Oral Answers to Questions
Andrew Gwynne Excerpts(3 years, 10 months ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
Mary Glindon (North Tyneside) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
Essential and urgent cancer treatment has continued throughout the pandemic and cancer specialists, as always, are discussing the best treatment options with their patients. We are working to ensure that referrals, diagnostics and cancer treatment are back at pre-pandemic levels across the whole of England as soon as possible. Due to covid-19, the 21 cancer alliances in England have established hubs to ensure dedicated cancer care away from hospitals dealing with the virus. From the end of April, local systems and cancer alliances have continued to identify ring-fenced diagnostic and surgical capacity for cancer in line with issued guidance. Regional cancer senior responsible officers must now provide assurance that these arrangements are in place to help minimal regional variation.
Andrew Gwynne [V]
I thank the Minister for that comprehensive reply, but she knows that people living with cancer are experiencing cancellation and delays to treatment all over the country, and that is causing anxiety and distress to many families. In getting people urgently back into treatment, will she look at the 12-point plan for restoration, recovery and transformation of cancer services outlined by Macmillan Cancer Support, Cancer Research UK and 23 other cancer charities, to ensure that cancer does not become the forgotten C during the coronavirus crisis?
Covid-19: R Rate and Lockdown Measures
Andrew Gwynne Excerpts(3 years, 11 months ago)
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Urgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Matt Hancock
Like anybody who has a heart, I yearn for grandparents to be able to see their grandchildren. My own children saw their grandmother at a social distance, appropriately, rigorously according to the rules, for the first time this weekend, and it was a real joy—the first time in months and months—but they have not seen their other grandparents, and of course they are not allowed to hug them yet. I am with my hon. Friend and no doubt you, Mr Speaker, and everybody else in this House in wanting to see a restoration of that basic human contact for which we all yearn.
Andrew Gwynne (Denton and Reddish) (Lab) [V]
The concern over the R rate in Greater Manchester on one measure has focused attention on possible local lockdowns, which would have a financial impact on people who are unable to work from home. In those circumstances, will the Government consider a form of local furlough for people whose workplaces are closed down or who are unable to get to work?
Matt Hancock
I am sure that Treasury Ministers will have heard the hon. Gentleman’s suggestion, but we do not need such a scheme now, of course, because the full furlough scheme is in operation nationally.
Covid-19 Response
Andrew Gwynne Excerpts(3 years, 11 months ago)
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Matt Hancock
I would be very happy and honoured to join my hon. Friend in thanking the staff at Russells Hall hospital and at Mary Stevens hospice, at the care homes and the community pharmacists, and indeed the volunteers of Stourbridge, who have come together. There have been many terrible things about this disease, but there have also been some heartwarming things. The dedication of staff and volunteers alike to coming to the aid of others is one of the things that the whole nation has been proud to see.
Andrew Gwynne (Denton and Reddish) (Lab) [V]
The Secretary of State will know the concerns across northern England about the Government’s approach to easing lockdown, specifically those raised by the Greater Manchester Mayor and the combined authority about the risk of a second wave of coronavirus owing to different R values across our city region. What measures is he putting in place to ensure that, as lockdown is lifted across England, those areas behind London in the curve do not see all their hard work undone?
Matt Hancock
Of course we take the decision after looking at the information for the whole country, and we take into account the R rate and the level of new cases and all other data from right across the land when deciding what is the appropriate step to recommend and to take. We do this cautiously and carefully, and we make sure that everyone is taken into consideration. The safety of the whole population is right at the front of our mind.
Social Care
Andrew Gwynne Excerpts(4 years, 2 months ago)
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Matt Hancock
No, I do not recognise those figures because they are not the accurate representation of what is actually happening. There are many within that figure who are judged under legislation to need to pay for their own care, and they do. We have to start from a basis of fact and, frankly, until Labour Members start working on this from a basis of fact, it is very difficult to take their contributions seriously.
The critical thing is that, as life expectancy is increasing, more people are looking forward to ageing in comfort and dignity, and that is good news. Opposition Members may not like it. It is odd; they do not seem to want to think that life expectancy is going up. We have a duty to ensure that our social care system is equal to the task. There are many things we should be proud of in our social care system, although we would not have gathered that from the speech by the hon. Member for Worsley and Eccles South. Some 84% of providers of social care are rated as good or outstanding, and 90% of people who receive care are satisfied with its standard. The proportion of adults with learning disabilities living in their own home or with their family has increased every year since 2014-15. That is good news, which we should welcome.
Andrew Gwynne (Denton and Reddish) (Lab)
Let me begin by welcoming the new Minister to her post. I sincerely hope that she enjoys her time in the role, and that at some stage in the future she will be able to look back and see herself as the Minister who truly transformed social care. That transformation is desperately needed, which is why we called today’s debate. I think it has been a thorough and thoughtful debate on both sides of the House.
We have had 16 Back-Bench contributions, including from my hon. Friends the Members for Leicester West (Liz Kendall), for Blaydon (Liz Twist), for Chesterfield (Mr Perkins), for Warrington North (Charlotte Nichols), for Dulwich and West Norwood (Helen Hayes), for Luton South (Rachel Hopkins), for Putney (Fleur Anderson) and for Liverpool, Wavertree (Paula Barker), as well as from the right hon. Member for Ashford (Damian Green) and the hon. Members for Thurrock (Jackie Doyle-Price), for Newton Abbot (Anne Marie Morris), for Bexhill and Battle (Huw Merriman), for Peterborough (Paul Bristow), for Bury North (James Daly), for Watford (Dean Russell) and for Meon Valley (Mrs Drummond). I also want to pay tribute to all who work in our social care services, whether they work in the national health service, for our local councils or for an agency, and whether they are paid or unpaid carers.
This is the third time I have closed an Opposition day debate on the crisis in social care. Someone on the Conservative Benches said earlier that they had a sense of déjà vu, and I have that same feeling myself. Just as I said last time in my closing comments, we have still seen no plan from the Government, despite the Prime Minister using his very first speech at 10 Downing Street to pledge to solve the social care crisis. I want to remind the House just what he said:
“I am announcing now, on the steps of Downing Street, that we will fix the crisis in social care once and for all, and with a clear plan we have prepared to give every older person the dignity and security they deserve.”
We have seen nothing. It is now 1,079 days since the Government announced their Green Paper on social care. That is 1,079 days in which we have been told that the Government have been working on their plan for social care. However, only a couple of months ago the Minister for Women and Equalities and Trade Secretary, the right hon. Member for South West Norfolk (Elizabeth Truss) was asked:
“Does the Green Paper actually exist?”
She shook her head and told the room:
“Not as far as I’m aware.”
After years of promises and failure to deliver, we can understand why many within the sector have very little trust in this Government, so will the Minister please clear this up now? Was the Trade Secretary misinformed, or was the Prime Minister not correct when he told the country that he had a plan for social care? If it is the former, surely the Minister will appreciate our concern that the Minister for Women and Equalities and her office have not been involved in the development of a policy that will impact on so many disabled and vulnerable people who depend on care, and on the predominantly female workforce who deliver it.
