Hospice Funding

Andrew Gwynne Excerpts

Monday 22nd April 2024 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to respond to the debate. We have had a very thorough discussion over the past few hours, so let me start by thanking not only the Backbench Business Committee for granting the time for us to debate this important issue—albeit a week later than most of us had expected—but the hon. Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing the debate; I congratulate them on their speeches.

I thank my hon. Friends the Members for Enfield, Southgate (Bambos Charalambous), for Coventry North East (Colleen Fletcher), for Birmingham, Erdington (Mrs Hamilton), for Hammersmith (Andy Slaughter) and for York Central (Rachael Maskell), my right hon. Friend the Member for Hayes and Harlington (John McDonnell) and my hon. Friend the Member for Leeds East (Richard Burgon), as well as the hon. Members for Colchester (Will Quince), for Southport (Damien Moore) and for Eastleigh (Paul Holmes), the hon. and learned Member for Eddisbury (Edward Timpson), the right hon. Member for Basingstoke (Dame Maria Miller), the hon. Members for North Devon (Selaine Saxby) and for Bolton West (Chris Green), the right hon. and learned Member for South Swindon (Sir Robert Buckland), the hon. Members for Loughborough (Jane Hunt), for Isle of Wight (Bob Seely), for West Dorset (Chris Loder), for South Dorset (Richard Drax), for Waveney (Peter Aldous), for St Austell and Newquay (Steve Double) and for Bracknell (James Sunderland)—not forgetting, of course, the hon. Members for Strangford (Jim Shannon) and for Glasgow North (Patrick Grady). I also congratulate all those who took part in the London marathon; I was not one of them.

Let me now turn to the subject that we are here to debate. End of life care is a subject that has touched the lives of most of us. It is a time when our loved ones, and the family and friends who surround them, can be at their most vulnerable and in need of the greatest support. Managed well, it can be a healing time for families to come together, but managed badly, it can leave deep and traumatic scars. I need only look at the experience of my family—the experience that I had during the deaths of my parents to know how this bears out. It was 30 years ago that I lost my mum to ovarian cancer—I was 19. Her final hours were spent at the end of an old Victorian ward with the curtain pulled around her, and she was in immense pain and suffering, which I remember vividly to this day. That was incredibly hard for our family to manage.

More recently, in 2022 I lost my dad following his own battle with cancer. Unlike my mum, he died at home, with my wife and I taking him in for the last few months of his life, and we were supported by a superb army of care staff. In fact, when the time came for my dad to decide whether he wanted to go to the local hospice, Willow Wood, or stay at home with us, the final words that he communicated to me and my wife were, “Stay here.” I come back to the point made by the hon. Member for Colchester about how we talk about death, how we deal with death and the end of life, and the fact that many people want dignified end of life services at home; we should do all we can to facilitate that.

In my dad’s case, the whole system worked. It came together in a way that, as I know from my constituency casework, it rarely does. The hospital, social services, Macmillan, Marie Curie, the GP, the pharmacy, the district nurses and Willow Wood hospice all worked together seamlessly, and my died passed away in comfort, peacefully and surrounded by those who loved him most in the world. We have heard from my hon. Friend the Member for Coventry North East and other Members that we have to get the end of life choice right for people, and hospice at home plays an important role in that.

The sharp contrast between my parents’ journeys emphasises to me, in a deeply personal way, just how impactful end of life care can be. For all of us, death should be about choice and what we want, and we should leave this planet with dignity. We talk about the integrated care boards, and the clue is in the name: they should be integrated, with both social care and other services, including hospice services. In my dad’s case, that worked, but as we have heard from Members across the House, in too many cases the integration just is not there yet. The Government have rightly devolved money to the ICBs for a specific purpose, but it is not being spent as we would want.

Hospices play such an important part in that deeply personal journey for hundreds of thousands of people and their families every year, right across the country. Working in partnership with existing local systems, hospices ensure that people receive the care that is most appropriate for them, considering all their needs. I pay particular tribute to one of my local hospices, Willow Wood hospice in Ashton, Tameside. The tireless work and dedication of its staff was a vital support when we were caring for my dad in his final days. Those staff showed hospice care at its best, and they have my immense gratitude for all that they continue to do. But they, like so many others, find themselves in a perilous financial position; Willow Wood faces a structural deficit of £750,000 this financial year. Without finding a way to plug the gap, its services will have to be reduced.

There is real pressure on all hospices to generate their own income, with Hospice UK estimating that as much as two thirds of income for adult hospices is generated through fundraising, with some, like Willow Wood, having to raise 80% of their funds themselves. Many hospices do incredible fundraising work, with armies of volunteers finding ever more ingenious ways to keep the money coming in, but with the incredibly hostile economic climate that hospices are finding themselves in, including as a result of energy costs, funds are being squeezed more than ever—[Interruption.] Someone put 50p in the meter; obviously the House cannot afford those costs now!

The sector as a whole is on track for a deficit of £77 million for the last financial year, the worst figures for two decades. As a result, hospices are starting to pare back some of their services. As we have heard, there is also a legal requirement placed on integrated care boards by the Health and Care Act 2022 to commission palliative care services in keeping with local need, and we need to ensure that that funding is passported down to the hospices where they need it. We know that delivery is far from consistent, leaving patients in some parts of the country without adequate services in their own community. The clear pressure on the sector shows no sign of letting up, because we are an ageing population and demands on hospice services are set to increase further, with Office for National Statistics data suggesting that a further 130,000 people will die each year in the UK by 2040.

