Health and Social Care Bill

Baroness Keeley Excerpts

Tuesday 20th March 2012 Commons Chamber

[Mr Stephen Dorrell (Charnwood) (Con)]

Thank you for calling me, Mr Speaker, for what I hope will be a brief intervention prompted by the remarks of my hon. Friend the Member for Banbury (Tony Baldry) and the right hon. Member for Wentworth and Dearne (John Healey).

Later this evening, the House will consider—yet again, many of us would say—the Health and Social Care Bill, but the issue for consideration now is whether the Government should publish the transitional risk register on the Bill. The right hon. Member for Wentworth and Dearne was explicit that he was not arguing that all strategic risk registers should be published, and acknowledged the argument that there needed to be private space in which civil servants could give advice to Ministers secure in the knowledge that it would remain private, because there was an important interest of good government that that discipline and space should exist. That is an argument that he explicitly accepted and of which I am a strong supporter.

My hon. Friend the Member for Banbury reminded the House that only yesterday two retired former heads of the civil service told peers in the other place of the importance of the principle that Ministers must be able to receive advice from civil servants on policy issues, including the risks associated with them, without that advice later becoming public. The issue that the right hon. Member for Wentworth and Dearne did not cover but which is important is that there needs to be confidence within the civil service about which side of the line advice will fall. If civil servants can give advice to Ministers believing that it will remain confidential and if, after the advice is given, the line is moved and the advice falls to be published, we run the risk that across Whitehall the space that he advocates will, in truth, not exist, because there will not be the confidence that the advice will not later fall to be published.

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

The right hon. Gentleman is talking about advice. It has been made clear that this is not advice but a management assessment of risks relating to the Bill and the reorganisation. It is not about policy or advice, which is why it is important that it is released.

[Mr Dorrell]

It is an interesting debate whether a risk register about a transition related to a policy is advice about policy or advice about management. The issue is that there is doubt. If the Government surrender this line without arguing the case to its conclusion, there is space for doubt about whether these risk registers will remain confidential or whether they will be published. The important principle is certainty.

Health and Social Care Bill

Baroness Keeley Excerpts

Tuesday 20th March 2012 Commons Chamber

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

Will the Minister give way?

[Paul Burstow]

No, I am going to make some progress and then I will be more than happy to give way. [Interruption.] I am sure there will be more opportunities and I will give way in a moment.

On how Monitor exercises its powers, the Government have supported amendments made in the House of Lords, which were tabled by my noble Friend Baroness Williams, providing that the Secretary of State can give Monitor guidance to help ensure it exercises its functions in a manner consistent with the Secretary of State’s duty to promote a comprehensive health service. The amendments also help to ensure that the Secretary of State can discharge effectively his responsibility for the health service in England and to ensure that Monitor carries out its functions to that end. I therefore commend the amendments to the House. Both this House and the Lords have stressed the need for Monitor to use its powers to support integrated services and co-operation between providers. The Government therefore tabled amendments in the other place to provide express powers for Monitor to set and enforce licence conditions that would enable integration and co-operation between providers.

On the detail of Monitor’s specific regulatory powers, Monitor would have powers to intervene proactively to support commissioners in ensuring continued access to NHS services if a provider became unsustainable. Amendments tabled by the Labour peer Lord Warner, which we agreed in the other place, provide that Monitor will have to identify and publish evidence where it identifies risk that it considers arises from unsustainable service configurations. Those amendments would require commissioners to act on that information where necessary. Hence, they make clear the expectation that commissioners will address problems proactively and ensure that patients continue to have sustainable access to the services they need. These are sensible provisions that had support from all parts of the House of Lords and I hope that this House will also agree to them.

I want to say a bit more about the powers and responsibilities of Monitor, which relate to further amendments made in the other place. The extent of the various matters that Monitor would have to take into account was the subject of considerable debate in this House and the other place. I want to be absolutely clear about where we are regarding the overarching duty that Monitor has to take into account. Monitor will have a single, unequivocal duty—to protect and promote the interests of patients by promoting provision of NHS services that is economic, efficient and effective and that maintains or improves the quality of services. Beyond that overarching duty there is no hierarchy. No preference is given to competition or integration because integration is clearly a responsibility that sits with commissioners and Monitor’s role is to support it.

Peers also raised concerns about proposals for the Competition Commission to undertake seven-yearly reviews of competition in the provision of NHS services. The Government were sympathetic to the arguments and were concerned that it might be taken to suggest that competition was being given a higher status than the interests of patients. In order to avoid that, we accepted an amendment tabled by my noble Friend Lord Clement-Jones that removed the provision in the Bill for Competition Commission reviews. We also supported other amendments tabled by my noble Friend Lord Clement-Jones requiring the Office of Fair Trading to seek advice from Monitor whenever it considers mergers or potential mergers involving foundation trusts. The amendments will help to ensure that benefits to patients are evaluated on an informed basis by a sector-specific regulator giving its expert advice to the OFT in the discharge of its responsibilities and as a paramount consideration.

--- Later in debate ---

[Paul Burstow]

Absolutely not; the reports to which the hon. Gentleman refers, which had a substantial exposé in The Mail on Sunday, really do not bear as close an examination as he would like of them. We know that the relationship that existed in terms of contracting McKinsey to provide services was one that the previous Government engaged in far more freely than the current Administration. The amounts that this Government have contracted and the nature of the relationships that this Government have are far smaller.

[Barbara Keeley]

I have asked the Secretary of State about McKinsey and Co. in this Chamber and through a written question, but neither he nor anybody in the Department seems able to confirm whether it has access to the risk register. It seems very strange to me that the Department is not able to answer the question of an hon. Member about what access that organisation has to those documents. It is a very strange set-up.

[Paul Burstow]

The hon. Lady says it is a strange set-up and refers to her endeavours to get an answer to the question. I have not seen details of her exchange with the Secretary of State, but I will look at that and write to her with an answer to the question.

