Baroness Keeley
Main Page: Baroness Keeley (Labour - Life peer)Department Debates - View all Baroness Keeley's debates with the Department of Health and Social Care
(10 years, 6 months ago)
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Mr Hunt
I am going to make some progress, and then I will give way.
The NHS is about more than just getting through difficult winters. Looking to the future, this Government will continue to take the bold steps necessary to prepare our NHS for the long-term challenges it faces. There are two key areas for action if we are to rise to this enormous challenge. First, we must never turn the clock back on Francis. The NHS will never live up to its founding ideals if it tolerates poor or unsafe care. The last Government presided over an NHS in which doctors or nurses who spoke out were bullied, in which problems at failing hospitals were brushed under the carpet and in which vulnerable older people were ignored and, tragically, on occasions, treated with contempt and cruelty. This Government have stood up for the patient, championing high standards with a new culture of compassionate care which is now transforming our health and care system.
Mr Hunt
Despite the amount of work that has been done in the past year, there is still much to do to improve safety and care. According to a study based on case note reviews, around 5% of hospital deaths are avoidable. That equates to 12,000 avoidable deaths in our NHS every year, or a jumbo jet crashing out of the sky every fortnight. On top of that, every two weeks, the wrong prosthesis is put on to a patient somewhere in the NHS. Every week, there is an operation on the wrong part of someone’s body. Twice a week, a foreign object is left in someone’s body. Last spring, at one hospital, a woman’s fallopian tube was removed instead of her appendix. Last summer, the wrong toes were amputated from a patient. This spring, a vasectomy was given to the wrong man. To tackle such issues, we need to make it much easier for NHS staff to speak out when they have concerns. We need to back staff who want to do the right thing, and we are currently looking at what further measures may be necessary to achieve that.
Today, this Government vow never to turn back the clock on the Francis reforms, and I urge the shadow Health Secretary to do likewise when he stands up. Another vital set of reforms that we need to make if we are to prepare the NHS for the future involves the total transformation of out-of-hospital care. We know that prevention is better than cure and that growing numbers of older people, especially those with challenging conditions such as dementia, could be better supported and looked after at home in a way that would reduce their need for much avoidable and expensive care. This year, three important steps have been taken towards that vital goal. First, the new GP contract brought back named GPs for the over-75s—something that was so shamefully abolished by Labour in 2004. Older people often have chronic conditions that make continuity of care particularly important. However, Labour scrapped named doctors, and we are bringing them back.
We are also acting to break down the silos between the health and social care systems with an ambitious £3.8 billion merger between the two systems. The better care programme is, for the first time, seeing joint commissioning of health and social care by the NHS and local authorities, seven-day working across both systems and electronic record sharing, so that patients do not have to repeat their story time after time and medication errors are avoided.
Barbara Keeley
The Secretary of State touches on a couple of issues, including safety, but ignores one of the most important ones, which is nurse-to-patient ratios. A safe patient-to-nurse ratio has been adopted at Salford Royal, and it could be adopted elsewhere. He is now talking about the better care fund. There is no new money in that fund, and if he is worried about pressure on the NHS, surely he should think about the £2.68 billion that is being taken out of adult social care. In my local authority of Salford this year, 1,000 people will lose their care packages. How is that good for alleviating pressures on the NHS?
Mr Hunt
Perhaps I can reassure the hon. Lady on those matters. First, the better care fund is the first serious attempt by any Government to integrate the health and social care systems and eliminate the waste caused by the duplication of people operating in different silos. The Government require all trusts to publish nurse-staffing ratios on a website that will go live this month. It is an important, radical change, and we are encouraging trusts to do exactly what she says is happening in Salford. It is important to say that, where other Governments have talked about integration, we are delivering it. We are doing one more important reform: we are taking the first steps to turn the 211 clinical commissioning groups into accountable care organisations with responsibility for building care around individual patients and not just buying care by volume.
