Health and Social Care

Baroness Keeley Excerpts

Monday 13th May 2013 Commons Chamber

[Mr Hunt]

I will make some progress, then take more interventions.

The Care Bill will allow for comprehensive Ofsted-style ratings for hospitals and care homes, so that no one can pull the wool over the public’s eyes as to how well or badly institutions are performing. The Bill will make it a criminal offence for any provider to supply or publish deliberately false or misleading information. We cannot legislate for compassion, but in a busy NHS, we can ensure that no institution is recognised as successful unless it places the needs of patients at the heart of what it does. The Care Bill will be a vital step forward in making that happen. That compassion should extend not just to patients, but to carers. The Bill will put carers’ rights on a par with the people for whom they care. They will have a right to a care assessment of their own and new rights to support from their local authority.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Is the Secretary of State as disturbed as I am that the Bill puts young carers backwards a step? Adult carers’ rights might be taking a step forward, but young carers’ rights are not. We must address that during the passage of the Bill.

[Mr Hunt]

We are not putting young carers backwards. We very much recognise their needs—and a children’s Bill will address their concerns in a way that I hope will put the hon. Lady’s mind at rest.

The second issue that we need to address for the NHS going forward is joined-up care. It is shocking that, in today’s NHS, out-of-hours GP services are unable to access people’s medical records; that paramedics and ambulances answer a 999 call without knowing the medical history of the person whom they are attending; and that A and Es are forced to treat patients with advanced dementia, who are often unable to speak, without knowing a thing about their medical history.

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[Andy Burnham]

I assure the hon. Gentleman that I will come on to that, but I have a job to do in holding this shambles to account and that is exactly what I am doing.

Under this Government, people are paying more out of mum or dad’s bank account for care, which often does not come up to the standards that they want, because their council has been cut to the bone. What are they meant to make of a promised, far-off cap of £72,000, or £144,000 for a couple? The Government are giving a little with one hand, while with the other they are grabbing a fortune from people’s bank accounts.

[Barbara Keeley]

Does my right hon. Friend acknowledge that this is not even a question of £72,000 or £144,000, because those caps will be metered at the level that the council would pay, and will take no account of top-ups or accommodation costs? I have seen examples that show that people might have to pay £250,000 before they get anywhere near the cap and any help from the state.

[Andy Burnham]

My hon. Friend is absolutely right. The cap is a mirage, and this will not feel like progress to people who are paying care charges. Indeed, it is a cruel con trick. The Government are loading extra charges on people while telling them that they might benefit from a cap in a number of years. This simply means that more people will be paying right up to the level of that £72,000 cap.

How can it be fair to pay for the cap by raiding council support? That does not make sense. Those of us who were involved in the cross-party talks—the failed cross-party talks, I might add—will remember that a question was put directly to Andrew Dilnot. He was asked whether, if there was not enough money around, it would be better to pay for a cap or to pay to support councils to ensure that the baseline was not cut further. His clear answer was that we had to do both. He said that it would not make sense to do one without the other, yet that is what this Government are doing—

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

I welcome the fact that we have a Care Bill to debate. I pay tribute to the hard work of colleagues on the Joint Committee on the draft Care and Support Bill. I also welcome the fact that the Government have taken on board a number of the Committee’s recommendations. However, some have not been adopted. I want to speak about the areas where the Bill could be improved and strengthened: the identification of carers and, as the right hon. Member for Sutton and Cheam (Paul Burstow) mentioned, the clauses relating to young carers.

[Roberta Blackman-Woods (City of Durham) (Lab)]

Does my hon. Friend agree with the National Young Carers Coalition, which has written to all Members pointing out that the Bill does not do enough for young carers and needs to be amended so that there is a greater responsibility for identifying young carers? Does she agree that the Government should have taken heed of her excellent private Member’s Bill and incorporated it into the draft Bill?

[Barbara Keeley]

I am absolutely bound to agree with that point, and I will come on to it shortly.

As has been said, we cannot separate the funding of social care from the law on social care. We need to take on board the fact that the Bill will not help those who are struggling without the social care support they need, either today or in the months and years ahead.

The Bill builds on the recommendations of the Law Commission’s review on social care and carers, but we should remember that until the Care Bill, carers had been given rights only through measures in private Members’ Bills: the Carers (Recognition and Services) Act 1995, the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004. We should pay tribute to the late Malcolm Wicks, Tom Pendry and my hon. Friend the Member for Aberavon (Dr Francis) for their work on that early legislation to give rights to carers.

When I came to Parliament in 2005, I raised the issue for the first time that GPs and other health professionals needed to identify carers within their practice population. GPs are best placed to help carers at the start of caring, which is when they need that help and advice. It is the GP who deals with the patient with dementia, the patient recovering after a stroke, or the patient with cancer. The GP and primary health care team are, after those life-changing events, well placed to see if there is an unpaid family carer. It is then a simple step for them and their teams to take time to check the health of the carer and to refer them to sources of advice and support. Caring can have a serious impact on the health of carers. In a recent survey of 3,000 carers, Carers UK found that 84% said that caring was having a negative impact on their own health—up from 74% in 2011-12.

I have introduced three private Members’ Bills on the identification of carers, and in September I introduced the Social Care (Local Sufficiency) and Identification of Carers Bill. The Bill had good support in the House. My hon. Friend the Member for City of Durham (Roberta Blackman-Woods) and 11 MPs from across most parties were supporters. We also had support from 27 national charities, the National Union of Students, the business group Employers for Carers and 2,000 individual carers. However, the Government did not support the Bill. In the debate, the Minister of State, Department of Health, who is responsible for care services, stressed that it was best to get everything codified in one place so that one piece of legislation addressed all issues of care and support. However, the Care Bill does not help with the identification of carers; it puts the duty of assessment on to local authorities. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers in any way that makes it a worthwhile exercise for those carers. If the Minister wants to look at the Joint Committee’s web forum on the draft Care and Support Bill, he will see that many of those who commented said that local authority assessments are of little practical help in their caring role.