--- Later in debate ---

We expect Monitor to oversee foundation trusts’ proposals to increase their income from non-NHS activity. As my noble Friend the Minister said in the debate in the Lords on Report, if a foundation trust is increasing its non-NHS income by more than 5% of its total income in a year, we will expect Monitor in every instance to review whether there is any cause to intervene in order to safeguard the ongoing provision of NHS services. That is a proportionate and reasonable response and a proportionate role for Monitor to assume.

[Barbara Keeley]

I do not know whether I am alone in this—I do not think so—but the notion of foundation trust governors having to approve an increase in private patient income does not feel like much of a safeguard, especially as the governors are inclined to balance the books. It just means that the proportion of private patient income will slowly grow to 49%, rather than jump to it straight away. While we are thinking about this aspect of clause 163, I understand that the Department of Health still has an explicit target in the operating framework to increase the proportion of non-public sector provision purchased with NHS funding. There are so many pressures and drivers that the denial that it is privatisation and the influx of competition—[Interruption.] It is privatisation that will slowly grow to 49%.

[Paul Burstow]

Absolute nonsense. That is part of the rhetoric and fantasy that we have heard throughout the Bill’s passage. Let me deal directly with it by reference to examples of current practice. The Royal Marsden and the Royal Brompton and Harefield all earn very high levels of private income but are consistently rated highly as providers of NHS services. They use those resources to reinvest in NHS services.

Health and Social Care Bill

Baroness Keeley Excerpts

Tuesday 13th March 2012 Commons Chamber

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

I want to speak in support of the motion, which notes the e-petition and declines to support the Bill in its current form. As has been said but deserves repeating, the Conservative-led Government have no democratic mandate for the Bill; quite the opposite, given the Prime Minister’s promise that

“with the Conservatives there will be no more of the tiresome, meddlesome, top-down re-structures”

of the NHS. Yet this reckless and unnecessary top-down reorganisation will cost £3.5 billion, which could be spent on patient care.

Already in my local area and many others, patients are losing services, waiting longer and receiving poorer treatment than before. Salford primary care trust has ended its active case management service for people with long-term conditions—the service had been both popular and effective. NHS budget cuts have meant that a community matron service was ended in a local area.

The Select Committee on Health recently dealt with the impact of the NHS reorganisation in its report on public expenditure—my right hon. Friend the Member for South Shields (David Miliband) quoted it. The report concluded:

“The reorganisation process continues to complicate the push for efficiency gains...it more often creates disruption and distraction that hinders the ability of organisations to consider…effective ways of reforming service delivery and releasing savings.”

Cuts are having a direct effect on treatment. A staff member of the local branch of the Parkinson’s Disease Society told me recently that NHS cuts mean that GPs and pharmacists are switching to cheaper brands of drugs for patients with Parkinson’s, many of which are much less effective. One person was admitted to hospital. She became ill following a switch to a cheaper, less effective medicine. The hospital staff told her that she should be “firm with her GP” and insist on the more expensive brand.

The Bill brings competition into the NHS at a level that is unhealthy and unwanted. The PIP breast implants saga showed us the dangers for the NHS of a vast increase in private provision when regulation of medical products for use in surgery is so poor. In January, 14 consultants, GPs and public health experts wrote a letter to The Times about the expansion of private provision and the issues arising from PIP implants. They warned that the Health and Social Care Bill

“provides much less protection for patients should their provider fail than is available to people booking package holidays”.

With PIP implants and private surgery, there was a strong marketing sell to patients of the benefits of surgery but little information about risks, and little or no interest in aftercare. That is an important warning. We know that there are potential health issues with metal-on-metal hip implants, yet there will be pressure on patients waiting for a hip or knee replacement to go for private surgery to avoid the waiting lists that we know are building up.

The Bill risks creating a two-tier NHS and a return to the long waiting lists experienced under Conservative Governments in the 1990s—the Government have already watered down guarantees on NHS waiting times. I recall meeting a patient in 1997 who had been waiting up to two years for vital heart surgery, yet more recently in my constituency I have met people whose lives have been saved in a matter of days by the rapid diagnosis and treatment of cancers.

A number of local GPs have written to me calling on the Government to drop the Bill because they feel it undermines the bond of trust between doctor and patient. One GP told me:

“The reforms are being made on the cheap. GPs are being asked to do the work of the PCTs with half of the funding and all of the blame when problems arise. The Bill drives a wedge between primary and secondary care.”

That GP actually supports the theory of clinicians being given more input and supports a reduction in bureaucracy, but says that the Bill “does the exact opposite” because it introduces new layers of bureaucracy such as the clinical senate. He says that people coming in

“are doing so at different levels of understanding…leading to confusion.”

He feels that, ultimately,

“it will be the patients who will suffer…no one has asked the patients what they want.”

[Bill Esterson]

My hon. Friend describes a GP in her constituency, but a GP in mine described his concern to me. He said that he is there to be a doctor and wants to care for patients, and that he does not have the expertise to be a manager. That is the overwhelming concern of his colleagues around the country. Does she agree that that is the danger of that part of the Bill?

[Barbara Keeley]

I very much agree. Only quite recently have GPs expressed such concern. I have never known GPs to come to their MPs in numbers, as they are doing, to complain about the implementation issues they are already finding. As I said, the GP I quoted supported the idea of GPs being more involved with decisions about patients, but he now thinks that the Bill is

“simply a mask for a cost cutting exercise…a way to deal with the NHS on the cheap. A way of farming out support systems…e.g. clinical support, into the private sector.”

He says:

“More money will be taken out of the NHS and put into the private sector.”

The hon. Member for South West Bedfordshire (Andrew Selous) asked us to trust the wisdom of our GPs. That is a damning indictment by a Salford GP, and one that I believe is echoed by GPs up and down the country. Trusting the wisdom of my local GP, I urge hon. Members to support the motion.

Adult Social Care

Baroness Keeley Excerpts

Thursday 8th March 2012 Commons Chamber

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

May I start by congratulating the hon. Member for Truro and Falmouth (Sarah Newton) on leading the debate and on the way in which she has just opened it? It is good to work with her on the all-party group on social care. In debates such as this we work together to ensure that social care receives the focus that it needs to have in the House.

