Male Suicide and International Men’s Day

Andrew Percy Excerpts

Thursday 19th November 2015 Westminster Hall

[Philip Davies]

My hon. Friend is absolutely right; we hear very little about that. If there were a shortage of female primary school teachers, I suspect we would hear a great deal more about it.

The fight for equality on all things that suit women has ended up in a situation where we are quick to point out that women need special protections and treatment in certain areas but need greater equality in others. Let me give the example of prison uniforms. Men in prison have to wear a prison uniform; women in prison do not. How, I have asked on many occasions, can that possibly be fair? Where is the equality in that? I will come on to the treatment of men and women in our justice system later, but that is clearly an issue. What is the explanation? I am told that it is because women are different. As I have said, it is a question of equality, but only when it suits.

[Andrew Percy (Brigg and Goole) (Con)]

I congratulate my hon. Friend on securing the debate. I may not agree with everything he has said until now, but one thing I very much agree with him on is the constant obsession with gender equality. Does he agree that some of the people who have the worst life outcomes, particularly in our areas, are working-class men, who suffer some of the worst health issues and have some of the poorest life chances? Simply replacing a middle-class, privately educated man with a middle-class, privately educated woman does very little to increase diversity and opportunity for working-class lads.

[Philip Davies]

I very much agree with my hon. Friend. Increasingly, working-class boys are some of those who are doing the worst at school and need the most help. I certainly agree with him about political representation. I have often said that replacing Rupert from Kensington and Chelsea with Jemima from Kensington and Chelsea does not do much for diversity in the House of Commons, but that is perhaps a debate for another day.

Of course, some people believe that only men can be sexist. Frances Crook of the Howard League for Penal Reform, for example, tweeted the following a few years ago:

“Sexism is not about choosing between two genders, it’s about historic & current oppression by men. Only men can be sexist.”

That view is not uncommon, but it is, I believe, misguided. If it is not okay for a man to be sexist, it cannot be okay for a woman to be sexist. A good example of that is positive discrimination, which is portrayed as a great thing that can rebalance things for oppressed females, yet it is just discrimination. Whether we put the word “positive” in front of it or not, it is still discrimination. In my opinion, there is absolutely nothing positive about positive discrimination, and it certainly has nothing to do with equality.

Just a few months ago, a publishing house declared that it would not accept any male authors for a year to redress some perceived discrimination against female authors. I never quite understood that, because as far as I can see, there are plenty of published female authors, but leaving that aside, people commended the publishers for their stance. Imagine if another publisher had said that it was not going to publish female authors—there would have been an outcry. Thankfully, when I put a complaint to the Equality and Human Rights Commission about that, it agreed with me that it would be unlawful. However, it is interesting to note the number of people whose minds that clearly did not cross; because it was in favour of women, they thought it was fine.

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[Philip Davies]

The hon. Lady has made her point. I would prefer that we actually dealt with trying to prevent people from taking their own life, or committing suicide, or whatever term anybody wants to use. The end result is the same and that is perhaps the thing we ought to concentrate on the most, rather than focus on what we call it, which does not necessarily help anybody who is a victim of it.

According to the Office for National Statistics, the number of female suicide victims declined from 10.9 per thousand in 1982 to 5.1 per thousand in 2013, whereas male suicide rates in the UK were much higher and were virtually the same in 2013 as they were in 1982—19 per thousand in 2013 and 20.6 per thousand in 1982. Those statistics sound bad enough, but it is nothing compared to the reality of suicide: according to the House of Commons Library, what that means is that in 2012, more than 4,500 men felt they had no choice but to take their own life. Given that there was an increase in suicides in 2013, the figure for that year is nearly 5,000 men.

In fact, over the last 30 years, according to ONS figures supplied by the House of Commons Library, more than 130,000 men have taken their own life. That is a staggering number: it is a staggering number of people who have needlessly died, and a staggering number of families left behind—parents, spouses, children, friends and colleagues —all of whom have been left grieving and suffering.

[Andrew Percy]

In our county of Yorkshire, 81% of the deaths from suicide in 2013 were men. To take my hon. Friend back to my earlier point, does he not agree that we have to do more to intervene early, particularly for young men from the poorest social backgrounds, who are the most at risk because of unemployment, low self-esteem caused by low educational outcomes, or the social conditions in which they live? Again, that is a particular group of our society to whom the services are not necessarily best placed to respond, but for whom we need to do better as a nation by intervening earlier.

[Philip Davies]

I am sure that my hon. Friend is right and that most people would agree with him. In fact, in the time allocated to this debate, statistically at least one man will have taken his own life, which means that yet another life will have been ended prematurely and another family will have been left devastated.

According to the Campaign Against Living Miserably, which is supported by many individual charities and which I would like to thank for its help with today’s debate, a YouGov poll this month that surveyed 2,000 men found that

“42 per cent…had considered suicide, with…41 per cent…never talking to anyone about their problems.”

In addition:

“49 per cent…of those who didn’t seek help ‘didn’t want people to worry about me’. A third…felt ashamed, nearly four in 10…did not want to make a fuss and…43 per cent…didn’t want to talk about their feelings.”

According to various sources, including the Government’s suicide prevention strategy for England, the suicide rate is highest among males aged 30 to 59. It has fluctuated in recent years between 30 and 44, but it is currently those who are aged 45 to 59 who have the highest suicide rate.

We might ask why these men feel that they have to end their lives in such numbers. There is the obvious issue of mental health problems; not wanting to ask for help could mean that those go untreated in some men. I was sent a briefing by the Royal College of Psychiatrists, which said:

“Three quarters of all people who end their own life are not in contact with mental health services and men who are suffering from depression are much less likely than women to look for formal help from mental health professionals.”

There are also clearly other things that are likely to affect men more than women—for example, being in debt or being a war veteran. The Samaritans point to evidence that suicidal behaviour comes about as a result of a complex interaction of a number of factors. In the case of men, financial worries play a big part—so unemployment and redundancy can be a trigger—and also the influence of a historical culture of masculinity.

In some cases, men might feel—usually mistakenly—that they are a burden on others or that people would be better off if they were dead. The fact that men still see themselves as the providers in many cases means that financial hardship is very significant, and in their mind reduces their contribution to the family unit. Someone in debt might think that their family would be better off if they were not there. Even putting aside the enormous emotional loss to those left behind, the financial gain may not be as the person intended, as taking their life could invalidate their life insurance.