[Mrs Moon]

Last week, I had a telephone call from a young man who is caring for his father. His father has the same condition as my husband, and he contacted me because of the debate we had on dementia. He told me that he had phoned his social services department twice and the psychiatric nurse twice to ask for help and support. He did not know where to turn. Is this not increasingly the problem? There is just no money: no money to provide the assessments and no money to provide the care if those assessments are carried out.

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[Barbara Keeley]

I agree with my hon. Friend: it is about carers knowing where to go for that help and support when they are so desperate.

In contrast to assessments, projects that work within primary care to help identify carers are producing outcomes that are genuinely helpful to carers. I spoke at an event last Friday organised by Salford carers centres for staff from those teams. The staff will help to identify carers and refer them to help and support. They will have a list of agencies and know where to go.

[Paul Burstow]

The hon. Lady is making important points about carers—an issue on which she has campaigned consistently. Would she join me in welcoming the announcement from the Royal College of General Practitioners over the weekend about the priority it wants attached to carers and the guidance it is now issuing to GPs to ensure that they do more? One in 10 of a typical practice’s patients are carers, so they could do a great deal more by identifying them.

[Barbara Keeley]

Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

[Norman Lamb]

I look forward to visiting the hon. Lady in her constituency on Thursday and discussing this matter further. I totally agree with her concerns about young carers, and will seek to meet the children’s Minister to discuss it further. It is really important that we get the framework right.

[Barbara Keeley]

Indeed, but a cross-party approach did not convince the children’s Minister in Committee, which is why I am stressing it today. It is very important. I welcome the Minister of State’s assurance just now, but he has given assurances before. We cannot let the opportunity presented by these two Bills pass. Younger carers and their organisations feel that the coalition Government are leaving them out of the equation. At the moment, the threshold for an assessment is higher for young carers than for adult carers. In its evidence to the Joint Committee, the Law Commission said that the inclusion of clauses on young carers was an important area of improvement for the draft Care and Support Bill. Frances Patterson QC told us that the Bill should make provision for services for young carers as well as their assessments, and that the assessments were of limited use for young carers.

The picture of provision for young carers is now very confused, and it is a priority for Parliament to sort it out. It is not good enough to have this partial recognition of young carers in the Care Bill or to have the children’s Minister rejecting cross-party amendments on provision for young carers. The Minister of State, who is responsible for care services, has said several times that he wants a single statute. If that single statute is the Care Bill, it has to deal with young carers properly. It is plainly wrong that it does not. I am grateful for his intervention, but we need to get this right. Does he still support a single statute, and if so, can we get it right for young carers?

I welcome the steps being taken in the Care Bill, but it must be strengthened and improved in the ways I have outlined, because things such as assessments are not very helpful for carers and young carers, if that is all we are offering. As was said earlier, older people face continuing increases in home care charges. The number of people receiving publicly funded care has fallen by 7%. Unmet need is soaring, which is putting pressure on carers and our acute services. We need a bold response to the crisis in care, greater investment in social care and genuine integration of health and care services.

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[Mr Leigh]

I have no idea when that will happen.

I said I wanted to talk about opinion in Lincolnshire. Despite all the Government’s success in their central aim of attempting to cut the deficit—we have cut it by a third—people there undoubtedly feel that their voice is not being heard. We have to listen to that voice. If I may be forgiven for being party political for a moment, I should point out that there is absolutely no enthusiasm for the Labour party, because people have not forgotten who created the borrowing mess we are in. We heard a lot about plain packaging from the right hon. Member for Leigh (Andy Burnham), who led for the Opposition today, but the whole Labour party is plain packaged. We have no idea, frankly, what it will do.

[Barbara Keeley]

I cannot speak for all parts of the country, but I campaigned in the recent county elections in Lancashire and there was huge enthusiasm for the Labour party.

[Mr Leigh]

We will have to see what happens in various parts of the country.

It is said that this is a thin Queen’s Speech. As a Conservative, I do not object to a thin Queen’s Speech. I do not object to deleting unnecessary legislation either, whether on minimal alcohol pricing or plain packaging. I view all these as creatures of the nanny state, so it is good conservatism that we are not introducing them. However, if we are to have a Queen’s Speech that is, shall we say, somewhat light and has lots of room in it, that means there are various other things that we could do. One thing we do not need to do, I would have thought, is persevere with the Marriage (Same Sex Couples) Bill. I will not repeat all the arguments, but this is an area where many people in Lincolnshire feel that their opinions are being not represented.

If anybody wants to look at an excellent article on this subject, they should read Charles Moore’s in The Daily Telegraph on Saturday. There is a real problem. We are trying to deal with an economic crisis and the very first thing we will do after this Queen’s Speech debate—although it was not mentioned in it; as far as the Government are concerned, this is the Bill that dare not speak its name—is have two days on same-sex marriage. The Bill will then go to the House of Lords. There are enormous, complex issues at stake for the Church of England. I have no doubt that we are moving to a world in which the Church of England will be allowed to conduct only religious marriages, but will not be able to complete them. They will have to be completed by the state because of equality legislation. These are serious issues. The Government could easily mend fences with many of their supporters by putting the Bill out to further consultation.

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[Norman Lamb]

What I would say to the shadow Minister is that since 2010, 1 million extra people have visited A and E. These are real pressures and we all have to think about how we manage them. Surely the way to do that is to try to improve people’s care so that they avoid ending up there in the first place. Tomorrow I will announce a decisive shift towards integrated care, which will be part of a major strategy for vulnerable older people, whom the Secretary of State talked about earlier. We have to focus on preventing people’s health from deteriorating, stopping the crises that end up with people in A and E despite the system’s best efforts.

Several hon. Members referred to pressures in social care, including the hon. Member for City of Durham (Roberta Blackman-Woods) and my hon. Friend the Member for Bradford East (Mr Ward). The Government have done what they can. We have put £7.2 billion extra into social care and local government to support the system through these difficult times because of the local government settlement, but we all know that things have to be done differently. The Care Bill is totally consistent with that approach: it focuses on prevention, co-operation, integration of care and spending money more effectively to improve care for patients. I was pleased that the hon. Member for Easington (Grahame M. Morris) welcomed the Bill, as did the hon. Member for Salisbury (John Glen) and many others. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for his work as Minister and subsequently as Chair of the pre-legislative scrutiny Committee. He has done a lot of brilliant work to highlight the issues that the Bill deals with.