I want to discuss two aspects of the future of social care. The first is the current crisis in care and the need to bring in extra resources to close the funding gap. The second is the recommendations of the Dilnot report, which the hon. Lady has already touched on, which mainly focused on dealing with the catastrophic cost of sustained high-level care and support.

On the funding gap, the Minister told me and the Health Select Committee recently:

“We don’t accept the position that there is a gap. We have closed that gap in the spending review.”

However, Age UK’s “Care in Crisis” report says:

“This year spending on older people’s social care in England has fallen by £500 million and the funding gap is growing. … We project that by 2011-13 the Government would need to spend £1 billion more than this year to stop the situation getting any worse. … The current system is at breaking point.”

Research by Age UK showed that 82% of local authorities now provides care only to those with substantial or critical needs. Fewer than one in five local councils still provide care for those with moderate needs. I have to say I am happy that that includes my own local authority of Salford.

The Economic and Social Research Council centre for population change has looked at the issue of unmet need for social care. It concludes that, regardless of the data source used,

“there is significant unmet need for care among older people.”

For example, 66% of people aged over 65 who need help with bathing were not receiving any support. That figure was based on data from 2008 and since then we have had front-loaded cuts to local authority budgets. I am sure that, although there is no up-to-date estimate, there are greater levels of unmet need than the figure I have given.

The Association of Directors of Adult Social Services has reported £1 billion of cuts to adult social care budgets in 2010-11, with further cuts predicted for next year.

This week many of us were involved when about 1,000 campaigners and 60 organisations lobbied Parliament for the urgent reform of social care and an end to the care crisis. For the first time, thousands more who could not attend Parliament joined the lobby online. A statement from those care and support organisations to MPs and Ministers said:

“Our social care system is broken. It cannot cope with a rapidly ageing population and positive impact of people living longer with illness and disability. Those who use our social care system can no longer tolerate a social care system which leaves many with no support and others with poor quality services. The public are angry that they can face huge care charges and end up losing all their savings or being forced to sell their home.”

One of the 1,000 people who came to Parliament to lobby MPs was a deaf-blind woman from Manchester who got up at 5 am to travel down because she said she was so worried about the future of social care. The Care and Support Alliance said that MPs heard personal experiences from people who need care but are receiving none, disabled people unable to access the support needed to live independently, families paying huge bills for care and carers pushed to breaking point.

I wanted to test the situation in my local area before the debate. Over the past few days I checked with three organisations that support older people and carers in Salford and the neighbouring area in Greater Manchester. This drew a depressing but familiar picture of services worsening, mainly due to budget cuts, but also due to cuts and organisational changes brought about by the NHS reforms. A staff member at Parkinson’s UK in Greater Manchester told me about her clients, people who have worked hard all their lives but are now struggling to pay for services that are essential to them. In some cases she had to apply for grants to help people with Parkinson’s buy a profiling bed or even pay off debts.

The staff member told me about a couple struggling to pay for the care needed by the husband, who has Parkinson’s. To help get him out of bed and dressed costs £22 an hour, and having someone sit with him while his wife does the shopping costs £11 an hour. Another carer of someone with Parkinson’s and dementia had her respite care cut from two weeks a year to one week. She feels that she cannot cope without those two weeks of respite. The staff member also told me that budget cuts mean that people with Parkinson’s can wait for a year for a stair lift, and she knows one man who has to go to bed at 7 pm because later in the evening his mobility gets worse and he cannot manage the stairs.

The staff member also told me that NHS efficiency targets mean that GPs are switching to cheaper brands of drugs for patients with Parkinson’s, but many of these are less effective. One person she told me about was admitted to hospital after becoming ill following a switch to a cheaper, less-effective medicine. The hospital staff had told her to “be firm with her GP” and insist on the more expensive brand. We have to be realistic that that is a difficult thing to do. NHS budget cuts in the local area have meant the loss of the community matron service, a service that was used by Parkinson’s UK staff for many of their clients but has now ended. In Salford—I have raised this point before—the primary care trust ended the pilot of active case management for people with long-term conditions, which was proving popular and effective.

Locally, Age Concern has told me that it has now lost the funding for a “Friends for Life” pilot scheme, which was part of the national dementia strategy. Its dementia support service has a planned income reduction of 40% over three years. It has had to make seven staff redundant and reduce its dementia support. Funding for day centres is being reduced by one fifth and will then be ended owing to the switch to direct payments from individual budgets. We all support personalisation and individual budgets, but not if it is a cover for cuts. I was disturbed to hear of a couple of cases where that is happening. In one case I was told about, a carer who had previously had two hours of respite care was given a budget of £9 and told, “Do what you want with the money.”

Our carers’ centre manager in Salford told me of her own experience of such cuts, this time to the personal budget of a family member she cares for with a learning disability who lives in Sheffield. Following what she described as a “fairly perfunctory” re-assessment that was done solely with the person with the learning disability, with no input from a carer or guardian—that is an important point—the personal budget was cut by £10,000. In that case, the carers’ centre manager was able to lodge a complaint and get legal help from a community care lawyer, but she knows that such an intervention would not be possible for other carers. These examples are what we mean when we talk about a care system in crisis.

However, those are not the worst examples. As I mentioned earlier, we know that some 800,000 older people are left without basic care. They have been described as

“lonely, isolated and at risk”.

Those are the words of 60 experts in social care in their recent letter asking the Government to make social care reform a top priority. We therefore know that the problem of unmet need is getting worse. Much of the additional burden will fall on unpaid family carers, many of whom are already overburdened. Statistics from the NHS Information Centre show that the proportion of carers providing more than 50 hours a week has doubled in the past 10 years. I think that that is the level at which it can be counted as a 24/7 caring job, as was discussed by the hon. Member for Brentford and Isleworth (Mary Macleod).

Many organisations have sent us briefings for this debate. There is a consistent call for a solution to the care crisis. Carers UK calls for the capped costs model that the hon. Member for Truro and Falmouth talked about. It sees a cap on costs as essential. It favours the cap being set at £35,000, which it feels would give carers and families the ability to plan for care arrangements and costs, and provide an opportunity for the development of care insurance products. I agree with that assessment and would caution against setting the cap at a higher level, such as £60,000, which has been discussed in the media. That is the value of some properties in Salford, so it could mean a family losing the entire value of their home, which would be wrong.