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[Philip Davies]

I agree with my hon. Friend that we need to do more to make sure that we have genuine equality, and not the “equality when it suits” agenda. We need to do as much as we can to help families stay together, wherever possible.

I will move on to talk about violence. In this House, we always seem to be hearing about strategies for combating violence against women and girls—in fact, there have been debates in the House on that very subject—so people might be forgiven for thinking that there is a special problem of violence against women and girls, and that it does not apply to men and boys. Some might think that far more women and girls than men and boys must be victims of violence, but the reality does not always match people’s concerns. It is a fact that in this country, men are much more likely than women to be victims of violent crime. The most recent biennial statistics from the Ministry of Justice on the representation of females and males in the criminal justice system confirmed that 1.4% of women interviewed in the crime survey reported being a victim of a violent crime, compared with 2.3% of men.

It is not just when it comes to violence generally that men do worse than women. Women accounted for around 30% of recorded homicide victims between 2006-07 and 2012-13, while men were the victims in the remaining 70% of cases. The picture emerging is that men and boys are far more likely than women and girls to be victims of violence and murder, but there is little or no mention of men and boys in our debates and strategies relating to females. I asked the Secretary of State for Education in Parliament last November

“what her policy is on educating children about violence against men and boys.”

I also asked

“what her policy is on educating boys about domestic violence against men and boys.”

The reply from the Minister for Schools was:

“Education has an important role to play in encouraging young people to build healthy relationships, and to identify those relationships which are unhealthy. Pupils may be taught about violence against men and boys in personal, social, health and economic (PSHE) education.”

I will just leave that there for people to reflect on.

There has been a lot of talk about the female victims of domestic violence. Figures from the Office for National Statistics show that 8.5% of women were victims of domestic violence in 2013-14, but so were 4.5% of men. That is equivalent to 1.4 million female victims and about 700,000 male victims of domestic violence. That figure refers not to partner abuse, but to all abuse in a domestic setting, including among families. When we look at the figures for partner abuse, we see that 5.9% of women and 2.9% of men report being victims. It is quite clear that around one in three victims is a man.

[Andrew Percy]

I wanted to make a speech, but I cannot because I have constituents visiting. My hon. Friend makes an important point about domestic violence towards men, but the fact remains that most domestic violence is towards women. Does he agree that although we should tackle domestic violence against men, International Men’s Day is the perfect opportunity for men to stand up as part of the white ribbon campaign, for which I am pleased to be an ambassador, and say that we will never remain silent when other men commit violence against women? Although both issues are important, International Men’s Day offers a particular opportunity for men to take a stand against other men who commit violence against women.

[Philip Davies]

My hon. Friend is absolutely right. All such violence is unacceptable, whether the perpetrator is male or female, and whether their victim is male or female. That is my point 100%. We should criticise them all equally.

There is evidence of under-reporting among male victims of domestic violence. In the crime survey for England and Wales, victims of partner abuse in the previous 12 months were asked who they had spoken to about the abuse that they experienced. A third of victims told someone in an official position about the abuse, but nearly twice as many women as men did. Perhaps more significantly, women were nearly three times more likely than men to tell the police. Despite what we might think from the focus on male perpetrators of domestic violence, there are also many female perpetrators. When anyone says “domestic violence”, the first thing that springs to most people’s minds—including mine—is a poor woman being attacked by a bullying man. The figures show that it is much more complex than that, however, and that stereotypical image needs to be smashed if we are to tackle the problem as a whole.

Something else that needs to change is the reaction to violence against males, certainly when it comes to female-on-male violence. Some see it as almost a laughing matter, but nobody would laugh or turn a blind eye if a female was the victim. Anecdotal evidence suggests that male victims are treated differently from female victims by the police and other agencies. Considering the sheer numbers involved, male victims are given hardly any resources in comparison with female victims. Resources should be available to both male and female victims of domestic violence.

Issues such as the lack of places of refuge and the lack of support for men need to be addressed. The ManKind initiative, which works with men suffering from domestic violence or domestic abuse, says that it will run out of funding in January. It needs people to back it now so that it can provide the emotional support and practical information that male victims need. There are moving stories on its website from men who have suffered domestic violence. Although there seem to be more female victims of domestic abuse, each male victim is also a person, not a statistic, and it is only right and fair that help should be there for victims of both sexes.

I have gone on longer than I thought I would because I have taken so many interventions. The final issue I want to raise is sentencing, and how men are treated differently from women in our criminal justice system. I had a debate here in Westminster Hall three years ago, at which I had plenty of statistical evidence to show that women were treated more leniently than men, but that did not seem to be accepted at the time. Since then, progress has been made, because that fact is now broadly accepted. For far too long, those who peddled myths were able to get away with it because people simply repeated their mantra without question. Perhaps someone would like to try to explain why women should be treated favourably in the criminal justice system, but at least it is accepted that that is the case.

Since that debate, I have amassed much more evidence on the subject. I will not go through it all now, otherwise we would be here all day, but I want to put some of the key facts on the record. About 5% of the prison population at any time in recent history has been female, and the other 95% has been male, yet so much consternation, time and effort have been expended on the very small number of women in prison. For every category of offence, men are more likely than women to be sent to prison. That is a fact. I will give an example to illustrate that: 45% of men sentenced for an offence of violence against the person will be given a custodial sentence, compared with just 23% of women. Of those with 15 or more previous convictions, 39% of men but only 29% of women are sent to immediate custody. In Crown courts, which deal with the most serious offences, probation recommends immediate custody in 24% of cases for male offenders, and just 11% of cases for female offenders.

The average sentence length for an indictable offence is 17.7 months for men and 11.6 months for women. Men serve, on average, 52% of their prison sentence; women serve 46%. The average length of time that men spend in a prison cell each day is 14.1 hours, but that figure is 11.5 hours for women. The list is endless. I have spoken about domestic violence and have an additional fact on that subject: 3,750 male sentenced prisoners were victims of domestic violence, compared with 1,323 female prisoners.

There has been a rise in publicity surrounding female paedophiles. In a few high-profile cases recently, the sentences given to women were much more lenient than those that would be given to men. Just the other week, a babysitter who had sex with an 11-year-old boy escaped jail. There is no way on this planet that a male who had sex with an 11-year-old girl would have avoided prison—a point that the National Society for the Prevention of Cruelty to Children made about the case. There is no chance of that happening at all, and yet that was the sentence handed down.