The Prime Minister might speak of levelling up as though he were playing a computer game, but his lack of action is having real impacts on real people. It is a national scandal, and the Government should feel ashamed that 1.5 million people are now not getting the necessary help to carry out essential tasks such as washing and dressing themselves. Millions are suffering because nobody cares for them. One in five people have gone without meals because of a lack of care. One in five people have been unable to work because of a lack of care. One in five people feel unsafe moving around their home because of a lack of care, and more than a third are unable to leave their home because of a lack of care.
This neglect does not only hurt those who need the care. As my hon. Friend the Member for Leicester West set out, and as my hon. Friend the Member for Luton South said when she spoke so passionately about Barbara and Ray, it is important to remember the 7.6 million unpaid carers who have stepped up to look after family and friends. One of those people, Frances from Harrogate, told the Care and Support Alliance:
“Dad has now passed away but his needs, with two broken hips and pneumonia, were not met in the slightest by either the NHS or social services. I feel if care had been better he would still be alive. Mum is in a care home and I have had to give up my job to care for them and I have received very little acknowledgement of this.”
At the very least, I hope we will hear from the Minister today how she plans to give unpaid carers the support they deserve.
We are yet to hear a Minister properly acknowledge the scale of the crisis. Instead, we heard once again from the Secretary of State in his opening speech the Government’s claim that they are addressing the problems in the system by investing £1.5 billion into social care this year. That has to be shared between adult and children’s services and winter pressures, and it is one tenth of what this Government have cut, according to the Health Foundation. In 2018, the Local Government Association warned that the funding gap for adult social care alone would grow to £3.5 billion by 2025, and the LGA revealed yesterday that pressure on children’s services has pushed overspending to £3.2 billion over the past five years.
We also know from LGA research that the new funding will not even be enough to cover the increasing costs that will come from the rise in the national living wage from April. Unfunded increases in the national living wage in social care have been shown by the Low Pay Commission to lead to an increase in failing businesses, insecure working conditions, and a reduction in care quality. Professor Martin Green, chief executive of Care England, has called on the Government to take responsibility for this situation, saying:
“If government fails to support this uplift then services may close, jobs will be lost and support to people in need will be reduced at a time when more people need social care. The social care system has endured chronic underfunding for many years and we call upon the government to fund not only the increases in the Living Wage, but the sector’s long term sustainability.”
Instead of the Government taking responsibility and recognising the scale of this crisis, their recent immigration announcement threatens to make it even worse. I endorse the words of my hon. Friend the Member for Leicester West, who said that we need to recognise the value of migrant labour to the social care services on which our constituents rely. Care roles fall below the salary threshold. The Minister knows that. The Government’s reluctance even to fund the costs of the increases in the national living wage does not give me much hope that they will fund the obvious solution—valuing and paying careworkers more for their vital work. It was worrying that the Home Office’s policy statement outlining the new migration policy failed to mention social care.
Councils led by all parties are facing a funding crisis, with devastating effects on key public services for children at risk, disabled adults and vulnerable older people. The services we all rely on, such as clean streets, libraries, children’s centres, street lighting and pavement repairs, are being cut back to pay for those people-based services. This is not a party-political issue. The issues are self-evident. In the recent state of the sector report by the Local Government Information Unit and the Municipal Journal, only 3% of councils said that they are happy with Government progress on local finances and only 2% said that they were happy with the Government’s work on social care. That is near-universal disappointment from council leaders and chief executives. Seventy-six per cent. said that they lack confidence that the Government are taking this problem seriously and prioritising a solution.
The Government’s delay is already costing lives. Last year, 2,000 people a day died while waiting for a decision on their application for social care. That should shame us all on whatever side of the House we sit, and there is only so much longer that this sector can wait.
This is the reality. Unless this issue is given the attention it demands, more councils will fall under financial pressure, more social care providers will fail and more of the most vulnerable people we are all here to represent will go without the support they need. It cannot go on like this. We need a plan, and I commend this motion to the House.
Stepping Hill Hospital
Andrew Gwynne Excerpts(4 years, 3 months ago)
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Mr Wragg
Absolutely. I congratulate my hon. Friend and constituency neighbour on the work that she has undertaken with me and others from across the region in securing additional funding. I will touch on that later. She is absolutely right, because Stepping Hills’ emergency department is overstretched and facing those rising demands. It was built to treat about 50,000 patients a year but is currently on track, as she says, to exceed 100,000 patients this year.
Andrew Gwynne (Denton and Reddish) (Lab)
I congratulate the hon. Gentleman on securing this Adjournment debate. Is it not also important to impress on the Minister the demographic nature of the borough of Stockport, which we all represent? Stockport is a microcosm of the whole country in that it has its own north-south divide. There are real health inequalities between those living in the north of Stockport and those living in the south. In the south of Stockport, people tend to live longer and stay healthier longer, but when they do reach old age, they often have very complex needs.
Mr Wragg
The hon. Gentleman, my constituency neighbour to the north of my constituency, is entirely spot on. His remarks are incisive and to the point, because the demand for emergency care in our area has risen by about 5% in the past year, and in the three months to December alone it increased by 6%. It was previously rare for Stepping Hills’ emergency department to see more than 200 patients a day, but now it is not uncommon for over 300 people to seek treatment per day. Indeed, in Christmas week, over 1,700 patients were seen by the department.
Bed capacity is also a problem at Stepping Hill. A hospital bed system should ideally run at about 85% occupancy to make way for new patients, but at Stepping Hill beds have been frequently running at over 99% occupancy. Having support in place to enable people to return home as quickly as possible once they no longer need acute hospital care is also key to achieving the national standard by improving the flow of patients through the hospital and its emergency departments. As the hon. Member for Denton and Reddish (Andrew Gwynne) says, Stockport has the highest proportion of elderly people in Greater Manchester, with 19.5% of the population being 65 or older. While increasing longevity is of course to be celebrated, our local population is living longer, often with complex and multiple health conditions, and they place a particular demand on the emergency department that is not seen to the same degree elsewhere in the region.
The hospital has implemented a number of short-term initiatives to try to fix and improve the situation in A&E, particularly to address the extra winter pressures due to influenza and the cold weather. The trust recently spent £1.2 million provided by NHS England to expand the number of consulting and treatment rooms in the existing emergency departments. This winter, Stepping Hill implemented its winter plans two months early, opening an extra 30 beds in the hospital. Even so, concerns this year were so great that they were recognised by the Greater Manchester health and social care partnership. In December, the hospital received an extra £2 million of funding to enable it to open an additional 51 beds until after the end of March this year, increasing staffing and supporting seven-day working.
However, I want to ask a number of questions of my hon. Friend the Minister, for whose consideration this evening I am very grateful. First, despite all those steps and extra beds, in December, alarmingly, 200 people waited for 12 hours or more in the department before a bed could be found for them. I wish therefore to ask him what more can be done by the Government to help Stepping Hill to improve its A&E performance in the short term.