Carers UK believes that if families know that costs will be capped, they might be more willing to buy care and support earlier. That would help to promote independence and reduce the pressure on carers, which can result in ill health, giving up work or reducing working hours. It is thought that it will be harder to produce that shift in behaviour and move towards a new market in insurance products without a capped costs model.

Care and Support Alliance members argue for an additional £5 billion to be put aside over the next three years to meet the growing demand for social care. The cases that I have mentioned show that there is a clear need for additional resources to meet the growing demand, address the unmet need and tackle the shortfall in resources that has been growing for some years.

The Dilnot commission was given the task of making recommendations on how to achieve an affordable and sustainable funding system for care and support. Its report confirmed what has been said repeatedly for years: the current system is unfair and unsustainable, and without reform it will deliver ever-poorer outcomes for individuals and families. That includes the 1,000 people we saw here this week. The report also said that the funding of social care is inadequate and that people are not receiving the care and support that they need.

Although we may not have time to discuss this today—I certainly will not—the provision of advice and information is poor and very limited. People struggle to find financial information and advice, and there is little information and advice for carers. Worst of all—perhaps we can understand this—because the system is complex and difficult to understand, most people do not plan for, or even think about, the future care provision that they may need.

There is much consensus around the capped costs model. There is support for setting a cap at £35,000 and, as the hon. Member for Truro and Falmouth mentioned, for setting an asset threshold for means-tested support at £100,000. There are other important aspects, such as the need for national eligibility criteria and the need for local authorities to meet the eligible needs of carers. I think that those points are equally important. What still needs to be discussed, and I am not sure whether we will get into it today, is how to pay for the capped costs model and the additional resources that are needed to close the funding gap.

Care and Support Alliance members believe that there is a public appetite for reform. I think that we must take the debate across the country and ensure that the issues and solutions that I have talked about start to be debated. I have spoken about social care issues for the past seven years and I believe that they are now well understood. The 60 organisations that have lobbied Parliament this week have been lobbying on these issues for many years. The people in those organisations and the people they represent are tired of being consulted on the future of social care. What they want is action.

[Andrew George (St Ives) (LD)]

I congratulate my colleague on the Health Committee on her contribution to the report on social care. Does she agree that underlying the issue of care in crisis is an issue with the work force, who often work on the minimum income, are poorly regarded and are subjected to a lot of unfavourable reporting in the press? Does she think that we take them for granted when we look at the overall sector?

[Barbara Keeley]

Indeed, the work force issues are very important. I will not have time to discuss them today, but perhaps other Members will. The things that we hear about, such as tasks being reduced to one-minute periods and visits being cut down to very short periods, must make it a distressing and difficult job. We also have to recognise that personalisation leads to people working in an isolated way. Whereas before they might have been part of a local authority work force, they are now individually employed by care agencies and may not see anyone else. There are some new issues for us to consider, including the one that the hon. Gentleman mentions.

In 2009, after much consultation, my party brought forward plans to establish a national care service. As my right hon. Friend the shadow Secretary of State knows, Labour’s proposals for funding social care were treated as a political football, and there were some regrettable political attacks on them during the general election. That was unfortunate, and we cannot allow it to continue. I congratulate him on going back into the cross-party talks with great willingness, which must have been difficult knowing what happened to him during the election. We must work to achieve consensus across parties and across the country, because the issues that I have mentioned are becoming more pressing than ever before.

I believe I have found a unique way to link two speeches today, both of which you have heard, Madam Deputy Speaker. I talked earlier about women in sport, and this Sunday I will be running in a 10 km race to raise funds for Age UK’s “Spread the Warmth” campaign, which is aimed at making life better for older people in winter and avoiding needless deaths from the cold.

--- Later in debate ---

[Paul Burstow]

I am most certainly aware of that. Social isolation is a huge burden on the individuals affected by it and has huge consequences for health care. That is why, when I talk about independence, I also mean interdependence—the recognition of the value of family support and carers, and of the fact that people need to be active in their community throughout their life. Social care has a role to play in enabling people to do just that, rather than become institutionalised in their own home or a care home. I absolutely agree with the hon. Gentleman about that.

The Dilnot commission made a number of recommendations on the development of a system such as I mentioned, and my hon. Friend the Member for Truro and Falmouth described them well. In the spending review, we allocated an additional £2 billion by 2014-15 —£7.2 billion over the spending review period as a whole. In November 2010, we also set out our vision for social care reform, including the roll-out of personal budgets and greater personalisation. I agree that we need to ensure that that is genuinely about how we enrich people’s lives, not just an opportunity to reduce the available resources to individuals. We are also investing £400 million over four years to help to give carers much needed breaks. We are ensuring that the NHS is held firmly to account for delivering the money in the coming year by making sure that it has to account directly to carers’ organisations locally, and agree with local authorities the plans to provide breaks, spell out how many there will be and the size of the budget for that purpose.

It is also important to dispel a myth about social care, which has been hanging around for far too long—that, in some way, it is just like the NHS and free. As my hon. Friend the Member for Truro and Falmouth said, it is not free and never has been. If people assume that the state will pick up the bill, they are unlikely to prepare themselves. If they do not prepare and they need help, the impact can be truly devastating for them and their families: life savings wiped out, family homes full of memories sold off, and thoughts of a comfortable retirement turned to dust.

We therefore recognise the problem, which is getting worse. Our population is ageing, and that should be a cause for celebration. Too often, debates about ageing in our media are couched in terms of demographic time bombs and the like. However, the current care and support system is not fit for purpose. I agree with the Care and Support Alliance about that. It is broken, and patching and mending it is no longer acceptable.

However, reforming social care will not be easy. As has been said, it will require bold thinking and difficult decisions. The Dilnot commission shed much needed light on the reality of social care funding. Soon, we will publish a White Paper and a progress report setting out our response to the recommendations.