The facts and figures that I have set out show that there are certainly questions to be answered about how men are treated in the justice system, compared with women. It seems that there is clear discrimination against men. If outcomes are all-important, what do people have to say about that? What will be done to deal with that balance? Well, the Under-Secretary of State for Women, Equalities and Family Justice has made an announcement. She has said that she wants fewer women in prison—not fewer people or fewer men. Yes, hon. Members heard me right: just fewer women. The Conservative manifesto read:

“We will improve the treatment of women offenders, exploring how new technology may enable more women…to serve their sentence in the community.”

Now, I am not somebody who supports prisoners, but where on earth is the equality in that? How does that fit in with the Equality Act 2010?

Care Homes (Regulation)

Andrew Percy Excerpts

Wednesday 4th November 2015 Westminster Hall

[Peter Heaton-Jones]

My hon. Friend makes an extremely good point. This must be about the elderly people who are in the care homes. They must be the entire focus of those who work in, manage and own those care homes, not the bureaucracy and the paperwork.

[Andrew Percy (Brigg and Goole) (Con)]

I congratulate my hon. Friend on securing the debate, and it is a pleasure to serve under your chairmanship, Ms Vaz. You will remember that we looked at this issue in the Select Committee on Health in the last Session, as will the shadow Minister. We welcomed the new inspection regime, but I seem to remember that one criticism we had in discussions in the Committee related to the fact that we are dealing with often very elderly, very frail people who cannot speak for themselves, and one thing that the CQC could perhaps do better is engagement with families. That is not just after an inspection, when everything is all right. It needs to ensure that family members of those in care homes understand what the inspection regime is and how they can engage with it before, after and during the process. Although some of the changes have been positive and there is now perhaps better regulation in England, the people whom we ask to give feedback are often not able to speak for themselves, so we need to engage families much better.

[Peter Heaton-Jones]

My hon. Friend makes an extremely pertinent point, and I will talk about some challenges in the entire system when it comes to engaging with people. As he rightly says, people have difficulty in understanding the best way to engage with the system.

When things go wrong and a member of the public needs to raise a complaint against a care home, I am afraid the system becomes even less satisfactory. The CQC’s website says that it

“is unable to investigate individual complaints”

against providers. So how does someone complain if something goes wrong and they are worried about the care that is being given to an elderly relative in a care home? It is difficult. What can someone do if they fear that an elderly relative is being neglected, mistreated or not given the right healthcare, or if they fear that their relative’s life might even be in danger and the care home provider has dismissed the complaint or will not listen to it? The CQC has that said it will not handle individual complaints, so should they go the Parliamentary and Health Service Ombudsman? No, because the ombudsman says:

“By law, the Ombudsman cannot look into complaints about privately funded healthcare.”

If someone tries to go to the ombudsman they reach a brick wall. The CQC will not handle individual complaints and the ombudsman does not accept them. There is one possibility: an organisation called the Independent Healthcare Sector Complaints Adjudication Service. The ombudsman’s website states that “you may”—I stress “may”—

“have the option of going to the Independent Sector Complaints Adjudication Service…which represents some independent healthcare providers.”

If someone’s healthcare provider is not one of them, they are stuck.

The system is bewildering. It lacks accountability and transparency, and would leave most people confused and frustrated. How are people in care homes supposed to deal with that bewildering system? They may be vulnerable, old and frail and perhaps suffering from dementia. Their loved ones might put all their time and energy into caring for them, but how are they supposed to navigate the system? It needs to change.

What changes am I proposing to try to put right some of the issues I have highlighted? Despite the best efforts of the CQC—I say again that this is not a criticism of individuals at the CQC, much less those who work in care homes—I am afraid that, as currently manifested, it is simply not fit for purpose when it comes to the regulation, inspection and investigation of standards in care homes. Its focus recently has rightly been on NHS hospitals and providers. In light of the Mid Staffordshire scandal and the findings of the Francis report, that is hardly surprising—indeed, it is right—but the unintended consequence has been insufficient focus on the private care home sector.

In the short term, we must hold the CQC to account and insist on significant improvements now, because the situation needs to be addressed immediately. In the long term, it seems to me that the solution is to create a new, single, dedicated body whose sole responsibility is the registration, regulation and inspection of private care homes. Crucially, that body should also be the first point of contact for anyone wanting to raise a complaint about a specific establishment or the care of an individual patient. It would have the responsibility and necessary powers and resources to investigate those complaints thoroughly and rigorously, and in real time.

At the moment, if someone has an immediate concern about the care being given to an elderly relative and the care home either disagrees or denies that there is a problem, there is nothing to be done and nowhere to turn. That could be a matter of life and death. It needs to change, and it needs to change urgently. When things need to be taken further, we need a complaints system that is easier for the public to access and more transparent, and whose findings are accountable to Parliament in individual cases. The current complaints infrastructure is bewildering and is just not working.

My constituent to whom I referred at the start of my speech has lived with the problem for the past six years. Over that time, he has invested a great deal of work, research and thought in it. It has been his life, and it has undoubtedly been part of the grieving process for his mother. He has produced a document that is the product of a lot of work, and I have it here. It contains 24 very detailed points, questions, proposals and recommendations. He is frustrated that despite his best efforts and with a few notable exceptions, the issue has been largely ignored by the media and not given sufficient focus by politicians. That is something I want to put right today.

In the many hours my constituent and I have spent discussing the issue, we keep coming back to one thing. It is not about processes, systems or organisations, it is about people—people who do not have a voice in a system in which, let us remember, four in 10 care homes currently fail to reach a satisfactory standard on the CQC’s own measures. That means that people—vulnerable, sick and elderly people—are not being properly cared for. That cannot be right. We must do something about it. I believe we have a moral duty to do something about it, and that we must act now.

[Jim Shannon (Strangford) (DUP)]

Thank you for calling me, Ms Vaz. I congratulate the hon. Member for North Devon (Peter Heaton-Jones) on bringing this topic to Westminster Hall, setting the scene and explaining its importance from his personal experience and knowledge.

Care homes should and must provide care and services to some of the most vulnerable in society. I believe and the House believes that those who have worked hard and have contributed to society and the economy all their lives deserve appropriate care and dignity in their old age. We have the opportunity to be a voice for those who cannot be a voice for themselves. That is the issue the hon. Gentleman has brought to the House today. The people involved are often at the fringes of society and are of all ages. Many people in care homes do not have immediate family and that is another concern. We read stories in the press and we may be suspicious of them, but they illustrate the problem. There is no smoke without fire, so if there is a story in the press there must be at least some truth in the story.

