National Minimum Wage: Care Sector

Angela Rayner Excerpts

Wednesday 23rd March 2016 Westminster Hall

[Paul Blomfield (Sheffield Central) (Lab)]

I beg to move,

That this House has considered Government policy on enforcement of the national minimum wage in the care sector.

I am delighted that you are in the Chair, Mr Rosindell, and that so many colleagues are here to speak about this issue.

I am pleased to have secured this debate, although I am disappointed that it is still needed, because we had a debate on this very issue, led by my right hon. Friend the Member for Oxford East (Mr Smith), back in November 2014, during which it was acknowledged that we had a real problem. That was acknowledged by all sides, including by the Minister at that time, the right hon. Member for North Norfolk (Norman Lamb), because in March that year the National Audit Office had estimated that up to 220,000 home care workers in England were being illegally paid below the national minimum wage. Eighteen months on, we still have the same problem.

We could talk forever about numbers, and I am sure that a number of colleagues will cite statistics, but I think the human stories explain what the issue is really about.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

I worked in the sector as a home help and represented home care workers. Does my hon. Friend agree that the human stories are quite tragic? What home carers end up having to do is subsidise their employers, who do not pay them travel time. A good employer will see the value of their staff, and pay them correctly and appropriately.

[Paul Blomfield]

I thank my hon. Friend for that intervention and I completely agree with her. I will illustrate that point further in my comments today.

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[Chris Stephens (Glasgow South West) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I refer Members to my entry in the Register of Members’ Financial Interests and declare my 20 years of trade union activity for the Glasgow city branch of Unison before my election to Parliament.

There are far too many instances of care home providers who provide services for a profit ignoring or disregarding their legal responsibilities to their staff. It is particularly insidious that those who are paid the least and provide some of the most vital services needed by our society, which we will need more and more as our demographics shift, are being denied even the most basic protections by their employers. In two recent cases, MiHomecare settled a national minimum wage pay claim with one employee for £1,250 and, as we heard from the hon. Member for Neath (Christina Rees), in south Wales Unison colleagues secured backdated wages for 100 workers amounting to up to £2,500 each after it failed to pay workers for time travelling between clients.

A leaked document from MiHomecare sets out exactly how much workers are being short-changed by. Its internal analysis in the wake of an HMRC investigation into its employment practices revealed that 44 workers could have been out of pocket by as much as £2,000 a year each. A Resolution Foundation report estimated that as many as 160,000 care workers are receiving less than the minimum wage simply on the basis of non-payment for travelling time, to say nothing of the myriad other changes to their salary. That amounts to more than £300 million and, as a sum being withheld from some of the poorest workers in the country, I find that breathtaking.

The closure of HMRC offices across the country concerns me greatly. HMRC’s enforcement work is invaluable in taking to task the criminality that sadly some employers believe is justified. The centralisation of services and cutting of jobs will inevitably give the green light to more employers to think that they can flout the law and get away with it.

[Angela Rayner]

As a former Unison activist and comrade, may I thank the hon. Gentleman for the work he has done in the sector? To come back to legality, is it not an absolute shame that many home carers will not be able to seek legal redress because of employment tribunal fees? It is unions such as Unison that enable carers to take cases to employment tribunals, because they pay the fees.

[Chris Stephens]

I agree with my Unison comrade and friend. One barrier to getting back-payments in this sector in particular is that the fees charged are often greater than the wages claimed for. I thank her for making that point.

If the green light is to be given to more employers, they will take that. In Scotland, with only two offices—in Glasgow and Edinburgh—to be retained under the proposals, it is simply not credible to suggest that, despite best efforts, HMRC’s minimum wage enforcement can continue at the same level. Given that the workforce in the care sector is female-dominated, it seems that a double whammy is created. We as a society pay women less overall and, even when a legal floor is put in place to stop wages falling below a certain level, many women are victims of their employers’ criminality and earn even less. There can be no place in a civilised society for the law-breaking that appears to be happening in areas of the care sector. A civilised Government should do all they can to stamp out that insidious practice.

Other Members have set the scene. As usual I enjoyed the contribution from the hon. Member for Sheffield Central (Paul Blomfield). He rightly said that the sector looks after the most vulnerable. The hon. Member for Ashton-under-Lyne (Angela Rayner) indicated her personal experience and the right hon. Member for Oxford East (Mr Smith) was correct when he said that it is not unreasonable to demand that the national minimum wage is paid.

Junior Doctors’ Contract Negotiations

Angela Rayner Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

My hon. Friend points to an interesting fact—that despite these many months of discussions, we have never had a clear line from the shadow Secretary of State or from the Opposition generally on whether they condemn or support the industrial action. It would be helpful if they made that clear because we would know at least whose side they are on. Are they on the side of patients, where we are trying to eliminate the weekend effect, or are they on the side of the BMA’s leadership?

