Care Homes: England

Anne Marie Morris Excerpts

Wednesday 13th January 2016 Westminster Hall

[Peter Kyle]

I am extremely grateful to my hon. Friend for raising an incredibly important point, and I know well from conversations that we have had both in the Chamber and outside it how much she advocates for her constituents who are in care homes. The fact is that the so-called bed-blocking problem is often caused not by a lack of beds, but by a lack of capacity out in communities, for various reasons. One of those involves communities and the care home sector itself. The fact that people are ending up in hospitals is indicative of the much broader problem of caring for people where they need to be cared for most, which is in their homes and communities. My hon. Friend makes that point very well.

The significant cuts to local council funding have led to a 17% reduction in real terms for local authority spending. Industry research cited by ResPublica points to a shortfall between the cost and provision of the average weekly fee paid by local authorities, which worked out as £42 per resident per week in the period between October 2014 to September 2015.

[Anne Marie Morris (Newton Abbot) (Con)]

As the hon. Gentleman may know, I have been a great champion of care homes and the need to meet the challenges over many years. Does he at least, despite being absolutely right to raise these problems, feel some comfort from the 2% precept? I understand that many of the county councils are going to take up that precept, which has been introduced to alleviate some of the challenges that he alludes to.

[Peter Kyle]

I am very grateful for that intervention. I will come to the precept in a moment, when I would welcome further interventions as we talk about the detail of the precept and how it actually, while being welcome on a surface level, will be rolled out in different ways and impact on communities differently. I will keep my eyes open, as the hon. Lady might well want to come back to this when we tackle those issues.

The pressures on care providers will only be exacerbated by the increases in the minimum wage that will come in from this April. However, let me restate my position on the rising minimum wage for the avoidance of any doubt: I believe that those working in the caring professions deserve a pay rise for the fantastic jobs that they do, especially considering that it has sadly become a low-pay sector. I am glad that there is now cross-party consensus on the ambitious rise that is deserved by all those on low pay. However, we must make this work, and it will only work if we are aware of and prepare for what will happen in the areas that this will impact on hardest.

The National Care Association, for example, has estimated that the rise will add at least 5% to payrolls this year and a further 7% year on year by 2020. Without extra resources, local authorities will end up pushing independent, statutorily funded care homes closer to the brink. The excellent ResPublica report from November laid bare the startling and shocking fact that an unfunded living wage could end up with the loss of 37,000 care home places. I know that the Minister and his colleagues will point to two actions that they think will mitigate that, so let me address both of those in turn.

First, there is the social care precept. Introduced in the autumn statement, it gives local authorities the power to raise council tax by an additional 2%, the proceeds of which are ring-fenced for social care. Although all additional funds are welcome, that is a drop in the ocean compared with the additional resources needed. Following the autumn statement, the King’s Fund estimated that the funding gap for social care could be as high as £3.5 billion by the end of this Parliament.

What is more, the precept may well end up generating extra revenue where it is least needed. At present, residential care home funding is split between people who pay for their care themselves and those who have it paid for by their local authority. Self-funders pay 50% more than those funded by councils so, in effect, they subsidise those paid for by the public purse. It is not hard to work out that the homes with a smaller number of self-funders are the ones who are most at risk financially from the cut in funding rates from local authorities. The split varies across the country, but on the estimated figures put together by LaingBuisson in its “Care of Older People UK Market Report”, the number of self-funders in 2014 was only 18% in the north-east, with the majority of other regions hovering around the 40% mark. It is pretty obvious that the power to raise council tax will generate the most revenue in the areas with a higher council tax base, namely the southern regions of England, which—you guessed it—have a higher number of self-funders.

[Peter Kyle]

I am very grateful to my hon. Friend for making that point. In representing Redcar, she knows better than anyone that people in residential care homes that are heavily reliant on statutory funding will be hit the most because of the cuts that are going into local authorities, and they will be hit again by the precept, which, because of the process that I have just outlined, will be front-loading resources into the areas that need it least. Her area of the country will have people who are more dependent on statutory funding for care home places. The 2% is based on a lower percentage of people paying council tax in the first place and will have to cover more people. That is why the precept is not fair and will not get to the people who need it most.

[Anne Marie Morris]

The hon. Gentleman is being incredibly generous with his time. He raised a point about inequality. Does he agree that we should be asking the Care Quality Commission to look at how much funding is being supplied in each county to each home? At the moment, it seems that it is a bit of a lottery, for all sorts of reasons, which may or may not be part of his argument. At the very least, we should agree the standard of care and it should be equal across the country.

[Peter Kyle]

I will always be generous with my time for the hon. Lady because, early in this debate, we have found common ground. Later in my speech, I will call for assessment of exactly those areas. We need to understand how the funding changes and the new mechanisms are impacting on the ground and geographically across the country. We must make sure that any revenues generated, particularly in these times of restraint, are going to the parts of the country that need it most. My hon. Friend the Member for Redcar (Anna Turley) made the point well from the Opposition Benches. In this case, the support promised by the Government will simply not end up where it is needed most.

Secondly, on the better care fund, Ministers have belatedly recognised some of the flaws in simply relying on a precept to generate the extra funds needed for social care. There is simply not enough revenue being generated in poorer areas. The Government have said they will take that into account and use a formula for allocating extra funds for these areas taken from the better care fund. That was announced less than a month ago and we wait to see exactly how the details will operate in practice. There are murky areas and a lot of detail is coming. We must make sure we know exactly how this will impact providers in the front line.

Care England, a leading representative body for the independent care services, has already voiced its concern. It doubts whether the funding will get to the care homes that need it most. It is more likely that it will be used on other unfunded projects across the social care budget. It is worth remembering that the initial funding for the better care fund was not new money; it was funding to assist health services which was re-allocated to local authorities. I want to give the Minister the opportunity today to confirm whether the £1.5 billion is new money, or is again taken from existing health service budgets.

Local authorities will not see any of this money, whether new or recycled, until 2017-18 and even then it will be only £105 million. It could be too little, too late to prevent parts of our care home sector catering for the most vulnerable people in our society collapsing or withdrawing from the market and focusing on self-funding residents. Initial better care fund plans have been signed off by local authorities and NHS England. It would be great if an evaluation was conducted into how the funding to date has helped to support residential care homes, if at all.

I think the Minister can now see that there is cross-party support for this kind of independent evaluation into how funding mechanisms are impacting on front-line care provision. It could act as a best practice guide for authorities going forward, even when the extra resources the Government referred to become available. Will the Minister commit to this evaluation covering the impact of funding on the sector? Both Government and Opposition Members would find that helpful.

The majority of media coverage of the sector has been about the state of big providers, such as Four Seasons Health Care and HC-One, and speculation about their future viability. It is important to realise that the 10 largest providers account for about only 25% of the market, the rest being much smaller, independent providers. In my constituency there is a small family home, Wilbury rest home. Last year I sat down with the owner, Graham Dean, shortly after the Chancellor’s announcement on the living wage. Graham is the second generation of his family to run the home and, remarkably, he was born in it. Listening to him and other local independent care home managers talking with kindness, compassion and outright professionalism about the people they care for day in and day out has left a deep impression on me. They provide the kind of loving, caring environment that every human being deserves into their old age.

There are countless homes like that dotted around the country, but they are being pushed to the limit. Indeed, a survey from the National Care Association shows that almost a quarter of providers could exit the market altogether. That would be a tragedy for residents and society, and a crisis for the Government.

Another issue that is putting pressure on the sector is the national shortage of nurses, which has resulted in the increased use of agency nurses. In some cases that costs double the amount for permanent staff. To the Government’s credit, they have recognised that there is an issue and have been working with the care sector and with the Government’s skills body to develop a new training scheme to create a career ladder into caring professions. Sadly, that project was axed last December, just weeks before it was due to be launched. I understand from written answers that I have received that that was not a decision taken by the Department of Health. As a member of the Select Committee on Business, Innovation and Skills, I am happy to take up this cause with the relevant Ministers in that Department if the Minister feels that would be helpful. I would like to aid his work and I hope that his officials have already been doing much work behind the scenes to fight for its reinstatement.

As I move to my closing remarks, I would appreciate some reassurance from the Minister that the Government have a plan—dare I say it, a plan B—that is ready to be implemented should the worst-case scenario predicted by ResPublica and other respected think-tanks in the health sector come to pass. Do the Government have in place a robust contingency plan should the statutorily funded care home sector collapse, resulting in the nightmare scenario of 37,000 older people becoming homeless?

When Southern Cross Healthcare went bust in 2011, there were just enough resources from other providers in the sector to take over. Due to the current state of the industry, no private provider has the capacity to respond to a shortfall of 37,000 beds.

Oral Answers to Questions

Anne Marie Morris Excerpts

Tuesday 5th January 2016 Commons Chamber

[George Freeman]

That is an important point. It is up to each hospital to implement digitalisation in its own way, but we are putting in place a series of steps to make sure that all parts of the NHS are supported and encouraged in the drive for delivery of a paperless NHS by 2020. In the new year, we are requiring the clinical commissioning group digital index, which will measure the digitalisation of all health economies, and we are launching a review of best practice. We are absolutely committed to driving digitalisation so that the 21st-century NHS is not running on paper and cardboard.

[Anne Marie Morris (Newton Abbot) (Con)]

10. What plans he has to publish a rural healthcare strategy.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

The “Five Year Forward View” published by NHS England sets out the healthcare strategy for the whole of England, including rural areas. Rural areas have their own health needs, which should be taken into account in planning and developing healthcare systems.

[Anne Marie Morris]

What specific research has the Minister undertaken in order to understand, and what steps has he taken to address, the very different needs and costs of rural communities in the south-west, which has disproportionately high numbers of over 85-year-olds and population distributions that make inflexible multi-speciality community providers and primary and acute care configurations unattainable?