Some people may be physically unable to look after themselves, including those who are elderly or have learning difficulties, dementia or Alzheimer’s. They deserve the very best care in care homes and their families need the assurance that they are well looked after. If someone has dementia, Alzheimer’s or a physical disability, they deserve the same treatment and care as others to ensure that their meals are correct and that they are given a wee bit of time, compassion and understanding, as the hon. Gentleman said. It is imperative to do all we can to protect those in care homes and to ensure that they receive the care and dignity they deserve.

I welcome the opportunity to question how the Government intend to improve regulation of the industry so that the people who are cared for are protected. I am always a bit suspicious of statistics—as the saying goes, there are lies, damned lies and statistics—but they are clear. Only 64% of care service providers in England are registered with the Care Quality Commission, so there is a question to be answered. I have great respect for the Minister’s understanding and I think the world of him, so I am sure that in his response we will hear the compassionate understanding that he feels personally and as a Minister. I look forward to that.

The Care Quality Commission monitors and regulates care organisations to ensure that they are continuing to meet national standards, and herein we encounter the first issue about regulating care homes. We need to press for much higher levels of registration if we are even to think about improving regulation. We cannot improve regulation if we do not have registration. I hope that we can make higher levels of registration a key part not just of this debate, but of the Government response. We cannot improve regulation if 36% of care service providers are not registered with the main body for monitoring and regulating the industry. Indeed, we should express immediate concern about whether those unregistered care providers are up to the national standard. I am not saying that they are not, but Government observation and monitoring is needed to ensure that they are.

Last year, following years of scandals, the Care Quality Commission announced that it would reinspect all care services and then rate them individually. We do not want to go into too much detail about the most horrible stories and incidents, but they do resonate with all of us as elected representatives. Care homes judged to be inadequate would be shut down and their directors banned from working in such positions again.

[Andrew Percy]

The hon. Gentleman is making a very important speech. He references the examples of abuse, mainly involving physical abuse, that we have heard about. Does he share my concern that in other care homes the problem is not physical abuse, but people not receiving proper nutrition? It is a national scandal that £13 billion of NHS money is spent every year dealing with poor nutrition, much of it in the elderly population. There are no doubt some very good nursing homes and care homes, but the quality of the food in homes often contributes to the decline of residents, and the CQC needs to get a handle on that as well.

[Jim Shannon]

I thank the hon. Gentleman for his intervention; he is right. I tried to make the point earlier about the food that residents eat and its nutritional value, and about the time that may need to be spent looking after someone and feeding them. I thank the hon. Gentleman for highlighting another very important issue.

The National Audit Office found that just 9% of services had been assessed as of July this year, despite the deadline for inspections being February next year—a deadline that has been pushed back. Obviously, the February deadline cannot now be met, because 91% of homes cannot be inspected in that time, but perhaps when the Minister responds we can get an idea of a new deadline in relation to the inspection regime.

However well intended the Care Quality Commission system is, there are clear failings in the current way of doing things, and today’s debate gives us the opportunity to discuss the way ahead in terms of improving the poor rate of inspection. The right hon. and hon. Members who are here will illustrate that very clearly. Concerns have been raised across the political spectrum, both in newspapers and by political representatives, and I hope that the solution to those concerns can also be found on a cross-party, bipartisan basis. After all, this matter concerns us all. It is not a matter of scoring points—it is never that with me anyway, but it certainly is not with anyone in this debate, because we all have the same focus and commitment to delivery of the same level of care and to ensuring that all homes reach a certain level.

We have had many issues in the past in Northern Ireland. I know that this is a devolved matter and the responsibility of someone else, but having the appropriate protection and regulation is so important to ensuring that abuses are not happening. The historical and the up-to-date abuse cases that we see in the papers need to become a thing of the past.

We can come together from both sides of the House, set the right course, address the issues and hopefully, through the Minister and the shadow Minister, the hon. Member for Worsley and Eccles South (Barbara Keeley), provide some direction in relation to the solutions. I hope that my contribution and the issues I raised have been noted by the Minister—indeed, I know that they have been—and that they will prove useful to eliciting a strategy and a response from Government to ensure that this matter is addressed correctly as a matter of urgency, as the hon. Member for North Devon said, and to the best of our ability.

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[Andrew Percy (Brigg and Goole) (Con)]

I will be very brief, because I have already made the points I wanted to make about nutrition, and about family involvement and engagement in the inspection process. I congratulate my hon. Friend the Member for North Devon (Peter Heaton-Jones) on securing this debate on a subject that has always bothered me in my other role, which members of the Health Committee have heard a lot about, as a volunteer first responder with the ambulance service in Yorkshire. In that role, I have spent a lot of time in care homes, and there is a real mix of standards.

There are two things worth raising with the Minister that bother me and that, I hope, broadly come within the scope of this debate. One is the quality and dignity of care for elderly patients in care homes. When they need to be taken to hospital, they are often, sadly, taken on their own. I remember watching a very elderly lady who was having a suspected stroke on a hospital trolley at Scunthorpe hospital. She was alone and obviously very distressed. The ambulance crew were doing the best that they could, but they were booking her in and all the rest of it. I remember looking at her and thinking, “I would not want that to happen to my grandma.” That happens too often.

The second point is about the need for an understanding of palliative and end-of-life care in care homes. That is an issue of training and standards. I have been called to care homes where I have had to try to resuscitate people who are clearly at the end of life in a very unpleasant situation. We must get better at that, because we know what inevitably happens to many people in care homes before they even get to nursing homes, so proper training must be given. In that respect, proper standards of care and the quality of training of people working in care homes are in desperate need of improvement. In some areas and some care homes, those things are very good. I have a wonderful care home in my constituency, which has a cinema and a hairdresser, and it is lovely to go into. It does not have some of the problems found in other care homes. People have to pay for that, however, and only those who can afford to do so get it. Too many people cannot afford that, so they do not access the same quality of care or staff training. I hope that the Minister can respond to those two brief points.

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[The Minister for Community and Social Care (Alistair Burt)]

It is a great pleasure to serve under your chairmanship, Ms Vaz. You will not find a lack of consensus here today; I am glad to start off in that way.