From next year, CCGs will have the ability to co-commission primary care alongside the secondary and community care they already commission. When combined with the joint commissioning of social care through the better care fund, we will have, for the first time in this country, one local organisation responsible for commissioning nearly all care, following best practice seen in other parts of the world, whether Ribera Salud Grupo in Spain, or Kaiser Permanente and Group Health in the US—[Interruption.]
Andy Burnham
I just gave way to somebody from Wales. What is the hon. Gentleman on about?
That is not all. As I said before, the NHS is now missing its standard to ensure that cancer patients start their treatment within 62 days. That will cause huge distress to thousands of families up and down this country.
Another way in which the NHS has got worse, and every patient knows this to be true, is that it is becoming harder and harder to get a GP appointment. It is a common experience for people to ring their surgery early in the morning only to be told that there is nothing available for days. A survey has found that almost half of GPs predict that the average waiting time will exceed two weeks by next year.
The clearest measure of growing problems in the NHS is what has been happening in A and E, which is the barometer of the whole health and care system. Problems or blockages anywhere in the health and care system will manifest, in the end, as pressure in A and E. If A and E is the barometer, what is it telling us? It is warning of severe storms ahead. Hospital A and E units have now missed the Government’s target for 46 weeks running. For the last four weeks, the NHS overall has missed the Government’s target, suggesting that the winter crisis has now been followed by a summer crisis.
Why is that happening? The fact is that cuts have been made to general practice, social care and mental health, which are pushing more and more people towards the acute hospital and placing it under intolerable pressure. Today, many hospitals are operating way beyond safe bed occupancy levels, and not surprisingly this is taking a toll on A and E staff. Today, we reveal that three times as many A and E consultants left the NHS in 2013, raising the worrying prospect of A and E now being trapped in a downward spiral.
Barbara Keeley
I thank my right hon. Friend for giving way. May I just take him back to the point about GP access, because that is the start of the patient’s journey? In our survey in Salford, we did not find the situation that we had under the Labour Government, where 80% of patients could get an appointment within 48 hours. Now only half our patients can get an appointment within 48 hours, with one in seven having to wait more than a week, which is concerning, and one in five unable even to get through to speak to someone in their GP surgery. This is concerning us in Salford because these are people who may have worries—they may even have cancer and need tests—and they cannot get through to their GP.
Andy Burnham
My hon. Friend is absolutely right—the deterioration in general practice has been marked during the past few years. There have been changes that have disadvantaged patients. Within weeks of taking office, the Government removed the guarantee that patients could have an appointment within 48 hours. That explains the situation that my hon. Friend describes, alongside cuts to funding of general practice to the point that some practices now say they are on the brink of deciding whether or not they can remain open. The Government have responsibility for that situation, but there is not a word from the Secretary of State about it and there is not an acknowledgement that people have severe problems in accessing their GP.
Barbara Keeley (Worsley and Eccles South) (Lab)
As this is carers week, I want to talk first about the impact that legislation and financial policy have on the one in eight people who are unpaid carers. We know that being a carer can have a significant impact on a person’s finances, career, relationships and, of course, health. Full-time carers are more than twice as likely as non-carers to have poor health, but sadly the pressure on them is increasing. Surveys last year told us that six out of 10 carers reported suffering depression, and nine out of 10 felt more stressed due to their caring role.
Since 2010, local government budget cuts have led to funding on adult social care falling rapidly. By this March, local authority spending on adult social care had fallen by £2.68 billion in four years—a 20% fall. Those Government Members who have talked about funding today have nothing to be proud of when they reflect on that. Nine out of 10 local authorities now set their eligibility for social care at “substantial needs” or higher, compared with less than half of that in local authorities in 2005-6. Therefore, fewer people are receiving publicly funded care—300,000 fewer since 2008. Of course more of the care work load therefore falls on unpaid family carers, who in turn report suffering more stress and depression.