It is hard to exaggerate just how badly the Care Bill is needed. Previous legislation is now hopelessly outdated and almost irrelevant to the needs of today’s society. Tinkering around the edges was keeping the system afloat, but no more than that. The shadow Secretary of State was dismissive of the value of the Bill, but it will be a big social reform—one of which this coalition Government should be proud. The new Care Bill will reform an antiquated, paternalistic system, improve people’s experience of care and establish both health education England and the health research authority as non-departmental, stable, independent public bodies. The Bill will pool together threads from more than a dozen Acts into a single, modern framework for care and support, but it is far more than a mere compilation. The Bill will fundamentally reform how the system works, prioritising people’s well-being, needs and goals, so that they no longer feel they are battling against the system to get good care.

[Barbara Keeley]

The Minister is back on his point about the Bill creating a single statute, but it will not do that for young carers, who will be left with the protection only of the private Member’s Bills I mentioned earlier. It is not good enough for young carers to face a higher threshold than other carers before their needs are assessed. That has to be looked at. The children’s Minister has let the House down on this issue; I hope that this Minister will not do that.

[Norman Lamb]

I was coming on to pay tribute to the hon. Lady for the work she has done. I absolutely agree with her that we need to get this right. We have the juxtaposition of two Bills, dealing with children on the one hand and adult social care on the other. Earlier I made a commitment to meet the children’s Minister; I had an opportunity to speak to him briefly when he was in the Chamber earlier. I am also meeting the hon. Lady later this week. I am committed to doing everything I can to get this right, and to ensure that young carers are not let down.

The Care Bill also highlights the importance of preventing and reducing ill health and of putting people in control of their care and support. This will involve the right to personal budgets, taken as a direct payment if the individual wants it, and putting people in charge of their care and of how the money is spent. This will put carers on a par with those for whom they care for the first time. The hon. Lady has consistently argued her case, and I am determined that we should get this provision right. The hon. Member for Rotherham (Sarah Champion) also made some powerful points on the subject.

The Bill will also end the postcode lottery in eligibility for care support. My hon. Friend the Member for Totnes (Dr Wollaston), the hon. Member for Easington and others raised concerns about the level of the eligibility. That question will obviously have to wait until the spending review, but I point out that if we were to set it at moderate need, the cost attached would be about £1.2 billion. All hon. Members need to recognise that this is difficult, given the tough situation with public finances. We also need to do longer-term work on developing a more sophisticated way of assessing need and providing support before people reach crisis point.

The Bill will refocus attention on people rather than on services. It will bring in new measures based on the Francis inquiry, ushering in a new ratings system for hospitals and care homes, so that people will be able to judge standards for themselves. The hon. Member for Walsall South (Valerie Vaz) criticised the idea of appointing a chief inspector of hospitals, but I disagree with her. It will be really important to identify where poor care exists and to expose it so that improvements can be demanded without fear or favour. The chief inspector will be able to do just that. It will also be really important to celebrate great care, so that those people in the health and care system who are doing everything right can be applauded and recognised for the work they are doing.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 16th April 2013 Commons Chamber

[Norman Lamb]

I pay tribute to the hospice movement, including Katharine House in my hon. Friend’s constituency. It is crazy that we are spending a lot of public money on caring for people at the end of life in places where they do not want to be. Most people do not want to end their life in hospital, yet about 50% of people still die in hospital. We are looking to create a new funding regime where money will follow the patient, to ensure people’s choice is respected so they can die where they want to, and so that hospices have fair funding.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I recently had a case of very poor care of a terminally ill patient in the last few days of her life. She was let down by a GP who refused to prescribe the pain relief she needed and a district nursing service that provided wholly inadequate support. Given what the Minister has just said and that 20% of people want to die at home, what action will be taken to ensure that such cases do not happen and that instead we start to provide much better support for people so they can die peacefully at home?

[Norman Lamb]

My ambition is that the UK have a global reputation for the best possible care at the end of life. Whether we are talking about the Liverpool care pathway and concerns that have been raised about some care in hospital or care in the community and caring for people at home at the end of life, it is essential that people have a dignified death and the best possible care. Everything we are doing is aimed at achieving that. Where there are specific cases such as the one the hon. Lady raises, the relatives have the right to pursue a complaint, and ought to do so if care has fallen below an acceptable standard.

Mid Staffordshire NHS Foundation Trust

Baroness Keeley Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. It is important that these assessments are made not just at an organisation level, but drill down into the different parts of a hospital, and we have taken that message on board from the Nuffield report on ratings. She is right that it is not just about resources, but sometimes it is about resources. Parts of a hospital can be understaffed when it comes to people who are required to perform basic and important roles in terms of care. Because it is a complex picture—and because numbers can be part of the problem, but are certainly not the whole problem—we want a chief inspector who will take a holistic view of every aspect of the performance of a hospital and be able to give proper feedback that a hospital can use to improve its performance.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

May I press the Health Secretary on this point? I have raised several times the point that adequate staffing levels are crucial to patient safety and good care, but we seem to dodge around saying that it is a question of values, not of numbers. Francis said clearly that one of the issues was numbers. I have given examples of my local hospital, which views it as crucial that it has the right staffing mix, which it adjusts every single day, for the patients that it has. Will he stop avoiding this question and address it directly, because one in 10 hospitals do not have adequate staffing levels?

[Mr Hunt]

I am not avoiding it. I agree that adequate staffing levels are essential to patient care. I remind the hon. Lady that the shadow Health Secretary said to the Francis inquiry:

“I do not think that the Government could ever mandate a headcount in organisations. Whilst we could recommend staff levels, we were moving into an era when trusts were being encouraged to work differently and cleverly, and take responsibility for delivering safe care whilst meeting targets”.

Immigrants (NHS Treatment)

Baroness Keeley Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

Obviously, I want to ensure that as much money as possible goes to residents throughout the country by tackling abuse, and I would not want to minimise what the issue might be in Worcestershire. I stress, however, that the biggest problem we face is in big urban centres where there are large numbers of illegal immigrants, and we must get a grip of that problem for the sake of the elderly population in those cities.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

If the Secretary of State is concerned to protect NHS budgets, why is he allowing a £2.2 billion raid from the Treasury? Is that not a much more serious cut in the NHS services we can pay for in this country?