[Barbara Keeley]

Perhaps the Minister will enlighten us on what is meant by “spring”. There is speculation that spring might extend to May, June or July. When I was in government, I spent a lot of time answering questions about what spring meant in relation to Government reports. Will he tell us what it means now?

[Paul Burstow]

On that basis, the hon. Lady knows the answer that I would give and I shall therefore not tire her by saying what she would have said if she were in my place. We are anxious to publish a White Paper as soon as we can in a way that ensures that we have successful dialogue with the Opposition on funding. Those two matters are interdependent.

We are considering not just funding reform, but the legal structure that governs social care, which must be updated. The Law Commission has done a sterling job of making recommendations for replacing the patchwork that has built up in the past 60 years with a legal framework fit for the 21st century. A new social care law will bring clarity where today there is a complicated and confusing system, facilitate personalisation and support staff, service users and carers.

Beyond that, we need high-quality, integrated care, which focuses on early intervention, prevention and the needs of the individual. Better care is about not just spending more money, but spending it much more wisely. The Health Committee made that point powerfully to us. Some councils do that well; others could do it better. That is why the Government are jointly funding with the Local Government Association work to support councils to release savings while improving the care and support they provide.

The Health and Social Care Bill will foster far greater integration between the NHS, social care and, importantly, other public services. Health and wellbeing boards will bring together democratically elected local councillors, directors of children’s services, adult social services and public health services, clinical commissioning groups, and, importantly, the public through Healthwatch, to improve services in our communities. They will identify local needs now and for the future and, importantly, be accountable for setting the strategy to meet those needs. The unprecedented transfer of money from the NHS to social care is creating new opportunities for joint working.

However, we have a long way to go to improve the quality of social care, especially for older people. Clinical audits on fractures or continence care; the parliamentary inquiry into the human rights of older people in health and social care; and damning reports by charities such as the Alzheimer’s Society and Age UK all point to the fact that health and social care in England is far from universally excellent. In too many cases, it is very far indeed from being excellent. There can be no excuses and no mitigating circumstances. Yes, there are excellent staff working in our services, but some staff need to be challenged, and some need to leave the profession because they do not do the right thing. We need to be honest. We need to applaud the good, but to shine a light where there is no good.

It is not a matter of not having enough staff. In some places—

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[Tony Baldry (Banbury) (Con)]

I am grateful for the opportunity to contribute to this debate, not least as co-chair with Baroness Pitkeathley of the all-party group on carers. The first point I want to make is about the phrase “adult social care”. One of the difficulties in this area is that if we are not careful we develop a secret garden of policy and we all start to descend into shorthand—referring to Dilnot as though everyone understands the five paragraphs that follow from that. I thought that the shadow Secretary of State for Health made a good point when he said that, for many people, this is all about being afraid of getting old. I think that this should be about not adult social care but care of the elderly.

When the Law Commission was asked to define social care, the best that it could come up with was the phrase

“promote or contribute to the well-being of the individual.”

That was pretty otiose. We should focus on care for the elderly because we will need to enlist in our constituencies many more people to get involved in this, not least local councillors, with the introduction of health and wellbeing boards. I do not know about other hon. Members but, although I think that the provisions in the Health and Social Care Bill on integration are really good news—I will come on to that in a second—I do not sense that county councillors and others have yet woken up to the fact that shortly they will be part of the boards and will be involved in delivering integrated care. Part of the reason for that is that this has been a bit of a secret garden of policy. One of the things that Ministers will have to do in the near future is go out and talk to, in two-tier authorities such as mine, county councillors, but in others those councillors who are responsible for running social services, to get across the fact that the whole way in which services are delivered will fundamentally change.

About half the speeches this afternoon have been what I would describe as old-fashioned speeches to Ministers, saying, “Please can we have some more money?” The truth of the matter, as we all know, is that there is no more money. It is actually more challenging than that. We have the Nicholson challenge of 4% efficiency savings in the NHS over four years. We will make this work only if we completely rethink the way in which we deliver services. We all know of far too many people who are in hospital but could be moved elsewhere if intermediate beds were available. That would mean they could be moved out of acute beds, such as those at the John Radcliffe hospital or the Horton general hospital in Banbury, but that would require someone working out how to provide more community facilities and intermediate beds and how they would be paid for, and that will require a lot of rethinking by county councillors and GP commissioning bodies working together.

We have to start to put this in a language that everyone understands. When the White Paper is published in the “spring”—that leaves only April—there is a danger that we will all get fixated on Dilnot and the cap. It seems to me that that is just one part of the whole equation for improving care for the elderly and, increasingly, elderly people suffering from dementia. The figures on dementia are really pretty scary. Among the many organisations that produced briefings for today’s debate is the Alzheimer’s Society, which reports—I had forgotten this—that there are now nearly 750,000 people in the UK with dementia, and that figure is set to rise to over 1 million by 2021, when many of us expect still to be in the House.

Dementia costs the UK economy £20 billion a year. When I was first elected to the House, most Christmases I would visit the homes for the elderly in my constituency. The residents then were mostly spry widows in their 70s, but now all the homes are almost totally full of people suffering from dementia or age-related dementia. This is about how we care for the elderly and, increasingly, elderly people with dementia, many of whom are having to stay at home longer. Indeed, the Alzheimer’s Society says that more than half of the people suffering from dementia have not yet been diagnosed as such because their families or those are caring for them are probably disguising the fact.

[Barbara Keeley]

I do not know whether the hon. Gentleman thought that my speech was one of the old-fashioned ones asking for more resources, but he probably did. However, I gave three examples of cuts to services for people with long-term conditions: the support services for people with dementia that Age Concern was running; a community matron service; and active case management for people with long-term conditions. It is inexcusable for those to be cut. If the Nicholson efficiency reforms are causing those services to be cut there is no way forward, because those are the supports in the community that will keep people out of hospital. It seems crazy. I now have three examples, whereas at Christmas I had only one. I am distressed to think that those services are being cut, because they are the way to support those people in the community.