[Ben Gummer]

The “Five Year Forward View”, written by Simon Stevens, takes particular account of rural areas, but of course not all rural areas are the same. It is down to clinical commissioning groups to judge the needs of their local areas and make sure that they are reflecting the specific circumstances in which they find themselves.

Off-patent Drugs Bill

Anne Marie Morris Excerpts

Friday 6th November 2015 Commons Chamber

[Nick Thomas-Symonds]

My point is precisely that it is about more than information.

A licence for off-patent drugs would make a big difference. The all-party parliamentary group on off-patent drugs, which I chair, met on 15 October and took evidence from experts across the board. Pan Pantziarka, a repurposing specialist, said that granting a new licence triggers a “whole cascade of things”: the British National Formulary gets updated, clinical commissioning groups and specialist bodies take note, and guidance is updated. He said that, without that, we are dependent on doctors reading the literature and prescribing off-label, and that that is not the solution we want.

Sir John Burn, professor of clinical genetics and a non-executive director of NHS England told our inquiry:

“The other problem is making decisions in a short time scale—we haven’t got time to look at the bundle of evidence presented. The whole point of the licensing process is to distil that for the physician”

[Anne Marie Morris (Newton Abbot) (Con)]

Will the hon. Gentleman clarify something for me? Under his proposed scheme, when a drug gets relicensed, what will the impact be on pricing? When a drug goes off-patent, one benefit is that it effectively becomes cheaper because any company can manufacture it, which is clearly a benefit for the NHS. With relicensing, is there a risk that the company will effectively re-price, landing the NHS with extra costs?

[Nick Thomas-Symonds]

I do not accept that that is a risk of the Bill. As the hon. Lady knows, the drugs are available for pennies a day. Under the Bill, the Government would step in to address a market failure. The Bill will not have the impact that she believes it will have. She makes a reasonable point, but it is not one that will arise under the apparatus and structure proposed by the Bill.

The alternative to the Bill—I firmly believe that if this Government do not do this, a future Government will have to legislate—is to continue to encourage more off-label prescribing. Even if that were desirable, very little has happened. In a letter dated 2 November, the Royal College of Physicians states:

“As there has been no meaningful progress on a non-legislative solution to this issue, we believe that your Bill is an important first step towards expanding access to these vital drugs.”

The proposal was debated a year ago and we have had a year to see whether there is a non-legislative solution to the problem.

The Bill has incredibly wide support across the professional spheres. I apologise in advance for not naming every charity that supports it.

--- Later in debate ---

[Nick Thomas-Symonds]

The hon. Gentleman is absolutely right. The Bill could really assist people out there in the country, which is why it should proceed.

[Anne Marie Morris]

The hon. Gentleman has not talked about the consequences for off-label drugs. I do not think that anybody would disagree with using good drugs for alternative purposes. Most of the concerns I have heard about the Bill are around the methodology and the process and the impact on off-label drugs. At the moment, drugs not on the agreed list can be prescribed, and I would be concerned if there was any threat to the ability to do so.

[Nick Thomas-Symonds]

With respect, that is precisely what the Bill seeks to do. We are talking about drugs that have been on patent for a particular purpose and that have a licence in that indication, but which also have another purpose. At the moment, theoretically, they can be prescribed off label, but that simply does not happen consistently across different spheres of medicine or across the country. The letter I read out from the Royal College of Physicians, dated 2 November, made that exact point.

The Bill is a common-sense solution that commands support across parties, in different spheres of the medical profession and from other stakeholders, and I commend it to the House.

NHS (Charitable Trusts Etc.) Bill

Anne Marie Morris Excerpts

Friday 6th November 2015 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

I congratulate my hon. Friend the Member for Aldridge-Brownhills (Wendy Morton) on bringing her private Member’s Bill before the House for its Second Reading. I also congratulate her on her election in May, which ensured that a seat that has long been Conservative remained blue.

I am pleased that the Bill is to receive its Second Reading today. It aims to allow Great Ormond Street hospital to continue to benefit from J. M. Barrie’s generous and noble gesture. It would allow all royalties derived from public performances, commercial publications or communication to the public of “Peter Pan” to be donated to Great Ormond Street hospital. It is not known precisely how much those royalties have raised over time, because apparently a condition in Mr Barrie’s will stated that he wanted the amount raised to remain unknown. The charity itself states that

“it’s enormously valuable—not only in financial terms, but as a symbol and as an icon—and has brought a fair amount of income to the hospital.”

To give some context to the value of the royalties, I draw attention to the fact that Disney donated more than £10 million to the hospital in just seven years, between 2008 and now. That money does not come directly from royalties and reaffirms the value of Barrie’s connection to the hospital.

The Bill makes provision in relation to two main subjects. First, as my hon. Friend the Member for Aldridge-Brownhills has explained, it would remove the Secretary of State’s powers to appoint trustees for NHS bodies in England. That would make good a commitment made by the Government in 2014. It would therefore allow for greater independence of NHS charities, which has been a concern for a number of generally larger NHS charities, which therefore support this reform. The Charity Commission, for example, said that dual regulation under both NHS and charity legislation made it difficult for NHS charities to achieve and demonstrate independence. Those concerns will be made better if we remove the Secretary of State’s power to appoint trustees on behalf of NHS trusts and foundations. I know the Department of Health is in favour of that.

Secondly, the Bill amends the Copyright, Designs and Patent Act 1998, notably sections 301 and 304 and schedule 6. Clause 3(3) changes the relevant words from

“on trustees for the benefit of the Hospital for Sick Children, Great Ormond Street, London”

to

“GOSH Children’s Charity for the benefit of Great Ormond Street Hospital for Children”.

The Bill permits the accumulation of all royalty rights to the trustees for the benefit of Great Ormond Street Hospital, London. It will allow the transfer of royalty rights to Great Ormond Street Hospital Children’s Charity of any performance or publication of the play “Peter Pan” in the UK. In doing so, Great Ormond Street hospital is free to move, in full, to become an independent charity under the regulation of the Charity Commission without the risk of losing its protection under the Copyright, Designs and Patents Act. This, as my hon. Friend made very clear, removes the dual legislation that may be perceived by some to be rather burdensome. Direct transfer of royalties will promote efficiency and, as she correctly says, reduce red tape and drive down costs, which all good Conservative Governments endeavour to achieve.

This Bill is not the first step that the Government have made towards reviewing the regulation and governance of NHS charities. In 2011, the Department of Health conducted a review of NHS charities and consulted on proposals to change the policy on their regulation and governance. In the response, charities welcomed the opportunity to seek greater independence by removing dual regulation requirements. It was clear from their responses that the current regulatory system was of considerable concern. The trustees of the Oxford Radcliffe Hospitals Charitable Funds gave the following favourable response:

“The Trustees are not likely to want to move in this direction proposed by the consultation paper in the near future, but have no objection to the Department making the transfer to an independent charity possible, providing there is no compulsion to do this.”

Sheffield Teaching Hospitals NHS Foundation Trust was also in favour, provided that the Department of Health ensured that the appropriate safeguards are in place. It said:

“The Trust has no objection in principle to NHS charitable trusts being transferred to a nominated charity outside of NHS Legislation subject to appropriate safeguards being in place to ensure that the interests of NHS patients and the relationship with the individual NHS provider bodies are preserved.”

Similarly, UCL Hospitals Charitable Foundation said:

“Yes, as this would allow the charity to be established under an incorporated model and remove the current unlimited liability for individual trustees and the freedom to appoint trustees without the constraints of the current set up.”

[Mr Speaker]

Order. Let me very gently say to the hon. Lady that I understand the natural temptation to look in the direction of a sizeable coterie of colleagues, but she is addressing her speech to the House as a whole and through the Chair.

[Anne Marie Morris]

I am appropriately reprimanded, Mr Speaker. I shall ensure that, in particular, I give you the focus and attention you clearly deserve, and indeed Members on the Opposition Benches.

I will continue with the history behind this valuable Bill. The Bill addresses concerns about the Secretary of State’s powers to appoint trustees of NHS foundations and trusts. In 2012, Barts and The London Charity and the Royal Brompton & Harefield Hospitals Charity said that it was

“unclear as to why the Department seems at pains to preserve the Secretary of State’s…ultimate control over the appointment and removal of trustees”.

They added:

“We broadly agree with the stated aims of the review and would welcome the outcomes listed in”

the report,

“particularly those that would result in NHS charities being able to deliver improved services to NHS patients as their beneficiaries.”

In “Review of the regulation and governance of NHS charities”, the Government’s response to the consultation, the Secretary of State said that he was

“willing to seek to remove those specific legislative provisions as soon as possible.”

The Bill allows him to fulfil that promise.

The Bill refers not only to past consultation, but to past legislation. Following the expiry of the copyright on “Peter Pan” in 1987—50 years after the death of J. M. Barrie—it was concluded that Great Ormond Street hospital should continue to benefit from Mr Barrie’s gesture, and legislation was enacted to do so under the Copyright, Designs and Patents Act 1988. Sections 301, 304 and schedule 6 briefly became redundant, due to a European Union directive on copyright, which meant that copyright law was

“harmonised at 70 years after the death of the author or 70 years after the work is lawfully made available to the public”.

The directive was implemented on 1 July 1995, giving Great Ormond Street hospital extra copyright until 2007. The 1988 Act then came into force and that unique Act remains in place to this day.

The Bill builds on this House’s commitment to Great Ormond Street hospital to benefit from the royalties from “Peter Pan”—as laid out in the 1988 Act—by effecting a change in the identity of the person on whom the right is conferred. That is because, under charity law, the trustees have converted from being special trustees appointed by the Secretary of State to being an independent charity.

There is much more to the relationship between Barrie and Great Ormond Street hospital than a benevolent gesture. Barrie’s brother was the inspiration for the play after his tragic death just before his 14th birthday. His mother was said to take comfort from the fact that her son would remain a child forever, and thus the seed was planted for “Peter Pan”.