It is clear that we need proper joined-up supportive policies for the hospice sector. We need to ensure that the money that the Government have ensured is there for the hospice sector gets down to where it needs it: at the hospices themselves. We need to focus on creating a health and care system that is genuinely joined up and has end of life care as part of the health and wellbeing policies for each and every one of us. This can no longer be the taboo subject it once was, and the hospice sector underpins so many care pathways that have a tangibly positive impact on patients and their families. End of life care matters. This current Government will have our support in ensuring that the hospice sector is protected and supported.

Parents and Carers of Infants: Support

Andrew Gwynne Excerpts

Tuesday 12th March 2024 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Henderson.

This has been a small but perfectly formed debate. I congratulate the hon. Member for Hastings and Rye (Sally-Ann Hart) on securing not just the debate, important though that is, but a Bill. I wish her Bill well on Friday, because, as the hon. Member for East Worthing and Shoreham (Tim Loughton) rightly said, there is a degree of consensus on these issues across the House. We all understand the need for children to have the best start in life, and for parents to have wraparound support as and when they need it. Those first 1,001 days are crucial to the development of a child to ensure that they start out in life with the best chances that we can give them.

I was interested in what the hon. Member for East Worthing and Shoreham said; my ears pricked up to attention when he mentioned Stockport. Being a partly Stockport Member of Parliament, I am keen to promote it as one of the two boroughs that my parliamentary constituency sits within. Stockport children’s services are good. They provide decent support to families when they need it, and there are some challenges. Stockport is a unique borough in many ways, in that it is a microcosm of the entire United Kingdom. It has some of the richest, most prosperous parts of Greater Manchester within its boundaries, and some of the poorest parts. It is almost a perfect make-up of the country.

[Tim Loughton]

Although it was 14 years ago when I went there, I have been back since. I am delighted to confirm to the hon. Gentleman that Stockport had a fantastic children’s services department then and it has remained so, with some impressive, experienced social workers. Where I went was not in his constituency; I visited nearby, with the full compliance and support of the then Member.

[Andrew Gwynne]

I would hazard a guess that the hon. Gentleman visited Brinnington, which is just over the border. Irrespective of that, he is absolutely right to support the Best Start for Life programme, and he is right that we should not change it for the sake of it. We can tinker around at the edges, but the ethos behind it is absolutely right.

I would also hazard a guess that if this Government had their time again, they might well have done the same with the Sure Start programme, which was starting to make a big difference. I will talk very briefly about my experience of Sure Start in my constituency. I was given the privilege of opening one of a number of Sure Start centres. This one was in the Dukinfield part of my constituency, in the Tameside borough. It was attached to a primary school in the middle of a 1960s deck-access council estate. The centre had been open and providing services to the community for about six months before it had its official opening. As the guest of honour cutting the ribbon, I was introduced to a number of people who used the services within the Sure Start provision.

I was introduced to a young mum called Sarah. She was very young, and had been ostracised by her family because she had become pregnant. She had no natural support network around her. Her only existence had been the four walls of her flat in the deck-access estate. Understandably, she had become very depressed post pregnancy, and the life of her young baby was essentially sitting in front of the television while mum was in her dressing gown eating crisps. Her brilliant Sure Start worker eventually convinced mum to go to the new provision across the way, and got her out of those four walls of the flat.

Dukinfield is a very white, very working-class community. The Rive Tame, which runs through Tameside—the clue is in the name—is only very narrow, probably no wider than this room. On the opposite side of the river from Dukinfield is Ashton-under-Lyne, and that part of Ashton-under-Lyne is very heavily south Asian, with predominantly Pakistani and some Bangladeshi communities. Never the twain shall meet. That river may as well be a wide ocean. Those two communities did not mix, but this Sure Start centre was shared by both communities.

Sarah very excitedly introduced me to her best friend Ameena, who lived in Ashton. Those two would never have met but for that Sure Start provision. She said to me, “Mr Gwynne, let me introduce you to my best friend Ameena. Her daughter plays with my daughter. They’re best friends, and I go to her house. Mr Gwynne, before I came here I couldn’t boil a pan of water. She’s now teaching me to cook curry.” I just thought: Wow! Not only is it a safe space for different communities to come together by accessing support through mainstream statutory services, but they are informally helping one another. I thought that was great. If we could bottle that and spread it out, that is what we should be doing.

That is why I will always argue passionately that Sure Start was working and why I am pleased that the Minister has brought in family hubs. Although they are not yet on the scale of Sure Start, from small acorns grow great oaks. I believe that, whoever is in government, supporting the family and nurturing them in those first 1,001 days really matters. In terms of the Bill from the hon. Member for Hastings and Rye, some really simple changes can make a big difference. She mentions that for many it is not easy to access information for support and that local authorities should publish the Start for Life offer on its website.

I know we are not supposed to use props, but I draw Members’ attention to the website of Grow in Tameside, which has a page for key Tameside contacts for early years support and information. It is all there on the website, in part because early years has been a passion of Tameside Metropolitan Borough Council for a long time. In the 1980s, before it was fashionable, they had child and family centres in Tameside. Those centres were used as the evidence base for Sure Start when the Labour Government came in in 1997. The Minister made sure that Tameside was one of the pilots for the family hubs, so we have family hubs operating already in Tameside and doing great stuff. They could do more, but it is great what they do.

This is not just about statutory services but about the wider support network, whether that includes religious organisations, community organisations, the voluntary sector or others. There are lots of things going on. I am a very proud patron of Home-Start in Oldham, Stockport and Tameside. Sarah and the team there do great work. The Dad Matters team under Kieran does great work engaging with dads. They have a breastfeeding service, and they have Cascade, where people can donate toys and clothes to families who need them. That work is being done, but we need to turbocharge it. That is why Labour will always support any measure that means the best start in life for children and families.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 5th March 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

It was the Minister’s party that promised to fix the crisis in social care “once and for all”. With vacancy rates almost three times above the national average and turnover rates for new staff at more than 45%, it is clear that the Government failed. Labour’s plan for a national care service with clear standards for providers and a new deal for staff will give social care the fundamental reset it needs. The Government have done it with our workforce plan, and they have half-heartedly tried it with dentistry. Does the Minister want to copy our homework once again?