[Angela Rayner (Ashton-under-Lyne) (Lab)]

I find the Minister’s language and tone in regard to the BMA and the junior doctors unfortunate. He speaks as though junior doctors do not care and do not want to help their patients, and I find that regrettable. In my time as a Unison official, when I used to represent public sector workers in health care, the BMA was hardly known for its militancy within that organisation, and the Minister needs to reflect on that. Does he really think that this whole problem is, as my hon. Friend the Member for Bolsover (Mr Skinner) denied earlier, all the blame of the BMA and doctors? Doctors care about their patients; that is why they are in this position. Does the Minister not accept any responsibility for the impact?

[Ben Gummer]

I entirely agree with the hon. Lady about the passion and dedication of junior doctors—and never once has the Secretary of State or I questioned that. What we have questioned are the tactics of the BMA’s leadership. I happen to agree with her, too, about her previous employer Unison. I have constructive relationships with that union. I disagree with it, and it with me—often—but we agree on many things and have a straightforward relationship. I am afraid that it is difficult to do business with the BMA, however, when it promises to talk about one thing and then refuses to do so a few weeks later, when it refuses to come to the negotiating table for months, and when it misleads its members in a way that I do not think Unison has ever done.

Vulnerable Adults: Transport

Angela Rayner Excerpts

Thursday 21st January 2016 Commons Chamber

[Rebecca Long Bailey (Salford and Eccles) (Lab)]

Before my hon. Friend the Member for Ilford North (Wes Streeting) leaves the Chamber, I would like to wish him a very happy birthday and congratulate him on his point of order.

I thank the Minister for attending what I have no doubt will be a lively and informative debate. It might be helpful if I first define what specific kind of transport I am focusing my comments on today. Adults with special educational needs often attend day centres or schools. Until recently, many councils have provided accessible transport to allow the most vulnerable to access these facilities, often by way of a bus or the provision of a driver plus an expert escort on board to ensure safety. That support is a vital service in many communities, providing independence for those with special needs and peace of mind for their parents and carers. It also provides a much-needed break for the unsung heroes of social care who struggle with the commitments of family life and work alongside caring for their loved ones.

Let me set a backdrop for the harrowing tale I am about to tell. In 2014 my local council, Salford City Council, was ordered by the Government to find £25 million of so-called savings in its budget. That was in addition to £97 million in spending cuts that it had already suffered since 2010. As an already efficient and well-respected council, it had already sought to find every possible means of saving money through genuine efficiency gains. It had fought for four years to find ways to save money or reduce spending here and there in order to ensure that all services for the most vulnerable residents across Salford were unaffected. By 2014 the council was way beyond being able to salami-slice budgets and, as a result, was forced to look at making real changes to a wide range of services. Our mayor, councillors and council officers were put in the agonising position of having to prioritise which types of care they provided and to determine who was the most vulnerable, instead of simply protecting all the vulnerable, as it had done before.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

This year, £16.4 million has been taken out of Tameside council’s budget for adult social services, £11.1 million has been taken out of Oldham council’s budget for adult social services and a deficit of over £20 million has been forecast for Tameside general hospital. Cuts to front-line local services not only cost more in terms of the quality of life for the individuals affected, but cost us all more in the long run. Does my hon. Friend agree that these cuts are really short-sighted and damage not only our local services, but our NHS, which has to pick up the pieces afterwards?

[Rebecca Long Bailey]

I thank my hon. Friend for those helpful comments. I completely agree. As she will hear, Tameside is not alone in suffering such savage cuts.

Salford City Council had to face the difficult decision to cut the in-house provision of vulnerable adult transport for over 200 families across the city, amounting to a £500,000 cut in transport support for those with special needs. That was alongside the £400,000 that the Government’s cuts took from the provision of adult social care support to those with learning difficulties in the same year. I must add that prior to the cuts the transport service was rated excellent as a council service. It was not inefficient and there were no plans to cut it had the funding been available.

Commenting on the Government cuts at the time, our mayor, Ian Stewart, stated that

“this is not about efficiencies any more. These cuts will cause untold damage to the services we provide”.

Even in this desperate funding crisis, the council worked hard to make the best of a terrible financial situation. In partnership with the individuals affected and their carers, appropriate alternative arrangements were made. Transport was not ended for anyone until suitable alternative arrangements had been agreed. The good news is that a number of parents were generally happy with the council’s new arrangements, because they can individualise their journey times. That means that they are not spending significant amounts of time on transport, which previously resulted in some people arriving at the day centre in an agitated mood. The council is very much aware that the change is not universally popular, and it continues to work with any individuals who express concern. The fact remains, however, that it does not hold sufficient funding to provide an in-house passenger transport service as it was provided.