[Tony Baldry]

One of the advantages of having been in the House for a little while is that one spends some time on the Government side, some time on the Opposition side and some time on the Government side again—I hope not to be on the other side again but am quite content wherever. One of the things I have learnt is that which side one sits on does not change reality. The reality is that this challenge is so enormous that it will not be solved simply by all of us telling the Treasury, “You’ve given us £2 billion. Please can we have another £4 billion, or another £8 billion.” It will only be changed if we fundamentally rethink how we deliver services for the elderly. If all Members asked how many delayed discharges there were in the general hospitals in each of our constituencies, I suspect that we would find that it is a huge number—I am afraid that Oxfordshire is currently one of the worse offenders. We have to do better. We have to fundamentally rethink the whole way we deliver these services.

Health and Social Care Bill

Baroness Keeley Excerpts

Tuesday 28th February 2012 Commons Chamber

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

The Deputy Prime Minister’s letter promised

“additional safeguards to the private income cap”.

Will the Secretary of State explain what are these additional safeguards aimed at ensuring that foundation trusts cannot focus on private profits before patients?

[Mr Lansley]

We have already made it very clear in another place that the legislation will ensure that foundation trusts should have the freedom to increase their private income, not least in relation to international work. However, their principal legal purpose is for the benefit of NHS patients, and so they already have to make sure that they reflect that in their annual reports and in their annual plans. As the letter indicates, we are, with my hon. Friends in another place, working on a further corporate governance mechanism to ensure that foundation trusts reflect their principal legal purpose in all that they do. [Interruption.]

NHS Risk Register

Baroness Keeley Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Mr Lansley]

It was, and it was staggering—my hon. Friend will remember this—that all the difficulties associated with building the Norfolk and Norwich PFI were evident to the last Government and yet they carried on. They carried on signing up to PFI projects that were frankly unsustainable, including, for example, the project in Peterborough—which, sadly, we had to include in the support that we are offering to unsustainable PFIs—which was signed off although Monitor had written to the Department to say that it did not support the project. I do not know, but perhaps the shadow Secretary of State wants to say something about that.

From my point of view, that is why we need to reform the NHS. It is why we were in the position of undertaking the work as the risk register was being published, because we had to avoid all those risks, reform the NHS and move forward to put doctors and nurses in charge, give patients and the public more control, strengthen public health services and cut bureaucracy.

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

rose—

[Charlie Elphicke]

rose—

--- Later in debate ---

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Lansley]

In a moment.

The Health and Social Care Bill underpins those reforms. We need to safeguard the NHS for future generations. The Bill does simple things—many things, but simple things. It cuts out two tiers of bureaucracy. It empowers the NHS Commissioning Board, which we promised in our manifesto. It empowers clinical leaders in local commissioning groups, which we promised in our manifesto. It empowers patient choice and voice, which we and Labour promised in our manifestos, but which only we are doing and Labour is now against. The Bill supports foundation trusts, which Labour said it was in favour of, but which we are going to act on. It introduces local democratic accountability, which the Liberal Democrats promised in their manifesto. It creates new, strong duties to improve quality continuously, reduce health inequalities, promote research and, yes, integrate services around the needs of patients. No fragmentation, no failure to connect up; for the first time, integration as part of the responsibilities, including those of Monitor; no change to NHS values; no undermining of the NHS constitution; strengthening the NHS constitution; free at the point of use, based on need; no privatisation, no charging—

[Barbara Keeley]

rose—

[Mr Lansley]

I will give way shortly.

The only change in the legislation in relation to the private sector is that the Health and Social Care Bill outlaws discrimination in favour of the private sector, which is what happened under the Labour Government, when the private sector treatment centres got 11% more cash for operations and £250 million for operations that they never performed. Perhaps the hon. Lady will explain that.

[Barbara Keeley]

I thank the Secretary of State for giving way—eventually. I want to get back to the risk register, which is the topic of this debate. I understand that staff from McKinsey and Co. attended meetings of the extraordinary NHS management board, which was set up to implement the Health and Social Care Bill. Can the Secretary of State tell us what parts of the transition risk register McKinsey and Co. has been given access to?

[Mr Lansley]

I am not aware of McKinsey getting any access to it, and I have to tell the hon. Lady that since the general election, I can personally say that I have not met McKinsey, so if it is involved in any of this stuff, it is not involved in it with me.

[Barbara Keeley]

rose—

[Mr Lansley]

No, I am not giving way again.

I asked about expenditure by the Department of Health on contracts with McKinsey, because I read about it in the paper and I thought, “Well what’s this all about?” I was told, “Ah, well, £5.2 million was paid to McKinsey in May 2010,” because it related to work done before the election—work done for Labour.

--- Later in debate ---

[Grahame M. Morris]

rose—

[Barbara Keeley]

rose—

[Mr Lansley]

No, I am not giving way.

Before the election, in 2009-10 when the right hon. Member for Leigh was Secretary of State, more than £100 million a year was spent by the Department of Health on management consultants; now less than £10 million is being spent on them, so we will take no lessons from the right hon. Gentleman.

We are managing the risks to the NHS. We have delivered £7 billion of efficiency savings and recruited 4,000 extra doctors, and there are 896 more midwives in the NHS than there were at the last election. We have cut the number of managers, 900,000 more people have gained access to an NHS dentist, and nearly 11,000 patients have had access to cancer medicines through the cancer drugs fund, which they would not have had under Labour. As I have said, waiting times are down, mixed-sex accommodation is down, and hospital infections such as MRSA and C. difficile are at record lows.

That is the progress we are seeing in the NHS today, but instead of celebrating it, the right hon. Member for Leigh has brought us a pointless debate. He talks about risk registers, which he himself refused to release. The debate is pointless, as the issue will come before the tribunal on 5 and 6 March, which is the proper place to examine these issues. It is a waste of Labour’s parliamentary time in an opportunistic attempt to divert attention from its lack of any alternative to the reform processes that the coalition Government are putting forward for the NHS. It is a futile motion, a pointless debate on Labour’s part, while we are supporting the NHS with reform through a Bill that has had unprecedented scrutiny. It has been consulted on through the NHS Future Forum, and through other routes continuously with thousands of NHS staff across the country, and we have listened and responded to everything they said. We are taking the responsible route by taking the NHS away from Labour risks towards a stronger future. I urge the House to reject the Labour motion.