[Helen Whately]

Let us be honest, Labour has no plan for social care. Whatever the shadow Minister says, it is unfunded. There is no funding committed to it and it is not meaningful. Those of us on the Conservative side of the House are reforming adult social care. We not only have a plan, but it is in progress.

Internationally Recruited Health and Social Care Staff: Employment Practices

Andrew Gwynne Excerpts

Wednesday 31st January 2024 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Hosie. I shall begin by congratulating the right hon. Member for Spelthorne (Kwasi Kwarteng) on securing this important debate and on the way in which he opened the debate; it was incredibly insightful and certainly chimed with a number of the issues that have been raised by Members across the House, as well as with the concerns we share about the role of an international workforce and how we look after those people who come to this country to help those in our social care service.

I also thank my friend, the hon. Member for Strangford (Jim Shannon). I know that it is convention to call him “hon. Member”, because he is from a different party, but he is my friend, because—I do not know whether I am stalking him or he is stalking me—we are always at the same debates. He made an important point about how we get workforce planning right across the United Kingdom. I am aware that if, at some stage in the future, I were to have the Minister’s job, it would be very easy to come up with a workforce plan for social care that plugs the gaps in England by pinching staff from Northern Ireland. We have to ensure that, as we go forward with our workforce planning, there are enough people in the social care workforce across the whole of the United Kingdom. We must not create a perverse situation whereby working in social care in England becomes very attractive at the cost of social care in Scotland, Wales or Northern Ireland. We must work together on this journey of upskilling and building a workforce for the future.

Likewise, the hon. Member for Westmorland and Lonsdale (Tim Farron)—I will call him a friend too as we are all friends in this Chamber—made some really important points. He spoke about the challenges—not just workforce challenges but general challenges—in delivering quality social care and other public services in sparsely populated areas such as his constituency in the Lake district, which are linked to other issues that he speaks passionately about in the Chamber, including housing and transport. We need to join up those things if we are to attract the right kind of social care workforce to meet his constituents’ needs.

I disagree profoundly with the desire of the hon. Member for East Dunbartonshire (Amy Callaghan) for Scotland to be separate from the rest of the United Kingdom. I am a proud Unionist. I have Welsh heritage, as my surname, Gwynne, indicates. I am half-Scots, as my first name, Andrew, suggests. My Scottish gran from Lochwinnoch was very adamant that I have a Scottish name. And obviously I am English—I am Mancunian—and proud of that. I see the benefits and the strength that comes from the people of the islands that make up the United Kingdom working together for the common good. I get that under the devolution settlement Scotland has the ability and the responsibility to develop, provide and plan social care services that meet the needs that are particular to the towns, villages and cities in Scotland, but migration is a reserved power. There must therefore be a relationship between the way in which the Scottish Government meet those needs and plan health and social care, and the United Kingdom Government’s wider responsibilities on migration.

We can be in no doubt that we have a workforce crisis in health and care services right across the country. Members have said that there are 152,000 vacancies in social care alone. I have been meeting providers and representatives of local authorities, and they tell me that the challenges are massive. That is why we need a proper grasp of how we build the workforce of tomorrow responsibly. It takes only the opening of a new supermarket in somebody’s area for social care to lose a whole swathe of low-paid workers because they get paid more to stack shelves, so there is something fundamental there.

We are failing to recruit the staff we need, and staff in the services are leaving. That is not sustainable. Our health and care workforce so often represents the best of Britain, going above and beyond to keep us and our loves ones safe. We cannot and must not exclude from that recognition those who come from overseas to support our health and care system. They make huge sacrifices day in, day out, and they deserve our immense gratitude and respect. They must not be used to score political points, as is too often the case.

As we have heard, overseas workers, particularly those in social care, often face very challenging environments and are vulnerable to shoddy employers, so it is vital that we ensure we have a system in which the exploitation of overseas workers is simply not tolerated. Steps must be taken to stop those who perpetrate abuse. That is not only good for them; it is essential if we are to ensure a decent quality of care. That should not detract from recognising that most workers from overseas come here to do legitimate jobs and are employed by legitimate care companies, including some that enjoy high CQC ratings for the quality of care they provide. However, those people still face abuse and exploitation in the workplace.

We must also recognise that the contribution of overseas care workers to our care economy has been, and continues to be, crucial to the functioning of health and social care. We should be deeply grateful; without them, many more care services would have closed in the last few years, leaving thousands without the support they need. Even with their contribution, Age UK estimates that 1.6 million older people in our country have some form of unmet need for care, and because our population is ageing, the demand for care is increasing all the time.

The hon. Member for Westmorland and Lonsdale referred to Beveridge and old age. An ageing population is a massive challenge to this country because of care needs and things such as pensions and the sustainability of the welfare state, but the real challenge in adult social care—this links to the issues related to our ageing population—is that in the past, people born with severe learning or physical disabilities did not live long into adulthood, if at all, and they are now living way into adulthood. Huge cost pressures are building in the system around working-age adults with disabilities, which we also need to address; it is not just about the ageing population.