Mr Wragg
First, may I congratulate my hon. Friend on his election in High Peak, which is next door to me, and for working as closely as possible with me on this issue as soon as he was elected? Like him, I welcome the investment that is coming, as I am about to outline.
Opening more temporary beds is not the answer to the pressures on our health and care system. A radical long-term solution is needed if Stepping Hill is to improve its A&E performance. That is why I, the hospital and all Members across the House with an interest in it have called for greater investment. The new £30.6 million of funding will enable the organisation to construct a three-storey, purpose-built emergency care campus. It will include an urgent care treatment centre, a GP assessment unit and a planned investigation unit, as well as a new ambulance access road and improved waiting areas.
The emergency care campus will not be simply a new accident and emergency; it is intended instead to care for patients who require a slightly lower grade of emergency care, thus relieving the pressure on A&E by improving the flow of patients through the hospital from the emergency department. Patients who need resuscitation or emergency care will still be seen in A&E. This much-needed investment will relieve the pressures on accident and emergency by implementing a better triaging system for patients, meaning that they get the right care in the right place. Patients who do not require full A&E emergency care will be seen in one of the three new services at the urgent care campus.
The urgent care treatment centre will provide an alternative for those who do not need resuscitation or emergency care. It is expected to triage about 45 patients a day away from accident and emergency. The GP assessment unit will support patients who are referred by their GP for hospital care, ensuring that they have quick access to the acute and medical specialists they need to see without going through the emergency department, thereby reducing A&E admissions by a further 25 patients a day. The planned investigation unit will improve the time in which patients are returned home with a care plan when they no longer need to access acute care services.
Andrew Gwynne
The hon. Gentleman is being incredibly generous; I am very grateful. I associate myself and my hon. Friend the Member for Stockport (Navendu Mishra) with the proposals the hon. Gentleman has outlined.
May I offer the hon. Gentleman some reassurance from across the boundary in the neighbouring borough of Tameside, which my constituency also covers? Fifteen years ago, when I was first elected to this House, the reputations of Stepping Hill Hospital and Tameside Hospital were almost in mirror image. Tameside was not the best place it could be. With great focus and new management, that hospital has been transformed. Does he share my confidence that better days are ahead of Stepping Hill, and my trust in the staff and the management to take the hospital back to where it needs to be?
Mr Wragg
I absolutely concur with the hon. Gentleman. The leadership of the hospital is excellent. I think that, as he says, better days are very near. May I take this opportunity to welcome the hon. Member for Stockport (Navendu Mishra), who has come to take part in this debate?
Social Care Funding
Andrew Gwynne Excerpts(5 years, 6 months ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
I begin by thanking hon. and right hon. Members for their contributions from across the House. It is the convention to mention Members by their contributions. I apologise that, because of the time restrictions that have been put in place, that is not possible.
I pay tribute to all who work in our social care services, whether they work in the NHS or our councils or are paid or unpaid carers. We have been here before. I have a sense of déjà vu. It was in April that we called for immediate action from the Government to address the crisis in social care, yet here we are, months later, and no progress has been made. Since then, we have had a new Health Secretary and a new Communities Secretary, but still no new ideas and still no Green Paper. There is only so much longer this sector can wait.
Given the lack of support from the Government, and in the face of year-on-year cuts, local government has been forced to step up. With the Cabinet too busy squabbling among themselves and in the absence of any Government action, the Local Government Association has published its Green Paper on social care. It is worth the Government considering some of the responses that the consultation received. According to the District Councils Network, the
“adult social care crisis is the single largest problem facing local government services and their financial sustainability”.
Karin Smyth
The Green Paper commends Bristol City Council for its Well Aware project. Will my hon. Friend join me in congratulating Bristol on that online and telephone advice and guidance service, which has proven so popular, and will he or the Minister visit to see how it works in practice?
Andrew Gwynne
Absolutely. I am always happy to visit my hon. Friend’s city of Bristol and to see the great work it is doing in very difficult circumstances—Labour local government leading the way and making a difference where it matters.
The LGA estimates that adult social care services face a £3.5 billion funding gap by 2025—just to maintain existing standards of care—but councils in England receive 1.8 million new requests for adult social care a year, the equivalent of almost 5,000 extra cases a day. It is a national scandal. The Government should feel ashamed that 1.4 million older people are now not getting the necessary help to carry out essential tasks, such as washing themselves and dressing. That is 20% more people without care than only two years ago. One of the people experiencing adult social care said of their provision:
“I haven’t washed for over two months. My bedroom floor has only been vacuumed once in three years. My sheets have not been changed in about six months and my pajamas haven’t been changed this year. My care workers don’t have time for cleaning, washing or changing me”.
Those words were taken from a report by the Care and Support Alliance into the state of care in the UK, and it makes for heartbreaking reading, but we have yet to see a Minister even acknowledge that a crisis in local government funding even exists. “We introduced the social care levy,” said the Secretary of State. No, they enabled councils to raise more council tax in a limited way, but a 1% increase in his council’s council tax raises a very different amount from a 1% increase in my area. That only widens the inequalities and the unfairness.
The Secretary of State’s big announcement at the Conservative party conference of an extra £240 million of emergency funding for adult social care should not be celebrated; it should be a source of shame. The Conservative leader of West Sussex Council summed up the response to the announcement:
“I am not skipping round—I am really cross about it. It’s half a crumb. It’s not even a crumb.”
Earlier this year, the former Secretary of State for Health made a candid admission to the British Association of Social Workers, when he accepted his share of responsibility for the lack of progress since the Tories entered government in 2010. The crisis is a result of this Government’s policies. Our Prime Minister has given up and our councils are at breaking point, but the Government remain committed to their programme of cuts, taking £1.3 billion extra funding out of local government next year. Let that sink in for a moment. It is now being reported that nearly 50% of council heads are seriously worried about impending bankruptcy in their councils, which should send shivers down the spines of members of the Government. One of the chief executives surveyed by the Local Government Chronicle said:
“The next three years are secure if we can manage the demand in adults and children’s services...a complete lack of policy means that even with a well-run council and relatively strong local economy we are likely to start to significantly struggle in 2021/22.”
That is the reality, and that is why I commend our motion to the House.
Social Care
Andrew Gwynne Excerpts(6 years ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
We have had a very wide-ranging debate with 16 Back-Bench contributions. I pay tribute to my hon. Friends the Members for Redcar (Anna Turley), for Luton North (Kelvin Hopkins), for Weaver Vale (Mike Amesbury), for Leicester West (Liz Kendall), for Blaydon (Liz Twist), for Warrington South (Faisal Rashid), for Keighley (John Grogan), for Stretford and Urmston (Kate Green), for Crewe and Nantwich (Laura Smith) and for Bedford (Mohammad Yasin) for their passionate, powerful and well-informed contributions. I also thank the right hon. Member for Ashford (Damian Green), and the hon. Members for North Cornwall (Scott Mann), for South West Bedfordshire (Andrew Selous), for Cheadle (Mary Robinson), for Solihull (Julian Knight) and for Redditch (Rachel Maclean) for their contributions. We might not always see eye to eye, but there is consensus that we have to fix the problem in adult social care, although how we go about that will always be up for debate.