[Mr Hunt]

If the hon. Lady is worried about that, perhaps she might like to complain to her own party leadership, which, during Labour’s last five years in office, had an average underspend in the NHS of £2 billion.

Accountability and Transparency in the NHS

Baroness Keeley Excerpts

Thursday 14th March 2013 Commons Chamber

[Rosie Cooper]

Yes, and if MPs have problems, God help members of the public and patients.

We had to demonstrate that we were really listening to patients. The medical and managerial staff had to take ownership and responsibility for complaints. They knew that at each board meeting they could be questioned and challenged. If we accept that there are large parts of the system that work well and focus our time and resources on areas that do not, we can raise standards and tackle deep-seated problems. As chair, I sought to build in assurance and be transparent about complaints; to solve them, not hide from them, and ensure that everyone was accountable right up through the management structure. I never believed in no blame; I believed in fair blame. Each time a problem was resolved properly, we became a better hospital. We were rightly proud that on the front page of the Liverpool Echo Liverpool Women’s hospital was called an NHS gem. Sadly, the main board’s complaints report stopped after I stepped down as chair.

We do not need to reinvent the wheel or have more reorganisation in the NHS, but we must make the complaints system work. From that important but simple action, culture changes happen and become embedded in the organisation. We then have real change, real transparency, real openness and real accountability—something we can all be proud of.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

A complaints system sounds very useful. When staff knew that complaints were being assessed and reported on every month, what impact did it have on them?

[Rosie Cooper]

In essence, it encouraged a change of culture. They were not operating in a vacuum, where patients did not matter and where the complaint might not ever get resolved—where, if a manager said it was okay, it disappeared. The fact that the light was switched on and that people could ask questions was valued.

There is a huge disconnect between the rules and the enforcement of rules. When local resolution fails there must be another, proper avenue for patients to appeal that decision: just having the NHS investigate the NHS is not the way to improve the health service, or patients’ confidence in it. Currently, the message we send out is that unless people have the financial resources to fight the system in the courts it is easy for families and patients to be ignored.

Chief executives and boards know that the ombudsman investigates only a tiny proportion of the cases referred to it, and it is not as feared as it should be. I say to the Secretary of State that we need an ombudsman service that is properly resourced, has the necessary investigative powers and sanctions, and makes public in its reports its findings to everybody who pays for the NHS, not just to Ministers. Being able to name and shame in the spirit of openness and transparency will be a powerful tool, especially when, in these times of foundation trust hospitals competing to attract business, reputation is the key.

Given that all hospitals will eventually become foundation hospitals, is the Secretary of State willing to say that foundation hospitals will have to report all their statistics openly and that every board meeting should be a public meeting? There should be no hiding; there should be openness and transparency right across the NHS. The light needs to be switched on not just in individual rooms but in the NHS, full stop.

I have on the wall of my constituency office this quote from an editorial in the Liverpool Echo:

“Doing the right things does not automatically follow saying the right things”.

At present, everyone in the national health service is saying the right things. What assurance can the Secretary of State give us that the NHS will do the right things? Frankly, the public do not want any more politics from anybody. They do not want warm words or excuses; they want actions that will lead to real change. No more big reorganisations; we just need to make a difference. He must listen to the people’s complaints. Actually, in Mid Staffs the complaints could not have been any louder.

I said to the hon. Member for Bristol North West (Charlotte Leslie) earlier that we cannot keep on saying that it is somebody else’s fault, that somebody else should be held accountable and that somebody else is going to supervise. This goes to the core of the Department of Health. If we listen to the people and give the ombudsman—the right person for the job—the powers to deliver, we will see a culture change.

[Mr Stephen Dorrell (Charnwood) (Con)]

I want to follow the hon. Member for West Lancashire (Rosie Cooper) on to very similar territory. She and I both sit on the Health Select Committee, which I chair. I want to start where my right hon. Friend the Secretary of State and the right hon. Member for Leigh (Andy Burnham) started, with what happened in Mid Staffordshire. It was shameful, and we will be judged today by whether we show a serious willingness to learn and apply the lessons of the Francis inquiry.

Francis made 290 recommendations, but they amount to just one core recommendation, which is that there needs to be a fundamental culture change through the whole of the national health service. With respect to the shadow Secretary of State, that is the sense in which challenges are posed for the health service way beyond Staffordshire. We have to learn the lessons of Staffordshire and apply them beyond it, as well as demonstrating that we understand what we mean—in the modern jargon, we “get it”—when we talk about the need for a culture change.

My hon. Friend the Member for Bristol North West (Charlotte Leslie) encapsulated that when she used the words “accountability” and “transparency”. I will not follow her down the route that she took in her speech. I want to focus exclusively on what we mean by those two words. They seem to trip too easily off the tongue, without anyone understanding what they mean, and that must change if we are to sustain a culture change in the health service.

My first proposition is that accountability without transparency is entirely meaningless. The ability to see what is going on and how decisions are being made in the health service, and to see the effects of those decisions, is fundamental to the delivery of the objective of culture change. With respect to the right hon. Member for Leigh—and, indeed, to some of the points that my right hon. Friend the Secretary of State made—we have to acknowledge that a lack of transparency lies deep in the culture of the health service, and that it goes back to way before the previous Government were in office. It was present in my time as Secretary of State and well before that, too. I was regularly accused of supporting a gagging culture in the health service, although nothing could have been further from my intention. However, that charge was made against me, against the right hon. Members for Leigh and for Kingston upon Hull West and Hessle (Alan Johnson) and, in truth, against all our predecessors right back to 1948.

The instinct to protect, rather than the instinct to reveal, is deeply embedded in the health service. When something is said to be going wrong, there is an instinct for the wagons to gather round. That is why Francis’s recommendation for a duty of candour is key to the delivery of the objective of greater accountability and transparency.