“Peter Pan” is the story of how a young family travel to a magical land—Neverland—with the help of a little bit of fairy dust. They learn that family is a very important concept, and I have no doubt that many of the visitors to Great Ormond Street hospital and many hon. Members can relate to that. They encounter numerous perils in the shape of a hook-handed pirate, a crocodile that has swallowed an alarm clock and a jealous fairy named Tinker Bell. The story concludes with Peter Pan, the boy who did not want to grow up—I know many other boys who do not want to grow up, many of them quite old—being unable to connect with his friends as they grow older and he remains a child.

Great Ormond Street hospital works to make sure that children do get that opportunity to grow up, but without losing the comfort and experiences of being a child and enjoying their young lives. Sadly, some visitors to Great Ormond Street do not grow up, much like Barrie’s younger brother David, and the connection to Peter Pan is therefore strong ever more.

Since its completion in 1904, “Peter Pan” has formed the basis of nine films, including a spin-off series on Tinker Bell, one radio adaptation and nine TV shows since 1955, the first of which was a stage adaption aired on NBC. Seven video games contain characters from the “Peter Pan” universe. Not only that, but “Peter Pan” has continued to be reproduced in countless plays, books and comics. According to the Great Ormond Street website, between now and next March, 23 runs of “Peter Pan” will be performed across the country—north, south, east and west—including in the northern powerhouse, which is a testament to the fantastic work and its legacy.

Barrie was a great supporter of the work Great Ormond Street hospital did then; it continues to do such work to this day. In 1929, he was approached to sit on a committee to buy some land so that the hospital could build a much needed new wing. Barrie declined to serve on the committee, but said that he hoped to find another way to help. Two months later, the hospital board was stunned to learn that Barrie had handed over all his rights to “Peter Pan”. At a Guildhall dinner later that year, Barrie, as host, claimed that Peter Pan had been a patient in Great Ormond Street hospital and

“it was he who put me up to the little thing I did for the hospital.”

It therefore seems fitting that such a gesture was made to the hospital to continue its great work.

As my hon. Friend the Member for Aldridge-Brownhills said, Great Ormond Street Hospital Children’s Charity raises money to enable the hospital to provide world-class care and to pioneer treatments and cures for childhood illnesses, with an estimated 255,000 patients coming through its doors every year. The hospital originally had just 10 beds and two doctors.

[Kevin Foster]

My hon. Friend is making a long and strong speech about the benefits of Great Ormond Street hospital. Does she agree that although the hospital is based in London, it actually provides specialist care across the UK, including for some of our constituents in Devon?

[Anne Marie Morris]

My hon. Friend makes an entirely correct comment. He is absolutely right that Great Ormond Street hospital makes a fantastic contribution across the country, and those of us representing the south-west have constituents who have directly benefited from the fantastic services that the hospital offers. He was quite right to make that point.

[Albert Owen (Ynys Môn) (Lab)]

The extra money going to Great Ormond Street hospital is well appreciated by people across the United Kingdom. However, many children’s charities tell me that there is an issue about drugs, in that more of them need to be made available. The second Bill is about off-patent drugs. Will she support that Bill, because it is hugely important to the very people she is talking about?

[Anne Marie Morris]

The hon. Gentleman raises a very important point about drugs. The Government are absolutely focused on that issue. Far be it from me to take words out of the Minister’s mouth, but I am sure that he may well cover the hon. Gentleman’s comments on drugs in his response. Among other things, the special cancer drugs fund has made a considerable difference to many people suffering from cancer.

On that note, I will carry on talking about this really important piece of legislation, and to explain to hon. Members a little more about the history of the hospital. As I originally stated—[Interruption.] Mr Speaker, you are looking querulous. May I continue?

[Mr Speaker]

The hon. Lady has the floor, but I am sure that she will want to have some regard to the fact that several other hon. Members wish to speak. I am cautiously optimistic that she is approaching her peroration.

[Anne Marie Morris]

Mr Speaker, this is such a fascinating subject that I want to ensure it gets the air time it deserves. I know that my hon. Friends also have a lot to say. I am sure that we will manage to have an interesting and long debate.

[Maggie Throup]

Does my hon. Friend agree that we must get things right not just because of the financial implications for the charity, but because of the charity’s reputation?

[Anne Marie Morris]

My hon. Friend makes a crucial point. Reputation is critical. The changes that we are making today will add to the charity’s reputation and help it to raise further funds for what is a worthwhile cause.

If I may, I will continue to explain the fascinating history of Great Ormond Street hospital, the contribution it has made to our country, and why the Bill is so important and valuable and has my support and that of the Government, despite the hospital’s humble beginnings. Just as you arrived, Madam Deputy Speaker, I was explaining that the hospital originally had just 10 beds and two doctors, and was situated in a 17th-century townhouse. It has constantly redeveloped itself to ensure that it is suitable for the treatment of modern illnesses as medicine develops.

Before the inception of the NHS in 1948, Great Ormond Street was a voluntary hospital that ran fundraising campaigns to expand its size from the 1850s onwards. Because private fundraising was strongly regulated, it was owing to the support of people such as Barrie who left legacies to the hospital that it was able to develop the highest standards.

Throughout its history, the hospital has been at the forefront of numerous breakthroughs in paediatric healthcare, such as appointing the first consultant paediatric surgeon, Denis Browne, in 1928; opening the UK’s first heart and lung unit in 1947; opening the UK’s first leukaemia research unit in 1961; pioneering the first heart and lung bypass machine for children in 1961; performing the first successful bone marrow transplant in Britain in 1979; undertaking the world’s first stem cell-supported trachea transplant in a child in 2010; becoming Europe’s first children’s hospital to offer a portable haemodialysis service in 2010; and opening the Newlife birth defects research centre in 2012, which is Europe’s first research centre to tackle birth defects.

Great Ormond Street hospital would not be able to make such advances without the relevant and up-to-date equipment it has. Thanks to its supporters, it is able to provide its patients with leading-edge equipment, so that its exceptional doctors and nurses can improve diagnosis and treatment, and continue to provide children with the world-class care they need. In one notable instance, a 15-year-old machine developed an unrepairable fault and had to be replaced in 2012. If the funds to upgrade it had not been available, the hospital would have had to continue to refer patients elsewhere for imaging, which would have been inconvenient for families and costly to the hospital.

The equipment owned by the hospital includes specialist X-ray equipment, such as cone beam CT technology, which can take high-quality 3D images with less radiation than a standard CT scanner. The ultrasound equipment in the Dubowitz neuromuscular centre is used to assess about 350 patients each year and helps clinicians to make a faster and more accurate diagnosis of conditions such as muscular dystrophies, myopathies and motor neurone disease. Nutritional equipment includes equipment that can help patients, such as premature babies, those in intensive care, or those receiving treatment for gastrointestinal conditions or cancer. Because those patients are in a fragile state or receiving strong medication, they need a precise recipe with the right balance of fluids and nutrients, and the hospital is able to provide it.

[Maggie Throup]

My hon. Friend has explained precisely why Great Ormond Street hospital needs extra charitable money. It carries out fantastic work that is over and above the work found in so many other hospitals, and it is renowned across the world for its work. Whatever money it can raise through charitable donations is important.

[Anne Marie Morris]

As ever, my hon. Friend makes an important point. It is right that the money goes towards new, far-reaching, novel pieces of equipment and medical solutions, which are exactly what we need in this country. We should be proud of that and do everything we can to enable the hospital to gain as much funding as possible.

The hospital is able to facilitate a number of different wards for a number of different treatments, and that is due to the continued contribution from donations and legacies. Barrie’s contribution has been so significant over the years that, fittingly, there is a Peter Pan ward—I am sorry that there is not yet a Wendy ward, but I am sure we can do something about that.

[Bob Stewart (Beckenham) (Con)]

The Lost Boys ward.

--- Later in debate ---

[Anne Marie Morris]

Indeed. Many other items within the hospital commemorate Barrie’s donation. Those include a statue of Peter Pan and Tinker Bell at the hospital entrance, a plaque dedicated to Barrie in the hospital chapel, a Tinker Bell playroom in the Octav Botnar wing, and a tiled mural of Neverland, which was created and donated by art students at the University of Wolverhampton.

The ability of charities to become independent and subject to regulation by the Charity Commission is important. That can be seen in the 2012 consultation that set out the rationale for reform. A number of NHS charities, their representative bodies and interest groups, have called for this reform. They raised concerns that the NHS legislative framework, and how it is applied, limits the freedom of charities to grow and best support their beneficiaries.

Madam Deputy Speaker, I am, in the words of Mr Speaker, “slowly but surely” coming to the end of my contribution on this important subject. The Department’s overall conclusion was that it is appropriate to allow NHS charities that wish to move to independent status to do so, and that that should be facilitated, subject to suitable safeguards being adopted and a suitable process followed. The Department of Health said in its review of the regulation and governance of NHS charities that since the majority of respondents supported the principle behind proposals for the transition of NHS charities to independent charity status, it is appropriate to allow those who wish to follow such a course to proceed, subject to appropriate safeguards and process. At the same time the Department will ensure that organisations that wish to retain the status of an NHS charity may do so.

Given the fantastic work done by Great Ormond Street hospital, the equipment it uses to treat children, and the staff it trains to deploy that treatment, I am thoroughly supportive of ensuring that funds from legacies such as that of J. M. Barrie continue to reach their intended destinations. His legacy does not live on in only a monetary way, or a legal way as we discuss this Bill, because Peter Pan has had a societal impact on this country—even the Wendy houses that many hon. Friends have no doubt bought for their children or a young relative originate from Barrie’s play and the house built for young Wendy Darling. As Barrie once wrote:

“I suppose it’s like the ticking crocodile, isn’t it? Time is chasing after all of us.”

Other Members want to speak, so I will bring my remarks to a close. The Bill will help to ensure that Great Ormond Street continues to do fantastic work, and at the same time it will implement some of the Department of Health recommendations from the review of the regulation and governance of NHS charities. I commend it to the House.