--- Later in debate ---

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

I support the motion calling on the Government to publish the transition risk register because I think it is vital to ensure informed public and parliamentary debate on the Health and Social Care Bill. As other Members have experienced, 40 of my constituents have written to me about this issue in the last two days. They rightly worry that the Government’s reforms will damage the NHS. They want to see the risk register released to inform them and to let them make up their own minds about the issues. My constituents also believe that Members here and in the other place should have all the available facts and information when debating and voting on legislation.

The proposed top-down reorganisation of the NHS is unnecessary, costly and a threat to our current health and social care services. As we have to consider these costly and unnecessary proposals, we at least need to know the threats and concerns that exist, about which the risk register might inform us.

Risk registers—like other local registers we have heard about—are routinely published by the North West Strategic Health Authority and other regions to communicate risks about the transition to new NHS structures and to ensure that those risks are understood and managed. Let me point out some of the risks mentioned in a recent risk register report for the North West Strategic Health Authority. The transition might mean a loss of grip on current performance or that organisational and system instability during transition could adversely affect corporate performance. Furthermore, corporate and individual capacity and capability might be diminished by uncertainties arising from transition. Those are all rated as high risk.

I believe that we are already starting to see some of those issues arising in the north-west and nationally. The Health Select Committee recently dealt with some of those issues in its report on public expenditure. The Foundation Trust Network had told the Committee that

“in the short to medium term there is significant disruption in relationships as experienced people leave the NHS or are redeployed.”

It also said:

“With the financial pressures on commissioners, combined with the changes in personnel and disruption of historic relationships, there is growing evidence that commissioners are making unsophisticated attempts to reduce costs.”

Based on all the evidence we heard, the Select Committee concluded:

“The reorganisation process continues to complicate the push for efficiency gains…we heard that it more often creates disruption and distraction that hinders the ability of organisations to consider truly effective ways of reforming service delivery and releasing savings.”

I can provide a local example. Salford primary care trust was running an effective service of active case management for people with long-term conditions, but it ended that a few months ago. That is a counter-productive change—the sort of change being made by NHS bodies as they rush to meet the pressures of making savings and reorganisation. I know that ending that service was to the detriment of my constituents and other Salford people living with long-term conditions. I have raised the issue in debates with the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), who is in his place on the Front Bench.

The Bill brings competition into the NHS at a level that I believe is unhealthy and unwanted. What are the potential risks to patients of a massive increase in the use of private clinics, private surgery and other private treatments? Much is said about choice, but what about the risks? We know that tens of thousands of women with PIP breast implants are sick with anxiety; they understand the risks of using private surgeons who then refuse to follow their duty of care to their patients. These are women who fear that they might have industrial-grade silicon leaking into their bodies, giving them immune system problems. They are finding that their surgeons are either untraceable or do not want to know about their problems with the implants.

[Dr Sarah Wollaston (Totnes) (Con)]

Does the hon. Lady accept that GPs will not be commissioning private breast surgery?

[Barbara Keeley]

In fact, there is a link, or a crossover, with the NHS. I have received letters from women who have had breast cancer and whose breast augmentation has been carried out in the private sector. I think that the hon. Lady attended the Select Committee meeting at which the issue was discussed, so she should understand the risks.

Many private clinics that were keen enough to sell surgery now want to charge their past patients just for a scan to check an implant. Women who have undergone surgery in those clinics have told me that the videos and brochures selling the surgery made no mention of the risks, or even of the fact that implants last only up to 10 years and that they would have to repeat the surgery every 10 years of their lives in order to keep replacing them. That was never mentioned.

Some clinics have gone into administration. My right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) described what happens in such instances. The new owners—if there are new owners—tend not to want to know anything about the problems of past patients. Questions of capacity are involved. The largest private medical company undertaking implants dealt with some 14,000 of the 40,000 patients who were given PIP breast implants, and thus could be seen immediately to be liable for 14,000 removal and replacement operations. However, it now says that it has the capacity to deal with only 4,000 operations of this type per year. Having created a problem, that group of private clinics is now saying that it does not have the capacity to solve it. The Committee was worried about the capacity of the NHS to deal with it, but the capacity of the private clinics who sold all those operations is much smaller.

The problem of PIP implants is on a huge scale, and I still believe that far too little is being done to help the women who are sick with anxiety about their implants. As I have said, the private clinics and surgeons do not want to deal with the problems, cannot deal with them because they do not have the necessary capacity, or deal with them only if the patient pays again, often when she cannot afford to do so. As we have seen, the Secretary of State has no power to compel private clinics or private surgeons to meet what we say are the moral obligations and their duty of care to former patients.

We also, sadly, have a regulator for devices such as implants—the Medicines and Healthcare products Regulatory Agency—which seemed to be incapable of conveying to the 40,000 patients with PIP implants the message that the product was faulty and could be toxic, thus causing 21 months of delay before the patients even knew about the new risk to them. Much surgery, including much private surgery, involves various medical devices and implants, and that situation is not acceptable. Given that we have seen such regulatory failure in the case of one sort of implant, I want to know what risk is posed by private surgery involving other devices. It is possible that in future we will see further scandals involving replacement knees and hips.

We need to know what risks, at national level, are inherent in the proposals in the Health and Social Care Bill, particularly the competition proposals. We need to know that in the House, as the Bill progresses, and we need to know it more widely. I support the motion.

NHS (Private Sector)

Baroness Keeley Excerpts

Monday 16th January 2012 Commons Chamber

[The Secretary of State for Health (Mr Andrew Lansley)]

We start 2012, and what is the Labour party’s priority? Is it to welcome the NHS improvements in performance, as reported before Christmas—that waiting times are low and stable, that there are now 90% fewer breaches of mixed-sex accommodation standards than at the same time last year, that hospital infections are at their lowest ever levels, or that there are more doctors and fewer managers in the NHS than at the election? No, none of those was Labour’s priority. Was it to welcome the increase next year announced just before Christmas in NHS funding for primary care trusts, or since Christmas an increase in the funding available this year direct to clinical commissioning groups to enable them to meet the needs of their patients? No, it was not that.