Kevin Hollinrake
Is the hon. Gentleman aware of the very constructive cross-party, collegiate visit of the Communities and Local Government Committee to Germany, where we looked at its social insurance scheme, which could provide the perfect, sustainable and scalable solution to the adult social care conundrum?
Andrew Gwynne
The Government need to decide their position, but there are examples across the world of how adult social care can be funded. We need to make sure we get a system that works for England.
I also pay tribute to the workforce and carers. They do not just need platitudes from us in the House; they need the Government and politicians on their side.
This is the second time we have had to call an Opposition day debate on this issue, following the Government’s lack of action on social care. In our debate last October, there was broad agreement across the House, as there has been more or less today, that reform of social care was a priority, but here we are, six months later, and little has changed. Last month, we heard the Secretary of State for Health and Social Care tell the British Association of Social Workers that he accepted his share of responsibility for the lack of progress since the Conservatives entered government in 2010.
The social care Green Paper, due this summer, has faced substantial delays. We need a commitment from the Government that it will not be delayed any further. There is only so much longer that the sector can wait. Let us remember that in January there was hope that the Government would place an extra focus on social care after the Department of Health was rebranded, but then, shortly afterwards, in what sounded like a tribute act to the Prime Minister, the Secretary of State for Housing, Communities and Local Government told a packed LGA conference—I was there—that
“nothing has changed, nothing has changed”.
Confusion still reigns, and it is true: nothing has changed. This confusion means that 1.2 million people are being denied the support they need.
Let us look at what the cuts mean. According to its director of adult care, social care provision in Northamptonshire County Council—a Conservative council —is
“on the verge of being unsafe”
as a result of the cuts. That council has effectively been the first in England to declare insolvency. According to the director, the additional funds in the local government finance settlement will have “little impact” on the county’s problems, and I fear that that is right, but the Minister will be aware of the widespread fear that what has happened in Northamptonshire could happen again elsewhere. Mark McLaughlin, who was appointed from the Department for Environment, Food and Rural Affairs in December to oversee Northamptonshire’s finances, has warned that all top-tier local authorities will soon face similar issues. Then, only last week, we heard that Worcestershire County Council, the Conservative-run local authority in the constituency of the Secretary of State for Housing, Communities and Local Government, had buried a report expressing urgent concern after rising costs, including the cost of adult social care, had forced the council to use more than half its reserves in the past five years. The Chartered Institute of Public Finance and Accountancy expects the growth in demand to result in a budget deficit of £60.1 million by 2020-21.
Andrew Gwynne
No, I will not. Well, I will, because it is the hon. Lady’s local council.
Rachel Maclean
Worcestershire County Council covers the whole of my constituency, and I am aware of the concerns that the hon. Gentleman has raised. I want to respond to them, because I too have been worried about the position, as many other people naturally are. I met the chief executive and the leader of the council to address this very issue, and I can assure the hon. Gentleman that they have a sustainable plan to deal with it. However, I will of course keep it under review, and I thank the hon. Gentleman for raising it.
Andrew Gwynne
I am grateful to the hon. Lady for providing me with a nice segue. On Monday, Paul Robinson, the chief executive of her council—Tory Worcestershire County Council—said that
“there comes a point where cost-cutting can’t go any further—there has to be a solution”.
He is right too, but we have yet to hear a Minister even acknowledge that this crisis in social care funding in local government is as serious as it is—and it is a crisis that has its roots in Downing Street. Let us be clear: austerity and cuts in local government budgets have been a political choice by this Government since 2010.
It gets worse. Behind every statistic that I can quote are real people working in the service, real people receiving services, real people requiring services, and families worried about how to support their loved ones. Funding cuts, poor pay, recruitment problems and a lack of support for the sector have hit the quality and availability of adult social care support. In the past year, one in five local authorities has seen more of its care homes rated “inadequate” or “requires improvement”. In some areas, as many as one in two care homes is now rated inadequate.
For some of the most vulnerable, even gaining access to any form of support is difficult. Vulnerable older people with conditions such as dementia and motor neurone disease are being denied support because there is a postcode lottery for treatment. According to Which?, where people live can make them 25 times more likely to receive social care support. South Reading paid care costs for 8.7 patients per 50,000 people, while Salford funded 220.3 per 50,000. In Stockport, people are nearly seven times less likely to receive the funding than those just a few miles away in Salford, and patients in Richmond are more than three times more likely to receive it than those in Ealing.
Ministers cannot hide the terms of a social care levy behind flexibilities on council tax. They know, as we know, that in the areas with the greatest need, a small increase in council tax will never make up the shortfall in funding caused by cuts in grants from central Government, which have been slashed by an average of 50% since 2010. That has exacerbated inequality, as poorer areas, which often have many needs, have struggled to raise the funding that they so desperately need. I will use a local example for the Minister. Tameside, one of two local authorities that cover my constituency, will face a £33 million funding gap in adult social care in the next three years, yet a 1% increase on council tax raises just over £700,000—never, ever enough to plug that gap.
The news that Allied Healthcare, one of the biggest providers of home care, has fallen into financial difficulty shows the impact that is being felt in the sector. The fact that 150 councils rely on Allied Healthcare should send shivers down the spines of Ministers. We got no real answers or any assurances from the Government that they were taking these developments seriously or putting in place emergency contingency measures to ensure that we do not see a repeat of the Carillion collapse.
There are four reasons that people now give for their dissatisfaction with social care: staff shortages, long waiting times, a lack of funding, and Government reforms. That is coming not just from the Opposition; the same concerns that we have raised today are being raised in living rooms and care homes across England. The Government have a duty to respond, and I commend our motion to the House.
Jackie Doyle-Price
To be frank with the hon. Lady, one of our priorities is to make sure that disabled people can live independently for longer. That is very much a central part of our approach and we are making more money available for it. [Interruption.] She can sit and smile, but that informs our approach.
I should also like to associate myself with the comments made by a large number of colleagues in paying tribute to the hard-working, committed people who make up our social care workforce and to the informal carers who play such a vital part in our health and social care system. Central to the points made by the hon. Members for Stretford and Urmston (Kate Green) and for Keighley (John Grogan) is that we all collectively need to send a clear message that the work that those people do is valued. We are working with Skills for Care to put more value on this as a profession. People who work in the care sector do so because they are personally motivated and money actually matters less to them. We ought to give them a clear message that we really appreciate all the efforts that they make.
Many Members have raised the issue of funding cuts to council budgets. That subject obviously informed the comments from the hon. Member for Denton and Reddish just now. I will not run away from the fact that there have been challenges for councils in recent times— [Interruption.] Opposition Members mention cuts, but the bottom line is that we can only spend what we collect from taxpayers. That is the reality of the situation. I will be first in the queue to pay tribute to those councils that have stepped up to the challenge, coped well with the reductions and worked hard to become efficient. They have shown real innovation in rising to the challenge.
