Home Care Workers

Andrew Smith Excerpts

Wednesday 6th March 2013 Westminster Hall

[Mr Andrew Smith (Oxford East) (Lab)]

It is good to serve under your chairmanship, Mr Turner. I am pleased to have the chance to discuss home care and home care workers, because it is an incredibly and increasingly important area of service and policy touching nearly every family in the land. As the number of elderly and frail people increases, many of them with some degree of dementia, and as more people stay in their own homes, it is vital that we as a Parliament and the Government take action to ensure that standards of care are what they should be and meet the needs of older people with the dignity and quality of service that they have a right to expect, and that I am sure we all want for ourselves when the time comes.

I appreciate that there are big funding questions. I certainly want social care to be a priority for resources. Under the present austerity regime, social services departments and care providers are struggling to meet the pressures that we discussing. I also favour the full implementation of the Dilnot proposals. However, it is my intention to focus not on finance but on care and care workers and what we can do to address the present shortcomings, which must be evident to Members from all parties.

Let me make it clear at the outset that we should praise the good job that so many care workers and care providers do, often—I shall say more about this—in difficult circumstances. However, there are far too many shortcomings, as described in the recent Care Quality Commission report and the Unison report “Time to care”. We need an across-the-board drive to raise the standards, training, working conditions, terms of employment and professional standing of this most vital group of workers. It is especially important because they are on the front line. They are the first point of care and contact for hundreds of thousands of elderly people and are responsible for helping with their intimate personal needs and medication as well as day-to-day living.

On standards, the Care Quality Commission found a quarter of services to be substandard. Both the Unison report and the survey last autumn by the consumers association Which? found too many instances of rushed and poor care, as well as evidence of good and excellent care. I have been surveying constituents on the issue and have seen the same mixed picture. One daughter in the Which? survey found her mother having her face washed with a flannel with faeces on it and being dressed in the previous day’s soiled clothes. Others spoke of relatives going all day without food or drink, untrained staff using lifting equipment, muddled medication and forgotten alarm pendants. It is clear that standards must be raised to a consistent and higher level.

Training must be an important part of that. We need to listen to people like the worker in the Unison report who said:

“Three half-days’ irrelevant training was given. Then I was on my own. I had never bathed, dressed or cared for anyone before. I had to empty urine bags, colostomy bags etc. with no training. I felt very scared and was left to struggle as best I could.”

The consequences of mistakes involving such vulnerable people do not bear thinking about. We can well understand how workers in that position are being let down by those in charge of home care provision across the country.

I argue, as Unison does, for standardised levels of training and detailed minimum standards on employers to provide practical training to that level, without making the requirements excessively academic, so that we do not exclude people who are good at caring but bad at passing exams. Requirements should include communication, though, especially given the number of people whose first language is not English working as carers. Someone in Oxford told me that her mother was in a care home where just three out of 60 staff had English as their first language.

I also argue for a professional register of accredited carers, just as we have for nurses. People would qualify to get on it and gain the status that it involves, but they could also be struck off if incompetence or negligence warranted it.

[Andrew George (St Ives) (LD)]

The right hon. Gentleman makes an interesting case. How long did it take him this morning, from the moment he got out of bed, to wash, clothe himself, have breakfast and get out the door? Although I appreciate that standards for care workers must be concentrated on, does he not agree that many of them are asked not just to undertake their work on the minimum wage but to complete their tasks in an unfeasibly short time?

[Mr Smith]

Absolutely, and I am coming to that point. I could not get myself completely ready in the limited time that some care workers have; some are allocated 15-minute slots for visits.

When things go wrong, it is vital that staff speak out, yet too often care workers feel vulnerable and not in a position to do so. I note that last month, the Secretary of State for Health said that he was “very sympathetic” to extending to home care workers the duty to whistleblow that the Government are thinking of applying to nurses. I urge the Minister to do so.

It is crucial that inspection is extensive, robust and effective. It is all the more so given the importance of care and the fact that it takes place in people’s homes, away from immediate supervision. There are concerns about that in Oxfordshire right now. Our local paper, the Oxford Mail—I am sure you will remember it well, Mr Turner, from your time in Oxford—has highlighted concerns raised by our local patient voice and county councillors about the adequacy of local CQC inspection arrangements. In November, there were just two inspectors for Oxfordshire, and even now there are only five, who between them are responsible for inspecting 447 health and social care institutions and thousands of home care visits.

There is all-party concern. Conservative councillor Jim Couchman, who chairs the county’s adult services scrutiny committee as well as being a member of the health overview and scrutiny committee, said after meeting the CQC:

“We did get pretty worried by what we saw as an extremely ill-equipped organisation to deal with the responsibility accrued to it…The CQC is not a proper inspection team in any way, shape or form.”

Councillor Couchman has also told me since that apart from the enormity of the task required of such a small staff, the most surprising fact was that recruits did not need any experience or knowledge of the NHS, health care or social services. The CQC seemed more concerned about whether new staff had a background in regulation.

I was also concerned that when asked to talk to the Oxford Mail, the Care Quality Commission declined. When such worries are being voiced, it is all the more important for a body such as the CQC to come forward and answer questions as a basic responsibility of public accountability, as well as to take the chance to build public confidence rather than undermining it, as the CQC ended up doing. Will the Minister look into the position on care quality inspection in Oxfordshire? More generally, will he ensure that the commission has sufficient inspectors across the country with the right experience to do the job?

Feedback from users and their families is another important yardstick by which to lever up care standards. Our county council uses individual visits and client satisfaction surveys to inform contract monitoring. However, a wider public satisfaction rating is needed for the plethora of care agencies. One of the paradoxes of modern life is that, if advice is wanted on the standards of service providers such as restaurants, hotels and garages, or of products such as cars and electrical goods, there is no end of reviews out there to guide people, but for something as important as helping someone to find a good care provider, there seems to be nowhere to look for advice. In theory there is competition for provision, but in reality all the customers are groping around in the dark. That is a good reason not to emulate in mainstream NHS provision the privatisation that has already happened in care services.

Underpinning all that, action is desperately needed on the terms and conditions of care workers. They are doing a demanding job, often on the lowest wages and with minimal security. According to the Unison “Time to care” survey, more than half of home care workers overall and more than 80% in the private sector are not paid for travel time or costs; it has been estimated that between 150,000 and 200,000 home care workers are in effect paid less than the national minimum wage as a result. To make matters worse, more than half of private sector home care workers have a zero-hours contract with no guaranteed pay, and more than half of all home care workers reported that in the past year things have got worse for them on pay, working time and the duties expected of them.

[Lilian Greenwood (Nottingham South) (Lab)]

I thank my right hon. Friend for setting out clearly some of the home care issues. Does he agree that zero-hours contracts in particular make it difficult to ensure continuity of care for clients and difficult for a provider to invest in its staff, because they are constantly having to look for alternative work to make up the hours to obtain a decent income to support themselves and their families?

[Mr Smith]

My hon. Friend makes an excellent point, and must be reading my mind, because my next sentence was that zero-hours contracts present real problems for continuity of care, which was the point she made. It is important that vulnerable clients in particular have carers whom they know, trust and have built up a relationship with.

[Simon Hughes (Bermondsey and Old Southwark) (LD)]

I am grateful to the right hon. Gentleman for initiating the debate and to Unison, with which I have met, for its initiative. I strongly reinforce the collection of points that he has just made. I have had not only users but care workers troubled by their ability to do their job come to see me. In my experience, such workers are troubled by a combination of not having enough time to look after the person they are caring for and no adequate account being taken of travel time, which means that they are in effect paid below the minimum wage to do a job that they cannot carry out sufficiently and that often there is no continuity of care from a particular individual for a vulnerable, normally elderly person. Those are big issues and I hope that the Minister will be sympathetic to all parties saying such things to the Government. All parties together can change what is a fundamentally flawed system.

[Mr Smith]

I am grateful to the right hon. Gentleman for his support. All those comments are vital, and he is right that throughout Parliament and society at large we can insist on raising standards for workers who are doing a demanding, important and professional job on poverty wages, often in pretty exploitative conditions. That has to be changed.