[Barbara Keeley]

Was the right hon. Gentleman as disturbed as I was to hear that the £500,000 gag at the United Lincolnshire Hospitals NHS Trust was put in place without any sign-off whatever, on the basis that it had involved judicial mediation? The Secretary of State refused to answer my question about this. Does the right hon. Gentleman agree that the Secretary of State really has to stop that, because it involved a very large amount of money, which was used very ill-advisedly?

[Mr Dorrell]

The position I take is the one set out in the Francis report, which was explicitly endorsed by Sir David Nicholson in the Select Committee inquiry to which the hon. Lady has referred. I believe that it would also be endorsed by my right hon. Friend the Secretary of State, but he must speak for himself. That position is that it is hard to imagine circumstances in which the use of public money in the context of a compromise agreement should be governed by a confidentiality clause. In an age when a bill from Pizza Express has to be published on the internet, decision makers should be held publicly accountable for the use of large sums of money in the context of a compromise agreement.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

I was appalled to read in the Francis report on the Mid Staffs inquiry the stories of the unnecessary suffering of hundreds of people and, indeed, to hear the examples given by my right hon. Friend the Member for Cynon Valley (Ann Clwyd) in this debate. Those Mid Staffs patients were let down and there was a lack of care, compassion, humanity and leadership. The most basic standards of care were not observed and fundamental rights to dignity were not respected.

Our Health Committee has taken evidence from Robert Francis, who has said that there was a failure of the NHS system

“at every level to detect and take the action patients and the public were entitled to expect.”

He has summarised his own recommendations as: fundamental and easily understood standards; openness, transparency and candour; accountability to patients and the public; enhanced training for nurses and leaders; and ever-improving measures of performance.

In the short time available, I want to focus on two areas: first, accountability or, indeed, the lack of it in our NHS structures, and secondly—this has already been touched on—the question of what is good practice on patient safety.

The Health Committee is increasingly seeing examples of a gap in accountability in the restructured NHS and I will touch on one small example that we heard this week. We had a session with senior Department of Health staff—the director of mental health, the national clinical director of mental health and the deputy director of secure mental health services—who are responsible for advising Ministers on mental health strategy, for devising mental health legislation and for clinical leadership on mental health. They did not know that patient groups were reporting cuts to community mental health services or that they lacked access to therapeutic services, with very long waits.

[Alison McGovern (Wirral South) (Lab)]

Does my hon. Friend agree that scrutiny to make sure that the dignity of mental health patients is protected is of utmost importance?

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[Barbara Keeley]

Indeed. It is disturbing that the people responsible for advising Ministers on legislation are not aware of what is going on. In fact, they started by trying to tell me that they thought that community services were still expanding, as they had been up to 2010. They did not have a picture of the services. Indeed, they told us that there was no routine collection of waiting times for mental health services and they did not have data on readmissions. They did not even seem to understand the trends involved in those important issues.

The exchange left me feeling very concerned about accountability in our new NHS structures. If staff at the most senior levels of the Department of Health who are responsible for strategy and legislation have no idea what is going on in health services across the country, that is serious. The major restructuring of the NHS seems to us—this has been mentioned by fellow members of the Health Committee—to represent a decline in accountability.

We need to learn from good practice to improve patient safety, which has been touched on by my hon. Friends the Members for West Lancashire (Rosie Cooper) and for Walsall South (Valerie Vaz). A major review is taking place of the 14 hospitals with the worst mortality rates. In recent Health questions, I told the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) that good practice in hospitals with low mortality rates should be investigated alongside the review of high mortality rates and poor practice in the worst-performing 14 hospitals. He did not take that point on board, so I will try again today.

I want to talk about what has been achieved at my constituency’s local hospital trust, Salford Royal NHS Foundation Trust. I visited the hospital recently in the wake of the Francis report and was impressed to hear what it has achieved over the past five or six years. It already seemed to have in place many of Robert Francis’s recommended actions, which I touched on earlier. Salford Royal has taken action on nurse staffing ratios, which my right hon. Friend the Member for Leigh (Andy Burnham) touched on; reducing MRSA infection and pressure sores; the transparency of patient information; and involving clinical staff in quality improvement.

[Mr Jeremy Hunt]

I completely agree with the approach that the hon. Lady is taking. One of the jobs of the new chief inspector of hospitals will be to identify the outstanding hospitals, the safest hospitals and the hospitals with the best compassionate care, so that other hospitals can learn to do the same things.

[Barbara Keeley]

That is very good. I hope that the Secretary of State will make that point to the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich, because he did not seem to appreciate it when I made it to him in Health questions.

Let me touch on what other hospitals might find if they start looking at the excellent practices at Salford Royal. I do not underestimate the importance of the terrible examples that we have heard about, but at the same time, my trust has had a quality improvement strategy since 2008, with specific projects that are aimed at reducing falls, unexpected cardiac arrests, surgical site infections, sepsis and other harms. Because harm tends to be caused to patients much more over the weekend—we have seen many examples of that in the cases that we have looked at—the trust has moved back to seven-day working in an attempt to achieve the same standard of care on the weekend and overnight as people receive on a weekday during working hours.

I believe that having the right nurse staffing ratios is vital to patient safety, but that issue keeps being glossed over by NHS leaders and Ministers. I have asked questions about it repeatedly in this House. Salford Royal uses a safe staffing tool to ensure that it works to safe staffing levels. There are minimum staffing requirements throughout the hospital and incident reports are completed if the ratios are not met. Each division reviews its staffing establishment every day and escalates concerns if the numbers fall below the minimum safe level. Salford Royal is a mentor site for nurse rounding which, as we have heard, means that nurses go round their patients each hour to ensure that their needs are being met.

My right hon. Friend the Member for Cynon Valley gave examples that showed the impact of hospital-acquired infections. All the work that is done to reduce MRSA and other infections is crucial. As in the other examples of flattened hierarchies that we have heard about, anyone at Salford Royal can challenge others on issues related to infection control. There is also mandatory training in aseptic non-touch techniques.

Teams design their own quality improvement projects in a clinical quality academy. There has been a specific quality improvement project over the past two years that is aimed at reducing the number of pressure ulcers. Each pressure ulcer is declared, the root causes are analysed and the patients are involved in the investigations. Nurses can monitor the positioning of patients on their hourly rounds and help to turn them if required. Those examples of good patient care can help us to get over the kinds of awful care that have been described today.