Carers UK reports that the ever-increasing need for care and support in our ageing population will outstrip the number of family members able and willing to provide it. A carers week survey found that fewer than three in 10 people believe that they will become carers, but about six in 10 of them will have caring responsibilities at some time in their lives. Between the last two censuses, the number of over-65s providing care grew by 35%. Among carers aged 60 to 64, 54% of men and 36% of women who were caring were also in paid work. Therefore, the pressures on men and women juggling work with caring have intensified.
Carers UK has found that one in five carers surveyed have had to give up work because either they were unable to secure flexible hours or their employer lacked understanding of their caring work load. Many carers then build up significant debts and have to cut down on basic expenditure, even on heating and food, to manage. This afternoon, I met a couple of carers at a speed networking event downstairs who told me exactly that. They had had to give up their jobs to care.
Dr Jamie Wilson, a dementia physician, has said that
“the financial welfare of carers should form part of a holistic assessment of needs. The combined effects of loss of income, additional costs of care and declining state benefits have led to an increasing impact on the resilience of carers and their ability to maintain the health of their loved ones.”
The Care Act 2014 represents a wasted opportunity, because it places on local authorities a duty to assess a carer’s support needs, but it places no similar duty on the NHS. The Act makes it clear that a local authority can charge for the support provided to carers. I feel that the Government are failing carers in two ways. Giving carers new rights to assessment is meaningless when the support available is dwindling as a result of higher eligibility criteria and increased charges. A right to a local authority assessment is of little help to carers who have no contact with their local authority.
At the meeting downstairs, I spoke with a carer called Caroline, who had come in with Macmillan Cancer Support. She has a multiple caring work load but has never been referred by her GP, or by any doctor she had ever met, to any sources of support. She only found Macmillan Cancer Support through a website. That is why identifying carers is so important. Macmillan’s survey of over 2,000 carers found that over 70% came into contact with health professionals during their caring journey, yet health professionals identify only one in 10 carers, with GPs identifying less than that. We cannot be smug or self-satisfied about that situation.
The need for NHS bodies to identify carers and ensure that they are referred to sources of advice and support was raised at all stages of debate on the Care Bill in the Commons, but the Government did not accept amendments on the issue, so now we will need further legislation. Another weakness of the Act is that it restated the option for local authorities to charge carers for services. Carers’ organisations have repeatedly asked the Government to make it clear once and for all that local authorities should not charge carers for the support they receive. However, Ministers did not consider it appropriate for the Act to remove that discretion, which I think is a shame. The Government are failing carers in a number of ways, as I have outlined. This carers week, it is time to show carers that we do value their caring.
Let me touch briefly on a further aspect of health policy that relates to the attitude of NHS staff towards patients, as highlighted in the Francis report. An important source of improvement in that area is the social media campaign #hellomynameis, run by Dr Kate Granger. The campaign started 10 months ago, after Dr Granger’s admission to hospital, when she noticed that many health professionals did not introduce themselves when treating her. She spoke movingly at the NHS Confederation conference last week on the importance for patients and their care of getting the small things right. She pointed out that, in patient relationships, health professionals have most of the power, but they can make things more equal if they introduce themselves and explain what they are doing. She also explained the impact on her when doctors and nurses described her only as “Bed 7” or “the girl with DSRCT”—a rare cancer. As she rightly says, health professionals should always try to find out the patient’s name and how they like to be addressed.
The #hellomynameis campaign has had great success on social media, but it deserves much wider backing. With 1.6 million people working for the NHS, we need to spread the message about the importance of treating patients as people. It should become routine for health professionals to think about a more courteous and human connection with their patients. I hope that shadow Health Ministers and Health Ministers will do all they can to support the campaign.
Finally, in the short time remaining, I want to refer to my concern about issues caused for my constituents by measures in the Infrastructure Bill to allow fracking or shale gas exploration under properties without permission or appropriate compensation. The measure will have negative consequences for people with homes, farms or businesses adjacent to shale gas wells. We have had an exploratory shale gas well at Barton Moss in my constituency since November 2013. I have heard from businesses adjacent to the site that are losing money as a result and from constituents who have been trying to move but are finding it impossible to sell their homes. I have to tell the Minister that the offer of a £20,000 community payment seems paltry by comparison with the losses that my constituents have already suffered, even during the six-month exploration. The Government seem more concerned about a rush for shale gas than about the communities affected by the industrialisation of land caused by this process. We must have more caution and more consideration for our communities.