An example to do with continuity was mentioned in the Care Quality Commission report: a client had 13 different home care workers for 35 calls. In such circumstances, clients have to explain time and time again to different care workers what needs to be done, how they like things and so on. Given that the people receiving home care increasingly have substantial health needs, the whole business of zero-hours contracts is a poor and inappropriate employment model. I do not like it anywhere, but it is especially damaging in this sector.

[Teresa Pearce (Erith and Thamesmead) (Lab)]

Is my right hon. Friend aware that in my borough of Bexley, a particular model now in use involves a care company that is acting as an umbrella agency? The care workers whom the company sends to vulnerable people are actually self-employed, which means that it is pushing an employment liability on to a vulnerable person and abdicating responsibility. What happens in Bexley is meant to give people greater choice, but it is bogus self-employment. Is the Minister aware of that model? Will he consider looking at it in detail, to see whether it is true self-employment or merely tax planning?

[Mr Smith]

Or, indeed, merely a way of circumventing the national minimum wage. My hon. Friend makes an important point. I will come on to some requests to the Minister for action in that very area.

We touched earlier on the 15-minute slots for care workers, and there are serious concerns about the care that workers are able and allowed to provide when they arrive at someone’s home. The financial pressures on social services providers and on paying clients are leading to increasing use of 15-minute slots. Those may give time for a brief check, but not for caring in any meaningful sense of the word.

We need a thoroughgoing overhaul of the terms and conditions of home care workers. The non-payment of travel time breaks the minimum wage laws, which I understand has been confirmed by Her Majesty’s Revenue and Customs to Unison. Will the Minister meet HMRC so that a priority drive can be put in place to ensure that every home care worker in the country is contacted and helped to secure their entitlements? That would help not only the workers’ basic rights but recruitment and retention in a job that is far too often seen as low-status because it is low paid and has such poor conditions, and that people get out of because they simply cannot afford to carry on working.

Last year, I was approached by a constituent who was working as a home care provider for a company under contract to Oxfordshire county council. The provider was paying him little more than the minimum wage for the exact, restricted time that he spent in each person’s home, with no allowance for travel. After paying travel and other employment costs, he was simply not earning enough to get by, and he found out that he would be better off back on jobseeker’s allowance, which was where he went. I took up the case with social services and the then Secretary of State for Health; both said that it was a matter for the provider. For the providers, however, it is a matter of profit, competition and, for far too many of them, what they can get away with. That is the nub of the problem: in a contracted-out, decentralised system operating to market competition, the buck does not stop with anyone.

I am sure that the public want better safeguards and decent treatment for the vulnerable people being cared for and for the workers who do that vital caring work. That means putting in place a framework of standards and entitlements for clients and their carers, along the lines of the ethical charter for which Unison has argued. That is what I am asking the Government to do. Will the Minister reply to my points on the issues of training to consistent and accredited standards, a professional register, properly enforced standards, the adequacy of inspection, comprehensive enforcement of the minimum wage and promotion of the living wage?

It is thanks to the dedication of many care workers and the good service providers that there are out there that home care is not worse than it is. Far too much of it, however, is not nearly good enough, and some of it is very bad. The people needing care and their families are worried about such matters, and a test of this Government, or of any Government, must be what they do to raise the standards of home care and the working conditions of those who provide it.

[Andrew George (St Ives) (LD)]

I congratulate the right hon. Member for Oxford East (Mr Smith) not only on securing the debate but on covering such fundamentally important ground on matters that clearly need to be addressed. From the litany of issues that need to be dealt with seriously by not only the two parties in government but all parties, it is clear that if we were to construct the circumstances for a catastrophe to happen on our watch, all the ingredients are being prepared in the services being provided to people in their homes.

The right hon. Gentleman described many symptoms, and at present the health system is under extreme pressure. The last Labour Government established the £20 billion efficiency gain, now colloquially known as the Nicholson challenge. All parties know that the pressure for efficiency gain inevitably resulted in an attempt throughout the system to push costs down to the least expensive care models, which means out of hospital, into the home and care by the lowest paid people. In addition, a whole heap of management babble obscures the way in which the trend is being catapulted. The health system depends on a group of workers in people’s private homes, but we should not ignore the fact that many people work in similar conditions in residential homes for people who cannot be catered for in their own home. There is a parallel situation in nursing homes.

With pressure on the system, there will be increasing attempts to ensure that patients are discharged from hospital much earlier than in the past. Part of the management mantra is that the worst place for an elderly person is an acute hospital and that unnecessary admissions should be avoided. That is self-evidently unarguable, but is often asserted. However, at the margin an assessment must be made before making that decision. There is a feeling that older people are being denied admission to hospital because of age discrimination in the system, and that because they are older they should be kept at home when, if they were 20, 30 or 40 years younger with the same condition, they would be admitted to hospital. Many of us know that that pattern exists.

MPs have many examples in their casework, and I am sure I am not unique in this: inadequate care is provided in the home for older people who must endure unacceptably poor standards of care and circumstances. The response is often pontification from the political classes, but the care workers are voiceless. Whenever the “Today” programme runs a story about poor care, which it often does when a shocking story of poor care is revealed or a report by the Care Quality Commission is published, some of our own classes are wheeled on to morning media slots and often denigrate the character of the people who provide care, as though a failing in the carers caused the problem. They say that we must address problems with carers’ characters rather than the unfeasible circumstances in which so many of them must operate.

I intervened on the right hon. Member for Oxford East to ask how long it takes him to get out of bed in the morning and to get ready to go out of the door. All of us in the Chamber are able-bodied and do not need a hoist to get out of bed or to use the toilet. We do not need to be assisted in every way, and we are not on a cocktail of medicines—perhaps some of us are. An hour is probably a reasonable time for most able-bodied people, yet we often hear that care workers must undertake those functions for other people in less than half an hour. That is simply not feasible. People may say that carers cut corners, take risks and do not complete the job, but they are asked to undertake an impossible task.

Many carers are on the minimum wage, and in areas such as mine in west Cornwall and the Isles of Scilly the travel time between visits is often significant. If the agency employing care workers is not prepared to cover properly travel times or costs, it may take the worker below the minimum wage, as my right hon. Friend the Member for Bermondsey and Old Southwark (Simon Hughes) said.

We must address the issues that the right hon. Member for Oxford East has properly listed. All the ingredients are there. As we go forward, the pressure will continue. Bed reviews will be undertaken as the new clinical commissioning groups swing into action in the next month. They will look at how many community beds there are in their area, assess whether they are affordable, and look for new ways of working and new pathways. They will use the usual language to argue that there are better ways of providing the care that is currently provided in community hospitals, that local communities should not be obsessed with bricks and mortar, that they can provide better care in the home, and that people should relax and understand that the number of beds can be reduced even when the population is ageing and the number of people needing care is increasing. Reducing the number of beds will increase the pressure on remaining beds. People will be discharged much earlier to their homes with assurances that adequate care packages are in place when we all know that those care packages are marginal and that the people providing the care will be asked to undertake work that is often unfeasible.

I often resist calls for diminution in the number of community hospital beds in my constituency, and I am sure that other hon. Members do the same. We used to know the number of beds in our local hospitals, but the service that used to be provided is becoming increasingly invisible. The problem is that the service can then be cut, denuded and reduced over time in ways that are very difficult for us all to properly assess, because people will not able to see or understand how it operates. Parts of the service will be shaved off in the same way that local authorities have redefined access to support from moderate to critical, and so on—as I know that many local authorities have done.

I have visited a number of agencies in my constituency. I am really pleased that we have some excellent agencies working in west Cornwall. Many of them are impressive agencies, but of course they are all competing, and there is a risk of a race to the bottom. Local authorities are commissioning on the basis of price, and the fear is that they are not necessarily looking at quality as much as they should be when they make assessments.

[Mr Andrew Smith]

I made the point about competition in my remarks. Does the hon. Gentleman agree that a very important dimension is that a lot of clients are paying for care themselves, and they have very inadequate information on which to judge one agency or provider against another?

[Andrew George]

Absolutely. Minimum standards and agreements across agencies—or if the Government will not establish minimum standards, baseline standards—would give people reassurance. What we understand is happening, as part of achieving the efficiency gain that all parties want, is that not only is there an attempt at constructing a clinical and patient interest argument that patients are better off being discharged to their home, which is better for them, because it is where they want to be—the mantra that is often used; but there is cost-shunting as well. Obviously, if a patient is in hospital, the state is paying for them. There is an increasingly harsh attempt at identifying what continuing care is and is not—in other words, the state continues to pay for that patient in their home—but what ultimately happens is that the sooner the hospitals can get patients out to their home, it is the individual, if they have any assets at all, who meets the bill.