I have spoken at length to some of the families affected. I have heard their tales of despair and their worry about which other services that they rely on might be cut in future. I have listened to the mayor, our councillors and council officers, who have frankly lost faith in the Government’s commitment to provide a welfare system, which should be there to look after the vulnerable. In the wider context, for the 2014-15 financial year, a total of £4 million had to be cut from community health and social care, £2.4 million from public health, £4.7 million from support services, £5.6 million from education, and £4 million from environment and community safety. These are not “efficiency savings”—they are cuts to front-line services.

Perhaps in 2010 there were areas where genuine savings could be made with minimal knock-on effects on front-line services, but by the time £97 million has been taken from the budget, there is nothing left to cut but vital front-line services. Even the Prime Minister’s own council leader had to explain this principle to him following the now infamous letter in which he criticised his local council’s cuts to front-line services. By 2016-17, Salford City Council will have to make budget cuts of £188 million in order to balance its budget; £83 million of that sum alone is the amount by which the Government grant has been cut. That is a cut of over 43%, but in real terms the figure is much higher.

This is not just an issue for Salford City Council. Every council has faced vast reductions in funding from central Government, and my local council is not alone in having to cut transport for those with special educational needs. Countless numbers of local authorities have reduced or completely ceased to provide transport for vulnerable adults. It is rather tenuous, therefore, for the Government to argue that all these councils have made the choice to cut such an important service when they could instead have made efficiency savings in their back offices. These councils have no such choice any more.

When my constituents visited me about this issue, my first reaction was to try to locate funding elsewhere. What about the northern powerhouse, I thought, all that money that is supposedly being unlocked in the north—surely Salford’s vulnerable people deserve a piece of that? When I examined the detail I became even more disillusioned. We have often heard the Chancellor wax lyrical about his so-called devolution revolution, which he argues will enable areas such as Salford to raise and spend revenues locally, but he fails to acknowledge that councils in poorer areas have very limited revenue-raising capacities.

For instance, the policy to allow councils to set and retain their own business rates without the safeguard of a grant scheme has the potential to create severe inequalities among different areas of Britain. Indeed, the director of the National Institute of Economic and Social Research has said that while he agrees with the principle, it would be “inconceivable” not to keep a grant scheme. He stated:

“does this have the potential to disadvantage deprived areas and advantaged rich ones?..Absolutely!”

The Institute for Fiscal Studies has expressed concern that such a move would create winners and losers, with poorer areas seeing a fall in revenue. Let us not forget that we are already seeing disparities between local authority cuts. Between 2010 and 2015, Salford saw cuts of £210 per head, while authorities such as Epsom and Ewell saw only a £15 per head decrease. With local government funding being cut in terms of the grant by 56% by the end of this Parliament, it is frankly terrifying for Members like me whose local councils will see even more significant reductions in their spending power.

The same issue arises with regard to the social care precept, which would allow councils to raise council tax by 2% in order to fund social care. The president of the Association of Directors of Adult Social Services has warned:

“The Council Tax precept will raise least money in areas of greatest need which risks heightening inequality.”

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[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

I congratulate the hon. Member for Salford and Eccles (Rebecca Long Bailey) on securing this debate and thank her for allowing me, on behalf of the Government, to put the record straight on some important issues relating to funding for care generally and for this group of vulnerable patients in particular. I will start by setting the scene of how our reforms have changed the way in which funding is provided, and I will then address some of the detailed local issues in Salford.

The way we look after some of our most vulnerable people is a benchmark of how civilised we are as a society. For that reason, the Government have tried, in a very difficult funding round, to make sure that funding for the most vulnerable is protected and ring-fenced. We understand that everybody in the country is tightening their belts to pay off the debts that previous generations and Governments have left us, but we have tried to be as careful as possible and to make sure that we protect the most vulnerable in our society who have no choice and are completely reliant on public services. That is why, through the Care Act 2014, we now have a reformed care system that is already leaving local authorities in a better position to meet the care needs of their people as they see best and to target resources at those who most need them.

Councils now have greater flexibility to arrange care, as well as to give greater choice and control to individuals. We have given councils freedom on how to use the money they receive and allowed them to work with their residents to decide how best to arrange their spending, based on local priorities and need. I am not pretending for a minute that local government has not faced real pressures on its finances over the past five years. However, when local authorities account for a quarter of the Government’s entire public spending budget, it is only right that local government must find its share of the savings that we all need to make to reduce the deficit we inherited from the Labour Government in 2010. It is a tribute to local government across the country, including Labour councils, that the vast majority of them have managed to deliver more with less. It was good to hear the hon. Lady acknowledge that there was fat in the system in 2010, and that councils could do a lot to deliver more for less. Many councils have indeed done so.