I will end with a story that explains the difference between the NHS in 1997 and 2010. In the run-up to the 1997 general election, I met someone in Wythenshawe and Sale East who had been waiting two years for cardiac surgery and was worried that he would die while waiting. In 2010, in my constituency, I met someone who within one week went to his GP, was diagnosed and had specialist cancer surgery that saved his life. That is the difference a Labour Government did make and could make again.
Norman Lamb
Let me complete this point.
This is a complex area and we should not rush to legislate. We will keep making progress to respond to the scandal of Mid Staffordshire for the remainder of this Parliament. We are working closely with the regulators to ensure that key provisions, such as a faster fitness to practise test for nurses and midwives and English-language checks for all health care professionals, are in place during this Parliament.
The shadow Secretary of State quoted selected statistics on access to a GP, yet 86% of patients are satisfied with their GP practice. The Government have introduced a £50 million challenge fund, which will support more than 1,000 practices to develop innovative and flexible services. That will include Skype and e-mail consultations, as well as extended hours, and will benefit more than 7 million people.
The right hon. Member for Cynon Valley (Ann Clwyd) again spoke extraordinarily passionately, giving a voice to those who feel they have no voice in our system. We should all express our gratitude to her for her continued campaigning on this critical issue, which demonstrates that we still have a long way to go if we are to ensure that we have a system of which we can all be genuinely proud. Like the right hon. Lady, I hope that one day the flood of letters on poor care will stop. We are doing what we can through the actions we are taking and we are grateful to her for the enormously valuable work she did on the complaints system. I hope the Labour Administration in Wales will do the same, especially after she eloquently highlighted the problems there in a recent BBC documentary.
Norman Lamb
I have given way quite a lot; I need to make some progress.
The right hon. Member for Newcastle upon Tyne East (Mr Brown) asked about allocations. It is right that the allocation of funding is no longer a political football but in the hands of experts. NHS England is seeking to make progress on reducing inequalities.
The hon. Member for Blyth Valley talked about charging in the NHS. Access to NHS services is based on clinical need, not on an individual’s ability to pay. That is fundamental to the NHS, and for as long as this coalition Government are in power the NHS will remain free.
We heard from Members on both sides of the House —my hon. Friend the Member for Bracknell (Dr Lee) and the hon. Member for Westminster North (Ms Buck)—that health care needs to change so that care is provided more locally. The better care fund establishes a £3.8 billion pooled fund, to help people to stay healthy and independent.
Norman Lamb
Of course it is not new money—this is a different way of working. We have never claimed that it is new money; this is to ensure that we use the money more effectively. Indeed, the hon. Lady’s Front-Bench colleagues have made the argument that by pooling the health and social care budgets, we can achieve more with the money available.
Norman Lamb
No, I will not; I have given way many times. The fund is the largest financial incentive by any Government to promote integrated care, and it would be better if Opposition Members applauded the initiative rather than constantly criticising it.
At the start of this Parliament, this Government had five priorities for health and social care. We have delivered on all of them. Through the Care Act 2014, we have delivered the most profound change to the care and support system for a generation. After a decade of inaction under the previous Labour Government, we have introduced, for the first time, a cap on care costs and extended means-tested support. No one will have to sell their home during their lifetime to pay for care.
Under the leadership of Public Health England, we have created a new public health service, giving public health the priority it deserves in local government alongside other local services. As my hon. Friend the Member for Newbury (Richard Benyon) outlined, it is vital that we prevent ill health in the first place, as opposed to repairing the damage once it is done.
We are transforming health and care so that services are integrated around the needs of patients and users. We have revolutionised NHS accountability and seen a successful transition to a new health and care system. Finally, by focusing on outcomes rather than top-down diktat, we can identify what works and where we need to give additional support to help the system do more.