In terms of standards, in my view, we should be encouraging agencies that are providing care to offer at least a living wage for workers—£7.20 per hour and, I think, £8.30 in the London area. Travel time between visits should be part of salaried time. A mileage rate should be set and understood, and everyone should share a mileage rate; in my area, the rate paid to travelling care workers varies between 35p and 40p a mile. There should be a minimum visit time of 45 minutes in very exceptional cases, and at least an hour for most visits, especially if it involves at least two of the following procedures for non-ambulant or semi-ambulant clients: getting out of bed; dressing or undressing; toileting; feeding; washing and mobility support.

An efficient and effective arrival and departure reporting and recording system should be introduced, because there is some dispute between agencies and local authorities on that issue. Registration of care workers is very important, and I hope there will be cross-party support for it. The Select Committee on Health, of which I am a member, has been pushing for it for some time. It would ensure that there is adequate training, proper registration and recognition of the significant job that home care workers do. With that kind of support, I believe that we can give home care workers the proper status and support that they richly deserve.

Cancer Care (England and Wales)

Andrew Smith Excerpts

Tuesday 12th February 2013 Westminster Hall

[Alun Cairns]

My hon. Friend raises an important point about diet. There are historical and social issues. Diets and issues like that are relevant and also need wider consideration, perhaps in another debate that my hon. Friend may choose to nominate.

[Mr Andrew Smith (Oxford East) (Lab)]

Does the hon. Gentleman agree that however good the cancer care in hospitals is—it is excellent in many places—it often leaves a gap in psychological, emotional and social support? Excellent work is being done by Maggie’s centres in that respect. There is one in Swansea, and I believe one is due to open in Cardiff. There are also many centres in England and Scotland, including in my constituency. Will he endorse the value of their work?

[Alun Cairns]

I am grateful for the right hon. Gentleman’s valid point. I absolutely endorse the role that independent and charitable organisations can play; I quoted Breakthrough Breast Cancer. Emotional support is exceptionally important, and that relates to my point about delays in receiving treatment. A consultant can reassure people on many occasions, give a realistic assessment of the condition and provide the wider support available from some of the charitable organisations that have been mentioned.

Antibiotics (Intensive Farms)

Andrew Smith Excerpts

Wednesday 9th January 2013 Westminster Hall

[Zac Goldsmith]

I had just quoted Sir Liam Donaldson, on

“a death warrant for a future patient”,

as a result of the overuse of antibiotics, and I had complained that the British Government have routinely ignored the link between antibiotics in intensive farming and the public health threat. I was about to cite the current chief medical officer, Professor Dame Sally Davies, on the growing problems of resistant strains of bugs, as well as the Health Protection Agency in November. It was striking that the message focused 100% on over-prescribing by doctors, with zero mention of the use of antibiotics in the livestock industry.

Similarly, when I tabled a parliamentary question to the Department of Health on what funding it provided for research into drug-resistant bacteria, the answer from the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), explicitly mentioned hospital-acquired infections, but not the use of antibiotics in farming. I was encouraged, however, by a reply from the then Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), when I asked him about the link between E. coli resistance to antibiotics and record antibiotic usage on farms. He said:

“Indeed, I was interested to see analysis some years ago of the extent of antibiotic resistance in hospitals in the Netherlands. Resistance was clearly much more prevalent in parts of Friesland where there was much greater antibiotic usage in farming. I therefore completely understand, and my colleagues in DEFRA understand this too. Just as we are looking for the responsible and appropriate prescribing of antibiotics in the health service, my colleagues feel strongly about the proper use of antibiotics in farming.”—[Official Report, 17 July 2012; Vol. 548, c. 842.]

However, since then, we have had a near complete clean sweep of Ministers at both Departments—the Department of Health and the Department for Environment, Food and Rural Affairs.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on raising a very important subject. Is his argument, at least in part, that the collaboration cross-departmentally, which should take place through the chief scientific advisers committee, is not happening, or is what they are considering simply not being taken proper notice of?

[Zac Goldsmith]

I thank the right hon. Gentleman for his intervention. I suspect that that is part of the problem, but as I will come to later, I think it is also the case that the agribusiness sector in this country has had a disproportionate impact on policy. That is a point that I hope to impress during the debate.

As I was saying, there has been a near clean sweep of Ministers at both Departments, so this debate provides an opportunity to clarify Government policy. The Government are right to insist on better infection control in hospitals and changes in the way that antibiotics are prescribed by doctors. However, other than the brief answer that I quoted from the former Secretary of State, there has been virtually nothing from the Government that could in any way encourage vets and farmers to be similarly prudent. Not surprisingly, therefore, there has been little progress; on the contrary, analysis by the Soil Association of the Government’s statistics indicates that the overall use of antibiotics per animal on UK farms increased by 18% between 2000 and 2010, while the farm use of third and fourth-generation cephalosporins—drugs described by the Health Protection Agency as hospital workhorses—increased by over 500%.

Furthermore, recently published data from the Veterinary Medicines Directorate show that sales of fluoroquinolone antibiotics for use in veterinary medicine over the past two years have been 70% higher than they were in 2000. It is worth noting that when fluoroquinolones were first licensed for use in poultry in the UK in 1993, there was no registered antibiotic-resistant campylobacter in people who had not been treated with the antibiotics, but by 2007, almost half—46%—the campylobacter food poisoning cases caused by the most common strain were resistant. It is worth noting also that in 2008, the European Food Safety Authority said:

“A major source of human exposure to fluoroquinolone resistance via food appears to be poultry”.

Clearly, antimicrobials should be used to treat sick animals, and I do not think anyone would argue against that.

Hospital Food (Animal Welfare Standards)

Andrew Smith Excerpts

Wednesday 12th December 2012 Westminster Hall

[Neil Parish]

The reason why I talk about England is that the food served in hospitals is a devolved matter. However, it is still important for Northern Ireland. I am keen to get good animal welfare standards, and I believe that that will help with the quality of meat and eggs served to patients. The two are linked. I believe that most production in the UK and Northern Ireland meets high standards, and I want to ensure as far as is practical that that is the sort of food served in hospitals not only in Northern Ireland but across England as well.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on securing this important debate, and I agree with the thrust of his argument. Does he agree that there are lessons to be learned from good practice in the NHS? My mum recently had quite a long stay in West Berkshire community hospital, and no praise is high enough for both the standard of care and the standard of food there. Knowing that this debate would be taking place, I asked the hospital about its sourcing, and it said:

“The food supplied to our restaurant is mainly from national suppliers that have been through a rigorous supplier accreditation process, using British-produced meat. Our Chef Manager on site, however, is very skilled in ensuring only the best but most cost-effective ingredients are used in his menus and, where possible, uses free-range meat in the restaurant.”

Does that not show that high standards of supply, value for money and good hospital food can go hand in hand?

[Neil Parish]

I thank the right hon. Gentleman for that intervention. In a minute, I will comment on various hospitals. He shows that hospitals can deliver high welfare standards, source a lot of their meat and egg products nationally and serve up good-quality meals, and that it can be done on a reasonable budget. The other argument is that the hospitals will turn around and say, “We only have a limited budget, and we have got to make it go a long way.” However, some hospitals manage to get a good deal and good welfare standards, and then produce good food.

I emphasise that I am not here to knock hospitals and the NHS. I only want to improve the welfare standards for the meat and eggs served in our hospitals. Our health service does a very good job, but sometimes—dare I say it—patients might like slightly tastier meals when in hospital. It would certainly improve our view of life, even if it does not cure us instantly. It can have a positive effect.

During the same period, in stark contrast, setting mandatory standards for food served in other public institutions has proved highly successful. For example, the introduction of mandatory school food standards by the Government in 2005 led to a dramatic improvement in the quality of school meals, ensuring that children who opt for them get healthy, tasty and varied options. The introduction of mandatory nutritional standards for food served in Scottish hospitals in 2008 and Welsh hospitals in 2011 resulted in a significant improvement in the healthiness of patient meals, and it has been at the forefront of the Scottish and Welsh Governments’ efforts to tackle the effects of poor diets on health, particularly in relation to heart disease, stroke and type 2 diabetes.