I congratulate my hon. Friend the Member for North Devon (Peter Heaton-Jones) on securing this debate, which has been really good. Colleagues have made some very moving and pertinent points. I find myself in the position that Ministers find themselves in; understandably, I have responsibility for an inspection and regulatory regime that we are all working hard to ensure does its job of protecting people in the manner that we all described. Inevitably, however, the issues that arise are always the things that go wrong. The question is how to strike the balance between, on the one hand, giving an assurance about the chief inspector of the Care Quality Commission, and the assurance that our degree of concern about what happens in care homes is absolutely appropriate, and, on the other hand, in no way being complacent about the issues that colleagues spoke about, and about where the problems are. That is what I hope to address.

I am really appreciative of the contributions made. I will come to the contribution of my hon. Friend the Member for North Devon in a moment. The hon. Member for Strangford (Jim Shannon) spoke with his usual decency and compassion. He wants speedier action, and he recognised our non-partisan sense of interest in those who require care. My hon. Friend the Member for Newton Abbot (Anne Marie Morris) made a number of interesting points, including about managers in care homes. When I have spoken to CQC officials and others, I have found that issue to be vital. If there is good management, it will be a good care home; if there is not, it will not be. The lack of registered managers is a genuine problem, and we are on to that. The issue of commissioning is also underplayed.

My hon. Friend the Member for Brigg and Goole (Andrew Percy) spoke movingly about the issue of loneliness and isolation. He talked about someone who was taken from a home in an emergency, needing urgent care, who found themselves on their own. That raises questions about the extent of care delivered to individuals in those circumstances, and I hope that anyone who heard that would question their procedures to ensure that it did not happen to anyone they were looking after.

This morning, I met Unison officials in the office and we had a word about training standards. We have to be absolutely certain that training is available for all who are active in care homes. As we know, there is the skills care certificate. However, I am led to believe that we cannot be sure that everyone is getting the training they need, and as a result of this conversation, I am really interested in finding out what more we can do to ensure that training is available for all.

[Andrew Percy]

One area of training where we really could help to take the pressure off the ambulance service is in relation to falls, which place a huge demand on our local health services. Paramedics often say to me that they feel those falls could be dealt with more appropriately by care home staff—or even avoided—if staff were trained properly.

[Alistair Burt]

I take my hon. Friend’s point, which confirms what I was saying about the need for training, and for appropriate treatment and rehabilitation to be available after falls. The role of occupational therapists should not be minimised after such incidents.

I am all too willing to hear from the hon. Member for Glasgow East (Natalie McGarry). The fact that this matter is devolved is of no interest; what is important is that we share best practice and best standards of care. I very much appreciate her contribution. The hon. Member for Worsley and Eccles South (Barbara Keeley) again challenged me on what we are doing, and really that is the meat of the remarks I prepared to give in response to the comments of my hon. Friend the Member for North Devon; I am grateful to him for sharing those with us before the debate.

Let me put one or two things on the record. The Government are committed to improving the quality of adult social care, and to ensuring that people receive high-quality and compassionate care. We have taken a number of firm steps in that regard, and that is partly because of the sort of issues raised today. However, we are in a relatively early phase of the use of the new powers given to the CQC, and in a sense this debate reflects the sort of baseline from which we all have to work.

My hon. Friend referred to the experiences of his constituent, whose mother died in a local care home, and he spoke powerfully about the frustration that his constituent experienced in raising concerns with the care home provider and other bodies, such as the CQC and the local clinical commissioning group. We offer our condolences to my hon. Friend’s constituent, and I share his frustration that the experiences of service users and their families have not always been central to the provision of care or the oversight of regulation. I know that my hon. Friend’s constituent has met senior staff at the CQC on more than one occasion, and I hope that those meetings were helpful to him. However, I appreciate that this debate is not an opportunity to reopen this case, which I know the CQC has investigated extremely thoroughly.

Picking up on some of the concerns expressed today, I want to reassure my hon. Friend that we have come a long way; we have made real improvements in the regulation of adult social care in quite a short time, but of course there is more to do. Our reforms to the CQC have been central to those improvements. The regulation of adult social care has three key roles: first, to identify poor practice and take action to protect service users from the risk of harm; secondly, to encourage improvement by identifying areas of weakness; and, thirdly, to highlight and share good practice and success. All these roles are built on the foundations of effective use of data and rigorous inspection. In that respect, the CQC has been transformed in recent years, not least by having been given new powers in 2014, which is obviously not all that long ago. Those powers need to be built on.

The CQC has put in place specialist inspection teams under the leadership of the chief inspector of adult social care. These teams include “experts by experience”—people who have personal experience of care—and inspections now take particular account of the views and experiences of the users of services and their families.

The great majority of CQC inspections are unannounced. In a very small number of cases, when there are good practical reasons for doing so, notice may be given, but in the vast majority of cases services are not tipped off or warned that an inspection team is on its way. Providers registered with the CQC are required to meet a new set of fundamental standards that govern the quality and safety of services. These standards only came into force on 1 April, but they are the standards of safety and quality that providers must always meet. The CQC has a range of enforcement powers that it can use against providers that breach these fundamental standards. These powers vary from issuing warning notices and fines and imposing conditions on a provider’s registration, to cancelling registration, which withdraws a service’s permission to operate, thus closing it.

The new fundamental standards include two important new registration requirements. The first—the duty of candour—requires providers to be open with service users about all aspects of their care, and to inform them when there are failures in their care. The second—a “fit and proper person” requirement for directors—ensures that accountability for poor care can be traced all the way to the boardroom if necessary.

The CQC’s model does not just assess whether providers are meeting the fundamental standards. The CQC asks five key questions of each service: is it safe? Is it caring? Is it effective? Is it responsive? Is it well led? All inspections deliver a rating for each of these five key questions on a scale running from “inadequate”, through “requires improvement” and “good”, to “outstanding”. Inspections also result in an overall rating for each location.

There was much talk about what has been found so far in relation to those ratings, with a small number of providers deemed to be “outstanding” and more providers deemed to be “good”. However, a number of providers were deemed to “require improvement” or be “inadequate”. In starting its inspection process, the CQC looked first at those providers that might have more difficulties than others. The CQC is aware of what is going on, and it started its inspections at the end of the scale where it expected to find difficulties. That was designed not to force closures, but to recognise where improvement and support, which my hon. Friend the Member for Newton Abbot mentioned, is so important. In 40% of those cases, improvement has been made; on a subsequent inspection, things were found to have improved. However, that still leaves a percentage of those providers having not improved, and I think it is those providers that have been highlighted today.

