, because it was about ensuring not only that the train companies were able to do the business they had been contracted to do, but that there was a level of fairness for the travelling passenger.
The Government must think hard about this matter. If consumers who have no practical alternative to travelling by rail are faced with steep fare rises year after year, they will think that it is a significant unfairness to them. Members on both sides of the House have made that point. We need to be clear that this is about different groups of passengers and train companies effectively negotiating their way through to maximise benefits, in some cases for them rather than passengers.
In Merseyside we have quite a specific situation. Travel around the Mersey travel network tends to be more reasonable. However, one of the things we are desperately trying to do is increase job opportunities for people in Merseyside who are perhaps a little further afield. Earlier I cheekily mentioned to the Secretary of State my campaign to improve the Wrexham to Bidston line. It is all about helping people to travel from places in the Wirral and the rest of Merseyside across our city region and further afield, to Manchester or north Wales, to find work wherever it may be.
That is the Government’s stated policy, and they tell us they believe in it. However, with rail fares continuing to increase—my hon. Friend the Member for Rhondda (Chris Bryant) made this point eloquently—those on the lowest incomes will not have an option. They will be unable to take a decision to make what is currently a 90-minute journey from Bebington, Birkenhead, other parts of the Wirral, Southport or the wider Merseyside area to Manchester and other cities, because once they have made that further journey it will be just too expensive. That runs absolutely counter to everything we are trying to achieve to drive up the economic performance of our northern cities. The Government must think carefully about whether their approach to rail fares is not actually against the drive of what they are trying to do across Government.
Secondly, we need to think carefully, perhaps as part of the Government’s ticketing review, about how to ensure that the sale of train tickets and rail travel in general works for the customers, who pay significant amounts. I am particularly interested in how the current set-up harms people working for businesses and organisations who do not use the railways frequently enough to be considered regular or daily users, or even commuters, but do use them frequently enough for there to be a significant impact on their business.
The Government need to pay attention to a couple of aspects. The first is what a peak time is. When I was growing up, it seemed as if we always knew what the peak times were and that they stayed the same year after year. That may be the effect of the rose-tinted glasses of hindsight; perhaps things were different in reality. However, now peak times seem to change all the time.
If a person is travelling on different parts of the network, things can get difficult. For example, if their business, like many businesses in Liverpool and the Merseyside city region area, requires them to go to London one week and Leeds the next, it will be difficult for that person to find out whether the peak times are the same everywhere. The member of staff at Eastham station in my constituency may or may not have in their head the relevant peak times for the ticket.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
Having grown up in Liverpool, I know the hon. Lady’s rail line, Wrexham to Bidston, very well; I had family in the area. However, surely people in today’s world just check online—on nationalrail.co.uk or other sites, which will tell them the pricing of tickets for when they want to travel, including for off-peak, super-advance and similar tickets. I am not sure why there is such a complication.
NHS Care of Older People
Debate between Alison McGovern and Thérèse Coffey(13 years ago)
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Alison McGovern (Wirral South) (Lab)
I congratulate the hon. Member for Stourbridge (Margot James) on securing the debate and thank the Backbench Business Committee for timetabling it. There are few issues that mean more to me or make me more angry than the poor treatment of older people, especially by our NHS. Therefore, it is highly important that we focus on that today.
I shall begin where other hon. Members might not have had time to go—by questioning our values. The hon. Member for Stourbridge listed societal problems as being one of the causes of indignity in hospitals and, when I intervened to ask her about that, she said that she did not have enough time to go into the subject. I hope I can assist her by taking us on that journey.
I am afraid that I shall start by disagreeing with the hon. Lady. I find it hard to believe that there is a lack of moral value or preference in society. Part of the problem is that those values are not made explicit often enough. We have talked much about dignity today. That word is often used, but rarely explored. I question and doubt the point made by the hon. Member for Truro and Falmouth (Sarah Newton) about older people being treated differently in other countries. If that is the case, it is incumbent upon us as politicians to make our values absolutely clear. In many ways, the national health service is, for Britain, an expression of our moral choices and preferences. Whether or not we talk about the NHS in those terms, that is what it is.
Let us begin by asking what we mean by “dignity.” It means inherently respecting the other person because of their humanity. In practice, that means demonstrating they are listened to, cared for and thought of, no matter who they are or what their personal circumstances are. Let me quote from the CQC report to give an example of what I mean and why it is so important that we make that absolutely explicit. In the report’s overview by Dame Jo Williams, she mentioned that they found cases where they believed that staff stripped patients of their dignity. She says:
“People were spoken over, and not spoken to…left without call bells, ignored for hours on end, or not given assistance to do the basics of life.”