My final point is about transparency. Patients and families can check the harm data, because they are shown on a whiteboard at the entrance to every ward. The board records not only how many days it is since the last MRSA infection or pressure ulcer, but provides assessment scores on 13 fundamental nursing standards. Such public reporting to patients and families is important because it aids accountability and helps staff to feel accountable for the standards on their ward. We need that now more than ever.

Unsurprisingly, Salford Royal has achieved the highest rating in the NHS staff satisfaction survey for acute trusts in the NHS. Staff are supported to challenge existing systems and test new ideas to improve standards. I am aware of how much of a contrast that is to what we have heard this afternoon. The NHS is a system in which one area has had a catastrophic failure at all levels of patient safety, while other areas have achieved the highest standards of safety and patient care. We must look at both if we want to understand why that is.

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[Mr Slaughter]

I am grateful for that. I did a company profile for Harmoni. It revealed that, although he might have sold his shares for that amount of money, Dr Goodman is still listed as head of clinical spine. A series of press articles deals with the failings of Harmoni—failures that have caused deaths through under-staffing or poor-quality staffing—and why it is under investigation.

Let me return in the time I have available to my attempts to get to the bottom of the matter. The same day as I read the article in The Guardian, I wrote a short letter to the chief executive of the NHS in north-west London. I said:

“I attach the front page article from today’s Guardian, which you may have seen, regarding the sale of out of hours GP service provider Harmoni to Care UK. The article states that a number of GPs will make substantial sums from the sale.

I note that four of the CCG chairs in NW London declare shareholding or directorship in Harmoni, as does your Medical Director. It would be helpful to know if they are beneficiaries of the sale and by what amount.”

I then asked for assurances as to the future.

A month later I received a non-reply reply, the most relevant sentence of which was:

“Any member who declares an interest in a meeting is expected to take no part in discussions and step out of the meeting.”

I wrote back a much longer reply, in which I pointed out that the chair of the Royal College of General Practitioners had said:

“it is not about excluding yourself from the room whenever there is a discussion; it is about how it will drive your decision-making overall”.

I pointed out that, as a consequence of hospital closures in north-west London, there had been a shift in funding from hospital to primary care, a greater involvement of private companies in the primary care sector, and an opportunity for those companies to increase their profits by cutting back on the level of service offered.

I principally raised the fact that the information that should be provided is not provided on declaration of interest forms, especially the scope and value of any interest. I listed doctor by doctor and CCG chair by CCG chair what those interests were and how they were not adequately declared. I dealt with seven out of the nine CCG chairs and the medical director. That was in a letter on 20 December.

I received a reply on 3 February which said:

“The Cluster does not hold this data.”

So three months on from my original inquiry, I am none the wiser in relation to these matters.

I advise any hon. Member to look at their CCG declarations of interest online—not Hillingdon, because it does not publish them online. I use Hammersmith and Fulham as an example here. The husband of one member is a partner of Drivers Jonas Deloitte. The first thing I found on the website of Drivers Jonas Deloitte was that it had been appointed to sell the Kent and Sussex hospital in Royal Tunbridge Wells when it closes in 2011. Another member is the owner of a provider of home care services. Another is the brother of the director of a design company that holds a number of contracts with NHS organisations. It might be that none of them has a direct financial pecuniary interest now or in the future, but it shows touching naivety, complacency or worse.

Before the 28 members of the joint PCT board made the decision to close the four A and Es in north-west London, I said at the public meeting that if any of them had or was likely to have interest of a pecuniary nature they should not take part in that decision. One of them rather touchingly volunteered the information that they had sold their shares. What world are we living in when a third of GPs on the new CCGs can hold financial interests in anything from land sales to an alternative provider?

I raised the question with the Prime Minister yesterday and mentioned Dr Goodman, although not by name, and his estimated minimum return of £2.6 million. Again, I got a non-reply in reply. Sooner or later the Government will have to address these matters.

There is another story in the Daily Mail today that states:

“In 1981 there were eight NHS press officers in Britain. Now there are 82 in London alone”.

It is not that there is a lack of spending on publicity in the NHS. Indeed, almost £1 million has been spent on a private consultancy firm simply to carry out the bogus and botched consultation on the closure of A and Es.

We are seeing the creation of a second-grade health service in north-west London.

[Barbara Keeley]

A number of months ago, I raised the case of a person who rejoices in the title “NHS head of brands”. There seem to be a whole set of units that keep cropping up.

[Mr Slaughter]

I am sure that all Members will have similar examples. It is an obscenity that millions of pounds are being spent on spin and disinformation while basic information is not being provided even to Members of Parliament after three months and persistent requests. Sooner or later, these issues will have to be addressed.

Of course, our main preoccupation is to maintain our first-rate health service—our blue light A and Es, our stroke centres and our major hospitals—rather than having it replaced by urgent care centres and minor primary care facilities. That is what we face in north-west London and, I am sure, around the rest of the country. It adds insult to injury if the individuals who are making the decisions to sell the land and to transfer services into the private sector are also the shareholders and owners or if they benefit in any other way. This is a corrupt act and it must be addressed by the Government. They cannot continue to turn a blind eye to it.

NHS Commissioning Board

Baroness Keeley Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

It is absolutely not the case that the regulations, as currently drafted, drive the privatisation of the NHS. As the hon. Gentleman will discover in the next few days, the amended regulations will make it abundantly clear that CCGs will be in the driving seat—the letter from the former Secretary of State made that clear back in 2012. They will take into account the importance of co-operation, integration and putting the patient’s interest first.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

On competition and integration, my hon. Friend the Member for Walsall South (Valerie Vaz) and I spent some time this morning talking to academics from Sweden, who told us how competition and fragmentation were preventing them from moving ahead with integration. The Minister should be concerned about the integration of health care and social care, so will he address that point? We will certainly never make progress on integrating health care and social care if we move ahead with all this privatisation, which will lead to a lot more fragmentation. Leaving that aside, 70 of my constituents also think this is just the wrong way to go.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 26th February 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that all staff in the NHS should feel able to speak up and raise concerns about patient safety, so that the organisations for which they work can take up their concerns and investigate them. He will be aware that the people who raise such concerns are protected under the Public Interest Disclosure Act 1998.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Last week I visited Salford Royal hospital, which has the lowest death and weekend mortality rates in the north-west, and the seventh lowest in the country. It is interesting to note that Salford also has higher ratios of nurses per in-patient bed, and that individual wards in the hospital publish data on their rates of MRSA, ulcers and falls. Does the Minister accept that good practice at hospitals such as Salford Royal should be investigated alongside the poor practice and high mortality rates in other hospitals?