We need to recruit and retain more care workers to give the sector the workforce it needs to deliver for those needing care, and we will support that. That is why we do not just have a workforce plan for the NHS; we have ensured that we have considered social care as well. The next Labour Government will introduce the first sectoral fair pay agreement in adult social care, which is testimony to the persistent battling of my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner), who started her working life as a social care worker. We will ensure that pay, terms and conditions and training and development meet the needs of staff. As part of our 10-year plan for fundamental reform of the sector, which culminates in the creation of a national care service in England, we will ensure that social care is no longer a route for those seeking to abuse overseas staff and fuel the perception of care being the bottom rung of a ladder.

We must make sure that we build a career pathway that incorporates training and has parity with caring responsibilities in the NHS as part of our workforce plan, so that there is more fluidity between the NHS and social care. Somebody who starts off as a nurse should be able to have a career pathway that ultimately leads them to be the chief executive of a major care provider. Why shouldn’t somebody who starts as a social care worker have a career pathway that leads them to be the chief executive of an NHS trust? We can only do that by building a workforce that has some form of parity.

We will ensure that, in future years, comprehensive independent workforce assessments are made, so that NHS and social care staff can keep up with the demands of a growing and ageing population, rather than falling behind. I get so frustrated at the lack of progress on some of these issues. I know the Minister is trying her best, but for too long, under too many different Governments, social care has been seen as that lean-to, as the hon. Member for Westmorland and Lonsdale put it. It is time that we have a Government committed to fixing social care and to developing the services we need, built around the needs of the people who require social care services, and it is time that we have a workforce plan that drives up quality, ensures career progression and fills those gaps. We need that general election—the country is crying out for change after 14 years of this Tory Government delivering an NHS and social care system that is broken. It is time to fix that broken system—it is time for Labour.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

But according to Care England and Hft, 54% of social care providers have increased their reliance on agency staff; 44% have turned down new admissions; and 18% have had to close services altogether. Labour’s fair pay agreements will ensure that staff in the sector are treated with the dignity and respect that will make them want to stay, but after 14 years, why do Ministers not have a proper plan to address the workforce crisis facing adult social care? Is it because it is a crisis of their making?

--- Later in debate ---

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Mike Reader, Labour’s candidate for Northampton South, shared with me the horrific experience of Stanley, who had severe abdominal pain and called an ambulance, only to be told it would take hours and to go to A&E. There, he was told to wait for assessment on a patio chair outside. It was 3°. Who is to blame?

[The Minister for Social Care (Helen Whately)]

I am very sorry to hear of the experience of that specific constituent. Because of challenges that the NHS faces, particularly our urgent and emergency care services, almost a year ago we set out our urgent and emergency care recovery plan, to speed up care for people in A&E and reduce waits. That plan is working. We are seeing ambulances get to people quicker, and people treated quicker in A&E.

[Andrew Gwynne]

That is not a one-off. Why will the Minister not take a shred of responsivity for the chaos that her party has caused our NHS? The last Labour Government achieved the shortest waits and the highest patient satisfaction in NHS history. The Conservatives have delivered the longest waits and the lowest patient satisfaction in history. Let us have that general election, so that she can defend her abysmal record to the public.

[Helen Whately]

The hon. Gentleman obviously was not listening to my answer; in fact, he was reading aloud. Our urgent and emergency care plan is working. It is reducing rates in A&E, and ambulances are getting to people faster. Meanwhile, I am sorry to say that in the Labour-run NHS in Wales, more than half of patients are waiting more than four hours in A&E.

World Stroke Day

Andrew Gwynne Excerpts

Thursday 23rd November 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. Like others, I begin by thanking my hon. Friend—I will call him that, because we are friends—the Member for Bromley and Chislehurst (Sir Robert Neill) for securing this important debate to mark World Stroke Day. I thank him for not just his continued advocacy and the work he does here in Parliament, but sharing his personal experiences. On behalf of the whole House, we send our love to his wife and to him for the work he does to look after her.

We have had a small but perfectly formed debate. I want to thank my hon. Friend the Member for York Central (Rachael Maskell) in particular for her powerful contribution. She speaks with experience that I could only ever dream of; it is so important that her expertise, knowledge and past experiences should shape and inform the debate. I thank her for that. Likewise, I thank the hon. Member for Strangford (Jim Shannon) and the hon. Member for Motherwell and Wishaw (Marion Fellows), who leads on health issues for the SNP, for their contributions. We have had a good, thorough debate, covering a lot of issues. Hopefully we have marked World Stroke Day well in this place today.

It is stating the obvious to say that stroke can have a life-changing impact. As we have already heard, the statistics show that in the time we are here this afternoon, 14 people across the United Kingdom will have had a stroke—that is one stroke every five minutes. Although often a sudden event, the lasting impact of stroke for patients can be devastating. It is one of the leading causes of adult disability across the United Kingdom. Two thirds of stroke patients—let that sink in—will leave hospital with a permanent disability, often needing lifelong care. Sadly, stroke is often fatal, causing around 35,000 fatalities across the UK every year, making it the fourth leading cause of adult death.

What those statistics demonstrate to me is that however far we have come on the journey with stroke, we need more concerted action going forwards—not just from a patient care perspective, but given the significant impact that not acting on stroke has on the economy. There is an economic argument, not just a patient care argument.

I pay tribute to the work of the Stroke Association, which does incredible advocacy, campaigning and research in this area, as well as other organisations across the UK. Stroke Association research shows that by 2035, stroke is expected to cost the British economy £75 billion a year. That is up from £26 billion as recently as 2015—a rise of 190% in just two decades. Given the strain already on stroke pathways across our health and care system, that is simply unsustainable. The need is clear, and the need is now.