Although the introduction of mandatory food standards worked in those settings, the use of voluntary guidance for hospital food has not succeeded to the same degree. Hospitals in England spend a third of their food budget and £167 million of taxpayers’ money every year on meat, dairy products and eggs. Approximately £1 in every £4 spent on hospital food in England is spent on meat, and approximately £1 in every £10 is spent on dairy. That represents a vast amount of public expenditure, which the Government can use to ensure that taxpayers’ money is invested in rewarding farmers who have adopted ethical farming practices rather than those rearing animals in unacceptable conditions.

It also helps to ensure that most of the meat, eggs and dairy produce that feeds patients in hospitals is sourced from Britain, and locally, I hope. Some hospitals are proving that it can be done on budget. A handful of NHS hospitals in England already only serve food that meets the animal welfare standards I am advocating, proving that doing so is both practical and affordable. For example, Nottingham University Hospitals NHS Trust, and Braintree community hospital and St Margaret’s hospital in Essex, have all been—

--- Later in debate ---

[Dr Poulter]

Indeed. We are looking into that at the moment, with a committee and working party looking at how to roll out good practice.

If we have a mandatory system, we may stifle the potential of what we are seeing locally under the current system. My hon. Friend has highlighted many examples of good practice, and I could add to them: in Sussex, there is a good programme, from plough to plate, which is managed by the head of catering there, William McCartney; and there are other good examples in Nottingham and Scarborough. Local innovation is driving up standards, and that happens in different ways in different parts of the NHS. One of the fundamental principles in which we believe, and it has always been thus, is that hospitals are able to determine how they respond to local conditions. Only this Government have taken seriously the need to support and encourage local innovation better. Through the approach that we have adopted and my right hon. Friend the Secretary of State’s interest in promoting good food in hospitals, we are now seeing many examples of local innovation driving up standards in local hospitals, and through such innovation we can identify and spread across the NHS better and good practice. The problem with a rigid framework or set of criteria is that it might stifle local innovation that can improve standards, as we have seen elsewhere in the NHS.

Our approach is for central Government to take an active interest in good hospital food for the benefit of patients, working through commissioning for quality and innovation payments. To promote good practice, the project is developing an exemplar pay framework within the CQUIN scheme, which enables health care commissioners to reward excellence by linking a proportion of providers’ income to the achievement of local quality improvement gains. We are developing two new CQUIN exemplars related directly to hospital food, one linked to the adoption of Government buying standards for food and one to excellence in food service. I hope that my hon. Friend is reassured by the fact that animal welfare is part of those standards. We are looking at linking CQUIN payments in the NHS to good, ethical Government procurement. We recognise and value the local innovation of various hospital food schemes, which have benefited patients from Scarborough to Sussex. That is better than a rigid framework and enables the NHS to learn from examples of good practice.

[Mr Andrew Smith]

The Minister referred to the more general application of Government buying standards. What is his response to the argument from the National Farmers Union that the standards would operate better if the red tractor standard of production was generally adopted as part of them?

[Dr Poulter]

Many of us are great fans of the NFU work to support the red tractor standard. Many great benefits can be obtained from British farmers, who often operate to higher standards of animal welfare and traceability. That is something that we are proud of, and there are great benefits for consumers in supporting such farmers. The Government therefore have an ethical framework for how food should be procured.

We are looking, through the CQUIN payments, at how to support and reward good practice in hospitals, taking into account the Government framework for welfare. When the NFU and other organisations highlight good local practice and support British farmers to lead the way in animal welfare through the red tractor standard, we want to ensure that we do not set up rigid frameworks that might prevent local hospitals from supporting such good ethical standards. Through local flexibilities that hospitals currently have, we are enabling the bar to be raised for animal welfare and the quality of hospital food.

Time forbids my going into greater detail, but we are encouraging friends-and-family testing in the NHS, putting patients and their relatives in charge of inspecting the quality of care and health care. That can be no more important than for hospital food. Recently, I visited Darlington hospital, which had had a patient-led inspection of hospital care, a key part of which was to look at hospital food, to ensure that every patient was served with nutritious food, cooked locally and on site.

A number of the issues raised in the debate cut across the responsibilities of Ministers in the Department for Environment, Food and Rural Affairs, so I will write to them and highlight the concerns expressed by my hon. Friend the Member for Tiverton and Honiton today. In my Department, however, we encourage hospitals to use and maintain ethical standards in the buying of their food, but we also enjoy and support local flexibilities that benefit patients and raise standards throughout the NHS.

Mental Health (Approval Functions) Bill

Andrew Smith Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

I am grateful to the shadow Secretary of State for that intervention. We have gone through a very careful process and have followed legal advice on what is necessary to regularise the position. This relates specifically to the approval function, which is defined in clause 1(2). As I have said, the legal advice is that this is the best way to regularise the issue that has been uncovered.

[Mr Andrew Smith (Oxford East) (Lab)]

Before the Minister responded to the intervention by my right hon. Friend the Member for Leigh (Andy Burnham), he told my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) that if mistakes had been made before the establishment of the SHAs, some of the doctors who had not been properly approved previously may not have been approved by the executive action that the Secretary of Sate referred to earlier. Will the Minister assure the Committee that, should such instances come to light, those doctors will also be subject to a re-approval process?

[Norman Lamb]

The first thing I want to clarify, again, is that the clause ensures that if any previous authorisations were not done in accordance with the statutory provisions, the clause regularises that process, full stop. Of course, if we go back a long way, that may apply to people who have long since been discharged from their section. This regularises the situation for all. It also ensures that the detention of anyone who continues to be sectioned is regularised, because the original authorisation is deemed to be acceptable under the Bill and in accordance with parliamentary intent, as the Secretary of State said earlier.

[Mr Smith]

I am grateful to the Minister, but he has not fully answered my question. The Secretary of State has now properly given approval to those who were previously improperly approved. The Minister is right that many of the people in question may have retired or left, but some may still be practising. If further instances come to light, will they too be subject to a new scrutiny process?

Mental Health (Approval Functions) Bill

Andrew Smith Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

My understanding is that people are approved for the SHA in which they work, but it is an important question and I will happily confirm the position to the hon. Gentleman in writing.

In the light of our legal advice, we do not believe that any decisions made about patients’ care and detention require review because of this irregularity. Doctors should continue to treat patients who are currently detained under the Mental Health Act in the usual way.

My second point is that we have been advised by First Treasury Counsel that there are good arguments to show that the detentions involving these particular approval processes were, and are, lawful. Given the seriousness of the issues, counsel also argues the need for absolute legal clarity and advises that this is most safely resolved through emergency retrospective legislation. We are taking that advice. As soon as the irregularity was identified, the Department moved swiftly to identify the best course of action and to put the necessary preparatory work in place. Officials immediately sought initial legal and clinical advice, and then swiftly analysed the options, including the reassessment of all the potentially affected patients, working with the health leads in the regions involved and clinical experts from the Royal College of Psychiatrists.

When I was briefed on the situation, I asked for detailed information on the time it would take—the Secretary of State has also sought and obtained this advice—and the clinical risks involved in reassessing all potentially affected patients. Last Friday, the Secretary of State asked for an emergency Bill to be drafted over the weekend as a matter of contingency, and he briefed the Prime Minister personally the following day. Following further discussions and analysis over the weekend, the decision to introduce emergency legislation was taken on Sunday.

At all times, the Secretary of State’s priority—and, indeed, mine too—has been to resolve this in a way that follows clinical advice. That is the most important thing. In the interests of a group of highly vulnerable individuals, it is important to do this in the most sensitive way. It would not have been feasible quickly to reassess all the patients and it may well have caused great distress to them and their families.

We have worked to remedy the problem as it relates to current and future detentions. The accountable officers for the four SHAs in question have written to Sir David Nicholson, chief executive of the NHS, to confirm that they have made the necessary changes to their governance arrangements. Furthermore, the accountable officers in the other six SHA areas have written to Sir David to confirm, in the light of this issue, that they have reviewed their own arrangements and are in full compliance with the Mental Health Act. That directly addresses the question asked by the hon. Member for Wolverhampton North East. I can confirm, incidentally, that approval in one SHA applies elsewhere in England. The Bill will put right those doctors’ approvals wherever they are now practising. That again gives complete clarity to that particular point.