Andrew Gwynne
I fully appreciate the Minister’s point that we can only spend the money that we raise from taxes, but this is a question of priorities. Why did she vote for a £5 billion cut to the bank levy in the Budget? Is that not the wrong priority?
Jackie Doyle-Price
I think the hon. Gentleman will find that we actually have a very progressive tax paying system none the less.
I want to celebrate those areas that have continued to deliver their social care responsibilities in challenging circumstances. We have heard a lot about what has gone wrong, but let us just remember this statistic: 81% of people in care homes are in homes that have been rated good or outstanding. I think that is an achievement, and something to be celebrated. I also want to compliment those councils that have really stepped up to the plate to deliver an improved performance on delayed transfers of care. Stoke and Trafford in particular have cut their delayed discharges by more than half. This comes down to leadership and determination. Where councils show real leadership, that will deliver improvements and change—[Interruption.] I have just named those councils: Stoke and Trafford.
NHS Negligence Cases
Andrew Gwynne Excerpts(6 years, 3 months ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
I beg to move,
That this House has considered NHS negligence cases.
As always, Mr Rosindell, it is a pleasure to see you in the Chair. I know that it is highly unusual for a member of the shadow Cabinet to speak from the Back Benches, so I am grateful to the Opposition Whips and to Mr Speaker for allowing me to do so as a final opportunity to seek some form of closure for my constituent in this very serious matter. I am especially grateful to Mr Speaker for granting this debate.
Sadly, I have to publicly outline how my constituent, Mr Hawkins, has been let down by public authorities. The law and NHS rules have been abused to avoid giving him the justice that is rightfully his. His attempts to seek that justice, along with some semblance of honesty and humility, have already passed the decade mark, so I shall be grateful for the Minister’s reply after I set out the case.
Mr Hawkins was admitted to Tameside General Hospital on 28 June 2006 to undergo surgery to repair a ruptured left Achilles tendon. Rupturing an Achilles tendon can tear it partially or completely, making walking difficult and the ankle feel weak. The surgery was listed for theatre in the afternoon under the care of an orthopaedic consultant surgeon, Mr Ebizie, but then postponed to the evening. My constituent believes that the most simple and sensible solution would have been to postpone it until the next day, allowing him to remain under the care of the same surgeon. He believes that that did not happen, however, because it would have meant the hospital missing its five-day Government target for a patient to receive treatment or surgery after attending accident and emergency. Records indicate that the surgery was instead carried out by Dr Manikanti, assisted by Mr Kumar. Mr Hawkins states that the change of surgeon was made without his knowledge or consent. Subsequently, both clinicians have left the hospital and the country, and the names and titles of those who carried out the surgery have been disputed.
Mr Hawkins states that the surgeon made a critical clinical error. He believes that the surgeon misunderstood the positioning of the two diagonal sutures forming part of the modified Kessler suture. They were brought to the surface and closed, which permanently fixed the repaired Achilles tendon to the rear of his leg. On 7 July 2006, nine days after the surgery, the plaster cast was removed, revealing an open wound between the two sutures. Steri-strips were applied in an attempt to close the wound, but the duty consultant wrote in his records that the wound had healed very well after surgery. Mr Hawkins states that despite being aware of the error, the hospital failed to correct it by releasing the repaired tendon from the rear of his leg as soon as was medically possible. This allowed serious adhesion and tethering to form as the sutures disintegrated.
On 12 January 2007, Mr Hawkins was discharged from the care of Tameside Hospital. Throughout the previous months, the repaired Achilles tendon had been continually swollen because of the aggravation of the fixation. Mr Hawkins raised concerns, which were ignored. Weekly and monthly appointments at the hospital were required thereafter. Mr Hawkins believes that he was discharged by Tameside Hospital before he was clinically prepared and regardless of his condition. He feels that that was done to conform to Government targets.
Mr Hawkins immediately made a complaint through the hospital trust’s internal complaints procedures. He believes that on receipt of his letter of complaint, the trust should have called him in for an examination and a scan. It should have admitted that a serious problem had occurred and carried out a further operation to release the Achilles tendon from the rear of his leg. In Mr Hawkins’s mind, the matter would then have been resolved. However, the trust decided to take a different route: it instantly instructed Hempsons solicitors.
Although, obviously, Mr Hawkins is concerned about the clinical errors that have caused him lasting damage, he is rather more appalled by the actions of a variety of organisations afterwards. He believes that those actions were deliberately designed to cover up the fact that a clinical mistake had been made, caused primarily by the replacement of a consultant surgeon with a junior doctor.
In 2008, Mr Hawkins instructed a solicitor, who requested disclosure of all full medical records. The trust passed his request on to Hempsons. However, in the immediate period after his request he received only a very selective number of his own medical files from Hempsons. Mr Hawkins’s solicitor failed to ensure that all full medical evidence was disclosed within statutory time limits and failed to apply for a court controlled disclosure, while knowing that the records he had listed were missing. Mr Hawkins’s solicitor instructed a clinical litigation medical expert, who produced a case-closing report that failed the objectivity test and was therefore invalid. The trust and Hempsons initially failed to disclose relevant medical records, doing so only after continued and considerable pressure from Mr Hawkins.
Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)
The hon. Gentleman is a strong advocate for his constituent and makes a compelling case about the difficulties that his constituent has faced. Does he agree that the case flags up a wider problem? He mentioned solicitors being involved at a very early stage in the process. The current system for dealing with medical negligence in hospitals pushes defensive medicine and defensive approaches from hospitals. That fundamentally needs to change, because it is not good for doctors and it is not good for patients. Does he think that no-fault compensation may be a good way forward?
Andrew Gwynne
The hon. Gentleman makes an important point. As Mr Hawkins himself acknowledges, if the hospital trust had taken his complaint down a different route by accepting that it had made a clinical error and deciding to put it right, I would not be standing in Westminster Hall today raising his case.
Mr Hawkins continued with his complaint. In 2013, the trust eventually conceded and his remaining medical records were fully disclosed. On analysis of the records, it was plain to see that there were omissions and that pre-action protocol time limits had been exceeded. In response, Hempsons sought the opinion of a medical litigation expert. A report was produced, but it was based on the selected medical records that I mentioned earlier, as well as on the falsified information. Mr Hawkins believes that that report would fail any objectivity test and is therefore invalid.
Mr Hawkins had involved the Information Commissioner’s Office on two occasions: in 2009 and in 2013. In both instances, it judged that the Data Protection Act 1998 had been breached by the trust’s failure to disclose relevant medical records on several occasions. After much time and effort from Mr Hawkins, on 11 December 2013 the new management team at the trust finally admitted to maladministration and awarded remuneration for it. In a move that Mr Hawkins believes was an attempt to close his complaint and prevent the case from going back to the Information Commissioner, or to the court for disclosure, the new management team disclosed that it would no longer discuss actions taken by the old management team. Mr Hawkins also believes that the Limitation Act 1980 was breached from 2008 and that rules 31 and 35 of the Civil Procedure Rules 1998 were breached in compiling medical reports, because the medical experts failed in their duty to the court to be objective.