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[Kevin Foster (Torbay) (Con)]

It is a pleasure to speak in the debate and to support the Second Reading of the Bill. Discussing a Bill about Peter Pan proposed by Wendy was not one of the subjects I expected to debate in this Chamber when I was elected, but the Bill has a serious purpose as it makes clear the independence of the charitable trusts it covers.

It is right that we should have oversight when public money is being spent, and the NHS is subject to plenty of oversight, including through this Parliament, but this is not about taxpayers’ cash but about the additional money that people freely donate. People donating should have confidence that the trustees, who are completely independent and whose goals are solely those of the charity, will decide exactly how the funds will be used. A trustee or director appointed by the Secretary of State will clearly be cognisant of their duties under charity law to put the charity’s interests first, but being appointed by the Secretary of State creates the idea that such trustees are there to represent someone else: even though those who are familiar with the law will understand the role of a trustee, that is not the impression given. It makes sense that the charities referred to in the Bill are in a similar position to most other charities in the country and may, through their members and supporters, find trustees and appoint them to the board to exercise their duties rather than having someone appointed for them by the Government.

Charities in the NHS bring additionality to NHS services; they are not about replacing them or replacing funding from the taxpayer, but about doing extra things. I think particularly of the Torbay Hospital League of Friends, an independent charity that raises money to support services at Torbay hospital and uses its flexibility and independence to get people to donate. Its “This is critical” campaign aims to equip the critical care unit that is being built. Public money provides the basic service, whereas charitable bequests and donations enhance the service.

[Anne Marie Morris]

Does my hon. Friend agree that one of the benefits of this independence is that it encourages not only donations but people to give their time? Charities need not just money but volunteers to give their precious time not only for fundraising but to work with families, patients and young children. Does he have any thoughts on that?

[Kevin Foster]

My hon. Friend is absolutely right. Charities depend on the money and time donated. That might mean time donated to raise funds for the charity or, as she mentions, for other work. Everyone can take part, rich or poor. An hour donated is an hour donated. As she will know, Torbay hospital’s cafeteria is staffed by volunteers. It not only raises money for the charity in the hospital but provides a service. People might have come in and heard not great news, or they might be anxious and stressed with a relative in hospital, and they get a valuable pastoral service over a cup of tea and a cake from volunteers who, in some cases, have been involved for many years. They provide an excellent service.

Today, we are naturally talking about the structures and finances of a charity. As my hon. Friend the Member for North Dorset (Simon Hoare) said, we should ensure that the money cannot go on Lucky Lad in the 3.10, but we should also not forget that volunteers are at the heart of charities and how they operate and work. If the charities are truly independent, that will only enhance their ability to attract volunteers, get donations and make a difference.

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[Alistair Burt]

Yes. I do not think I am trespassing on any party political ground in saying that we should recognise that people’s desire to give is built on more than just paying their taxes; it is built on an innate desire to help their communities and their neighbours. That is an instinct that cannot and should not be stopped, and it will always find its way into other areas where there are services funded by the state, but it adds a dimension that is very special. Each is valuable in its own way, and my hon. Friend is right to draw attention to that.

My hon. Friend the Member for Yeovil (Marcus Fysh) spoke of his young days visiting hospitals as the son of a paediatrician. My dad, who might be watching this debate, is a retired general practitioner and I also remember visiting hospitals with him. Perhaps, like me, the sight of needles and machines that go “ping” were sufficient to put my hon. Friend off going into medicine, which means he has ended up in the same place as me. Those days, however, were valuable and we are grateful to all those who work in the health service and have made a contribution. As a senior paediatrician, my hon. Friend’s father will have certainly done a lot of good throughout his career.

My hon. Friend the Member for North Dorset (Simon Hoare) also supported the change in the law and invited us to comprehend the risks involved in various trustees supporting Lucky Lad at Uttoxeter. Unfortunately, my brief does not extend to whether that is common practice among trustees or whether it was a major inspiration for the Bill, but my hon. Friend made his point well and it is covered by what we will go on to do.

My hon. Friend the Member for Torbay (Kevin Foster) spoke of the importance—he has also just mentioned this in his intervention—of recognising that Great Ormond Street hospital serves so many of us. He also spoke of the Torbay Hospital League of Friends and its “This is critical” campaign, which is a perfect example, as my hon. Friend the Member for Erewash has said, of a combination of people who recognise that funds are available through the national health service, but who want to make an extra contribution on top of that. We wish that and similar campaigns well.

[Anne Marie Morris]

We have heard today about a great number of institutions that undertake such voluntary work. This is a timely debate, because we are approaching Christmas, a time when more and more of this sort of work, volunteering and giving takes place. Does the Minister agree that it is absolutely on point for us to be debating the Bill at this time of year?

[Alistair Burt]

My hon. Friend makes her point well. This is traditionally a time when people look very hard at what they plan to give, both for the Christmas season and for next year. A number of appeals will be run and local hospitals recognise that this is an important time for them. I imagine that many charities will benefit from the sentiment described by my hon. Friend.

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[Alistair Burt]

My hon. Friend neatly sums up her Bill, which I will now address, and reminds us of the work of so many different trusts.

Before I finish my tributes, may I briefly mention the work of the Bedford Hospitals Charity and Brian Woodrow in my constituency? They have made an immense contribution to my constituents and those around Bedfordshire, not least through the Primrose appeal and the magnificent Macmillan cancer treatment centre that resulted from it.

Although I intend to go into the technical details of the Bill, because that is important, I also want to speak in the following debate. I do not want to take an unreasonable amount of time, but I hope the House will appreciate that there are things I must cover.

I am delighted we have the opportunity to debate and discuss NHS charities, which provide support to our health system that is crucial to the delivery of better care for patients. Thanks to the generosity of the people of this country, NHS charities have been able to deliver valuable enhancements to the wellbeing and experience of patients and staff for many decades. I hope that today’s debate has helped to publicise the valuable work the charities do, and that it will encourage more people to give them their support.

This Government have listened to NHS charities and delivered the opportunity for those that wish to have greater independence in order to evolve and grow to meet the needs of their beneficiaries. A number of charities have seized the opportunity to become independent, with others planning to do so in the near future.

The Bill puts the last pieces of the jigsaw in place to deliver the vision the Government set out in 2014. When the previous Government came to office in 2010, a number of NHS charities and their representative bodies and interest groups were calling for reform. They were concerned about the NHS framework and inflexibility. The Government were also committed to deregulation, promoting localism and the big society, and freeing the NHS from central Government controls.

Following a review in 2011, the Government consulted in 2012 on options for changes to the regulation and governance of NHS charities. The fundamental aim of the proposals was to review the legislative powers relating to the governance of NHS charities, to preserve and extend their independence from central Government.

In their 2014 response to the consultation, the Government noted that the majority of respondents supported the principle of the proposals for the transition of NHS charities to independent charity status. They concluded that it would be appropriate to allow those NHS charities that wish to do so to convert to become an independent charity.

[Anne Marie Morris]

One of the questions we have not touched on is how that transition will be made. Will the Minister add a few words about how, in practical terms, we will move from having two sets of trustees and pots of money to one set? We clearly want that to be as unbureaucratic as possible.

[Alistair Burt]

It will be. The procedure is very simple. Some of it is laid out in the Bill and some of it will be discussed in Committee. The intention is to make it very simple for trustees, and some charities are already moving that way. It is certainly not the intention to let any bureaucracy get in the way of the process, and there is no reason why it should do so.

The Government concluded that where trustees have been appointed by the Secretary of State, the provisions for the appointments will be repealed as soon as possible. I am pleased that the Bill will remove those powers. The Bill will confer the rights to the play “Peter Pan” on the new independent charity for Great Ormond Street. That will enable the charity to complete its conversion by removing the statutory obstacle preventing Great Ormond Street Hospital Children’s Charity from becoming fully independent.

An informative debate has taken place and, as I have said, I thank all hon. Members for their speeches. I thank my hon. Friend the Member for Aldridge-Brownhills for all the hard work and endeavour she has put into presenting the Bill today. We salute her for the way in which she has applied herself, her diligent research and her time spent engaging with NHS charities. I also want to pay tribute to Baroness Blackstone for her foresight and determination in securing Great Ormond Street Hospital Children’s Charity’s rights to the royalties from the play “Peter Pan” so that current and future generations can benefit from J. M. Barrie’s generosity.

As several Members have mentioned, the work of NHS charities often goes unheralded. The charities play a crucial role in supporting the NHS in a wide range of initiatives and projects, including research, new buildings and equipment, and helping to provide services over and above those provided by the NHS. Some have large sums at their disposal, many have much less, but they all make a big contribution to improving the lives of patients and staff.

Thanks to the generosity of the public and the hard work of its fundraisers, Birmingham Children’s Hospital Charities reached its £2 million target for its children’s heart appeal. It will make Birmingham the only children’s hospital in Britain with its own hybrid theatre, which will enable two procedures to be done at the same time so that children do not have to go back in for a second operation at a later date. Fundraising helped to build the hybrid theatre and a new catheterisation laboratory, where keyhole cardiac surgery can be carried out, and it will increase the number of intensive care beds from 20 to 31. The trust invested some of its own funds in the project, and its supporters raised the final £2 million in a variety of imaginative ways, from sponsored abseils and a freezing Snowdon swim to major corporate donations and half marathons. The new theatre is now in use and has treated 126 patients so far, many with hugely complex heart problems. It will treat an extra 300 patients a year, and there are plans for more in the future. That is a perfect example of how the work of a hospital and a charity can coincide, and of how work done in one area can benefit other areas throughout the region.

The Sheffield Hospitals Charity has provided funding for a revolutionary bionic exoskeleton suit in the spinal cord injury centre. This revolutionary suit enables paralysed patients to experience standing and walking, sometimes for the first time, with the suit’s assistance. The University College London Hospital Charity supported the construction of the Cotton Rooms, the first four-star, purpose-built boutique hotel for NHS patients. Opened in 2012 at a cost of £4.5 million, it has 35 rooms for patients and their partners. Over 1,000 patients a year typically stay at the hotel, spending between one and 25 nights.