Although we believe that there are good arguments that past detentions under the Mental Health Act were and are lawful, it is vital that doctors, other mental health professionals and, most importantly, patients and their families have absolute confidence in the decisions made. That is why, in relation to past detentions, we have decided that the irregularity should be corrected by the Bill.

[Mr Andrew Smith (Oxford East) (Lab)]

On this serious matter, will the Minister give a fuller explanation of why, given that the proper procedure was not followed, making it irregular, it is none the less his advice that it remained lawful?

--- Later in debate ---

[Andy Burnham]

The Secretary of State is nodding from a sedentary position, so I assume that is correct. Surely, therefore, a concern arises that the SHA part of the process is no more than a rubber-stamping exercise. The Department will be entirely remote from the local situation on the ground relating to the individuals involved and the clinicians and institutions making the judgments. If this process is taken up to the national level, will that not give rise to more concerns that mistakes might be made in the future, because of the distance between the process of approval and the individual cases on the ground? Has the Secretary of State had discussions with mental health organisations about whether they believe those arrangements are acceptable? I must say that I have serious concerns about them.

[Mr Andrew Smith]

That is a very important point. Following the logic of my right hon. Friend’s argument, does he agree that the Government would be well advised to ensure there is independent professional involvement in auditing and overseeing that process?

[Andy Burnham]

That is a tremendously important point. Over the years, in terms of crucial public functions such as those we are discussing—and, indeed, in wider considerations such as assessments of new treatments with the National Institute for Health and Clinical Excellence—there has been a trend towards independent decision making, so that people can feel that there is no political, or departmental, interference, such as through changing local resource decisions.

The taking of these powers, and the rubber-stamping of approvals to section people, up to the national level will give rise to concerns about whether the process is sufficiently independent and people’s rights are being properly considered. I hope Ministers have listened to the important point my right hon. Friend the Member for Oxford East has just made.

I will end by addressing a point of wider principle about mental health policy and the place of mental health within our society. I believe it is possible that this whole unfortunate episode is symptomatic of a wider cultural problem: that mental health simply does not get sufficient focus and resources in the NHS at both the local PCT level and the regional SHA level—and, indeed, within the Department of Health. Beyond that, I do not believe that mental health gets the consideration it needs in Government or in this place. We do not give sufficient consideration to the hugely important issues relating to mental health.

When I was Health Secretary, hundreds of submissions would come across my desk in the course of an average week, and it was unusual if just one of them related to mental health. It is very much seen as a fringe consideration, pushed to the edges of the system—a peripheral concern in PCTs and SHAs, and all the way up to the Department of Health. That situation must not be allowed to continue.

The culture of separateness in the way we consider mental health, as opposed to other NHS issues, has deep roots in our society. Mental health services have often been provided in buildings that are out of sight, out of mind and on the fringes of the mainstream health care system.

That has to change. In the 21st century, we demand it. In our lives, we are all now dealing with much greater levels of stress, change and upheaval, and sometimes we are all left reeling by the sheer pace of modern life. We are discussing today between 4,000 and 5,000 very vulnerable people as though they are somehow apart from the rest of us. They are not. Any family can suffer the terrible consequences of serious mental health issues. In such circumstances, we would all want to be assured that those affected are not forgotten and pushed to the fringes where proper procedures are not carried out because there is a somewhat out-of-sight, out-of-mind approach. These issues are central concerns because they go to the heart of 21st century living.

Mental health must no longer be left at the edges of our national debate about health and care policy. It has to come to the very centre of our health care system. The Health and Social Care Act 2012 includes one good measure at least: to create parity of esteem between physical and mental health. I must say that it was a Labour amendment in another place that introduced that improvement into the Act, but, to be fair to the Government, I should add that I am pleased that they accepted it.

Will the Secretary of State explain what parity of esteem means in practice? What action has the Department thus far taken to put parity of esteem into effect in the national health service, and what plans does it have for the future? We have learnt in recent days that the budget for mental health has been cut in the last financial year, which suggests to me that the NHS is reverting to its default position in tough times.

--- Later in debate ---

[Mr Andrew Smith (Oxford East) (Lab)]

Like the hon. Member for Southport (John Pugh) and my right hon. Friend the Member for Leigh (Andy Burnham), I see no alternative but to proceed with the Bill, but I too have concerns.

Clause 1(1) states:

“Any person who before the day on which this Act is passed has done anything in the purported exercise of an approval function is to be treated for all purposes as having had the power to do so.”

The clause then defines the approved function in relation to the Mental Health Act 1983, but will the Secretary of State tell us why the concept of “any person” needs to be so broad for the Bill? It could be taken to legitimise approval by anybody. Should it not have been limited to the four trusts in question, if that is the problem the House is addressing—as it is—rather than being so sweeping?

My next question relates to my intervention earlier, when we were assured that there were good legal reasons to suppose that while the procedures that had been followed were irregular and not in conformity with the legislation, they were none the less lawful. The Secretary of State owes it to the House to spell out why they were regarded as lawful even though we are having to act in such a precipitate fashion to put things right.

I see that the Secretary of State has certified the Bill as being in compliance with the European convention on human rights, but as the previous speaker pointed out, the use of such retrospective legislation, which impacts on something so fundamental as the citizen’s right to liberty, may raise questions under the charter of human rights, so I should be grateful if the Secretary of State reassured us that the most careful attention has been given to that most precious of issues.

--- Later in debate ---

[Mr Hunt]

Yes. What Sir David Nicholson is doing is ensuring that all SHAs have a proper communication process in place, but we want to follow clinical advice on the appropriateness of individual communications with individual patients. Where we are advised that is clinically sensible, we must ensure that it happens, but we want to listen to the advice carefully because of the vulnerability of some of the patients involved. The right hon. Gentleman makes an extremely important point. We must do this properly but, as I know he will agree, we must proceed with extreme care and caution.

I will start with some of the issues that the right hon. Gentleman raised, particularly the role of the review being conducted by Dr Geoff Harris. He is absolutely right that it needs to be done speedily because of the changes being introduced by the Health and Social Care Act 2012. I want to reassure him that Dr Harris’s review will not be simply a retrospective review; he will not just be asking, “Why did this happen?” He will also be stepping back and asking, “Where might this happen again and are our governance procedures sufficient to ensure that it does not?” In particular, he will look at the new structures that will be put in place over the next few months to give us good and independent advice on whether we have the safeguards in place to prevent this from happening again. That is an important point.

With regard to how many people are affected, the figure is up to 5,000. We think that the number includes all the patients at Rampton and 57 patients at Ashworth, but we are still verifying the exact numbers. I will keep the right hon. Gentleman informed as more information becomes available.

The right hon. Gentleman’s other point was about the new arrangements that are being put in place. He wondered, legitimately, whether, as the powers are returning to the Department of Health following the abolition of the SHAs—he was correct to pick that up from my comments yesterday—there is a danger that the process could be more remote for local areas. We will keep him informed of our plans in that regard, but we do not intend to have a single national panel doing this. We intend to have a structure that draws on local and regional expertise to help us to make the right decision on the suitability of doctors for the role. That is also something we hope Dr Harris will advise us on when he conducts his review.

I will move on to some of the comments made by the right hon. Member for Oxford East (Mr Smith). Independent oversight is also something we will ask Dr Harris to look at. He is independent and he is looking at it. We will also ask him to look at the general issue of independent oversight and whether it has been missing in the structures we have had to date and, therefore, whether it contributed to the concerns that we are now addressing.

The right hon. Gentleman and the hon. Member for Wolverhampton North East (Emma Reynolds) raised another issue: the wording we have been using, the fact that we believe there are good arguments for saying that the detentions that happened as a result of approvals made by the doctors in the four SHAs were and are legal and, therefore, why we feel the need for emergency retrospective legislation. It is a reasonable question. The answer is that we believe that there is legal precedent for why, in so sensitive a situation, a court, in deciding whether a detention was lawful or unlawful, would consider what the will of Parliament was when it passed the original law. Therefore, we believe that we have a good argument for why a court should rule that these detentions were and are lawful.