[Angela Rayner]

I want to reiterate that I welcome the fact that Tameside is a pilot area for the Government’s proposed integrated care model. I mentioned the figures earlier, including the forecast £20 million deficit in Tameside general hospital’s budget. Does the Minister not think that that will completely undermine the fantastic and innovative work such areas are trying to do to ensure that people who need care can get it in the right place and at the right time? These savage cuts undermine all the proposals for an integrated care model.

[George Freeman]

If the hon. Lady had asked her question in slightly more moderate terms, I might have been able to agree, but when she talks about “savage cuts” completely undermining any progress on integration, I cannot agree with her. That extreme language does not tally with the rather better numbers—I am not pretending that there are not challenges, because there are—but I will come to them in a minute.

Student Nursing (Finance)

Angela Rayner Excerpts

Monday 14th December 2015 Commons Chamber

[Wes Streeting]

I am very grateful for that intervention and I wholeheartedly concur with the hon. Lady.

Government Members may wear the NHS badge on their lapel, but they are quick to attack the conditions of NHS staff when it comes to taking difficult decisions. [Interruption.] They ask how I would fund it. When we were in government, even when we made changes to higher education student finance, we did not do this. We will take no lessons from the Conservative party on spending plans. It attacked Labour’s spending plans at the 2010 general election because we wanted to halve the deficit and it was promising to eliminate it. Then what did it do? It halved the deficit. When it comes to their record on spending plans, the Government are in no position to hector other parties.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

Does my hon. Friend agree that what is so devastating about these plans is that people from my constituency and from my background—I am a former Unison activist who looked after NHS staff—will not be able to go into the nursing profession? We are crying out for nurses and for people to fill the positions. The NHS has been burdened by the use of agency staff because the staff are not available. This policy will put people from my constituency off going into those positions.

[Wes Streeting]

My hon. Friend speaks with great experience. The Government should heed the points she makes.

I will turn to the other questions I have for the Minister. How will clinical placements be funded under the student loans system? The Government talk about the number of places they can expand, but it is not like expanding a history undergraduate course because occupational placements need to be arranged. The Government should explain how they intend to fund them.

Given the number of mature applicants for nursing, midwifery and allied health subjects, what assessment have the Government made of the likely impact of the reforms on applications from mature students? Are the Government at all concerned that applications from mature students may fall, given the detrimental impact that the coalition Government’s student finance reforms had on mature and part-time student numbers? Given that many people choose healthcare as a second degree and may not be willing to take on more than £100,000 of debt, how will the Government ensure that this route is not closed to such students? Have the Government conducted any evaluation at all that might give us a clue as to the extent of the risk that these reforms pose to recruitment?

The Government suggested in the spending review that half of all applicants to nursing courses are turned away. Do they have any evidence of what stage they are turned away at? If it is really the case that people are flocking to these professions, will the Minister explain why my local NHS trust has been so reliant on temporary and agency staff, including nurses who have been flown over from Portugal, to address the recruitment and retention challenges facing the NHS?

Additional allowances are currently available for students with different circumstances. Will the Minister inform the House whether any changes will be made to additional allowances, such as the extra weeks allowance or the dependants allowance? If so, what are those planned changes and what assessment have the Government made of their potential impact?

Given the press speculation over the weekend that the Government plan to increase the overall cap on university tuition fees, what assurance can the Minister give the House that students studying nursing, midwifery and allied health subjects will not see their tuition fees and debts hiked up even further than is being suggested? Given that the Government seem content to shift the goalposts for existing students and graduates, does the Minister really expect current or future students to believe that the terms and conditions they sign up to will not be changed and applied retrospectively further down the line? At the very least, I hope the Minister will confirm this evening that the NHS will continue to fund the tuition fees for existing students for the remainder of their studies.

When the coalition Government chose to increase tuition fees in 2010, the move was subject to a debate and a vote in this House. Given the media speculation that Cabinet Office Ministers are busy trying to find ways to avoid proper debate and scrutiny of a possible increase in the overall cap on tuition fees, will the Minister give the House an assurance that we will have a full debate and a vote should the Government choose to extend tuition fees to nursing, midwifery and allied health subject courses? Many students have already written to Ministers in the Department of Health and are awaiting a reply. Will the Minister commit to meeting student representatives to discuss their concerns?

It is not hard to understand why the Government’s shift in policy is generating so much concern and anxiety. In recent days I have heard representations from, among others, Unison, the Royal College of Nursing, the National Union of Students, the University of Hertfordshire, the Royal College of Speech and Language Therapists, and the Chartered Society of Physiotherapy. I have been contacted by student nurses and midwives in my constituency, and received messages of support for this debate from those in the constituencies of other right hon. and hon. Members.