The delays in disclosure of information meant that Mr Hawkins’s complaint to the Parliamentary and Health Service Ombudsman was ruled out of time. My constituent believes that that makes a mockery of the trust’s failure to disclose his medical records within statutory time limits, which he believes the ombudsman ignored while upholding the strict time criteria regarding his making a complaint to the ombudsman.
Mr Hawkins appealed the decision on several occasions when the evidence was retrieved through the Information Commissioner. However, he was unsuccessful in overturning their original view that a letter from the trust indicated that the complaint was closed in 2007, which he utterly refutes. Hempsons later apologised and admitted that that letter did not clearly state that the local complaints procedure was closed. However, the ombudsman still refused to investigate the complaint and, in doing so, Mr Hawkins feels that the ombudsman has assisted the trust to conceal the cause and effects of a clinical error.
In 2013, Mr Hawkins wrote to the NHS Litigation Authority, as the trust was not reporting clinical mistakes. Initially, the NHS Litigation Authority would not get involved and requested my involvement, as Mr Hawkins’s Member of Parliament, which I duly offered. Two replies were received that indicated that the NHS Litigation Authority was involved in the case, despite previous assertions and written evidence that it was not involved. Mr Hawkins was notified in writing that the trust, on receipt of his letter of complaint, had instructed Hempsons in January 2007, with the NHS Litigation Authority directly instructing Hempsons and the trust from November 2007 to February 2009.
Hempsons was aware of a breach of the Limitation Act 1980 and the Data Protection Act 1998 when it disclosed to Mr Hawkins his missing medical records in October 2009. This means that the trust and Hempsons had illegally avoided disclosing all full medical records within statutory time limits and successfully passed the three-year limit for litigation. Mr Hawkins believes that indicates that the NHS Litigation Authority was aware that rules had been broken, yet failed to take retrospective action based on the strength of the evidence that he had disclosed to it in 2013.
The actions taken by the trust, assisted by Hempsons and the NHS Litigation Authority from January 2007 to December 2013, clearly indicate that the trust was covering up a clinical incident and its cause. With so much time having passed since my constituent first exited the operating theatre in the summer of 2006, I hope that today the Minister of State will be able to afford Mr Hawkins guidance and support in this matter, and finally bring to some closure what has been a dreadful episode for my constituent.
The Minister of State, Department of Health and Social Care (Stephen Barclay)
As always, it is a pleasure to serve under your chairmanship, Mr Rosindell.
I begin by commending the hon. Member for Denton and Reddish (Andrew Gwynne) for securing this debate. Although he opened it by saying that it is perhaps unusual for a member of the shadow Cabinet to secure a debate such as this one, it is absolutely right that he is doing so on behalf of his constituent and bringing these matters before the House. I am very sorry to hear about Mr Hawkins’s experiences, which have clearly caused him distress.
As you are well aware, Mr Rosindell, the NHS complaints process operates independently of Government, to prevent political bias in the handling of individual complaints. However, a number of points arise from the hon. Gentleman’s remarks, in respect of his contention that Mr Hawkins was let down by a number of individuals and organisations within the NHS. Specifically, it is alleged by Mr Hawkins that the hospital failed him by prioritising then Government targets, which delayed his operation; that the clinician failed him through clinical error; that the duty surgeon failed him by falsely reporting that his wound had healed; that the hospital failed him by not correcting the alleged mistake and by instructing lawyers; that Hempsons solicitors failed to disclose full records; that his own solicitors failed him by not obtaining his records; that his own clinical medical expert failed him; that the hospital failed him, regarding his report; that the ombudsman failed him; and that the NHS Litigation Authority failed him.
Although the Department of Health does not comment on individual cases, and it is not for me to adjudicate whether all of those claims by Mr Hawkins are valid, it is worth noting that a very wide range of both individuals and organisations are alleged by Mr Hawkins either to have conspired against him or, indeed, to have failed him in this matter.
It is also worth placing on the record that NHS Resolution, which was formerly the NHS Litigation Authority, informs me that in January 2016 it first became aware of an independent medical report commissioned by Thompsons, Mr Hawkins’s own solicitors, which had not been previously disclosed to NHS Resolution in the course of Mr Hawkins making his claim. That medical report concluded that there was nothing to suggest that the operation in question had been performed anything but competently. Although I very much recognise that the hon. Gentleman’s constituent is of a different view, and he is perfectly entitled to be of a different view, it is worth placing on the record that his own medical expert, who reviewed this case, did not feel that the operation had been performed in the way that Mr Hawkins has claimed.
I note that Mr Hawkins referred this matter to the Parliamentary and Health Service Ombudsman, which is independent of both the NHS and Government, but the ombudsman ruled that the claim was out of time. Ombudsman decisions are final and there is no automatic right for them to be reviewed. However, the law provides for the ombudsman to consider whether to review a decision if it was demonstrated that the ombudsman made their decision based on inaccurate facts, or that there was new and relevant information that was not previously available, or that they had overlooked or misunderstood parts of the complaint or relevant information.
If a complainant believes that there has been maladministration in the handling of their complaint, they can apply to the courts for a judicial review. However, that must be done within three months of the conclusion of the complaints process.
Andrew Gwynne
The Minister hits the nail on the head there, and it is where the system has let Mr Hawkins down; Mr Hawkins will have been listening very attentively to the case that I set out. Mr Hawkins was denied that ability to apply for a judicial review because of the way that the hospital itself had delayed the process by not informing him that the case had been formally closed, so that by the time he was advised that the case was closed, the time limit by which he was able to take a legal route had passed.
Stephen Barclay
I very much recognise the point that the hon. Gentleman is making. Obviously, I do not want to get drawn into the specifics of this individual case, for the reasons that I have already set out, but within this case and within the claim made by Mr Hawkins a number of factors have been outlined, and I recognise that the hon. Gentleman’s point is one limb of the claim that Mr Hawkins has made.
What brings the various issues together is a question that I think applies to all of us, from all parties in the House: in the future, how do we collectively avoid cases such as Mr Hawkins’s case, and how do we improve the complaints process? That is an area where the Government have been particularly active, not least following “Hard Truths”, the report into Mid Staffordshire and the issues that arose there. The Department of Health has established the complaints improvement board to take forward a series of projects to improve the complaints process. So I hope that—irrespective of the specifics that we are discussing today—as part of the “closure” that the hon. Gentleman referred to, the improvements in the complaints process in the future will be a source of some comfort to Mr Hawkins.