However, because of the technical irregularity in the process of approving some of the doctors who made the decisions in the four SHAs, that argument could be challenged. That is also an important part of the advice we have received. It is because it is so important to put the decisions beyond doubt, with respect to this narrow and technical issue, that the Bill is so incredibly important. However—this might help to address some of the concerns raised during the Opposition winding-up speech—this piece of retrospective legislation refers only to that narrow and technical issue. If people question the grounds for their sectioning under the Mental Health Act on clinical grounds and claim that the wrong clinical judgment had been reached, for example, or if they do not agree with what the panels have said, the Bill will not affect their right to challenge the decision and, if the court upholds the challenge, to get compensation if they have been detained. The Bill relates only to the very narrow issue of the technicality.

[Mr Andrew Smith]

I am grateful to the Secretary of State for giving way and for his response to one of my earlier points. As he is adopting a belt-and-braces approach to this—a sort of “We think it was lawful, but let’s make absolutely sure” approach—would it not also be wise to arrange, if not in the Bill then as an executive action, for the doctors in question to be re-approved by the correct process?

[Mr Hunt]

The right hon. Gentleman makes an extremely important point. I am pleased to reassure him that that has happened. That was one of the first things that happened, and it was completed yesterday, so all the doctors who are currently making these approvals in the four SHAs were approved using the correct process. We are confident that the problem will not arise in future, but we still have the issue of the decisions they took when the technical process had not been followed.

We have taken a number of actions to deliver parity of esteem for mental health services. I wholeheartedly agree with the concerns that have been raised about mental health issues having been for too long the poor relative in a number of areas. The right hon. Member for Leigh (Andy Burnham) will know that in July we published the implementation framework for our mental health strategy, “No health without mental health”. We have legislated, with his party’s support, for parity of esteem. The operating framework for the NHS expands access to psychological therapies, which is one of the key things we can do. The number of people accessing psychological therapies has increased to 528,000 people this year, which is more than double the figure for last year, and the amount of money going into it has increased from £364 million to £386 million. Those therapies have a very good success rate of about 45%, and we think that we can get it up to 50%. I want to reassure right hon. and hon. Members that we note the general view of the House that more emphasis needs to be put on mental health services.

[Mr Hunt]

The right hon. Gentleman makes an important point. I believe that in actual terms the spending on mental health has increased slightly, but when we take inflation into account it might have gone down slightly in real terms. I do not think that it is a significant drop, but overall, as he knows, the NHS budget has been protected. I would be extremely disappointed if, as we go through a process of finding important efficiency savings in order to meet the increased demand on the NHS, the picture that he paints were to be the case, but I will be watching the situation very carefully. I will expect him to hold me to account for my commitment to ensuring that mental health services are properly addressed.

Crucially, it is not just about what we say but about what we deliver, particularly as regards the progress that we make towards improving access to mental health services, which were never included in the waiting times targets that were introduced by the previous Government. There are obviously financial implications in doing that, but we are working on it. Parity of esteem needs to include access to mental health services and not just the availability of those services.

[Mr Andrew Smith]

Does not parity of esteem also, crucially, need to apply to research funding—a point that was made earlier during the urgent question on Winterbourne?

[Mr Hunt]

rose—

Winterbourne View

Andrew Smith Excerpts

Tuesday 30th October 2012 Commons Chamber

[Norman Lamb]

I pay tribute to my right hon. Friend for his work in this area. He draws attention to the fact that there is a serious issue about the quality of commissioning and the work done by primary care trusts and, in some cases, local authorities. Too often, people seem to be placed in those settings and then to all intents are purposes forgotten about, which is not acceptable. Standards of commissioning and ensuring that contracts contain the right terms are extremely important.

[Mr Andrew Smith (Oxford East) (Lab)]

Does the Minister agree that this whole dreadful saga—which he rightly describes as a national scandal—underlines the importance of self-advocacy for vulnerable people? In his legislation and any guidance that may follow from it, will he take steps to ensure that the voices of these most vulnerable people will be heard directly wherever possible?

[Norman Lamb]

The right hon. Gentleman makes an extremely valuable point, and I would be happy to discuss that with him further. Too often in the past there has been a paternalist approach in which others have decided what is best for individuals. Hearing the voice of people with learning disabilities is absolutely central to getting this matter right.

084 Telephone Numbers (NHS)

Andrew Smith Excerpts

Tuesday 24th January 2012 Westminster Hall

[Mr Ainsworth]

The GPs will deny that there is any profit and will say that they provide an enhanced service for which the customers pay. But if there is profit in the partnership at the end of the year, it returns to the doctor, so potentially there is a profit, and that would clearly be in breach of the contract. People could be provided with access to their GP services without any enhanced charges, but GPs, because they have chosen to enter into the contracts, are passing the costs on to their patients.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate my right hon. Friend on securing this important debate, on an issue that my constituents, in Risinghurst in particular, have raised with me. I commend his suggestion to the Minister that renewed guidance be issued. Could the Department not send out with it a legally watertight template letter that any GP practice that is genuinely worried about its legal status regarding its present contract could use, to change to the cheaper alternatives that he has mentioned?

[Mr Ainsworth]

That is a good idea. If the Minister communicates with GPs again, he should do so in the strongest of terms, because it is clear that well over 10%—the estimated figure is 13%—of GPs have totally ignored the Department of Health to date. They are determined to continue not to pick up the costs of the systems that they have put in place and to pass them on.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

I congratulate the right hon. Member for Coventry North East (Mr Ainsworth) on securing this debate on the use of 084 telephone numbers in the NHS. The Government’s position is extremely clear—when patients contact their GP or anyone else in the NHS, they should not be charged more than they would be to call their next-door neighbour’s landline. Those are the rules. That is why we have retained the previous Government’s directions, published in December 2009, and regulations, passed in April 2010, which make it a contractual requirement for GP surgeries to ensure that that is the case.

Under the directions and the amendments to the general medical services and primary medical services regulations, it became compulsory for GP practices and NHS bodies to review how much it cost patients to call them. If they found that patients were being charged more than a standard local landline call, they had one year to take all reasonable steps, which could include varying the terms of their telephony contract, cancelling the contract, or offering an alternative number to call, such as an 03 number, which charges callers at a local rate. GP practices should not, in any case, enter into, extend or renew their contracts with their telephone supplier if patients are being charged more than a local call.

This legislation was the result of a lengthy consultation by the Department in 2009, to which there were about 3,000 responses. The vast majority agreed that patients should not be charged additional costs to contact their GP. However, many also valued the enhanced services they receive when calling their GP, such as queuing and additional booking options, but we are clear that that should not cost patients any more than a local landline call.

[Mr Andrew Smith]

Will the Minister give way?

[Mr Burns]

I will not at the moment, because I do not have much time to answer all the points raised by the right hon. Member for Coventry North East. [Interruption.] I might give way in a moment, although hon. Members should remember that the right hon. Gentleman did not give way to me either.

We must also be clear that the additional services can also be offered on other number ranges—such as 01, 02 and 03—and GP practices should feel able to choose the number that is most suitable for their patients, provided that it does not cost them any more to call.

Many people ask why we do not simply ban 084 numbers outright. I fear that that would not solve the real problem, which is that some patients continue to be, or believe that they are being, charged too much to contact their GP.

[Mr Andrew Smith]

Given that the Minister has said that practices should not charge more than the cost of a landline call to a neighbour, if a patient can demonstrate from their bill that they have been so charged, will they be able to get the money back, and how would they go about that?

[Mr Burns]

The right hon. Gentleman has anticipated something that I will deal with shortly, namely the 1,300 GP practices mentioned by his right hon. Friend the Member for Coventry North East that have allegedly been abusing the system.

As I have said, I fear that banning 084 numbers would not be the panacea that Opposition Members might believe it to be. The Department, to its credit, banned the use of premium-rate telephone numbers beginning 087 and 09 in 2005, but new number ranges with additional costs began to appear. Although it seems to be a simple solution, I do not think that it will be over the medium and longer term, because people will seek to avoid it. That is why it is crucial that the previous Government rightly sought to tackle the problem at source and why we have continued the policy that they introduced in the dying days of their regime. The 2010 regulations make it clear that patients must not be charged more to contact their GP than they would be if they called a local number.