Before I conclude, I would like to share with the House some of the stories that I have heard, and I will finish by making a few points about nursing and midwifery students. These are exceptional people and their dedication to others is truly remarkable. They work long hours, often in difficult situations, and they take a direct role in caring for patients when they are at their most vulnerable. Nursing students have told me how immensely challenging their work can be. They hold the hands of patients in their final moments, and comfort them as they pass. They are the face of reassurance to patients, and a bedrock of support for families.

Mental Health

Angela Rayner Excerpts

Wednesday 9th December 2015 Commons Chamber

[Angela Rayner (Ashton-under-Lyne) (Lab)]

I am proud of the work that the Labour campaign for mental health has done to highlight many of the issues that have been raised today. In particular, I congratulate my constituent, Victoria Desmond, on her work.

I want to raise the case of one of my constituents. I have briefly outlined it before in this House. Kane was only 18 years old—the same age as my eldest son—when he took his own life. Kane had grown up in care, in foster homes and in institutions, and he had a history of mental health problems, but those difficulties were compounded by the problems that society threw at him. Already extremely vulnerable, his unemployment benefits were suddenly stopped after he missed a doctor’s appointment. He was one of many people with mental health issues who are increasingly being sanctioned through no fault of their own. Then Kane was hit again when the moneylender Wonga, from which he had taken out a payday loan, cleared out his bank account in one fell swoop as part-payment of his debt. Kane was left absolutely destitute, literally without a penny to his name. Hours later, Kane hanged himself.

That is a shocking story about a young boy who had already had more than his fair share of problems in life being left penniless by a payday loan company. After being penalised by the state, which withdrew his benefits, it must have seemed like he had nowhere to turn to for help, support or a little human understanding.

Of course Kane is not alone. He is one of 16 men, on average, who commit suicide every year in my constituency. Many more attempt to take their own life. It is a miserable fact that men are three times more likely than women to take their own life. It would be wrong to speculate on the reasons, but it seems irrefutable that economic circumstances play some part. I try to be non-partisan, but that is difficult after my experience and that of my mum, who suffered from bipolar disorder for many years. The Government shout about their long-term economic plan, cut taxes for the richest in the nation, and then tell my mum, “You’ve got to move because of the bedroom tax. You’re having your benefits cut, and we’ll cut funding to local authorities and charities.” Charities such as Mind that look after people like my mum can no longer offer the support that she once had.

Economics plays a huge part in the treatment of people with mental health problems. The number of mental health beds in Greater Manchester has been cut by 5.9% in the past five years, despite increasing demand. My hon. Friend the Member for Stalybridge and Hyde (Jonathan Reynolds) mentioned that the regional press in my area today reported the start of a consultation on cutting £1.5 million from Manchester Mental Health and Social Care Trust. More than 600 patients are set to be hit by these proposed cuts.

If people listening to this debate need support, I commend the services out there run by the voluntary sector and charities, including the Samaritans, of which I used to be a member.

Hospital Services (South Manchester)

Angela Rayner Excerpts

Tuesday 8th September 2015 Westminster Hall

[Mike Kane]

The Healthier Together commissioners left us in a binary situation, so it became a competition between two hospitals. That should never have been the case.

The aim of Healthier Together—to give patients throughout the region the same standard of excellent service wherever they live—is the right one. The challenge is huge: Manchester has the highest premature death rate of any local authority in the country. There can be no doubt that healthcare services in Greater Manchester need to change.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

Will my hon. Friend join me in congratulating a hospital in my constituency on its news? Today, Tameside general hospital has come out of special measures. Although we are concerned about Healthier Together and some of its proposals, that is fantastic news for the overall package for my constituents.

[Mike Kane]

May I say a couple of things? On a personal level, I am delighted that my hon. Friend won her seat of Ashton-under-Lyne. She worked at the coalface of integrated care services in east Manchester and she brings all that experience to the House. I, too, was involved in public life in Tameside, for six years, so I am delighted that the hospital has been taken out of special measures today. I pay tribute to everyone who has helped that to happen, from those in the Ministry to local leaders and the consultants at Wythenshawe hospital who over the past few years have advised on bringing Tameside general hospital out of special measures.

Almost £2 billion has been taken out of the budget for adult social care, with more cuts to come. We need to do things differently to meet the challenges of the time. Better integration of local authority services and the NHS will be a key part of that change and will be realised under the new powers being devolved to Greater Manchester. My hon. Friend the Member for Stretford and Urmston (Kate Green), the hon. Member for Altrincham and Sale West (Mr Brady) and I have serious concerns about the outcome of Healthier Together and believe that the decision-making process is flawed.