[Dr Poulter]

The hon. Lady is absolutely right. That is exactly what the review is about. It is going into the 14 hospitals in which concern has arisen over mortality data, looking at the practices there and commissioning a peer review of them from leading clinicians and patient groups. That will help to raise standards of practice where required.

Social Care Funding

Baroness Keeley Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

I absolutely agree with my right hon. Friend’s points; he speaks wisely, as ever. I, too, want to pay tribute to the work that my predecessor, our right hon. Friend the Leader of the House, did in laying the ground and making the big call that we needed to have the Dilnot commission, and in last year publishing the care and support White Paper, which moved this agenda much further forward than in any of the 13 years of the previous Labour Government. My right hon. Friend is also right about the fundamental randomness and unfairness. Of course, we are not saying that the Government will pay for all the social care costs we encounter—public finances could not possibly be in a state to allow that to happen. However, this provides certainty and allows people to plan, so that they can cope with the randomness and unfairness of the current system and know that it will not put their precious inheritance at risk.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

At £75,000 the cap on social care is far too high to help people in an area such as Salford. The Secretary of State has talked about insurance products developing to help people meet the costs of the cap. In our inquiry into social care, we on the Select Committee on Health were told that this country has no market at all in long-term care insurance—not only that, but no country in the world has a working market in pre-funded long-term care insurance. Is it not wishful thinking of the highest order to talk about people being able to rely on products that do not exist either here or anywhere else in the world?

[Several hon. Members]

rose—

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

I am happy to do so, and I commend my hon. Friend for her campaigning, because if we invest properly in community health services, we can allow the frail elderly, who are among the biggest users of the NHS, to stay at home happily, healthily and for much longer. That must be a key priority for us all.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

At the last Health questions, the Secretary of State told me:

“Every NHS bed is getting an extra two hours of care per week compared with the situation two years ago.”—[Official Report, 27 November 2012; Vol. 554, c. 122.]

Quoting national average nurse-patient ratios does not help to improve the patient experience, but cutting 7,000 nurses sure does affect it. We have unsafe levels of care in 17 hospitals. Will he treat this issue a bit more seriously and do something about those unsafe levels?

[Mr Hunt]

With respect to the hon. Lady, she cannot talk about alleged cuts in the NHS while her Front-Bench team support a policy of real cuts in the NHS budget. In the last Opposition day debate, the right hon. Member for Leigh (Andy Burnham) said that he thought it was irresponsible of the Government to increase the NHS budget in real terms. That means he wants a real cut in the NHS budget, which would make the staffing issues to which she referred much, much worse.

Dementia

Baroness Keeley Excerpts

Thursday 10th January 2013 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this Back-Bench debate on dementia. I congratulate my right hon. Friend the Member for Salford and Eccles (Hazel Blears), the right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Chatham and Aylesford (Tracey Crouch) on securing the debate and on their excellent contributions. I join others in saying how much I appreciated the moving and personal contributions from right hon. and hon. Members this afternoon. It must have been very difficult for them to talk about their personal experiences, but they did it very well.

My right hon. Friend the Member for Salford and Eccles has worked unstintingly on this issue, locally and nationally. Like her, I want Salford to become a dementia-friendly community. I share her pride that Salford contains one of the 10 national demonstration sites, in the Humphrey Booth centre in Swinton, which has its own day centre, the Poppy centre. I also agree with her that more needs to be done to improve our community services, to reduce hospital stays, to increase rates of diagnosis of the condition—many Members have mentioned that today—and to end the stigma that is so often associated with it.

I want to talk specifically about carers for people with dementia. As others have pointed out, about 10% of our 6.5 million carers are caring for a person with dementia, which means that at least 2,000 of our 22,000 carers in Salford must be in that position. The nature of the symptoms of dementia clearly makes providing such care particularly difficult. People with dementia can grow agitated, and they may wander at night and call out when asleep, which means that the carers themselves get little sleep. The personal care needs of those with dementia can be very great, as has also been mentioned today. Many people are performing a caring function for more than 100 hours a week. As we have heard, family members caring for a person with dementia must cope with personality change and loss of memory. Those very serious changes cause them to suffer feelings of grief and loss, similar to the experience of bereavement but before bereavement.

Dealing with that heavy caring work load also means that shortcomings in the provision of appropriate care services will be keenly felt. If carers do not have confidence in the quality or appropriateness of care, they will not have the confidence to take the respite breaks they so badly need. In 2007, when I was parliamentary champion for carers week, I visited some local carers and talked to them about our local services. One of them, a remarkable woman, was caring for her husband, who had vascular dementia. When she and I introduced ourselves, she told me “I am his nurse.” That was the change that had come about in her relationship with her husband.

The woman also told me how impossible it was proving to be to find adequate respite care locally. On one occasion, a week’s respite care had been arranged, with her husband staying at a local nursing home. Owing to a catalogue of problems at the start of the week, she then had no confidence that the home would manage her husband’s care properly, and she began to visit him there every day. By Wednesday, when family members found him lying unshaven in a soiled bed, she said that enough was enough, and brought him home. The end result of all her worries during those four days was that she developed eczema and had to visit her GP. That was her one week’s respite care.

One aspect of that woman’s life that she did praise was the support given by Crossroads Care, which is now part of the Carers Trust. Twice a week it provided two hours of respite care that she trusted. During one two-hour slot, she did her shopping at the local supermarket; during the other, she went to play bingo. When I asked her what we politicians could do for her and what changes she wanted to see, she told me that she wanted regulators who inspected care or nursing homes to ask carers for feedback about their experiences, and that, for herself, she wanted occasionally to have respite care lasting longer than two hours, so that she could wander around the shops rather than racing to get back home.