Since the rules came into force, I understand that there has been confusion in the NHS about what the regulations and the directions include. I am grateful for this opportunity to clarify some of those misconceptions in the NHS and elsewhere. There have been claims that mobile phones are not covered by the 2010 regulations, but that is not true. The regulations cover landlines, mobiles and payphones equally. The legislation is absolutely clear that if a person calls a GP surgery with an 084 number from a mobile, landline or payphone, they should not pay more than they would if they called a local landline number from the same phone.

That is very important, because more and more people now use mobile phones as their primary form of communication, as has been mentioned by the right hon. Member for Coventry North East. That is particularly true of the less well-off—the right hon. Gentleman also made this point—where 25% of households only have access to mobile phones, and for young people, where a third of people under 25 only use mobile phones for communications purposes. In 2011, for the first time, the majority of call minutes originated from mobile phones.

Questions have also been raised about how a patient can challenge their GP practice or PCT if they believe that they are being charged more than the cost of an equivalent local call. Any action taken should be on the basis of robust evidence. GP practices and their PCTs should look at evidence of call costs to determine whether their patients are being charged more than they should be. Such evidence could include cost-per-call information from providers, such as O2, Vodafone and BT. A suitable sample should be considered, bearing in mind the different contracts that patients can choose to sign up to.

A practice can also look at cost-per-call information that is provided by patients. Using that information, it would be possible to compare directly the cost of calling a GP practice’s 084 number with the cost of calling a local land-line number. If the evidence suggests that using a specific number is not costing patients more than it should, the GP practice should be free to continue using 084 numbers. If patients are being charged more than they should be, they should take the steps that I have already mentioned to rectify the situation.

Innovation (NHS)

Andrew Smith Excerpts

Wednesday 12th October 2011 Westminster Hall

[John Glen (Salisbury) (Con)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I requested this debate in order to raise important issues about the ongoing review of how the national health service extracts the full potential from innovative, commercially realisable ideas generated by NHS employees and to seek clarification from the Minister about the scope of the Carruthers review of innovation in the NHS announced this July.

I was led to the subject by my involvement with Odstock Medical Ltd in my constituency, a company that has grown from Salisbury NHS Foundation Trust. OML has pioneered a technique called functional electrical stimulation that produces contractions in paralysed muscles by applying small pulses of electrical stimulation. Having experienced it myself, I can attest that it assists walking. OML has developed a range of neuromuscular stimulators to improve the functional ability of people with neurological conditions such as multiple sclerosis. The devices have been developed during many years of collaboration among clinical engineers, clinicians and patients at the National Clinical FES Centre at Salisbury NHS Foundation Trust.

Last year, it came to my attention that, because OML is partly owned by the local NHS foundation trust, under EU rules, it cannot be classified as a small or medium-sized enterprise, and therefore cannot access grants and support through normal Department for Business, Innovation and Skills channels. That seems ludicrous. I met the Minister of State, Department for Business, Innovation and Skills, my hon. Friend the Member for Hertford and Stortford (Mr Prisk), who has responsibility for small business, along with Professor Ian Swain from OML. Little progress could be made, although attempts were made to access specific funds and schemes. It is a systemic failing.

Anxious to overcome that barrier and explore other aspects of innovation in the NHS, more recently, I met with Alun Williams, the CEO of NHS Innovations South West, who has an office in my constituency and is here today. Alun is wholly committed to the NHS and is passionate, as am I, about finding ways to develop streams of revenue for the NHS. I thank him for his support and advice as we have discussed the subject in recent months.

My key concern is this: as populations age, as the cost of drugs and treatments rises faster than inflation and as medical science, thankfully, finds ever more treatments for human ailments and medical conditions, the NHS must be more radical in exploiting the bright ideas of its staff to ensure that the commercial potential of those ideas are realised fully by the NHS.

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Gentleman on securing this enormously important debate. I was brought to the subject by NHS Innovations South East. Does he agree that NHS staff can come up with innovations—examples cited to me include improvements in child protection investigations and adolescent mental health programmes—that do not readily or easily translate or crystallise into commercial benefit? Is it therefore not short-sighted for the Government to insist, as I understand they do, that innovation bodies must be totally self-supporting commercially?

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I congratulate my hon. Friend the Member for Salisbury (John Glen) on securing this debate on what is widely recognised as an important issue for the NHS because of the crucial role that innovation plays in the present and will play in the future. Given his ideas, views and thoughts, he might seek to arrange a meeting, if he has not already done so, with my noble Friend the Earl Howe, who is the Health Minister with responsibility for innovation.

I shall respond by first setting out the Government’s approach to innovation, before looking at the specific issues that have been raised by my hon. Friend. As we all know, and as he has reiterated, we face a significant challenge. Without real change, the cost of health care will grow faster than the rest of the economy. Moreover, the quality of care in vital areas such as cancer will lag behind other countries, and the gap between the best and the worst NHS care will continue to grow. More of the same simply will not do. We cannot afford it and patients do not deserve it. We need, in other words, to innovate, as my hon. Friend has said.

Fortunately, there is a vast reservoir of innovation to tap within the NHS. It has a long history of innovation, invention and research by great people and great institutions. Ian Donald, for instance, pioneered the use of ultrasound in the 1950s. Sir Peter Mansfield’s work led to the MRI scanner in the 1970s. The Sanger Institute developed the first working draft of the human genome in 2000. We continue to lead the way in cutting-edge research, as the recently announced first European trial of embryonic stem cell research at Moorfields eye hospital demonstrates.

The creative spark that kick starts the long and difficult journey from initial idea to widely adopted treatment is a precious and delicate thing. We need to do all we can to encourage that creativity within the NHS—to grow and propagate the ideas that clinicians and others have for the benefit of their patients. While we continue to achieve great things, we must always strive for more.

Innovation does not happen when power is centralised and people are told what to do, so the single biggest thing that we are doing to encourage innovation is to devolve power to clinical professionals, trusting their professional judgment and their desire to do their best for their patients.

Our modernisation of the NHS will encourage innovation in three main ways. First, it will place the patient at the centre of decision-making about their own care—informed, empowered and able to choose the best possible appropriate care—so that providers will have to innovate to stand out. Secondly, it will have a resolute focus on improving health outcomes—publishing the data and rewarding excellence—so that hospitals and others will have a powerful incentive to innovate and improve. Thirdly, it will place power in the hands of local clinicians, thereby getting rid of the huge and wasteful bureaucracy that can strangle and frustrate innovation, and let the knowledge and expertise of clinicians drive innovation locally.

That will lead to a more personalised NHS, with services tailored to patients’ needs; a more integrated NHS, with solutions that tackle inequalities, improve access and deliver care closer to home; and a better quality NHS, with every provider encouraged, rewarded and incentivised to constantly improve outcomes for patients.

There is also a wider economic imperative for innovation. The health care sector, including pharmaceuticals, medical technology, research, equipment and services, directly or indirectly employs hundreds of thousands of highly skilled people in companies, from small and medium-sized enterprises to global giants, generating billions of pounds in revenues, all helping to drive future economic growth. Innovation in health care applies to everyone—scientists, nurses, doctors and managers. In fact, it applies to all those working to deliver better health, better care and better value. We must ensure that innovation is not simply the preserve of elite minds at the top of august institutions, because it is not just about the latest drugs or high-tech pieces of equipment. The spirit of innovation should be part and parcel of every part and every level of the NHS.

One of my favourite examples of innovation in action is a jug—a health care assistant in Milton Keynes decided that patients whose fluid intake needed close attention should each have a bright red water jug. That particular innovation gave ward staff a clear visual reminder of those patients’ specific needs, helped them to better care for patients, avoided the need for drips, reduced the risk of infection, cut patients’ stays in hospital and consequently cut the cost of their care. That is all because of a bright red jug and one very bright idea from a health care assistant.

We have also made a strong and ongoing commitment to innovation through research. The Government’s plan for growth cements our commitment to health care and the life sciences as a force for growth in the economy. The Government’s National Institute for Health Research aims to support outstanding individuals, working in world-class facilities and conducting leading-edge research focused on the needs of patients and the public. We have recently announced a record £800 million in additional NIHR funding for experimental medicine and translational health research. We will also streamline regulation and improve the cost-effectiveness of clinical trials, speeding up the process of translating research into better lives for patients, their families and their carers.