Having met Andrea Sutcliffe, I am quite confident that her determination is exactly the same as that of everyone in this room. However, it is clear that there are so many places to cover that we have to be certain of ensuring that the standards that we have spoken of, and that the CQC is working to, will be delivered by all providers. Those are standards in training, management and ensuring effective monitoring.

My hon. Friend the Member for North Devon used the phrase, “There’s nowhere to go”, in relation to someone having concern about an individual. I would not want that to be the message; I would not want anyone to feel that they had nowhere to go if they felt that someone was at risk of being, or was being, ill-treated in a care home. That is not the case. The truth is that if someone has such a fear, they can contact the CQC, which will act if it agrees that a person’s safety or wellbeing is at risk, and if need be the CQC will contact the police. I would not want anyone to think that if they knew of someone in a care home being ill-treated, there was nothing they could do as of this moment. They can and should do something.

However, it is also clear from the nature of the debate that if the CQC’s most recent report has set a baseline, there are things that we need to do and improve. The sort of information available to us through our constituents, and the sort of interest that specialists such as those here have taken, will give me good guidance on how to ensure those improvements are seen through.

NHS Reform

Andrew Percy Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

I thank the right hon. Gentleman for finding time to come to the Chamber on what I know is an important day. I am not sure whether I am allowed to wish him luck, but I greatly value the time that I spent working with him as a ministerial colleague, and I know he will make an important contribution to the House. He is right, as ever, to speak about mental health. The programme towards seven-day working is as important for mental health as it is for other services, and we must also ensure that the revolution happens for things such as suicide rates and crisis care. He is right about the importance of the social care system; and in my mind when I speak about seven-day care I am thinking about social care and health as one entity.

[Andrew Percy (Brigg and Goole) (Con)]

Our doctors no doubt work incredibly hard in our hospitals. The people of Brigg and Goole and the Isle of Axholme work at weekends, whether in factories, at the docks or in the fields, and they want an NHS that does the same. The Secretary of State will know about my passion for ambulance services, which at weekends are often the last line of support for patients. What will his plans mean for ambulance services and the incredible job that paramedics do across the country?

[Mr Hunt]

I thank my hon. Friend because he leads by example as a first responder and does a fantastic job in his constituency—indeed, that role takes place at weekends. Paramedics and ambulance services operate a seven-day service. Nurses, paramedics and others who work in hospitals currently do not have an opt-out; consultants are the only ones who do. These measures will give ambulance services confidence that if they take someone to hospital at the weekend, there will be a proper senior consultant present and their patient will get in front of the right person. That will make their job all the more rewarding.

A&E Services

Andrew Percy Excerpts

Wednesday 24th June 2015 Commons Chamber

[Mr Reed]

My hon. Friend puts her finger on the problem precisely. It is absolute madness, and it is happening at trusts throughout England, as their deficits edge up towards £1 billion for this financial year.

The number of patients waiting more than four hours each year has rocketed by more than 1 million, meaning that there are now almost four times as many people as there were five years ago waiting more than four hours. That is a damning record, and based on the performance over the previous Parliament five more years of the same will see almost 2.5 million patients each year waiting more than four hours by 2020. For the benefit of patients, medical professionals and the healthcare system as a whole, that cannot be allowed to continue.

[Andrew Percy (Brigg and Goole) (Con)]

The hon. Gentleman may know that I spend my weekends working in the NHS, attending seriously ill patients. We are seeing more patients who are elderly, who have a higher acuity and who need admission to hospital; hospital is the only place for them. On his suggestion that the situation has arisen on the Government’s watch, how does he account for the Royal College of Nursing’s telling the Health Committee that the decisions that needed to be taken to deal with this demographic shift should have been taken a decade or more before my party entered government?

[Mr Reed]

If the hon. Gentleman wants to compare the records of this Government and the previous one, we will do that all day long and he will come out on the wrong side of that debate. On the ageing society, we would think from listening to Ministers and Government Back Benchers that this has just been sprung upon us. He is right to say that it has been coming for a long time, but we did an awful lot more to address it than this Government are doing. I will go on to explain why in just a moment.

A real worry for the NHS, and for those of us who use it or work within it every day, is the Government’s plan to suspend the work of the National Institute for Health and Care Excellence on its safe staffing programme. That move is a rejection of a key recommendation made by the Francis report, and in response to the move, Sir Robert Francis said:

“I specifically recommended the work which NICE has been undertaking for a reason…I would not be surprised if this news generates a significant level of concern, and it seems a shame that the work of NICE has been stopped.”

Dr Clifford Mann, president of the Royal College of Emergency Medicine, has said:

“There are real pressures on nursing levels in Emergency Departments.”

He has also said:

“We are concerned about patient safety and staff welfare.”

I would be grateful if the Minister could explain to me, and to Sir Robert Francis, why on earth the Government have suspended this crucial work.

Health and Social Care

Andrew Percy Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

I am afraid that this is exactly the sort of distortion and scaremongering that got the right hon. Gentleman nowhere in the election campaign. He knows perfectly well that the 2012 Act does nothing different from what the EU procurement rules required under the primary care trusts when he was Health Secretary. Yes, I do believe that there is a role for the independent sector in the NHS, but I think the decision whether things should be done by the traditional NHS or the independent sector should be decided locally by GPs doing the right thing for their patients. That is the difference between us.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State is spot on with regard to the use of language. In the last Parliament the Health Select Committee saw an attempt to paint a picture of privatisation as equalling the provision of private health care. Will my right hon. Friend confirm that under the previous Government private sector activity in foundation trusts fell and the rate of privatisation was slower than in the preceding five years—something that the Committee noted in a report that was blocked by Labour members of the Committee?

[Mr Hunt]

Yes, I will. The figures that my hon. Friend cites are right. I will tell him something else. Half a million fewer people took out private health insurance in the previous Parliament because the quality of care that they could get on the NHS was rising. The Government are committed to the NHS. If the right hon. Member for Leigh does not want to believe what I am saying about privatisation, perhaps he will believe the respected think-tank the King’s Fund, which is clear that his claims of mass privatisation were and are exaggerated.