Reorganising our tertiary services before resolving the huge challenges that we face to integrate our health and social care in the region feels like putting the cart before the horse. The benefits to be gained from our devolved powers in this area are yet to be realised, so we are redesigning our tertiary services in the dark. My constituency is home to the University Hospital of South Manchester Trust, which delivers services costing £450 million, employs 6,500 people and has 530 volunteers who give up their free time to help patients and visitors. The UHSM hospital has several fields of specialist expertise, including cardiology and cardiothoracic surgery, heart and lung transplantation, respiratory conditions, burns and plastics, and cancer and breast care services. Indeed, the trust is home to Europe’s first purpose-built breast cancer prevention centre. Its hospital not only serves the people of south Manchester and Trafford, but helps patients from across the north-west and beyond.

Healthier Together has decided that UHSM will partner the Central Manchester University Hospitals NHS Foundation Trust, or CMFT, in a single service for Trafford and Manchester. UHSM and CMFT have agreed to work together to improve collaboration between the trusts. There is clearly a great opportunity for two of Greater Manchester’s leading university teaching hospitals to work together to improve services, to increase integration at all levels, including with social care, and to improve research and education.

The Wythenshawe hospital, however, provides an extensive portfolio of secondary and tertiary services that rely on support from general surgery to maintain their quality and safety. In fact, UHSM provides all 18 of the services identified by Healthier Together as needing support from general surgery, including secondary services such as maternity, gynaecology, gastroenterology, urology and acute medicine, as well as tertiary services such as heart and lung transplant, burns care, cystic fibrosis and extracorporeal membrane oxygenation, which are provided only by UHSM for patients from across Greater Manchester and the north-west.

UHSM regularly accepts elective and emergency surgical patients from Greater Manchester and beyond who require the specialist support of its tertiary services —for example, patients requiring emergency or complex elective general surgery with complex cardiac disease. There is genuine concern that those secondary and tertiary services, which are outside the scope of Healthier Together, could be destabilised or downgraded through the implementation of the proposals.

UHSM also provides all the services, as identified by Healthier Together, on which emergency, high-risk general surgery is absolutely dependent, such as interventional gastrointestinal radiology and interventional vascular radiology. The latter is only provided at three hospitals in Greater Manchester that also provide vascular surgery, one of which is UHSM’s Wythenshawe hospital. Wythenshawe hospital must continue to deliver high-risk, emergency general surgery procedures for in-patients and for surgical emergencies in its secondary and tertiary services. UHSM will need to retain its existing level of general surgery support at Wythenshawe hospital in order to undertake surgical assessment, perform emergency surgery and manage the elective workload from a highly complex group of patients.

We were pleased that, in order to support UHSM’s tertiary services, Healthier Together recognised at a public meeting on 15 July that Wythenshawe hospital would need a higher level of general surgery service than that described in the Healthier Together service model for a local hospital. Much greater clarity, however, is required on how secondary care services, such as maternity, gynaecology, gastroenterology, urology and acute medicine, will continue to be supported, as the service model for general surgery could have significant implications for many services outside the scope of Healthier Together.

UHSM believes that the key features of a service that would maintain the quality and safety of its secondary and tertiary services are that Wythenshawe hospital should meet the Healthier Together quality and safety standards; should remain a receiving site for emergency general patients, including those with co-morbidities in its tertiary specialties and those who self-present; should have 24/7 senior general surgical assessment and opinion rapidly available to A&E; should remain able to admit and manage general surgery patients of all types; and should continue to deliver all emergency general surgery procedures, both major and minor, for in-house emergencies—for example, in-patients in urology—as well as for emergency general surgery patients with co-morbidities in its tertiary specialties. I am thinking, for example, of a patient with a bowel obstruction who is also being treated by the hospital for cystic fibrosis. As a minimum, the existing level of general surgery capacity must be retained in order to deliver and maintain that level of service in support of UHSM’s secondary and tertiary services.

Wythenshawe currently has a high-capability team of 10 consultant general surgeons with experience in all specialities of managing high-risk surgical emergencies in-patients, supported by a team of trainee surgeons. Although Healthier Together analysed implications for the consultant workforce, it is not clear what analysis there has been of the implications for other staff, including the effects on medical training posts and the support those posts provide to consultants.

Healthier Together has recognised that the service model required at UHSM must be more than that described by the programme for a local general hospital, and UHSM’s surgeons have been invited to discuss potential service models with the Healthier Together team. However, serious questions have been raised with both me and Members whose constituencies border mine about patient safety and quality in what can only be described as a fudged model for UHSM, which would be neither a specialist hospital nor a local one.