As part of that process, the complaints improvement partnership was established by the Department and system partners, including NHS England, NHS Improvement, the Care Quality Commission, the Parliamentary and Health Service Ombudsman, and NHS Resolution. That partnership is currently examining options for delivering a more effective complaints management system, and better use of all forms of feedback to improve NHS services. That includes expanding the role of the “freedom to speak up” guardians, to give them powers to initiate whistleblower complaints processes where possible. My predecessor, the hon. Member for Ludlow (Mr Dunne), particularly championed that when he was a Minister, and he did a huge amount to progress it.
The complaints improvement partnership also engages with non-executive directors to explore options for them to have responsibility for monitoring the progress of complaints and serious incidents within trusts, and with Healthwatch England, to empower local healthwatch organisations. As constituency Members, I think we all work with and see the value of that body. Working with the ombudsman, the partnership also promotes best practice in the handling of complaints by providing information, advice and training. In addition, NHS Resolution has recently launched a service to increase the use of mediation in the NHS, to resolve issues at an earlier stage without the need for protracted litigation. My hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) has previously championed reducing the impact of lawyers when disputes arise.
It is important that patients receive the safest care possible from the NHS and that when things go wrong clinicians are open and honest, and able to learn from their mistakes. It is equally important that patients and their families are listened to and their concerns taken seriously and addressed.
Andrew Gwynne
That brings us back to the point made by the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). When Mr Hawkins complained that his Achilles tendon had adhered to the back of his foot again, it surely would have been better for Tameside General Hospital’s old management—the hospital has come a long way since it was in special measures—to investigate and put it right at that point, rather than immediately going down the legal route.
Stephen Barclay
The hon. Gentleman will appreciate that the events took place more than 11 years ago and that it is, therefore, not for me to comment on what the trust knew at that time or their actions accordingly. I think we all, across the House, recognise that resolving issues without recourse to litigation is preferable, where possible, to lawyers being involved at an early stage—and I say that as a former lawyer. That is why the Government seek to improve how complaints are handled, including improving the regulation. The Care Quality Commission now rigorously inspects all trusts and primary and adult care providers, and a duty of candour—a new protection for whistleblowers—encourages staff to speak up for safety and hence fosters greater transparency. There is also the development of a culture of learning, through patient safety collaboratives and the national Sign up to Safety campaign, and last April the healthcare safety investigation branch became a fully operational and independent branch of NHS Improvement, to investigate serious incidents in the NHS with a strong focus on system-wide learning.
Andrew Gwynne
I thank the Minister for his kind words and his outlining of how things are changing to give patients better systems through which confidently to seek redress when things go badly wrong. Unfortunately, though, that does not fix the problem for my constituent, Mr Hawkins. He is not looking for a solution. He has exhausted every avenue, as the Minister has set out, and has been badly let down and failed at every stage by a variety of public and private bodies.
My aim today was to set out Mr Hawkins’s case so that Ministers could learn from it in taking forward improvements to the NHS complaints procedures, to ensure that hospital trusts do not play the system to avoid being held properly to account by the ombudsman and other statutory bodies such as the Information Commissioner. My aim was also for Mr Hawkins to feel that the world knew what had happened to him, and to receive assurances that the Government are fully aware of and understand the pain, hurt and concern caused to him for more than a decade, and are intent on putting that right.
Question put and agreed to.
Social Care
Andrew Gwynne Excerpts(6 years, 6 months ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
We have had a good and full debate. I wish to thank the 25 Back-Bench colleagues who have contributed to it, including my hon. Friends the Members for Leicester West (Liz Kendall), for Leigh (Jo Platt), for Colne Valley (Thelma Walker), for Sheffield, Brightside and Hillsborough (Gill Furniss), for Bedford (Mohammad Yasin), for Batley and Spen (Tracy Brabin), for Warrington South (Faisal Rashid), for Bury North (James Frith), for Crewe and Nantwich (Laura Smith), for Weaver Vale (Mike Amesbury) and for Birmingham, Edgbaston (Preet Kaur Gill) and the hon. Members for Totnes (Dr Wollaston), for Erewash (Maggie Throup), for Halesowen and Rowley Regis (James Morris), for St Ives (Derek Thomas), for South West Bedfordshire (Andrew Selous), for Yeovil (Mr Fysh), for Faversham and Mid Kent (Helen Whately), for Rochester and Strood (Kelly Tolhurst), for Bexhill and Battle (Huw Merriman), for Chelmsford (Vicky Ford), for Redditch (Rachel Maclean), for Thirsk and Malton (Kevin Hollinrake), for Aldridge-Brownhills (Wendy Morton) and for Edinburgh West (Christine Jardine).
Clearly, on both sides of the House, there is a shared concern over the Government’s inaction on addressing the growing crisis in social care. It has been illuminating to hear the thinking of the Social Care Minister in her opening speech. I am astounded that a Minister of the Crown thinks that austerity is the mother of invention.
Andrew Gwynne
Let me finish. I will let the hon. Lady in if she wants to apologise.
It is a play on words of the old English proverb that necessity is the mother of invention. Let me tell the Minister that she might be quoting a councillor, but she did not deny that it was her view, too. There is nothing necessary about austerity. It is a political choice, and it is a choice that is driving up inequality and unfairness.
Jackie Doyle-Price
I need to remind the hon. Gentleman that the only money that we can spend is that we collect from taxpayers. I pay tribute to the innovation shown by local authority leaders who deliver better outcomes with less money. That is good value for money and should be celebrated by Opposition Members, too.
Andrew Gwynne
I pay tribute to councillors who are making very difficult decisions under very tightly constrained financial situations. I remind the hon. Lady that, yes, we can only spend money that we have, but it is a question of priority about how we spend it. That is why we set out in the election exactly how we would use the money in a better, smarter, fairer and more equal way.
As Members of Parliament, we have a duty to our constituents to defend the services on which many rely and the services that are there to protect us all should we find ourselves in need of support—care homes for the elderly, child protection and support for parents with disabled children. It is the duty of all Members to protect the principle on which our welfare state was founded. All people deserve a life of dignity. As shadow Secretary of State for Communities and Local Government, I speak to council leaders, to councillors, to council staff and to organisations delivering public services, and they are all telling me the same thing. They are not only unable to cope financially; they have lost confidence in this Government. The country needs fresh ideas and leadership. Instead, it is suffering from the weakest and most divided Government in memory. One thing is clear: this Government are facing a looming crisis of trust in local government. Many within the local government sector, including the Tory chair of the LGA, had hoped that the Prime Minister would use her Tory conference speech to announce new measures to help to alleviate the pressures on adult social care. But I, like many, think they were left wanting for leadership.
Our ageing and growing population means that there is more demand for social care. An increasing number of people will need support with their mental health, a physical disability or learning and social needs. Skills for Care has predicted that we will need an additional 220,000 to 470,000 workers by 2025 due to population growth and ageing, but local government will be unable to meet this demand under current and projected budgets.
We do not have to wait until 2025 to witness a crisis. Across the country right now, our health and social care system is straining at the seams. Last year, councils spent over £366 million more than they had predicted on their social care budgets. That is double the overspend reported in 2015-16, and it is not sustainable. The only response that we receive from this Government is the long-awaited consultation, which a Minister first promised would be published in the new year. Now it is suggested that it might even be delayed until next summer.