Some charities support vital research work. The Chelsea and Westminster Health Charity is supporting the Borne programme, which has two ambitions: first, to prevent death and disability in pregnancy and childbirth, and secondly, to create lifelong health for mothers and babies. In the UK alone, one in 10 babies is born too soon; that is nearly 80,000 babies a year. Premature birth is responsible for 70% of disability and death in new-born babies. The charity has raised £3 million, which has enabled it to identify treatments that could reduce the risk of pre-term labour in high-risk pregnancies from 35% to 10% or less. It has also supported a study highlighting the link between maternal diet and a baby’s brain development.

NHS charities are supporting and enhancing mental health services. Poor mental health is one of the major challenges facing society today. Never in my political life have I noticed a time when mental health has been given so much attention in so many quarters of the House and by Members from all the different parties. I think that the cross-party contribution to the development of advancements in mental health treatment will be one of the signature features of this Parliament. I welcome the interest that has been shown by those, including Front Benchers, on both sides of the House.

[Anne Marie Morris]

I am delighted that the Minister has raised the issue of mental health, because what we achieve in Parliament is not just done through legislation and regulation or by debate in the House. Does he agree that communities have taken this issue on board? I have been involved in dementia-friendly projects in two of my towns, whereby everybody in the street is made well aware of what they can do to help the confused or those with mental health problems.

[Alistair Burt]

My hon. Friend makes a very important point about the community’s engagement and the way in which it can work with existing health services. The renewed attention paid to mental health will provide many further such opportunities.

Care Homes (Regulation)

Anne Marie Morris Excerpts

Wednesday 4th November 2015 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Con)]

Thank you, Ms Vaz. I shall endeavour to speed through my comments. First, I commend my hon. Friend the Member for North Devon (Peter Heaton-Jones). We are both MPs from the south-west, and our constituencies have a significant number of elderly residents and therefore of care homes and nursing homes. The issue he raises is crucial, but perhaps I can take the opportunity to broaden the debate, because I believe that the problem is not as simple as just the CQC. Many of his points about the CQC were well put, but this is a broader challenge.

I shall start by explaining that nine statutory bodies—all independent and all accountable to Parliament—are overseen by the Professional Standards Authority for Health and Social Care, so it is a question of looking not just at the CQC, but at all those bodies together. You can appreciate, Ms Vaz, that nine bodies will inevitably have various sets of regulations, which will not necessarily be consistent and work well together. Indeed, the Professional Standards Authority report in 2015 made it clear that the regulatory framework was unfit for purpose.

However, this is not just about the regulatory framework; it is broader than that, too. Rules and regulations do not make people good. Regulation is about trying to ensure best practice and that those who default are made to sort the situation out. As my hon. Friend said, too much bureaucracy takes the care out of caring, and this is really about care. It should not be about bureaucracy —box-ticking. It should be about ensuring that elderly residents are properly respected and cared for.

The Professional Standards Authority has concluded—unsurprisingly, given its oversight of nine authorities—that less is actually more. It suggests that we need a new framework and that we should look at sharing objectives across all the regulators and sharing the theories of what works so that there is a consistent approach. Most importantly, we should rebuild the trust among the professionals, the public and the regulator, because at the moment there is an awful lot of mudslinging among the three and that is not helpful. What we need is a good system that works for our society. We also need proper risk assessment models to ensure that we are looking at the things that really matter and actually put residents at risk.

There are, inevitably and tragically, many cases that none of us want to be repeated. It almost goes without saying—my hon. Friend has already made it clear—that there are plenty of examples. Indeed, the statistics demonstrate that there is clearly something wrong. The report “The state of health care and adult social care in England 2014/15” showed that 60% of providers found to be inadequate were not improving, so there is clearly something not quite right. In Bedfordshire the Old Village School home managed to go from “good” to closure within six months; previously it had been excellent. There is clearly something at the root of this that is not just about regulation and bureaucracy, but is more fundamental.

Before I move to that broad picture, I have a couple more thoughts on the Care Quality Commission itself. I have met Andrea Sutcliffe on a number of occasions and I believe that she is cognisant of and takes seriously the concerns raised by my hon. Friend. However, there is a challenge, which is that the remit of the CQC was expanded to cover so much that in reality it is almost inconceivable that it could do the job properly, to the right standards, given how stretched it is. Indeed, in its own survey in 2014, 40% of CQC staff felt that they were not adequately trained. There is clearly a challenge—about regulation, about structure and about asking an organisation to do more than realistically it is capable of doing. If that is the case, we should not be surprised when things fall apart.

There was an interesting comment, however, from the National Audit Office. It said that the CQC does not know whether its model for predicting staff numbers is accurate enough. That, for me, goes to the heart of the matter. We can have as much regulation as we like, but if we do not have staffing right—if we do not have the right numbers or the budget to pay for them—inevitably, there will be huge problems.

I have looked at the care home reports for Teignbridge District Council in my constituency. The new regime and the five new tests came into play April this year, and the new tests are absolutely on point: the home must be safe, efficient, caring, responsive and well led. That is absolutely right. Twenty-one of the 70 care homes in the area have been inspected and 10 have been found to be good. I share my colleague’s concerns about the homes that were not found to be good, but I took to reading the reports to find out what they actually said. Although the reports covered 10 or 15 different areas, if I dug down to the root causes I found that they were really about staff and the adequacy of both numbers and training.

I meet people from my care homes regularly, every three months, and they tell me that if hon. Members do as I did, they will reach a similar conclusion—that it is a real challenge to find the managers needed to run the homes. Without those managers, the homes are found wanting but they have no ability to resolve the problem. There is a similar challenge in the shortage of nurses. Being a nurse in the care home sector is much more challenging, I think, than being a nurse in the NHS. Care home nurses often work on their own at night, whereas a nurse in an NHS hospital will be surrounded by lots of colleagues. In the care home sector, nurses often work with difficult individuals who have complex problems, often including dementia, with all its attendant behavioural complexities.

The feedback from those responsible for care homes in my constituency conveys much frustration. They understand the role of the CQC, but they feel deeply frustrated that they cannot always put right the things that are found to be wrong. That must be incredibly frustrating. They feel that there needs to be a new balance between scrutiny and support. Although they feel it is right that they are properly scrutinised, they also feel that there is a lack of support. I had the pleasure of talking to the Minister only yesterday, and he was at pains to tell me that the CQC was indeed endeavouring to provide such support. I said to him then, and I will repeat it today, “They don’t see it and they don’t feel it.”

In the old days, under the CQC’s predecessor, care homes received guidance as well as criticism. Because of the desire to separate the two, which I can understand conceptually, they now feel as though they are left on their own. I am proud of our Devon homes, because we have produced our own kitemark for dementia care, as a result of which the homes work together, peer review each other and provide their own training schemes. I think that that is a good way forward.

For me, the big question is: are we looking at everything that impacts the system that endeavours to provide care in care homes and nursing homes? I do not think that we are. There is a big piece missing—the commissioning. At the moment, we review and scrutinise the provision of care, but we do not scrutinise the commissioning done by local authorities and unitaries. If they do not get the commissioning right and ensure that the right providers are providing what is needed, the system will fall down. I have, for example, seen individuals placed in care homes who should be in nursing homes because they have needs that are well beyond the capabilities of a non-nursing care home. That is something that must be critically and urgently addressed.

I am also concerned that we should look in a fair and balanced way at what we are paying our providers. At the moment, commissioners are not in any way held to account for what they pay providers. There is no standard review of the pricing across the country. If pricing is worked out on an ad hoc basis, the amount of money that local authorities pay their providers will vary across the country. At the end of the day, however, although there will be minimal differences in some staffing costs, by and large the costs will not be as diverse as the pricing structure indicates. There needs to be a proper analysis of the prices paid and what we are getting for the money. Are we getting tin tacks, or are we getting platinum? Is the situation as diverse as I fear it is? As a civilised society, we need to determine what we should be giving our citizens, and we need to ensure that that is delivered consistently across the country. The failure to do so will give rise to safeguarding issues.

My final point on commissioning is that we should separate commissioning and provision. At the moment, a local authority can do both, so there is a potential conflict of interest. I am conscious of the fact that time is not in my favour and you would like me to move on, Ms Vaz. I have made most of the points that I wanted to make, so I will just say that dealing with that is a key issue. Regulation is only part of the problem. As the sun slowly comes out, we need to start to fix the roof, and this has to be a key part of that process. We need a proper system of care, not merely compliance. It needs to be properly funded, and staff need to be properly trained.

GP Services

Anne Marie Morris Excerpts

Thursday 5th February 2015 Commons Chamber

[Derek Twigg]

As I will come to later in my speech, there are a number of things that the Government coming into office after the May election will have to deal with to address the sustainability of GP services. They will have to consider whether the training is correct and whether there are enough incentives for young people to go into general practice, or, indeed, other parts of the NHS. That will be an important part of any sustainable plan to make sure we have enough doctors throughout the health service, and in particular GPs. That is a point that needs addressing.

The British Medical Association is also concerned that not enough foundation doctors are choosing to pursue a career in general practice. Application rates for training programmes continue to fall year on year. According to figures from the National Recruitment Office for GP Training, the number of applications for 2014 was 5,477, which was a reduction from 6,034 in 2013. I am told that this is leaving GP vacancies unfilled in parts of the UK: in the east midlands and Merseyside just 62% and 72% respectively of vacancies are filled. To come back to the point Members have been making, 9% of the general practice work force are aged over 60 and 38% are aged 50 or over. Just 27% of the general practice work force are under 40 years of age.

One of the reasons for speaking today is to deal with the access problems. I am sure most, if not all, MPs will have had complaints about that raised with them by constituents and by GPs.