Throughout the Healthier Together process, we have been told that the dominant driving force of the proposed changes is to save more lives, yet in the end the final part of the decision to allocate the fourth specialist site was taken based on one factor only: travel and access. It is clear that for the Greater Manchester-wide—indeed, north-west-wide—specialist services provided at UHSM to continue safely, a robust and high-quality general surgery service must be maintained at Wythenshawe hospital. That is essential to ensure the quality and safety of the secondary and tertiary services that our constituents and patients from across Greater Manchester, and beyond, rely on.

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[Jeff Smith (Manchester, Withington) (Lab)]

Thank you, Mr Hollobone, for the opportunity to take part in today’s debate. It is a pleasure to serve under your chairmanship for the first time. I echo other hon. Members’ congratulations to my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) on securing the debate.

I will be brief because I do not want to repeat other hon. Members’ comments about Healthier Together, but I agree with a number of concerns raised about the process. The consultation was less than ideal and I think we all agree that the model needs review to ensure that we deliver the highest quality services for patients. I also agree that there was a strong case for awarding Wythenshawe the fourth specialist status. The high quality of the services at that hospital has already been outlined and the transport connectivity, especially given the new developments of the Metrolink line and the relief road, makes it the best option.

Like other Members here, I was disappointed by the decision not to award the fourth specialist status to Wythenshawe. What is key now is for the assurances that we have been given in relation to the existing specialisms to be robust, and for those services to be protected. I visited Wythenshawe hospital over the summer and saw for myself some of the absolutely excellent, world-leading specialist heart and vascular care provided there. What I took away from that visit more than anything was how much some of that excellent specialist provision relied on high-quality general surgery support. I agree that it is vital that we do not lose those connections and that expertise.

Having expressed disappointment about the process and the outcome of the consultation and decision making, we should not be blind to the opportunities that we now have in healthcare in Greater Manchester, particularly south Manchester. Co-operation, not competition, needs to be the future for our NHS. That is what lies behind the principles of Healthier Together, which we agree with, and the plans for devolution of health funding and organisation to Greater Manchester.

[Angela Rayner]

I congratulate the hon. Member for Altrincham and Sale West (Mr Brady) and my hon. Friends the Members for Wythenshawe and Sale East (Mike Kane) and for Stretford and Urmston (Kate Green) on making a compelling case, which I hope the Minister listens to.

Does my hon. Friend the Member for Manchester, Withington (Jeff Smith) agree that when we are looking at devolution and the reconfiguration of health across Greater Manchester, the evidence shows overwhelmingly that public opinion will be undermined if we rush ahead with a proposal that is clearly not good for the people of Greater Manchester? People have genuine concerns that we will not achieve the fantastic things that we could by looking at reconfiguration of health. We must consider pausing the situation and listen to the general population of Greater Manchester, giving them a voice in this process which they feel they have not had so far.

[Jeff Smith]

My hon. Friend makes an excellent point. Clearly, Wythenshawe was the public choice for a specialist hospital.

On working together, which I was just talking about, there is clearly a growing and improved relationship between Wythenshawe and the Manchester Royal Infirmary. Some people see that as a concern, but I think that it is very much to be welcomed and we need to see it as an opportunity.

In south Manchester, we have the opportunity to be an exemplar of partnership working. We have two fine hospitals in Wythenshawe and the MRI, which are on either side of my constituency. My constituency also houses the excellent—and, I believe, underused—facilities at Withington community hospital, which was established under the last Labour Government. I look forward to an expanded role for Withington community hospital in health provision in south Manchester, supporting the two major hospitals and providing joined-up services for all our communities.

We have an opportunity to use Withington community hospital to integrate community services, primary care, secondary care and mental health support, with health services and social care services working together for the benefit of all the community in Manchester Withington and the whole of south Manchester. I urge everyone involved to make the most of that opportunity to expand and improve services at Withington community hospital.

I agree with many comments that hon. Members have made about the Healthier Together process, but I welcome the opportunity to use all those hospital resources together—to use Withington as a thriving community hospital to improve health outcomes for people in south Manchester.

Oral Answers to Questions

Angela Rayner Excerpts

Tuesday 7th July 2015 Commons Chamber

[Matthew Pennycook (Greenwich and Woolwich) (Lab)]

6. What progress the Government have made on achieving parity of esteem for physical and mental health services.

[Angela Rayner (Ashton-under-Lyne) (Lab)]

7. What progress the Government have made on achieving parity of esteem for physical and mental health services.

[Pat Glass (North West Durham) (Lab)]

15. What progress the Government have made on achieving parity of esteem for physical and mental health services.

--- Later in debate ---

[Angela Rayner]

Mental health budget cuts have hit us hard locally. I hope that the Minister will join me in paying tribute to the work of the Anthony Seddon Fund, which has raised thousands of pounds for mental health and wellbeing projects in Tameside and Failsworth? Will he promise real parity of esteem and pledge to increase mental health spending, not to cut it?