One of the issues holding us back in our fight against stroke is the workforce, as is so often the case and as we have heard today in other contributions. A well-skilled, well-resourced workforce is vital to saving lives and improving the outcomes for patients. However, for too many across the United Kingdom, the workforce is simply not there for them or not there for them in adequate numbers. Half of all stroke units across the country have at least one vacant consultancy post, with the average vacancy being left open for 18 months.

When it comes to thrombectomy—a life-changing treatment that can have a fundamental impact on patient outcomes, as the hon. Member for Bromley and Chislehurst set out—the postcode lottery for care only gets worse. A third of clinicians in this country who can perform thrombectomy are based in London. That is good for Londoners but not for other parts of the country. Given that speed of treatment is critical when it comes to long-term outcomes for strokes, this lottery facing so many people cannot be allowed to continue.

Further along the stroke treatment pathway, other issues persist. Only a quarter of community rehab teams and early supported discharge services are offering support seven days a week. That is not good enough. With patients waiting too long for treatment when they need it and too long for support in the community following treatment, it is clear that the system is broken. That is why I am proud of Labour’s firm commitments on giving our NHS the workforce it needs to get patients seen on time, by delivering an extra 7,500 medical school places, training an extra 700 district nurses each year and ensuring that at every stage of the treatment pathway stroke patients will have access to the care they need when they need it.

But there is so much more work we can do to break down the barriers that too many stroke patients face on their care journey. Breaking down those barriers will take innovation and all parts of the system to be pulling in the same direction. For stroke patients, that is exactly what is needed. Given the crucial role played by primary, acute and social care services in delivering positive, long-term outcomes for stroke patients, co-ordination is the key. However, in too many cases, that co-ordination is simply not happening, and patients are suffering as a result.

We have a primary care system with vast variety in detection of key stroke indicators, such as heart conditions, atrial fibrillation and so on. We have people not getting to the right place in hospital, with only 40% of stroke patients admitted to a stroke unit within four hours of arrival. We have a community care system without the resources it needs to deliver for patients, with the Stroke Association’s report about life after stroke highlighting that only 37% of stroke patients receive a six-month post-stroke review of their needs. It smacks of a system that is not working for anyone.

[Rachael Maskell]

My hon. Friend is making an excellent speech. When it comes to social care, people are often untrained and as a result could cause more harm than good if they do not know how to care for a patient who has had a stroke. Will he ensure that Labour discusses how it will train our care workforce to have the right skills to deliver ongoing care?

[Andrew Gwynne]

My hon. Friend makes an important point. Some of the discussions that I have had, including this week, with professionals in the care sector have been about how we upskill care professionals working in our social care system so that they are able to genuinely—in an integrated fashion, with the NHS—work in accordance with the interests of the person they are caring for and take that person’s needs as a whole. It is also important for these workers to have the professional development, and parity of esteem, terms and conditions and so on with the NHS, to be able to take on those extra responsibilities. My hon. Friend is absolutely right, and that issue is certainly on the radar of the shadow health and social care team as we develop our plans—not just Labour’s workforce plan for coming into government, but our plans on the road map to a national care service.

Whether it is by training more GPs to ease the immense pressure on our primary care system, by putting an end to dangerous hospital waits or through a 10-year plan for fundamental social care reform delivered in partnership with users and their families, Labour is determined to get the system working again. We are determined to build a national health service that is fit for the future, with a long-term vision for a national care service firmly integrated within it. Only by doing all that, getting it right and taking people with us on that journey can we deliver on our long-term mission of cutting stroke deaths by a quarter within the next decade. That is a mission. It is something we are determined to do, because at the heart of this are people’s lives and we want to ensure that we have in place the stroke services that patients deserve.

Healthcare Students: Pay and Financial Support

Andrew Gwynne Excerpts

Monday 20th November 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Fovargue. I welcome the Minister to his latest position on the Government Front Bench. I hope he enjoys what remaining time the Conservatives have in government in the Department of Health and Social Care. I wish him all the best over the next few months.

I am grateful for the opportunity to respond to the debate on behalf of the shadow Health and Social Care team. I thank my hon. Friend the Member for Battersea (Marsha De Cordova) for her powerful speech, and my hon. Friend the Member for Sheffield Central (Paul Blomfield) for his wise contribution. I also thank the Petitions Committee for its work in preparation for the debate.

Being a student nurse during the cost of living crisis is tough. We know that valuing our NHS workforce through fair pay and conditions is crucial to tackling vacancies, yet according to the RCN’s 2023 summer survey, almost nine in 10 student midwives in England—89%—worry about the amount of debt they are in, and 74% of them expect to graduate with debts of more than £40,000.

[Paul Blomfield]

My hon. Friend is making a very important point, and I am sure that he will come on to say that the experience of midwives also applies to nurses and others on healthcare courses. The report by the APPG for students, which I mentioned a moment ago, highlighted the way in which the student funding model was broken, not least by pointing out that, according to Save the Student, the average loan now falls short of living costs by £439 every month. Most students are dealing with that by taking on ever-increasing amounts of paid employment, which is raising some concerns. One Russell Group university told us that a significant number of its students work more than 35 hours a week. Does my hon. Friend agree that that option is not available to most nurses, midwives and other healthcare students on similar courses, because of the structure of their courses? The Government are failing to address that issue.

[Andrew Gwynne]

My hon. Friend hits the nail on the head. We are talking about student nurses and student midwives, who do not have any spare time to dedicate to other forms of paid employment: it is physically and mentally impossible for them to do so. There needs to be greater recognition of the unique nature of these kinds of students. Many students—including me, many years ago—rely on extra support to make ends meet, but people studying in the caring professions, including nursing and midwifery, do not have that same ability. That was one reason why there was always additional support for those groups of people.