Last year, Healthwatch Halton carried out a GP access and out-of-hours provision survey, and it is important to share some of the key results with the House: 56% of people rated booking an appointment with their GP as “very difficult” or “not easy”; 33% of people rated the length of time it took to get through to their GP practice as “poor” or “very poor”; and 62% of people would like their practice to be open longer, particularly at weekends and in the evenings. That is a particularly important point when considering whether GPs are accessible and we should move to weekend working, which we have had and are debating. However, doing that requires resources. Importantly, a sizeable proportion—32%—were unhappy with the way in which their complaints were handled. That is roughly in line with national findings. On the very big plus side, the general satisfaction level of people with their GP was more than 90%, which is important.

The figures provided to me for Halton by the Royal College of General Practitioners—my constituency covers most but not all of Halton; some is covered by the hon. Member for Weaver Vale (Graham Evans)—show that we have 66 full-time equivalent GPs and that we need to increase that by 24, or 37%, by 2020. In one of the most deprived boroughs in the country we already have a shortage of GPs. My area deals with some of the most difficult health problems—high cancer rates, and high levels of chest disease and of heart disease—so being able to access a GP, and quickly, is very important. Any shortage has an impact on all that.

[Anne Marie Morris (Newton Abbot) (Con)]

The hon. Gentleman makes a good point about access and about the challenges in deprived communities. In Newton Abbot, we have faced a real challenge in trying to replace the services there. Does the research he refers to indicate any difference between rural and urban communities, and between deprived and well-heeled communities?

[Derek Twigg]

I cannot answer the hon. Lady’s question because I do not have those figures in front of me. I am sure that if she talks to the Royal College of General Practitioners or the BMA she will be able to find all those figures. I am sure she understands that I represent one of the most deprived urban constituencies in the country and so I am going to focus on that, as I am sure she would focus on her constituency.

Let me re-emphasise a point I made earlier: whoever forms the Government after 7 May, they will have to come forward with solutions to the mounting pressure on general practice and the NHS overall. There needs to be long-term, sustainable investment in GP services in order to attract, retain and expand the number of GPs. Retention is just as important as recruitment—a point made in the comments about GPs retiring early.

--- Later in debate ---

[Anne Marie Morris (Newton Abbot) (Con)]

There is absolutely no question but that we all have a huge respect and admiration for our general practitioners. They do a fantastic job, and I am immensely proud of our GPs in Devon. Indeed, my GPs do the out-of-hours services themselves; they created Devon Doctors. Although it is accessed through the 111 service, we all love it because we see it as our doctors.

It is unquestionable that GP services are currently challenged—in large part because there has been an awful lot of change. As previous speakers have commented, there are simply more people; we are building more houses; there are more homes. Although being able to live longer is a wonderful benefit, the fact that we have more elderly individuals with more complex needs puts a different level of pressure on GPs trying to deal with this challenge.

The issue of GP numbers is a complex problem. The issue involves training places, attracting people and a whole range of other things. As others have dealt with the matter very competently, my comments will not focus on that particular challenge, but I would reiterate some of the comments made by the hon. Member for North East Derbyshire (Natascha Engel) about the challenges of keeping partners and passing partnerships on to the next generation. The hon. Lady was right that the burden of paperwork and bureaucracy acts as a deterrent, and that being a locum provides a much easier lifestyle.

Capital cost is a major issue. I understand that in the old days a loan could be acquired through the primary care trusts—not directly, but there were schemes to enable people to buy into a practice so that the partner could retire—but that that option is no longer there. That shows that there are problems beyond the bureaucracy and red tape—particularly about financing the challenge of GP numbers.

One of my greatest concerns is about rural and deprived communities. I would like the Minister to undertake a proper analysis of where those deprived and those rural communities are. I am absolutely convinced that it is possible to work out what is where, and consider the quality and adequacy of the GP services within those different areas. We need to unpick the problems before we can ever find solutions.

I believe that we need a new model. This has been talked about for many years and under a number of Governments, but I am hopeful that, under Simon Stevens’s leadership, we will come up with something fit for purpose, on which all parties can agree. He is already indicating some changes. I would certainly not advocate another major reorganisation, but he is looking sensibly at the use of GPs in hospitals and similar issues. As I say, we need a new model.

Clearly, we need to consider the possibilities for integrating within primary care and across primary and secondary care. I do not believe in a one size fits all, but we need to look at a variety of models. I am pleased that in my local community, whether it be NHS, social care, the third sector or indeed the private sector, they are all working together to give the quality of care that constituents need. That is greatly to their credit.

I am pleased, too, that in Newton Abbott we have had funding from a pot of £3.5 million for a pilot scheme on dealing with the frail and elderly. It deals with how to look across the spectrum to ensure that these individuals can, with the right sort of support, stay for longer in their own homes, which is clearly better for them as well as reducing pressures on A and E. I very much look forward to seeing the results from that.

The overall model needs to take integration into account, because for too long primary and secondary have been seen as separate sectors, never mind their separation from social care. We need to look, too, at a new physical model. We talk about public health—a responsibility now given to our county councils or unitary authorities—and we need to consider what we can do to keep people healthy and fit. The concept of a hub is important, where medical care and social care, perhaps along with a gym, could be provided. We need something to pull all those things together—a way forward in some areas. I would like to think that that could be a practical solution in one of my towns such as Kingsteignton. It is challenging to find somewhere for a new GP practice: one integrated in that way would enable us to support the serious funding challenges . I would love to think that NHS England has limitless pots of money, but that is simply not true. That is why we need to involve the private sector—providing the gym or other attribute—in making the new hubs work.

We also need to look at non-physical structure, by which I mean telemedicine. A particular challenge for rural communities is how to use telemedicine more effectively. That could be an additional challenge, of course, because it depends on whether we have the internet and whether individuals know how to use it. It is a challenge that we need to take seriously none the less. We must be careful to ensure that we do not say, “If you live in a rural community, you can have just telemedicine”. That would be a great mistake. One of the greatest fears of my local rural community is that as it becomes more sparsely populated and people become older, they will effectively be forgotten. That would be absolutely wrong. Telemedicine has a place, but it cannot be the only solution.

The main challenge is to meet the need for a long-term plan. I hope the Minister will tell me that he and NHS England have a vision of how to deal with—or at least look at—urban and rural issues, how to deal with deprived and less deprived communities, how to deal with the physical versus the non-physical solution and how to deal with the issue of integration versus stand-alone. We must ensure that we have space and place for the new solutions and the new models.

One of my deepest frustrations is that a good local authority will take into account the housing numbers and the need for a new hospital or a new GP surgery, but because the NHS is not a statutory consultee of the planning process, it is not properly thought through. The challenge is to get the NHS involved. The average GP and indeed the CCG have enough on their plate without getting involved in planning issues. That said, it is crucial for us to get this right, because otherwise we shall be landed with huge challenges. New homes will be built, and there will be no local GP services. Our local plan for Kingsteignton, which was completed recently, provides for a substantial number of new houses, but does not reflect the clear need for additional general practices. We need to find, somewhere in the area, a new space and a new place.

When it comes to planning applications, the NHS is—again—not a statutory consultee, and therefore faces considerable challenges. The number of houses involved in an application can suddenly start to increase exponentially. In the north of my constituency, in the Dawlish and Starcross area, we were to have 1,000 new houses; now we are to have more than 2,000. The local general practices are very worried about how they will cope. Having looked at their existing sites to see how they can develop them, they apply to the council for planning permission, and they cannot get it. They are feeling incredibly frustrated, because they want to provide a service, but there is absolutely no way in which they can do so.

In the case of a development in Newton Abbot, a surgery has relocated, which is great—the accommodation is much better and more fit for purpose—but the issue of bus services has been overlooked, and many people have complained to me that it has not been thought through. That is partly because the NHS has simply not been involved, in any guise.

Local residents are deeply concerned about the changes, and I am regularly approached by patient groups who say, “What are we going to do? We absolutely need to support our local communities, but we cannot see a way forward. We face challenges because existing practices cannot expand, because we need funds so that new partners can replace those who wish to retire, and because the grand plan has not been thought through and our local NHS body has run out of money.” Although the financial year has not yet ended, there is no money, and if we are to have a new general practice, we must find another way of securing that money.

There is a huge fear that if the Government cannot come up with a better way of dealing with those challenges, large private organisations such as Boots will suddenly become the new general practices. Boots currently provides flu vaccinations and the like, but it is clear that it is only one step away from starting to look into how it could provide GP services alongside a supermarket or health hub. Access is obviously important, but the fear is that people in rural areas and the elderly who cannot get to Boots will not receive those services.

We need a plan, and that plan needs to be articulated. We must have a strategy to establish how we are to plan for all this—“plan” as in “planning”—and patients and residents must be involved in the decisions. At present, they feel that they are out of the loop. There is a real fear among rural and elderly communities that they will lose out, and we absolutely must ensure that that does not happen.

Health

Anne Marie Morris Excerpts

Monday 9th June 2014 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

The Gracious Speech was an extremely fine speech, but I would have liked more work on the care agenda. The Care Act 2014 made a very good start, but there is more to be done. This concerns me particularly because Devon has the highest number of over-65s in the country, and my constituency has a very large chunk of that population.

By 2035, 25% of the population will be over 65, 620,000 will be in care homes, 50% will have a sight impediment, and 75% will have a hearing impediment. Today, one in five over-80s has dementia, and that figure is set to double within the next 30 years. The demand is not going to diminish, while the supply is a real challenge for our society as a whole. Seventy-five per cent. of current need is met informally through the voluntary sector and by families. We must give thanks for that, but we then need to think about the financial contribution from the state. The NHS budget, which is now 8.4% of GDP, is in absolutely the right place—that is exactly what we should be spending given the current state of our finances—but the social care budget is decreasing and has decreased by 10% in real terms since 2010, if Age UK’s figures are correct. The reason is cuts in council funding. In my rural constituency, council budgets have been seriously hit, and I see the consequences day in, day out. Day centres in Devon are facing closure and support for supported living is being ripped out. This is a matter of great concern that must be addressed quickly.