However, no matter how extraordinary the innovation or how miraculous the invention, it is worthless if it is not used, as my hon. Friend the Member for Salisbury said. Any innovation that is not widely adopted is a tragic waste. Like many large organisations, the NHS’s uptake and spread of innovation has often been slow. We need to raise our game, as my hon. Friend alluded to. We need to do more to recognise the contribution that innovators and innovative organisations make and to encourage adoption and diffusion across the NHS on a scale never seen before.

[Mr Andrew Smith]

In that context, can the Minister say what future he sees for the work presently being undertaken by the regional NHS hubs, especially in the area to which I alluded earlier where there might not be an immediate commercial return?

[Mr Burns]

I am grateful to the right hon. Gentleman for that intervention. I will certainly come to that matter during my comments and before we finish the debate.

A substantial amount of work is already under way, including the £60 million that has been invested in regional innovation funds, which support front-line staff to develop and spread new ideas and validate the notion that it is good to challenge the way things have always been done. The funds are massively over-subscribed and have to date given money to more than 300 projects. Further work includes the innovative technology adoption procurement programme, which aims to encourage the NHS-wide adoption of high-impact innovative medical technologies, and the innovation challenge prizes, which reward the ideas that tackle some of our big health and social care challenges, improving productivity and the quality of health care. The first innovation challenge prizes—ranging from £35,000 to £100,000—were awarded in March. Winning entries helped to reduce waste and increase the benefits of medicines, helped people with kidney failure to lead a more independent lifestyle and helped in the early diagnosis of cancer. An expert panel is going through this year’s round of applications and I very much look forward to seeing the results later in the autumn.

There is also much of value in the innovation hubs, to which the right hon. Gentleman referred. Identifying, developing and commercialising new ideas within the NHS is a must, and we need to adopt a systematic approach to that. We also need to ensure that all parts of the innovation pipeline—invention, adoption and diffusion—are more efficient and effective. The NHS chief executive’s innovation review will consider that and how we can achieve better value for money.

As announced in “The Plan for Growth,” NHS Global is being developed to help NHS organisations to compete in the global market. NHS Global seeks to build and grow the NHS brand and reputation overseas, enabling the NHS to compete in the international health care market and to exploit the commercial value of its technologies, products and knowledge. In doing so, NHS Global acts as another mechanism to support great ideas generated in the NHS being widely accepted across the world.

In the case of the company mentioned by my hon. Friend the Member for Salisbury—Odstock Medical Ltd—if it has not done so already, I suggest that it contacts the NIHR’s invention for innovation scheme. i4i supports product development and the guided progression of innovative medical product prototypes, and I strongly advise the company to get in touch with it if it has not done so.

The Health and Social Care Bill, now passing through the House of Lords, will place a legal duty on the NHS commissioning board and on clinical commissioning groups to promote innovation and research. Soon the NHS chief executive, Sir David Nicholson, will set out achievable, high-impact recommendations that will inform the strategic approach to innovation that is so important within a modernised NHS. We will open up NHS procurement to small and medium-sized enterprises, simplify the process and challenge them to come up with solutions to problems within the NHS. We have committed £10 million to the small business research initiative.

Innovation can never be mandated and it should never be restricted to a particular group. Innovation in health and social care will come from a wide variety of partners—for example, NHS staff and patients, private companies, the voluntary sector and academia. They all have a crucial role to play in pushing forward the boundaries in developing and dreaming up innovative products and services to meet the ever-increasing demands of a modernised NHS.

Innovation is not easy. It takes more than just a good idea to innovate; it takes courage to speak out against how things have always been. Innovators have to hold and develop an idea often in the face of opposition and keep pushing forward until it begins to bear fruit. I fully appreciate that the process of innovation can be a very frustrating time. We must encourage people, so that they do not become frustrated and give up. They should be able to pursue dreams and ideas that will bring a greater improvement to the general provision of health care and the NHS.

Let us imagine a world without antibiotics, without insulin, without cancer screening. Then let us imagine a world with a cure for cancer or where we can reverse dementia and end heart disease. Without innovation none of that would be, or could be, possible. Innovation is essential for the future of our NHS and for the future of the UK economy. I assure hon. Members that the Government will do everything in their power to continue to promote innovation, so that it can flourish and develop along the lines that we would wish.

Congenital Cardiac Services for Children

Andrew Smith Excerpts

Thursday 23rd June 2011 Commons Chamber

[Mr Andrew Smith (Oxford East) (Lab)]

I congratulate the hon. Member for Pudsey (Stuart Andrew) on introducing the motion and arguing his case so powerfully. The debate shows the value of Back Bench-initiated topics, which has enabled the House to speak out on an issue of enormous concern to the public, as demonstrated by the petition he referred to and by the Southern Daily Echo petition of nearly 250,000 signatures that was taken to Downing street earlier this week in support of the Southampton centre, which is mainly what I want to speak about. I will make just a few key points, as many Members wish to speak.

First, I want to praise the work done in the existing centres, including the John Radcliffe hospital in my constituency, which commands fantastic support from the parents of children who have been treated there. The Young Hearts organisation, which was set up to support parents of children with heart conditions in Oxfordshire, has been leading a great campaign, rightly paying moving tributes to the skill and dedication of surgeons, doctors, nurses and whole medical teams who have saved children’s lives and to whom we all owe a debt of thanks.

Secondly, as the hon. Gentleman noted, a key concern in the debate, and in considering the Safe and Sustainable review, must be to secure the best possible treatments and outcomes for children with congenital and other heart conditions. We must be guided by medical and research expertise, which few of us in this place are in a position to second-guess. I am therefore mindful of the joint statement by the Royal College of Surgeons and the Society for Cardiothoracic Surgery, in which they strongly support the concentration of treatment centres. They state:

“England has the right number of heart surgeons treating rare heart conditions in children, but we do know that they are thinly spread over too many units. A better service would be provided if this expertise were condensed in fewer units with the critical number of staff to support each other, disseminate new techniques and train the next generation of specialists.”

They believe that the proposals

“will result in rapid and significant improvement in treatment for some of the most vulnerable patients treated by the NHS.”

We should give great weight to that unequivocal statement.

The joint statement went on to suggest—this brings me to my third point—that:

“The benefits of undertaking this change, however, need to be balanced against longer journeys for some families”.

That, along with quality, is a matter of great concern on both sides of the House, and certainly in Oxfordshire. It was also stressed by the Oxfordshire joint health overview and scrutiny committee and the Young Hearts campaign in relation to the implications for patients in our area if any option other than option B, which is to retain the centre at the Southampton University Hospital NHS Trust, is chosen. As today’s Oxford Mail editorial states:

“If Southampton loses out in the Government shake up of children’s heart services, then so does Oxford.”

The benefits of this option, and in particular of retaining the Southampton centre, lie not only in the fact that the Kennedy review ranks Southampton highest in the country outside London for quality, but that the Oxford Radcliffe Hospitals NHS Trust has developed a joint network of care with Southampton, enabling local children who have surgery in Southampton to receive follow-up care and support services in the excellent facilities at the Oxford children’s hospital and to be able to progress as they grow older to the Oxford heart centre, thereby maintaining continuity of care, which the hon. Gentleman rightly said was so important in the relationship between children’s services and adult services. I very much hope that this south of England congenital heart network, with Southampton and Oxford working closely together, will be part of the option that is finally chosen.

That network does not figure in the present options, but I welcome the news in today’s briefing from Safe and Sustainable that a specialist team is examining it. The need for this flexibility is a key reason why I support the call in the motion for the joint committee not to restrict itself narrowly to the options set out in the original review. As Young Hearts has pointed out, it is important to consider the children needing paediatric cardiac services who were not born with a heart defect but who have suffered a virus or accident requiring cardiac treatment. The Oxford-Southampton partnership will retain ready access to the skills and facilities needed for that care.

That form of partnership network, with collaboration between a surgical centre and another cardiac care centre, offers a good model for other parts of the country. It enables us to ensure that children have the benefit of both the critical mass of surgery, which surgeons advise can significantly and rapidly improve treatment, and more convenient access to related services and continuing care nearer their homes. Surely that is the outcome that we all want. I very much hope that the review and the Government will take it forward, with the Southampton-Oxford partnership being the best way to retain high-quality and accessible services for central southern England.