Child and Adolescent Mental Health Services

Andrew Percy Excerpts

Tuesday 3rd March 2015 Commons Chamber

[Andrew Percy (Brigg and Goole) (Con)]

It is a pleasure to take part in this debate as a member of the Committee, and I associate myself with the kind words of our excellent chairperson, my hon. Friend the Member for Totnes (Dr Wollaston), about everyone who gave evidence, and about all the Clerks and House staff who supported the inquiry. It was one of the most important and far-reaching inquiries we have undertaken in the past few years, and I was proud to have been a part of it, because the issue is so important.

I wish to make a few general comments about this whole area and then to talk specifically about the role schools can play in mental health services for children and young people. I noted with interest the comments made by the hon. Member for Stoke-on-Trent South (Robert Flello). The comments today have generally been quite consensual, although something I will say a little later about funding may be less consensual. He pointed out that 10 years ago we were having many of these same conversations, but things have really moved on in the past 10 years, not least in this area; we heard in our inquiry about the increase in demand. Although many of the pressures young people faced 10 years ago are similar, a whole host of other pressures on young people now did not exist then, particularly those of a cyber nature, be it those arising from Facebook, Twitter or online bullying. When I started teaching in 2002 people did not have a great deal of understanding or expectation of any of those things, but they have now become so widespread that we have had a massive increase in demand in this area.

In addition, the way in which mental health services and care are delivered has changed beyond recognition during that period, and some would argue that it has not always been for the better. As we know, between 1998 and 2010 the number of mental health beds reduced from 35,000 to 25,000, and we have seen a continuing shift away from in-patient treatment units. What came out of this inquiry, and what I have seen in my constituency in mental health service provision for both young people and adults, is that although that more traditional unit-based, hospital-based, bed-based system of treatment has changed, what has replaced it has not necessarily always filled users with confidence or has even been consistent across the country. As our report makes clear, there is a lot more we need to do.

As I have said, I wish to focus on what we heard from young people. It was great that our inquiry had a session with young service users, including some from Hull, near my area, who came down to tell us about how they have engaged with local voluntary, local authority and, of course, school services. In our inquiry, we heard that the support schools offer young people is very patchy across the country, changing even within cities or within counties. Some young people we heard from, and some of the other evidence we took, made it clear that some of the best support they had received had come from dedicated teachers who understood mental health issues, really wanted to engage with those young people on them and help them access services. Having a teacher who was engaged and who understood what to look for in mental health really helped young people. Some pupils had different experiences. They felt that teachers either lacked the skills or were too uninterested to deal with the problem. Very often that can be because teachers are scared of mental health issues. In some cases, therefore, pupils experiencing mental health problems did not receive the support that they needed.

I started teaching in 2002. When I think back to some of the young people we had to deal with, I can see that many of them probably had mental health issues. At the time though, those pupils were dismissed as being badly behaved or as having background problems. As a practitioner, I was sometimes guilty of not understanding the signs that were being presented to me. However, teachers cannot be blamed for that; they work in a pressured environment. The pressures around school standards seem to get more intense every year and with every Government initiative.

What we did hear in our evidence was that 61% to 85% of schools are providing access to school-based counselling. Although that is a wide variation, it is a positive thing. We heard that some schools engage really proactively with the local authority and the NHS in this area. Unfortunately, though, we also heard of others that do not engage so well. Some schools seem to think that mental health issues are for health services and social services, but not for schools. When we talk about integration in all areas of health care, this area is one in which we need it the most and, potentially, it could have the biggest impact. My hon. Friend the Member for Totnes talked about early intervention. When we fail in that regard, the consequences are picked up by other services. That means that we have increased referrals and more behavioural difficulties in our schools, which leads to more exclusions. Those exclusions have consequences not just for the management of the school but for that young person’s life chances.

What can we do in schools to make a real difference? Increased collaboration among the services is vital. Although we talk about integration and greater collaboration, we need someone at some point to take responsibility for that and to be held accountable when that collaboration does not work. As we heard in our evidence sessions, some schools are keen to take the lead in that regard, and others less so. Clearly, this is an area where we need greater clarity.

The curriculum was raised by a number of young people, particularly around personal, social, health and economic education. They said, “We learn everything in PSHE. We learn about sexual activity, financial matters, career advice and career choices, but what we do not learn about is mental health and well-being.” Ofsted found that 40% of PSHE provision required improvements nationally and that one third of young people say that they want to know more about how to deal with stress and how to access help for eating disorders. Some 38% said that they wanted education around bereavement, which surprised me.

We have seen some good things happen with the curriculum. We heard in our inquiry that the ICT curriculum now contains a section on cyber-bullying. Clearly, some improvements have been highlighted but an awful lot more still needs to be done. The focus should be on young people as much as it is on teacher training. In our evidence sessions, we heard from the Secretary of State about how a great deal of effort has gone into providing teachers with the tools to deal with mental health issues and to improve training, and that is really important.

When I did my postgraduate certificate in education, I do not remember receiving a great deal of education about mental health and young people’s emotional well-being. Clearly, that needs to change, but the focus should be not only on equipping teachers better, but on ensuring through the curriculum that young people are able to understand mental health issues. The stigma needs to be removed through both teacher training and the curriculum, and young people who have had experience of mental health issues should be involved in developing that curriculum.

I wanted to say a little more about youth services, but I do not have a great deal of time. We have heard a lot about council spending reductions and the impact that that can have. The truth is that whoever was in power, we would be in this position, with council budgets having been reduced. In my area, I am very pleased that North Lincolnshire council has made a concerted effort to reverse the cuts to youth services instituted by the previous administration of a different party, which cut the services by £194,000. Even in these tough times the council has been able to put in an extra £100,000 of funding and over the next three years will add to that a further £300,000.

Local authorities can do that if they have the necessary vision. In the case of North Lincolnshire, the driver for that is a very good portfolio holder in the cabinet who understands that we have to get it right early. That means that we need proper investment in positive activities for young people, because that allows savings elsewhere down the line. Despite all the difficulties that we have faced in local government funding, where there is leadership and vision, people who understand the value of these services can find the money to invest in them. With that, I will end as I am conscious of time and I know that one of my colleagues wishes to speak.

--- Later in debate ---

[Grahame M. Morris]

That is true. Some of the organisations that submitted evidence to the Health Committee and subsequently provided briefings made that point.