I welcome the 2015-16 better care fund of £3.8 billion, but will it be enough and will it be too late? Age UK says that £3.41 billion more is required if we are really to meet the need. I am a great believer that we do not solve everybody’s problems through money, so we must look at what we need to do. There is nothing more important than health and dignity in the ageing population. We need to look at what we, in a civilised society, believe good care should look like. We need a proper debate about who pays. Is it the individual, their family, or the taxpayer? We need to look at who delivers it. Is it the family, the voluntary sector, or the state? Clearly, it must be all those.

The Care Act made a good start. It provided uniformity in the funding structure, consolidated the assessment process, capped costs, recognised carers and the need for support, put a duty on local authorities for care and well-being of our older population, introduced safeguarding adult boards and the star rating system—very good steps forward—and recognised that prevention is better than cure. In some ways, however, it was a missed opportunity. The commissioning process that decides what is ultimately purchased is not overseen. We still have a postcode lottery against which people’s only recourse is an individual appeal. We still have a conflict of interest in that our councils can commission and provide care, as many do. That has to change. On quality, star ratings are a good move. Let us remember that this is about relativity, not absolute quality. What are we paying for—brass or platinum? There is, as yet, no reassurance that wherever anybody lives they will get the fair share of care that they deserve.

Staffing issues were not addressed. Best practice as regards staff and patient numbers is a ratio of 1:5, but the reality is more likely to be 1:7 given the budgetary constraints. No thought was given to trying to deal with some of the training concerns. Skills for Care is a voluntary programme. If we are going to make something really work, there has to be some stick and some carrot. I am pleased that we have a studio school in Torquay that meets some of the training needs and that the University of Surrey will introduce a proper foundation degree in 2015, but more is needed.

Integration could have been addressed. This is not just about money; it is also about health and wellbeing boards. The King’s Fund suggested that there should be a requirement that providers are engaged in health and wellbeing boards. At the moment, only 30% are so engaged, and that needs to change. I am very pleased that in Newton Abbot we have a pilot on the frail and elderly that deals specifically with integration.

There has been a missed opportunity for change, and change must come soon. We need to think about how to fund smartly. How can we increase the amount available to councils? After all, prevention is better than cure; otherwise A and Es and the NHS pay the price. How can we better support families to care for their elderly as we help them to care for their children? What can we possibly do in terms of time, flexibility and tax support? How can we support the voluntary sector? There is not an inexhaustible supply of volunteers, and they are fed up with the form filling that makes their lives burdensome. How can we reduce the capital burdens that councils face when having to deal with providing care? The capital cost of the homes and day centres is driving the closures. Let us work with social enterprise, housing associations and others to look for a better model.

Let us improve quality and remove the postcode lottery. Let us, as we can under the Care Act, ask the Care Quality Commission to review the whole commissioning process. Let us look at what is provided by our county councils, what value for money we get, and whether it is the same across the country. What are we paying for? Are we finding that people in one county are getting bronze and those in another, where more money is allocated, are getting platinum? That cannot be right. Let us look, once and for all, at splitting purchasers from providers as we have in the NHS. Let us get rid of the potential bias that exists in this regard. Let us review the make-up of health and wellbeing boards and make sure that providers serve on them.

Without proper resource, and that means people, we cannot get this right. We need to ensure that more nurses are trained and that they get the respect and the pay that makes them want to work in social care as much as they want to work in the NHS. Let us produce a proper career path that drives respect and reduces the fear they live in that they are going to be criticised for trying to do their best in an impossible situation. Let us enforce the best practice ratio of 1:5. Let us look at how we are going to fill the gap whereby unless one gets to a level of substantial need one will not be funded by the state. There is so much to be done and so little time. This has to be a priority for Government this year.

Care Bill [Lords]

Anne Marie Morris Excerpts

Monday 16th December 2013 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

For my constituents this Care Bill is one of the most important pieces of legislation we have seen in my time in Parliament. That is because the west country attracts a lot of people wanting to retire to our very beautiful countryside. In Newton Abbot, 23% of residents are over the age of 65, compared with the national average of 16.5%. Social care is therefore a very important issue for us.

I congratulate the Government on what they have done, because they have introduced an holistic framework that sets the scene for ongoing legislation to flesh out that framework. They have listened to Dilnot and to Francis and that is very much to their credit.

Integration of health and social care has been the watchword on everybody’s lips. All Members will have come across examples in their surgery case loads of where that does not work, and I am very pleased to see the integration—the balancing provision—that we already have in the Health and Social Care Act 2012 now reflected in this Bill.

On the adult safeguarding framework, I say well done! This is crucial. This is the first time we will have had anything like this for vulnerable adults. In my constituency, I am regularly addressed by carers who are frustrated not only by the challenges of those they care for but by the lack of support they receive. The Bill will provide the answer in the form of care plans and proper assessments. It is not often that individuals come to me who have fallen into the gap between the care plan for a child and the plan for an adult, but it does happen, and I am pleased to see that the Bill will mean that that will change.

One of the big challenges is dealing with the cost of care, and it is to the Government’s credit that they have started to look at that difficult question. How much is it right for the taxpayer to pay, and how much for the individual? This is a good Bill, but there are many things that I am sure all of us would like to see added, improved, amended or clarified. For me, one of the challenges is the role of the local authority in its commissioning and provision of care services. It seems bizarre that it should do both, because that must surely give rise to a conflict of interest. How can it commission and provide? The conflict was recognised in the NHS, and a split was introduced. It is now time to introduce such a split in this regard as well. Now that local authorities will have a key oversight role, it would be madness not to review that situation.

An important change involves the concept of true integration, and the challenge will be to identify the stakeholders who should be included in that integration. Clearly, it must involve the NHS, the local authorities and housing, but one area in which there is often no acceptance of stakeholder responsibility is that of transport. Transport to get people between care homes and hospital appointments has almost reached crisis point in my constituency, and there is huge reliance on the voluntary sector to fill the gap. There is clearly some provision for the NHS to provide that transport, but the rules are so broad that, when times are tough, transport provision becomes limited.

So who provides the transport? The volunteers in my constituency are brilliant, but they can afford only so many vehicles that are equipped to take wheelchairs, and there are only so many drivers. That issue needs to be properly addressed. In the guidance on integration that is to be given to local authorities, the NHS and other stakeholders, we must look seriously at the transport question and ensure that appropriate responsibility is taken for it and that it is properly funded. We cannot assume that the voluntary sector will continue to fill the gaps.

The assessment will form a critical piece of the jigsaw, and the Government are to be commended for trying to clarify the process, to avoid confusion and to get agreement on this. I understand their need to limit mandatory provision by a local authority to those in substantial need and above, but I fear that there could be confusion over the interpretation of the word “substantial”, and I would welcome clarification on that from the Government, in guidance or elsewhere.

Having looked at the definition of substantial need, we then need to consider who is to be involved in agreeing the care package. This is about the process of assessment, and it will be crucial for all the stakeholders to be involved. I have seen diverse levels of application in my local authorities. In some, this is very much a matter for the local authority, and it can sometimes almost seem as though a care package is being imposed on an individual. In other authorities, however, the individual, the carer, the family and the care home are all involved to ensure that the package is understood, agreed, accepted and fit for purpose. It would be extremely valuable if guidance could ensure that that always happened, when the Bill becomes law.

Having assessed the individual’s need, we need to ensure that the quality of the provision is fit to meet that need. I welcome the introduction of the new, almost Ofsted-like categorisation of quality, which will give us a real insight into what is on offer, and what “good” and “average” look like. That in turn will give rise to further questions. Once we know what they look like, we shall have to answer a much more difficult question: to what level should the taxpayer pay, after which there should be a personal top-up? That issue can be addressed only when we have some experience of those categorisations.

If there are to be different levels, the option of a top-up has to be real and available. It clearly exists, but I have seen a reluctance to make it happen in practice in some local authorities. In some ways, that is understandable. The contract is with the local authority and the care home, and not with the relatives or, more usually, the individual picking up the extra cost. The local authority will be concerned that, should there be a problem of affordability for the caring relatives, it would be left to pick up the bill. The top-up therefore needs to be reviewed. If it is to be available, it must be meaningful, and that might involve looking at whether relatives can be part of the contractual arrangement.

In the longer term, following the successful passage of the Bill, there is a lot more that could be done. The Bill will undoubtedly put in place the framework, and we can then begin to look in more detail at the strategies needed for those living in their own homes with support. Historically, we have asked what we should be doing for those in residential care or in hospitals, but once we have the framework, we will have the opportunity to look at a much more concrete strategy. That is something I would very much like to see.

Given the financial circumstances in this country at the moment, we can afford to support only those with substantial needs as a minimum requirement, but the Bill makes provision for local authorities to offer advice as well as providing services, and we should perhaps give more support to those who have only moderate needs. Their needs could be better explored, and they could be better championed and provided for.

The final word needs to be that change is not just about legislation. This is also about a culture change. That will always be a challenge, and it is incumbent on all of us in the House, whatever happens to the Bill, to follow it up and ensure that it becomes something meaningful in practice that will benefit all our residents, who very much deserve it.

Community Hospitals

Anne Marie Morris Excerpts

Thursday 6th September 2012 Commons Chamber

[Anne Marie Morris (Newton Abbot) (Con)]

I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this debate. We are discussing an important topic and there are many wide-ranging issues to be addressed. I also congratulate the Minister on having been appointed to her new role. We all look forward to working with her.

Community hospitals do not just provide excellent clinical medical care. They are also places where patients feel the warmth of the community, which adds to a sense of well-being that is also part of their recovery. One reason why people feel so strongly about having community hospitals close and accessible is because it means friends and relatives can attend, which helps to make patients feel well. That is not just emotional clap-trap.