When we talk about dignity, that is what we really mean. I find it hard to believe that we live in a Britain where most people would walk past, look the other way or not consider the needs of somebody who is extremely vulnerable and stripped of the basic necessities of life. The vast majority of people in our country would consider that situation to be utterly intolerable.
The question is: what is going on in the health service that leads us to see cases in our surgeries and examples among our families where people are bereft of their dignity? Given that we set such high moral value by the appropriate respect given to people because of their inherent dignity, what is going on in the health service that allows such a situation to occur? I accept other hon. Members’ points about the level of frequency and the commitment of staff by and large, and I was also most taken by the remarks of my hon. Friend the Member for Nottingham South (Lilian Greenwood), who is no longer in her place, about the best practice demonstrated to her. Given that we know what the right answer is, we need to consider what happens when there is a failure.
Alison McGovern
I thank the hon. Lady, who spoke so well and so bravely earlier, for her intervention. I will come on to describe the differences within hospitals—a point at the heart of the debate.
Last year, the Wirral University Teaching Hospital Trust experienced some of the worst staff survey results in England. They were awful. The percentage of people who would recommend our local hospital to a member of their family was disturbingly low. I know I speak for other hon. Members in the area when I say that we are extremely concerned about this. The trust has a plan of action to try and put this right and there are many examples of the best quality of care being given to my constituents. However, some wards have been very poor. What we have observed locally relates exactly to the point raised by the hon. Member for Suffolk Coastal (Dr Coffey). Some wards are very good and some are extremely poor, and the CQC report also found that. Some of the places of most concern also had very good practice, so this is a problem.
We ought to ask the following questions about staff in the NHS, and I think that they should ask the same questions of themselves. The first question relates to the point that I started with: do they have the right values? Do they make the right moral choices? Do they have the right preferences? By and large, I think our answer would be yes. I do not believe that people in this country somehow just do not care—I think that that is wrong. The second question is: are NHS staff empowered to make choices in line with those values—the basic right to dignity and sense of humanity that we want them to? Are they empowered? Finally, in line with the points that have just been made, are they accountable if that does not happen? That is a crucial point.
The Front Line Care report is an important report written under the previous Government about the future of nursing. There is, perhaps, a missed opportunity. It covers, in detail, many of the questions that we have about nursing care. My mother was a nurse. Her line on nursing is that a nurse’s job is whatever the patient needs. That coheres entirely with both the Front Line Care report and the CQC report, which points out the problem alluded to by other hon. Members. Dame Jo Williams states that care seems to be:
“focusing on the unit of work, rather than the person who needs to be looked after.”
We need staff who are empowered to provide person-led care that looks at the needs of each person, and delivers for them what they need in the health service.
There is, of course, the question of targets. The Government have moved towards dropping some of the waiting list targets that were in place under the previous Government. Is this the kind of thing we can have targets for? I am not sure. However, I know that we know good quality when we see it. If the model of staffing for the dignified and respectful care of people is right, then that will drive up the quality of experience they receive. Leaving aside whether we have targets, quality of experience can definitely be monitored. There are some difficulties relating to monitoring older people, not least people who die in hospital. It can be very difficult to ask for feedback about the death of a loved one, but we need to find a way of asking. A good death is at the heart of what it means to be a dignified person. I encourage all hospitals to think carefully about how they ask for feedback from the relatives of a patient who has died. Even in the case of an older person with dementia, how do we get feedback on how the NHS has treated them?
As politicians, we need to back nursing staff and doctors. At the beginning of my speech, I tried to be very clear about the values that we espouse and I hope that they are shared across the Chamber. Those values give people absolute faith about what is expected. We can be clearer about the standards of care that we expect. I have concerns about systems, such as the red tray one, which rely on a tick-box culture, rather than saying, “Here is the standard that we expect people to live up to and it is your responsibility to do so”. How people in different wards meet those standards would be different, but they must meet them.
I would set the following test for the NHS. I believe in the NHS not merely through custom and practice, but as an article of my political faith. It is a fundamental expression of our values that everybody should be looked after if, through no fault of their own, they become unwell. Everybody should be taken care of. That means that if one person is not taken care of in the NHS—whether they are related to us, or nothing to do with us—in the way that we would expect for a member of our family, then that is not good enough. We should articulate that value. I hope—and know, in my case—that local leaders of hospitals share the belief that we should care for people in the NHS as though they were members of our family and give them the dignity to which they have an absolute moral right. We need to articulate those values and then make people empowered and accountable to living up to them in the NHS.