When will our communities see action to help the one in eight elderly people who will not receive the care they need, such as help getting dressed, going to the toilet and washing themselves—basic dignity for those most in need? When will we see an end to the closure of children’s centres that are providing support to families in need? Right now, one children’s centre closes every week. When will people no longer have to live in fear in their own homes? Cuts to care hours mean that a fall in the home could leave somebody trapped on the floor, unable to get up for several hours. If Ministers had discussed these issues with the sector, they would know about them. They would know that the sector is warning that social care faces a perfect storm of staffing shortages, rising demand and a lack of funding made worse by this Government’s policy on transfer of care.
I recently asked the Minister whether his Department had conducted an assessment to ensure that local authorities had the financial and staffing capacity to comply with their statutory social care duties. I was told that these were decisions for local authorities, not for the Government. Well, I have done the work for the Minister. The number of social care workers has fallen each quarter for five years to its lowest level since 1999. It has decreased almost 8% in the last year alone. Councils face a £2.3 billion annual social care funding gap by 2020. With this black hole in the Budget, I am unable to understand the justification for fining cash-strapped councils for failing to meet transfer targets. The Minister denied that it is a fine. But if it looks like a duck, waddles like a duck and quacks like a duck, it is a duck; and this is a fine.
The Government are at odds with the whole sector. As the LGA has also argued, I am unable to see how this will not make the financial pressures affecting social care even worse. Ministers have failed to understand the depth of the problem with delayed transfer. Too many patients are stuck in hospital who could be better cared for elsewhere, but ensuring that patients can be cared for in the right settings requires investment in not only social care, but intermediate care, reablement services, and sheltered and supported housing. Added to that, we know that there are issues about pay too.
I urge the House to recognise that this problem does not fall on party lines: these cuts hurt all our communities, whichever side of the House we sit on. The Evening Standard reported this week on a new poll. Three quarters of Conservative councillors said that long-term funding for children’s social care was a major concern. Over half said the Government’s cuts had made it difficult to deliver legally required services. So this is a crisis in not just adult social care but children’s services.
History will not look kindly on a Government who promised so little and delivered even less. That is why I urge Members on both sides of the House to vote to support Labour’s motion. Abstention is a cop-out—join us in the Lobby.
NHS Sustainability and Transformation Plans
Andrew Gwynne Excerpts(7 years, 7 months ago)
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Andrew Gwynne (Denton and Reddish) (Lab)
My hon. Friend is making a very important point. She has already touched on the financial problems in the NHS, but allied to those are the financial problems in adult social care. We shall not have the truly integrated health and social care that we all desire when these STPs are being swept under the doors without people knowing precisely what they will mean for public services in their areas.
Ms Abbott
My hon. Friend has made an important point.
The danger is that, in a blizzard of apps and Skype, patients—particularly the elderly—will find it harder to access one-to-one care, and that those who can afford it will find themselves forced into the private sector.
Let me now say a word about the increasing private sector involvement in the NHS.
Dr Philippa Whitford (Central Ayrshire) (SNP)
I am sorry that this is such an acrimonious debate. I welcome the principle of the sustainability and transformation plans, as they are a key opportunity to reverse fragmentation and to reintegrate the NHS, but we have to get it right. To turn this whole matter into just a game of moving the deckchairs on the Titanic is something that we would all regret in a few years’ time. We are talking about a place-based approach, which is very similar to what we have in Scotland. I absolutely welcome it, but the places must be right—they need to cover the whole population and the geography must make sense. That is in the relationships of the organisations that are there, but we have to think of things such as public transport. There is no point plonking a community in an STP if there are no connections to it. How these places are designed is really important, as are the partners that are in them. All of this should be about integration and re-integration from acute care through to primary care and local authority care. We need single pathways and wrap-around patient-centred care.
Andrew Gwynne
I have some sympathy with what the hon. Lady is saying. Does she agree that that integration will not happen if any one part of those partnerships is severely underfunded? For example, she mentions local authorities. Many of the pressures in the NHS today are solely as a result of the severe underfunding of adult social care. Do we not need to ensure that the finances are in place for these STPs to work?
Dr Whitford
I totally agree with the hon. Gentleman. I was about to come on to that. However, it is not just the funding, but the entire model. The tariff model that we have at the moment rewards hospitals for doing more minor things, and punishes them for doing more acute things. Taking on more A&E cases and more complex cases, working harder and doing more make their deficits grow. Our problem is that we have all sorts of perverse incentives in the system that mean that organisations will still be looking out for their budgets and their survival instead of working together.
In Scotland, we got rid of hospital trusts and primary care trusts, and, since 2014, we have had integrated joint boards. Those boards were handed joint funding that came from health and the local authority, which meant that the whole business of “your purse or my purse” disappeared. They were then able to start to look at the patient’s journey and the best way to make the pathway smooth. That is what we want to see.
Having a shared vision of where we are trying to go to is crucial. That means that stakeholders—both the people who work in the NHS and the people who use it—need to believe in where we are trying to get to. Public conversations and public involvement are the way forward. We should not be consulting on something that has already been signed off, but involving people in what they would like the plans to be, as that would make those plans much stronger.
We need to make deep-seated changes to the system, as opposed to only talking about the money for the deficits. This is something that the Health Committee has been talking about for ages. The phrase “sustainability” has become shorthand for paying off the deficit. Of the £2.1 billion earmarked for sustainability and transformation, £1.8 billion is for deficits, which leaves only £300 million to change an entire system. I know that we talk about money a lot in here, and of course it is important, but we have far bigger sustainability issues than the £2.5 billion deficit in the NHS. We have an ageing population, and those people are carrying more and more chronic illnesses, which means that we have more demand, more complexity and more complications. That is one of the things that is pushing the NHS to fall over. On the other side of that, we have a shortage in our workforce; we do not have enough nurses or doctors, and that includes specialists, consultants, A&E and particularly general practitioners. Although the advice has been very much that finances were third, and prevention and quality of care were meant to come first and second in delivering the five year forward view, finances seem to be trumping everything else.
It is absolutely correct that health is no longer buildings; there are lots of methods of health that are bringing care closer to patients, and also some things that are taking patients further away from their homes. We have hyper-acute stroke units, and we have urgent cardiac units, where they will get an angiogram and an angioplasty that will prevent heart failure in the future. However, we cannot start this process there; we cannot shut hospitals and units to free up money to do better things. We have to actually go for the transformation and do the better things first. We have to design the service around the pathways we need—that wrap-around care for patients—and then work backwards. If more health and treatment is coming closer to the patient, at some point they will say, “Actually, I don’t go to the hospital very often. I want the hospital to have everything it needs when I need it.” Then we can look at the estate to see whether we have the right size of units and the right type of units in the right place. What concerns me is that the process we have seems to be the other way around—we are starting with hospitals, which is often a very expensive thing to do, and hoping it will deliver everything else.