Another issue of concern is the complex commissioning landscape for CAMHS, which can result in poorly co-ordinated services and a lack of clarity about roles and responsibilities, leading to gaps in provision and poor transitions from child to adolescent and from adolescent to adult. The service is certainly underfunded. We often talk in this place about parity of esteem. As other Members have reported, CAMHS nationally is receiving about £1.8 billion of the £14 billion that is spent on mental health. Local authority-provided services, which are often having to bridge the gap, are facing huge financial challenges. My local authority, which I share with my hon. Friend the Member for North Durham (Mr Jones), has had to cope with cuts of £250 million over the lifetime of this Parliament. That is forcing councils to make extremely difficult decisions about which services are funded.

I fully understand the point made by the hon. Member for Brigg and Goole, but I also fully understand the difficult decisions faced particularly by authorities in the north that seem to be suffering disproportionate cuts. Councils are embracing their new public health responsibilities—

[Andrew Percy]

I hope the hon. Gentleman understands that both my local authorities are in the north of England; I would not want him to get his geography wrong.

[Grahame M. Morris]

I am certainly aware that some authorities are facing higher cuts than others. My area is one of relatively high deprivation, but we seem to be in a far worse position than some in the south that are more affluent and do not have the same kinds of pressures.

In rural areas, in particular, people face problems with travelling long distances, a lack of accessibility to specialist services, and long waits. One issue is the 12-week target for referral to CAMHS in cases where children and adolescents are referred out of their local areas. Transition between services varies from one area to another. In some areas it happens at 16, in some at 18, and in some at a point in between. These issues all need to be addressed.

Fundamentally, this issue comes down to funding. I welcome the establishment of the taskforce and the provision of £30 million over the next five years to improve services for young people with mental health problems. However, we must recognise that councils play a vital role in working with health services to target support and co-ordinate services, and they should play a key role in directing the funding.

Francis Report: Update and Response

Andrew Percy Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I will look into the issue that the hon. Gentleman raises, but let me deal now with the issue of nurse training places. The cuts began under the Labour Government, and we have been gradually reversing them. The main point, however, is that, in all parts of the House, there was a lack of understanding of the importance of safe staffing in wards before the Francis report, which is why successive Secretaries of State made mistakes in their projections of what was needed.

We have 8,000 more nurses in our hospital wards, including those at Stoke, and I hope the hon. Gentleman welcomes that.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State will want to congratulate North Lincolnshire and Goole NHS Foundation Trust on getting out of special measures and employing more nurses and doctors. On the issue of “freedom to speak up” guardians, will he ensure there is one in every hospital, because in my trust staff in the smaller hospital sometimes feel their voice is not heard by the two big district general hospitals, which are up to 60 miles away?

[Mr Hunt]

That is a very good point. I had a great visit to my hon. Friend’s local hospital and saw a knee operation which was quite gory but looked to me to be a very good example of safe care. He makes a good point and I will certainly feed into the consultation the idea that it should be easy to contact somebody who works in the same hospital or building, rather than someone who is a long way away.

Oral Answers to Questions

Andrew Percy Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I do recognise the pressures on the ambulance service and the hon. Lady’s local area has had £1.6 million extra to help to deal with winter pressures. We have 1,700 more paramedics in the ambulance service and they are doing 2,000 more emergency journeys every day, but none of that is any consolation to the family whom she talks about, and that is why we must always ensure that every lesson is learned.

[Andrew Percy (Brigg and Goole) (Con)]

The Secretary of State, the Department of Health and my local hospital trust inform me that there are more doctors and nurses in the local NHS and the NHS nationally than there were in 2010. This weekend, residents in north Lincolnshire received a leaflet from the Labour party saying that there were fewer doctors and nurses and less care. Who is telling the truth?

[Mr Hunt]

It is not the Labour party, because all it wants to do is to turn the NHS into a political weapon. It might just think about the impact on NHS patients and staff when it does this. It does not help anyone and it is bad for the NHS.

A and E (Major Incidents)

Andrew Percy Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

Of course I regret any individual incidents where people do not get the care they need promptly. The hon. Lady will know that the solutions to such problems are not always things that can be done overnight. If she looks at the record of joined-up care over the past few years, she will see that this is the first Government to encourage 150 local authority areas to sit down with their local NHS and jointly plan care for the most vulnerable people in the social care system. That is a very big step forward. We are also doing nearly 1 million more operations every year across the NHS. In accident and emergency, the number of people being seen within four hours has gone up by nearly three quarters of a million since the start of this Parliament. That is real progress, but of course there are long-term issues, and we will focus on those as well.

[Andrew Percy (Brigg and Goole) (Con)]

I congratulate Goole hospital on hitting its target 99.7% of time, and the trust as a whole on hitting its target 93% of the time. I spent my Christmas volunteering in the NHS at A and E and with the ambulance service. Staff repeatedly told me that as first responders what they see are more old and frail people needing to be admitted to hospital. That situation was not helped by 50,000 hospital beds being cut by the previous Government. One way of dealing with the problems would be to move to a community paramedicine model and to use the skills of our ambulance services more. I encourage the Secretary of State to ensure that NHS England is seriously looking at that option.

[Mr Hunt]

May I congratulate my hon. Friend on the shining example he gives to everyone in this House by being a first responder? I do agree that one thing that we could do in the next year is to integrate better what happens in the ambulance services, out-of-hours GP services and 111. Individually, they are all doing a good job, but they could do a much better job if what they did was integrated.

A and E and Ambulance Services

Andrew Percy Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for championing care for his constituents. Let me reassure him: I had a meeting on that very issue on Monday. It is important that the NHS community care sector plays its role alongside the social care sector in making effective discharge possible.

[Andrew Percy (Brigg and Goole) (Con)]

I thank the Secretary of State for his kind words about first responders. I will be on duty tonight, as will thousands of first responders in Yorkshire ambulance service, Lincolnshire ambulance service and throughout the country, responding to cardiac arrest, respiratory disease and so on. On the matter of community service, what are the Government doing in the light of the Royal College of Nursing saying to us at a Health Committee a few weeks ago that a failure to invest properly in community services 10 to 15 years ago is having a major impact now on our hospitals?

[Mr Hunt]

My hon. Friend is right about that. Just as this Government have taken a very robust attitude towards poor care in hospitals—we now have 6,000 more nurses on our hospital wards following the Francis report—we need to take an equally robust attitude towards what is provided in people’s homes, to make sure that we have proper care. It is a false economy to cut back on out-of-hospital care to pay for hospital care, as we need both.