The Economy
Debate between Alison McGovern and Thérèse Coffey(13 years, 5 months ago)
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Dr Coffey
Well, perhaps he did not, but he seems to have changed his mind and is stepping up the pace of deficit reduction.
Plan C is the VAT cut that the shadow Chancellor announced, unknown to some of his shadow Cabinet colleagues, it seems. Yet again, it is another unfunded tax cut. I was not a Member the last time that happened, in 2008, but many people will remember that earlier that year the 10p tax rate was abolished, and what was the impact of that? The economy continued to contract, leading CEOs said that £12.5 billion had been wasted on that tax cut, and hon. Members may recall the Federation of Small Businesses survey, in which 97% of its members said that their earnings had not increased.
In spite of all that, the right hon. Gentleman has wheeled out the plan again, and eight times today the right hon. Member for Edinburgh South West (Mr Darling) refused to endorse it. We have been told that we need a credible plan with public and political support, but perhaps the shadow Chancellor needs to start with his Back Benchers, rather than by trying to persuade the British public.
I know brotherly love is a big feature of the Labour party, so perhaps the right hon. Gentleman will start with his brother, who I understand works for PIMCO, the world’s biggest bond fund, which has publicly stated that the UK has the best combination of fiscal and monetary policies in the G20—and so say all of us. No wonder in a Populus poll last week, only 23% of the population supported the Labour leadership in its desire to control the economy, a reduction of 10% in the past three months.
Instead, the British public have responded to the two parties on the Government side of the House, which just over a year ago came together in the national interest to form a coalition, and which with wide political support have put together a credible plan to restore fiscal sanity. Government Members have demonstrated a proactive attitude in starting to untangle red tape; in incentivising the creation of small businesses and entrepreneurs; in the significant policy of welfare reform, whereby we have been very clear that people will be better off if they work, unless they cannot; in the extra money going into apprenticeships, building on the good work—I recognise—of the former Government; and in funding infrastructure.
I was a little surprised at the contribution of the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop), who seemed to have forgotten the amount of money that the Government are spending on infrastructure. Indeed, we recognise that we need to do so.
Reference has been made to RDAs, but a PricewaterhouseCoopers report last year suggested that generally they have been poor value for money, and despite spending those billions, the prosperity gap has widened.
The hon. Member for Liverpool, West Derby (Stephen Twigg) referred to life in the ’80s in Liverpool, but I grew up in Liverpool and was there in the ’80s. I am going to do a lame Welsh accent, because it was a Labour council—a Labour council—that fired 30,000 employees to stave off bankruptcy—[Hon. Members: “By taxi”]—by taxi. Those people were understandably fed up with the Labour council leader, and they did not just take the ferry across the Mersey to Birkenhead; they left Liverpool. We have seen that with the reduction in the number of people living there, and in the money that is left, too. Ironically, the port of Felixstowe in my constituency benefited from the situation, but it has been a great shame, because I am very proud of where I grew up.
The Conservatives went in and put in investment.
Alison McGovern
The hon. Lady cannot mention our home city of Liverpool without acknowledging the previous Government’s role in rebuilding it and in restoring the pride that we take in it. Will she acknowledge their role, because her comments do not paint a true picture?
Dr Coffey
The hon. Lady is absolutely right. I am very proud of my home city, but I hope that she will also credit Lord Heseltine. We started back in the ’80s, we saw the Albert dock and other aspects of the city transformed, and some of that continued under the previous Government, but investor confidence in the city was knocked by that legacy of the ’80s which was referred to earlier.
The right hon. Member for Morley and Outwood also seemed to use marine terms, trying to suggest something about fancy yachts and the similar. The previous Government, in marine terms, were possibly the equivalent of the Titanic. People took their eye off the ball—holed by an unseen disaster, perhaps—with unintended, tragic consequences. That is the state of the economy which has been left behind, however, with tens of thousands of pounds of debt being loaded on to every child born and on to children not yet born.
The hon. Member for Newcastle upon Tyne North (Catherine McKinnell) referred to the impact of the Budget last year on mothers and families, but every mother and family I know has to cope with a household budget which means that they have to try to balance the books every month. That is absolutely key.