That was more than five years ago. I wish I could record that the situation for carers for people with dementia had improved radically in that time, but, given the increasing number of people with dementia and the crisis in the funding of social care—which has been touched on by several Members—the amount of respite care per individual carer cannot be stepped up dramatically, which is a pity. Crossroads Care told me that in 2008 it had provided 9,000 hours of respite care for 398 carers. This year it will provide some 13,800 hours of respite care for 567 carers. As I said earlier, we probably have some 2,000 carers for people with dementia, so the support is reaching only just over a quarter of the people who might need it.

The Health Committee’s recent report on our accountability hearing with the Care Quality Commission concluded that the regulator inspecting our care homes still did not have the confidence of carers, families and residents. It recommended that feedback from carers and other members of the public should start to be regarded by the commission as “free intelligence”, and that the regulator should act swiftly when complaints were brought to light.

In 2007 I introduced a ten-minute rule Bill, the Carers (Identification and Support) Bill, which required health bodies

“to identify patients who are carers or who have a carer”

and take steps to promote their health. I have introduced similar Bills subsequently, including, on 7 September this year, the Social Care (Local Sufficiency) and Identification of Carers Bill. I am still convinced of the need for health bodies—hospitals or, in primary care, GPs and their teams—to identify carers and ensure they receive information, advice and health checks. That would help avoid the isolation carers feel, which my hon. Friend the Member for Bridgend (Mrs Moon) talked about. They would be connected with professionals and other carers.

[Martin Horwood (Cheltenham) (LD)]

I agree with what the hon. Lady is saying, and, indeed, we might mention institutions such as the National Institute for Health and Clinical Excellence in this context. When I worked for the Alzheimer’s Society, we had the experience of trying to persuade NICE that evidence from carers about some quite difficult-to-research things such as behaviour and daily living skills was valid evidence when collected systematically and at scale—and, indeed, just as valid in its way as the evidence from things such as clinical trials and cognitive scales?

[Barbara Keeley]

Yes, and probably more so. The key concept here is that of the expert carer. Reference has been made to the professional carer, but I think expert carer is the right term. I shall talk about NICE shortly.

My Bill stated that health bodies should promote and safeguard the health and well-being of carers. They should ensure that effective procedures exist to identify patients who are carers or who are about to become carers, and ensure systems are in place to make sure that carers receive information and advice and that general medical services are rendered to patients who are carers. The reason for that is that carers will ignore their own health. They will entirely put the person they are caring for first, and put their own health to the back of the queue.

I was interested to see that this week NICE started a consultation on the topics prioritised for development in the quality and outcomes framework for 2014-15. The hon. Member for Banbury (Sir Tony Baldry) discussed the three indicators, the first of which is:

“The percentage of patients with dementia with the contact details of a named carer on their record.”

The second indicator is:

“The practice has a register of patients who are carers of a person with dementia.”

The third indicator is:

“The percentage of carers (of a person with dementia) who have had an assessment of their health and support needs in the preceding 12 months.”

I would have welcomed this development, as the identification and support of carers is a crucial issue, but I have some comments to make on the indicators. I doubt whether the QOF is the best way to achieve progress, and in some respects this issue is a higher priority. We currently give three QOF points to GP practices that keep a register of carers, but they could, in fact, have a small and static register of carers that they did not consult on, improve and develop. They would still get three points, however. The task of properly identifying carers and making sure they get the advice and support and the health checks they need is certainly worth more than the £400 that these three QOF points averages out as being worth. Is that what we think these tasks are worth? They surely must be worth more than that.

I have taken advice on this matter and I suggest that a better solution would be to tier the indicator payment based on the percentage of carers identified. Sufficient QOF points should be given properly to recognise the achievement of the task as well. It will take a number of people quite a bit of time to perform it, particularly if it is performed at the higher levels of achievement. Carers trusts tell me it is hard to find GP practices where more than 3% of carers are identified. The figure should be about 10%.

I fully support the indicator measuring the percentage of carers who have had an assessment of their health and support needs in the preceding 12 months, as that is a very important development, but why does it cover only carers of people with dementia? In my constituency there are carers of people who have had a stroke who have a very heavy, and very similar, work load to carers of those with dementia. It would be better to specify a small range of long-term conditions that lead to carers having a heavy caring work load, and they should be identified and receive assessments.

I want to record my thanks to organisations in Salford and elsewhere that do a wonderful job in supporting carers of people with dementia. I have mentioned the Humphrey Booth centre, and Age UK in Salford has a dementia support service. Those services are very important. They provide buddy cafés that support both people with dementia with activities and carers with respite. A buddy café lasts for five hours. That is a welcome period of respite for carers. There is a drop-in café at the HBC as well as a carers training programme, and it offers vital information, advice and advocacy services. It is a key partner in Salford, providing better quality services to people with dementia.

Last, but definitely not least, I should mention Salford Carers Centre, which plays a key role in identifying carers and helping them with information, advice and support. I believe that our practice in identifying carers, both in primary care and acute settings, is making a real and vital difference to helping our carers to care. I have invited the Minister, just as I invited his predecessor, to come to Salford to see what we do. The key other part of that now is Crossroads Care, which provides vital respite care.

I will finish on the issue about the funding of care, as many hon. Members have done. The right hon. Member for Sutton and Cheam referred to the moving speech made by a carer at the meeting earlier in the week to launch a pamphlet he wrote. In her contribution, that carer described the difficulty of managing catastrophic care costs for a person with dementia. She said:

“A £35,000 cap, as proposed by Dilnot (or even £50,000 or £60,000) could give me back my life. Our liabilities would be over. I could concentrate on my frail mum instead of the practical and emotional burden of single-handedly selling our family home. My mother has an incurable disease that has robbed us both of our lives; must it rob us of our assets too?”

I could not put it better than that, so I will not try to do so. As other hon. Members have said, we must consider setting the cap, up and down the country, at a lower level than £75,000, which will help people such as this carer. I have outlined a number of ways to support the carers of people with dementia, and I hope we give them the priority they deserve.