[Alistair Burt]

I refer the hon. Lady to the answer I gave to the hon. Member for Greenwich and Woolwich (Matthew Pennycook). Mental health funding is increasing, and parity of esteem is demonstrated by having access targets and targets for waiting times for the first time. Those measures could have been introduced by a previous Government but they were not, and the demonstration of parity of esteem shown by that legislation and by the increase in investment should help to reassure the hon. Lady’s constituents. I pay tribute to those who work in a voluntary capacity to assist those with mental health issues.

Health and Social Care

Angela Rayner Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Angela Rayner (Ashton-under-Lyne) (Lab)]

Thank you for calling me to speak, Mr Deputy Speaker. I also thank the hon. Member for Hereford and South Herefordshire (Jesse Norman) for his speech.

There has been an Ashton-under-Lyne constituency since 1832, and although there have been significant boundary changes during the last 183 years, the strength and character of the people of my constituency have not changed. It is the people of Ashton-under-Lyne who are at the start, the heart and the end of my maiden speech. It is to them that I owe this tremendous honour and privilege. They remain proud, warm and welcoming, and, most of all, resilient, although I fear that those qualities will be severely tested over the next five years.

My constituency consists of three distinct communities, Ashton, Droylsden and Failsworth. It has been well served by its elected representatives over the years, and I am proud to say that, since 1935, it has happily returned an unbroken line of Labour MPs. I pay tribute to David Heyes, my predecessor, whom Members will recall for his 14-year service in the House. A former advice worker and a proud fellow member of my trade union, Unison, David was adept at handling constituency casework, as I now know because of my casework load. He was also a real champion of our NHS, and, in particular, of Tameside general hospital, in our constituency.

All the previous MPs who have represented my historic constituency have had one thing in common that I do not share: they have all been men. Today, I stand here making my maiden speech as the first woman MP to serve Ashton-under-Lyne in 183 years, and, as the first woman MP, I promise that I will do all in my power to live up to the examples shown by my predecessors. Of course, I could never fill their shoes—mine tend to have three-inch heels and to be rather more colourful—but I walk in their footsteps. We are different, and I will be different, but we are equal too.

Today, in this House of democracy, we are making a little more history. I lay claim to being the only Member of Parliament ever to have worked as a home carer. I have known the insecurity of zero-hours contracts myself, as a worker, and also the insecurity of the people who depend on our care. I have also seen how quality care can change lives and make a real difference. One in eight adults in Ashton-under-Lyne is providing unpaid care by looking after a loved one. Carers make a remarkable contribution to our society, holding families together and enabling loved ones to get the most out of life. Their care saves the United Kingdom billions every year. I agree with all that was said earlier by my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley).

A careworker becoming a Member of Parliament: that is real aspiration for you. Perhaps I am also the only Member who, at the age of 16 and pregnant, was told in no uncertain terms that I would never amount to anything. If only those people could see me now! I am proud to be in this place, for myself, for my family, for my party, and for the people whom I represent. I am proud, too, for women, who are the backbone of our society and the rock of our families. As a mother, I know what it is like to struggle to make ends meet. However, I also know how Governments can change people’s lives for the better. It was my party—the Labour party—that in government founded the national health service. Many Members on both sides of this House will have cause to be thankful for the care the NHS has provided. One of my sons owes his life to our NHS. He was born at just 23 weeks’ gestation. He clung to life for months in an intensive care unit in Manchester’s St Mary’s hospital. He finally pulled through thanks to the care of our NHS staff. Members may therefore understand that I will be watching intently how this Government treat our NHS over the next five years both as an MP and as a mother, and let me give a warning—an angry mother is someone you just don’t want to tangle with.

I take my job—this, my only job—extremely seriously. I will bring determination and commitment to my socialist values in representing my constituents. The failures of the last Government on our NHS have led to crisis after crisis and countless broken promises. For all the talk from those on the Treasury Bench, they cannot hide from the daily misery people face up and down the country. Because of Government failures, the NHS has no money and not enough permanent staff, and GP services are overstretched.

I will always tell it how it is—my constituents deserve no less—and I will do so in my own little northern way. I also have a message from my constituents to the Treasury Bench: stop privatising and selling off our NHS.

To sum up, I turn back to my constituency of Ashton-under-Lyne and its journey from mill town to, today, a centre for manufacturing and retail excellence, supported by excellent transport links, not to mention our award-winning market.

I thank you, Mr Deputy Speaker, for giving me the opportunity to make my maiden speech and I thank Members for listening.