Fifty-eight per cent of respondents to the survey conducted by the Petitions Committee for this debate said that it was difficult or very difficult to afford energy, including gas and electricity, 19% said they had visited a food bank, and 26% said they were considering using one. That is a national scandal—a cost of living scandal that is having a devastating impact on our ability to recruit and retain staff in the national health service. Over nine in 10 student midwives in England—91%—know someone who dropped out of their midwifery studies because of financial problems.

The Conservative Government abolished NHS bursaries for student nurses, midwives and allied health professionals back in 2017. Students undertaking their degree since then have had to pay to train to work in the NHS. As a result, not surprisingly, the number of applications to study nursing in England fell, with applications down by almost 30% by 2019. It is not rocket science to work out what caused that. Labour said at the time that the decision to remove the NHS bursary was the wrong one, and the Public Accounts Committee, in its September 2020 report, agreed that the decision

“failed to achieve its ambition to increase nursing student numbers.”

That is just another example of a Government who have time and again failed to plan for the long term.

In this NHS workforce crisis, we have deteriorated to the point where we now have over 100,000 vacancies, including 40,100 nursing vacancies. We have waited so long for the NHS workforce plan, and now we finally have it. Labour has been calling for a workforce plan for years, and I am glad that the Government pinched the plan of my hon. Friend the Member for Ilford North (Wes Streeting). Since its publication, though, not much has happened. It makes clear the scale of the neglect—a wasted decade of drift and inaction, impacting not only on staff but on trainees.

Placements are an important part of nursing and healthcare courses. They provide the vital supervised training that allows students to gain the necessary skills and experience to meet education outcomes and work in clinical settings. Labour knows the value of placements, which is why increasing them is an important part of our plan to expand the NHS workforce. We will focus on ensuring we have the roles, trainees and senior professionals needed to tackle the challenges we face and seize opportunities, drawing on a diverse range of skills and inspiring people around the country to pursue a career in the NHS and caring professions. We will also work with health staff and their trade unions to review existing training pathways and explore new entry routes to a career in the NHS, including high-quality apprenticeships.

The childcare sector is under huge strain. While some healthcare students may be eligible for parental support from the NHS learning support fund of £2,000 a year, that is dwarfed by the ever-increasing cost of childcare. It leaves many studying parents vulnerable to childcare costs, particularly considering the hours needed to fulfil placement requirements. It has been reported by openDemocracy that some nursing students considered leaving their courses because of financial pressures related directly to childcare costs. That is, sadly, a trend across our economy. The cost of childcare is pricing parents, especially women, out of the professions they love.

Does the Minister agree that adequate support for a profession as critical as nursing or midwifery should not depend on where a person studies but should be the same across the board? What assessment has he made of support at all stages of training for studying parents, in order to build an effective and inclusive workforce in our NHS? The 11,000 people who signed the petition will be looking for a response from the Government, so does the Minister regret the decision to abolish NHS bursaries? What additional support can healthcare students expect, given the current cost of living crisis?

Two in five student nurses and three in five student midwives said that they considered leaving their course last year, so we must take this seriously, especially given the threat to the future of the NHS workforce that it poses. Already students have cited the placement experience and lack of support as major factors in their leaving their course. The Conservative-made crisis in the NHS only makes this worse. We might have expected in this month’s King’s Speech to hear of something to deal with the worst NHS crisis in its history, but there was virtually nothing.

The energy price cap has increased by half this Parliament, the cost of living crisis is hammering healthcare students, and we have a flagship energy Bill that

“wouldn’t necessarily bring energy bills down”.

Whether we are talking about the NHS or the cost of living crisis, this Conservative Government look like they have thrown in the towel. They are divided, weak, out of ideas and out of time. Every day that goes on, it is British people, our public services and our patients who pay the price. For Labour’s part, we know that our healthcare staff are our national health service’s most valuable asset, and we know how vital it is to ensure that there is a pipeline of future talent coming through. That is why the next Labour Government will put their workforce plan at the heart of their plans to restore, renew and rejuvenate our national health service.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 17th October 2023 Commons Chamber

[Mr Speaker]

I call the shadow Minister.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The whole purpose of integrated care systems is to join up social care and NHS services in a better way. We know, for example, that fracture liaison services keep 100,000 people out of hospital, but only 50% of English NHS trusts have them, and despite the commitment given by the Under-Secretary of State for Health and Social Care—the hon. Member for Lewes (Maria Caulfield—to providing more, nothing has happened, and Lord Evans has walked back from her commitment. I realise that I am pushing at an open door in directing this question to a Minister whose leg is strapped up, but when will the Government finally deliver for the “back better bones” campaign to help older people to survive and thrive?

[Helen Whately]

As the hon. Member has mentioned, I have a broken ankle, and I am taking my responsibility as Minister with oversight of urgent and emergency care very seriously in making use of several of those services. As for my oversight of integrated care systems, what I am seeing is that they are making a very good job of enabling the integration of services. For instance, we are seeing real success in the growth of virtual wards—or “hospital at home”—which bring together acute and community services to look after people in their homes and help them to be discharged earlier. The NHS has achieved its target of having 10,000 “hospital at home” places ready for this winter.

LGBT+ People and Spouses: Social Care

Andrew Gwynne Excerpts

Tuesday 12th September 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Robert, and to respond to the debate on behalf of the shadow Health and Social Care team in my first outing as the newly appointed shadow Minister of State for Social Care. It is always good to see the Minister for Public Health in his place.

I sincerely thank my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes) for securing the debate and for all her work on this important subject. Her contribution this afternoon was heartbreaking —the way in which her constituent was treated was utterly shameful. I also thank my hon. Friend the Member for York Central (Rachael Maskell) for her contribution. She ended on such a powerful poem, which speaks to so many who suffer in care home settings.