My hon. Friend the Member for Totnes put her finger on a key point when she said that this is about the community and trying to extend and expand the range of community services that are available. My community hospitals in Teignbridge are going from strength to strength, and there is a move towards integrating social and health care. That will be the salvation of community hospitals in the future. I support my hon. Friend’s comments about volunteers, too. The league of friends and the community transport in my three hospitals are first class. Without them, our community hospitals would not be nearly as successful and happy.

My three hospitals are quite different, but they all have minor injuries units and X-ray facilities, and provide a variety of services to the old and the young. Dawlish was the first private finance initiative hospital ever built, and patient surveys consistently put it in the top three of the 22 Devon hospitals. Remarkably, Teignmouth still has an operating theatre, as well as a physio unit funded by the league of friends—well done! Newton Abbot got the 2007 PFI deal of the year. Unusually, it has a maternity unit, as well as a first-class stroke unit.

My hon. Friend the Member for Totnes also raised the important issue of ownership. I raised this matter last year in a Westminster Hall debate. It is crucial that we get clarity about how ownership is to be managed once the asset is transferred from the primary care trust. In the case of Teignmouth hospital, the property is owned outright by the PCT. As I understand it, that property will be transferred to NHS Property Services Ltd. My local community has put in £850,000, so how does it feel about that? What will happen on future fundraising? Will the money just go into a central pot? What terms and conditions will be imposed on the service provider?

The situations at Newton Abbot and Dawlish are much more complicated, because those hospitals are the subjects of PFI contracts. That means that the buildings are owned by a private contractor and are, in effect, rented out to the service provider subject to two charges, an availability fee and a service charge, both of which have historically been extraordinarily high. In those cases, the contracts will be transferred to the NHS Commissioning Board. That raises a number of legal questions about the validity of the transfer, given the nature of that contract, and about the ability of the new owner to renegotiate the contract. Why do I talk about renegotiation? I do so because it is well known from evidence in the press that some of the charges that have been levied are disproportionately high. What can we do to enable such a renegotiation? Clearly it will be completely inappropriate for a local trust provider to undertake such a renegotiation, so will the NHS Commissioning Board do it?

My hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) has been brilliant in raising a campaign to look at renegotiating these contracts. The Government have already started to look at the whole management issue of these contracts to see whether costs can be cut, and they reckon that a substantial saving has been made and 5% savings can be achieved. They have established a fund of more than £1.5 billion for this; that is the amount that any one trust can get over 25 years to assist with the blighting cost, but that can be obtained only in exceptional and historic circumstances. The fund has been used, but generally that has been in much larger cases involving much bigger hospitals; I cannot see a community hospital being able to pass the test of having exceptional and historic problems. So what can the Government do to help those hospitals blighted with the burden of a PFI contract? I have heard of hospitals that, under the service charge, have had to pay £333 just to change a light bulb. I am pleased to say that that was not the case in my local hospital, but my goodness me that sort of situation has to change.

[Guy Opperman]

My hon. Friend rightly raises the issue of PFI and asks what the Government can do. I would venture to suggest that the previous Health Secretary’s decision to approve the county council’s assistance to the health trust so that it could buy out the PFI contract that was crippling Hexham hospital is exactly the right way forward. Under that approach, a PFI arrangement is bought out and a much better financial basis is put in place—an ongoing future financial basis approved by all.

[Anne Marie Morris]

My hon. Friend makes absolutely the right point, but the tragedy is that few communities can afford that sort of buy-out. As he rightly says, if we could achieve that, it would undoubtedly be the answer.

All we need from the Minister is some clarity as to exactly how these properties are to be transferred; what the position with the local community will be when properties are owned by NHS Property Services Ltd; and what the position will be on the PFI contracts when they get passed across to the NHS Commissioning Board. Clarification on those matters would be helpful and it is now urgently needed, because local trusts that are looking at continuing to run these hospitals need certainty about what they are going to be including in their budgets, and the sorts of figures that the availability fee and the service charge take out are phenomenal. The availability fees at my local hospitals range from 18% to 35%; that is the fee simply to repay the funding costs of the overall PFI arrangement. The service charge can also be high, reaching 18% to 20%. Set against that, private investors are currently seeing returns of up to 50%. That is huge and it seems unreasonable. The previous Government entered into a voluntary arrangement whereby any excess profits, particularly as a result of contracts being bundled by external private bodies, should be shared between the taxpayer and the private investor.

All those tools, which are available for the Government, need to be used. We need certainty and manageable budgets so that our community hospitals can thrive and so that money is available for what we really need—the services.

Care (Older People)

Anne Marie Morris Excerpts

Tuesday 6th September 2011 Westminster Hall

[Anne Marie Morris (Newton Abbot) (Con)]

This is an important issue and probably one of the most important topics that we as a Government and a Parliament will need to consider. On current estimates, the number of 85-year-olds will double by 2026, so it is a serious issue and I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing this timely debate.

Dilnot focused on the financial issues and found that the current system is not fit for purpose. I think that there is another issue in relation to quality. The Government clearly want to ensure that we have a system that, ultimately, is fair, affordable and sustainable. They want to invest in a system that will ensure that we have more care and support in the community, so that we can keep people in their own homes rather than force them into residential care as the only option. However, if we want that quality, we need to ensure that there is proper monitoring and proper regulation. Although I am not a great fan of over-regulation, we have to bear in mind in this particular argument that we are dealing with consumers who are often not very vocal or not able to be very vocal. Therefore, it cannot necessarily be assumed that the way in which a market would normally self-regulate will be the way in which this market will regulate itself.

My comments are based on conversations I have had with the Care Quality Commission, a number of local authorities and private providers. I have a long-term interest in the issue. I was a county councillor and chairman of the health overview and scrutiny committee, and in Devon we currently have the largest number of retired individuals in the country. I will turn first to residential care, then to domiciliary care, look at how they are regulated and monitored, and raise some concerns that need to be addressed by the Minister.

Residential care is commissioned by the local authority. Although provision is monitored by the CQC, the commissioners, per se, are not. I have a concern about that, because it is the local authorities that are determining whether to commission in their own homes—where one might argue that they have a conflict of interest—or in the private sector. What I have found particularly disturbing is the price that is paid for each of these contracts. I hear that local authorities—I give this by way of an example—are paying £700 in the public sector, compared with £350 for a private provider. Whatever the savings might be, there is no way that, for half the price, the same quality of care can be provided.

There is no standardisation of contract in the current system. Although choice is clearly important, I think that, for a consumer who has a difficult time getting their voice heard, it is difficult to ensure that they get consistently good quality. If we are to ensure that there is real choice, genuine quality and fair pricing, we need to look seriously at how the commissioning bodies—the local authorities—might be monitored and regulated in future. I believe that the Government have looked at HealthWatch as a possible source. My concern about HealthWatch is that, first, it does not yet exist and, secondly, it seems to have been conceived as a reactive rather than proactive body.

The provider of residential care is, principally, either the local authority or the private home, and here CQC does monitor. Although the intention was to set out a new framework that, rightly, was more outcome-focused than process-focused, the challenge for the care homes is to comply with this new care quality regulation. I have talked to a number of homes and the majority have indicated that they expected a light touch from Government. They expected that they would be able to provide evidence of compliance and that there would not be many onerous visits. I hear that there are many visits, which surprises them and surprises me. They are saying that it is taking up an awful lot of administrative time. Given that, as a Government, we are committed to cutting red tape, something is clearly not working somewhere. The position needs to be reviewed. Clearly, it is important, because we need to guarantee quality, but let us find a way of doing it better. The other concern that homes have expressed to me is that, with the new outcome framework, there is no guidance as to how to meet the new requirements. In the old days, the CQC used to provide guidance, but now it does not see it as within its remit.

Domiciliary care is, perhaps, one of the most tragic and most important areas of concern. Commissioning of domiciliary care is done by local authorities. Here again, there is no monitoring and, I understand, no regulator; I would love to hear the Minister tell me that I am wrong. I cannot therefore see how we can ensure that our local authorities are really making sensible, informed choices about how they award contracts for domiciliary care. Indeed, I have heard stories of local authorities trying to take out costs and to subcontract their role to lead providers, who then take on the role of subcontracting further to find individuals and more providers of domiciliary care. In all that process, the quality control and the quality test seem to be lacking. I have talked to providers in the private sector who have seen some of what goes on, and the stories are horrifying.

Let me give one example. A provider indicated to me that she had gone into the home of an elderly person who was having to be put on to the toilet. The lady was literally sitting in her chair eating her sandwich lunch and the providers came in and lifted her up in a way that is apparently not appropriate or correct from a nursing perspective. They put her on the toilet, went out, smoked a cigarette and came back in. The sandwich was still in that poor old lady’s mouth. They then took her and stuck her back in her chair. That does nothing for the dignity of the older person.

The provider of domiciliary care is sometimes the local authority but, increasingly, it is the private sector. Unlike the residential end of care, there is no Care Quality Commission monitoring domiciliary care and I understand that there are also no spot checks. Although there is an obligation on local authorities to have a watching brief, what I am hearing anecdotally shows that very little of that is actually happening.

The concept of e-monitoring was introduced to try to assist with that. The idea behind e-monitoring is that, when someone goes in to provide care in a home, they pick up the phone in the individual’s residence and log in. When they have finished dealing with the client, they log in again through the telephone. However, the reality is that once someone has logged in, frankly, they can do almost anything. As in the case I mentioned, that could be putting a lady on the toilet and then disappearing outside and having a cigarette. Therefore, e-monitoring is not an effective way forward. The other thing happening is that, because there is no monitoring of quality, cost rules and consequently quality are going down.

I shall make this a very short contribution. In conclusion, the Minister should carefully consider having a regulator to deal with the monitoring process for commissioners both of residential and domiciliary care. In addition, certainly with regard to domiciliary care, some urgent and immediate action needs to be taken to examine current practice.