The Care Quality Commission guidance for all providers of adult social care clearly states that people using care services

“must not be discriminated against in any way and the provider must take account of protected characteristics, set out in the Equality Act 2010.”

As we have heard today and as we know from other studies, however, that is not always the case.

A survey conducted in 2017 found that 23% of open LGBT+ respondents who had been in a care home or other form of institutional care reported that being gay, trans, bisexual or lesbian, or having other protected characteristics, had a negative effect on the care that they received. Those examples are varied, but each and every one of them is concerning. Some respondents to the 2017 survey said that they felt invisible. Other responses related to use of language—for example the assumption that a partner or spouse is of the opposite sex, when that is not necessarily the case.

At their worst, the experiences of LGBT+ people in care home settings can be traumatic, as demonstrated by the story of Noel Glynn and his partner Ted Brown, who is a constituent of my hon. Friend the Member for Dulwich and West Norwood. Before he died, it is reported that Mr Glynn, who had dementia, suffered bruising across his body and had a cigarette burn on the back of his hand because of abuse from care staff. Other residents warned his partner Ted not to reveal to staff that he and Noel were a couple, saying, “That won’t be good for either of you”.

Mr Glynn and Mr Brown sued Lambeth Council, but Mr Glynn very sadly died before any compensatory payments were made. This case is beyond abhorrent. I hope the Minister will set out how it happened and what steps the Government are taking to ensure that it never happens again. The Minister will know that the Care Quality Commission does not currently consider the extent of homophobia or transphobia in inspections, despite its fundamental standards. Following this case, will the Minister look again at that guidance?

More generally, what this issue comes down to is the importance of personalised care. A report by the Women and Equalities Committee published in 2019 points to research showing that 72% of care workers do not consider sexual orientation to be relevant to one’s health needs. That same report states that

“most health and social care professionals feel under-equipped to deal with LGBT people’s needs rather than intentionally discriminating.”

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are clear on this subject. Regulation 9 states that people using a service should have care or treatment that is personalised specifically for them. It is important that care providers respond to the serious concerns raised by LGBT+ people and ensure that those accessing services feel respected and safe, and benefit from care that is tailored to their needs.

My questions to the Minister are as follows. Given the extraordinary shortages in adult social care staff—sitting at around 165,000—what work are he and his Department doing to protect the principle of personalised care? Further, what steps is the Department taking to monitor the experiences of LGBT+ people in social care settings? In the 2018 LGBT action plan, the Government pledged to develop best-practice guidance for monitoring and to make this openly available to the public sector. Why were these pledges not implemented? Have they simply been abandoned alongside a plethora of other Government commitments, from banning conversion therapy to tackling waiting lists? Finally, LGBT+ organisations have called for better guidelines and staff training for those working in care settings. Can the Minister outline whether the Government support these calls?

The next Labour Government will address the vacancies in social care by delivering a new deal for care workers, guaranteeing fair pay, training, terms and conditions and career progression.

[Richard Foord (Tiverton and Honiton) (LD)]

I am curious to know from the shadow Minister what fair pay in the social care sector would be. What does he think of the Liberal Democrat proposal to pitch an additional £2 per hour minimum wage for social care workers?

[Andrew Gwynne]

If the hon. Gentleman had been at the TUC conference today, he would have heard the shadow Deputy Prime Minister, my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner), outline precisely what Labour’s fair pay deal will be for the social care sector, but we need to go beyond that. We need to ensure that social care becomes a valued profession again, rather than just assuming that agency staff can fill the vacancies. We need to make sure that social care once again has parity with the rest of the healthcare system and that care workers want to work in the care sector not just because of pay, terms and conditions, but because it is a profession—which, sadly, many feel it no longer is.

We will work in partnership with users and families and develop a set of national standards based on existing minimum entitlements and legal rights, including legal rights that exist in the Equality Act 2010—a piece of legislation of which I am fiercely proud, and which the last Labour Government took through Parliament and put on the statute book. We need to make sure that all service delivery, particularly in social care, meets the ambitions and legal expectations of the Equality Act—sadly, that has let down so many LGBT+ people in the social care sector, as we have seen from the statistics in the surveys that I have cited this afternoon.

We would also ensure that our commitment to raise standards right across the sector is upheld by requiring all care providers to demonstrate financial sustainability and, crucially for this debate, to deliver high quality care for service users before they are allowed to receive contracts from local authorities, making sure that local authorities commission care providers who are capable of delivering the care that people need at the standard we should expect. That would result in more personalised and ultimately higher-quality care for all individuals.

In 2023 people who are lesbian, gay, bisexual, trans and others should not feel ostracised by a system that is there to support them. They should not feel ignored and that their personal needs are not being met. Ultimately, they should not feel the need to hide the fact that they are gay, lesbian, bisexual, trans or other. I hope that the Minister will agree with me that we can get to work on delivering that higher standard of care for all service users. The testimony that we have heard today from my hon. Friend the Member for Dulwich and West Norwood should stand as that end point. Never again should somebody from the LGBT+ community be treated as we have heard. “Never again” should be more than a slogan. It should be deeds.

Radiotherapy: Accessibility

Andrew Gwynne Excerpts

Tuesday 18th July 2023 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

As ever, it is a pleasure to serve under your chairmanship, Dame Maria. I thank the hon. Member for North Devon (Selaine Saxby) for securing this important debate and for all her work on this issue, which is not a party political one. As we have found today, there is great consensus across the House on this cause, because it is the right thing to do to use our voices as Members of Parliament to champion it. I commend her and other hon. Members present for their work.

We have had a good debate. There has been a lot of repetition, because these issues need reinforcing, and I fear that I will be reinforcing some of the arguments that we have already heard. I commend my hon. Friend the Member for Easington (Grahame Morris) for all his work over a long time. He is always championing the cause of radiotherapy and bending the ear of shadow Ministers, and no doubt of Ministers, about its importance. I also commend the hon. Member for Westmorland and Lonsdale (Tim Farron) for his work as chair of the APPG for radiotherapy. He brings great knowledge to these debates.

This issue is close to my heart, too. As the hon. Member for Westmorland and Lonsdale said, all families are touched by cancer. Some have good experiences, where loved ones survive; others have less good experiences. I lost both my parents to cancer: my mum died from ovarian cancer when I was 19, and my dad died last year. In fact, last week was the first anniversary of his death. He lived to the age of 77. He had a very rare and aggressive form of rectal cancer; sadly, it could not be treated, because by the time even the earliest symptoms had been discovered, the cancer had already spread in various places throughout his body.

I will be forever grateful for the loving care that my dad received, principally from The Christie in Manchester, but also from the satellite at Oldham. He received palliative care, chemotherapy, immunotherapy and, indeed, radiotherapy. It gave him at least a year longer than he should have survived. My dad was a sporting man and a bit of a gambler, so he was willing to take those odds. Anyway, it gave him an extra year with his great-grandson, as well as with the rest of his family. That is precisely why radiotherapy is key. It was a game changer. The chemotherapy and the immunotherapy did not work; it was the radiotherapy that probably prolonged his life for those extra months.

As we know, radiotherapy is a key treatment for many people affected by cancer. It can be used to try to cure cancer completely, it can make other treatments more effective; it can reduce the risk of cancer coming back post surgery, and it can relieve symptoms in palliative care. Unfortunately, as we have heard today, radiotherapy services are under significant pressure, which is all too evident in the treatment statistics that have been cited. For example, the proportion of people in England having their first cancer treatment within two months of an urgent GP referral has fallen to 58.7%, which is down from 61% in April. As we heard from my hon. Friend the Member for Easington, the target is 85%, but that target has not been met on an annual basis since 2013-14. That really needs the Government’s urgent attention. We cannot just blame the pandemic for these statistics, because way before the pandemic the targets were not being met, although I am sure it exacerbated the issue and made the challenge even harder.

My first question to the Minister is what action he is taking to reverse this concerning decline in treatment within two months. We all know that the key to treating cancer is catching it early, but it seems that a significant number of patients are waiting far too long even to begin care, which potentially harms their chances of receiving successful treatment.

There are also serious concerns about technology and infrastructure within radiology services, as we have heard from hon. Members today. In a response to the Government’s long-overdue NHS workforce plan, the Royal College of Radiologists stated that

“we all know how frustrating it is to try and do our jobs with systems and infrastructure that simply aren’t fit for purpose.”

The RCR also cited an interview in which

“Tom Roques, Vice President for Clinical Oncology, talked…about needing to use seven passwords for seven separate systems in order to provide information to one patient”.

When the Opposition talk about embracing new technology and giving NHS staff the tools they need to do their job, that is precisely what we mean. We must embrace new technology. For example, there are tools that can map radiation therapy to cancer cells, avoiding organs more precisely and more quickly than a human can. That is standard technology in the United States of America, but is used by just one in three radiotherapy planning centres in England. Alongside the workforce plan, what is the Minister planning to do to address this problem? Staff already face an uphill battle. The last thing they need is inadequate equipment or overly complex systems.

Regarding the workforce plan, Cancer Research UK has highlighted what it calls

“a lack of detail on cancer-specific professions”.

What assessment has the Minister made of that? Can he set out what engagement his Department is having with organisations such as Cancer Research UK on ensuring that services such as oncology are adequately staffed into the future?

The final point on which I wish to press the Minister relates to the inequality in access that all hon. Members have spoken about. Approximately 30,000 extra cases of cancer in the UK each year are attributable to socioeconomic deprivation. Studies have consistently shown that there is unwarranted variation in radiotherapy access rates. We have heard about poor access in rural parts of England, which is an issue that specific hubs linked to the main centres of excellence would start to tackle. I certainly welcome the calls from the hon. Members for North Devon and for Westmorland and Lonsdale. It is crazy that their constituents are missing out on key treatments because access requires them to travel too far, and some who do access such treatments give up their treatment early. We should be doing everything we can to encourage people to access those treatments and keep on them until they are completed.

There are issues with monitoring the inequalities. Cancer Research UK has called for improvements to be made to radiotherapy data collection so that policymakers can understand the scale of the problem and set about addressing it. Does the Minister agree? What action is he taking to ensure that we eliminate the inequalities in radiotherapy access that we have heard about today, and certainly to try to get England to the average level of kit needed, if not to exceed the average? I do not just want England to be average at these things; I want us to be an exemplar.

The next Labour Government will work tirelessly to improve access to radiotherapy, alongside providing the NHS with the staff it needs. We will reform our health system and embrace new technology that has the potential to transform the way we deliver care. We will build an NHS that is fit for the future, and we aim to achieve all relevant cancer waiting time standards within our first term. That is a pledge that we have made: we have done it before, and there is no reason we cannot do it again, with the political will.

Until then, however, we need to see this Government engaging with clinicians and experts, and doing everything in their power to ensure that the treatment is there for patients when they need it most. As I said, this is not a party political point. We are a responsible Opposition. We encourage the Government to do more. We want them to meet those targets and to expand services—particularly in rural areas, so that access is equal across the country. We encourage Ministers to do that, and to do it at pace. If they do, we will support them.