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

I know that the Secretary of State was at Salford Royal hospital last week, where the abundance that he is describing does not seem to be around. That hospital—he went there to talk about nursing—will have to lose many hundreds of its nurses. It seems strange to us that we do not seem to see the abundance that he talks about and it certainly was not apparent at Salford Royal.

[Mr Lansley]

That is exactly the same question that the hon. Lady asked during oral questions. The Prime Minister and I did indeed go to Salford Royal hospital and we were tremendously impressed by what is being done there but, like other hospitals across the NHS, as part of a process of using resources more effectively and as part of the consequences of a transfer to supporting patients more in the community than in the acute sector, that hospital is changing the way it manages its services, and it is delivering cost improvements. We make no bones about that.

We delivered £4.3 billion of cost improvement in the NHS in the last financial year. We are aiming to do more this year. We delivered £2.5 billion, according to the deputy chief executive of the NHS, in the first two quarters. Every penny saved by reducing costs in the NHS is available to be reinvested in the NHS. That is why we are in a position to improve the performance. The hon. Lady did not talk about how that funding is becoming available through savings on central costs—for example, £150 million extra funding this year announced since Christmas for support for the integration of health and social care.

Was that Labour’s priority? No. Did Labour come to the House and say, “We want to welcome the way the NHS has achieved an increase in the flu vaccine uptake,” or the simple fact that flu activity at this stage is at its lowest level for the past 20 years? No, none of that. The hon. Lady talked about Salford Royal and the way nurses are engaging in some best practice—

[Mr Lansley]

No. I am still answering the previous intervention. Nurses are engaging in best practice to improve the quality of care for patients in Salford Royal. Was that the basis upon which the right hon. Member for Leigh (Andy Burnham) chose to come to the House to talk about the things that matter to patients—the quality of care being delivered to patients? No, it was none of those things.

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Lansley]

No. I answered the hon. Lady’s question.

Labour Members came to the House not to pursue the priorities of patients or of those who work in the NHS, but to pursue Labour’s priorities. They are not in 2012; they are not even in the 21st century. They are back in the past. Talking of the past and somebody who lives in the past, let us listen to the hon. Member for Easington (Grahame M. Morris).

--- Later in debate ---

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

I want to speak in support of the motion and argue that NHS hospitals are not private businesses and should not be turned into private businesses, pitted against each other and competing for the most lucrative procedures.

Many of the dangers inherent in the Government’s plans have been displayed in the saga about PIP implants. In that case, tens of thousands of women have been left worried sick about implants received in surgery in private clinics. There are, of course, serious questions about regulation of the products used in private clinics on those tens of thousands of women. Indeed, it has emerged that the PIP implants were effectively counterfeit goods below medical grade, and I understand that some of the gel used in them is designed for use in mattresses.

On 23 December, the Health Secretary’s initial response to the scare affecting tens of thousands of women was that his current advice was that there was

“no need to routinely remove these PIP breast implants. In the meantime we would recommend that all patients who have questions about their PIP breast implants should seek advice from their implanting surgeon.”

As we have heard since, however, some women who had that surgery could not even contact their original surgeon and many clinics demanded hundreds of pounds even for a scan—money that the women involved just might not have. Last week, many private clinics said that patients must pay in cash to have the implants removed.

I did not feel that the initial advice would reassure the women involved, who were left with all their fears and concerns over Christmas and new year, so I asked fellow members of the Health Select Committee to consider an inquiry into the saga and the issues of regulation that it raised, and I am glad that Committee members agreed and that there will now be an inquiry. We have to remember, however, that reviews and inquiries move slowly for people worried sick about their health. I believe that the NHS should stand by these women, which it reluctantly now seems to be agreeing to do.

The Medicines and Healthcare products Regulatory Agency passed the products despite their being substandard or, as I said last week and previously, effectively counterfeit. I thought that the point was well made in an article by the health writer and commentator Roy Lilley. He wrote that

“women who have PIP made breast implants are the victims of a crime”,

having

“spent fortunes on enhancements that have turned out to be counterfeit and possibly…injurious to their health… The NHS would not turn away a patient convulsing from consuming counterfeit vodka. Neither should it turn these women away.”

This saga raises many issues about not only the quality of implants but regulation—or the lack of it—in private medicine. That is key to this debate. More issues have been raised in recent days about the ability of surgeons who practise cosmetic surgery in private clinics. Apparently, they are not always trained or skilled enough to apply to be consultants or even to practise in the NHS without supervision, but they are skilled enough to operate alone in cosmetic surgery and private clinics. To what standard do those private clinics operate? What about the many other products implanted in surgery—hips, knees and heart valves, for example? How well regulated are those products and how can we be sure of their quality? I hope that the Health Committee inquiry can tackle some of those regulatory issues.

The concerns raised recently about the cosmetic surgery industry prompt many questions about where we will be if the Government continue with their Health and Social Care Bill. Last week in a letter to The Times, 14 consultants, general practitioners and public health experts wrote:

“The government proposes a vast increase in private provision of health care just as we are told that existing private providers are unable to supply adequate records of what they have been doing and are charging exorbitant sums to consult their records for those women seeking information on what happened to them.”

They continue to warn that the Health and Social Care Bill, now in the other place,

“provides much less protection for patients should their provider fail than is available to people booking package holidays.”

We have to think about that, because the implications are frightening for the future of the NHS.

The other major area of decline is waiting lists—this has been touched on in the debate—which are already getting longer, to the detriment of NHS patients. We must question what will happen when up to half of hospital beds are being used for private patients. In 1997, this country had a Conservative Government and NHS waiting lists were shockingly long. I was out campaigning in the 1997 election with my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins), and I met a man who had been told that he would wait two years for vital heart surgery. He was worried that he would die while on the waiting list. That was the reality of the NHS then.

After 13 years of a Labour Government and while campaigning in my constituency in 2010, I met a man who told me about a totally different experience of the NHS. He visited his GP on Monday and was sent for blood tests. On Tuesday, he was told that he could have serious problems and was admitted to a north Manchester hospital for further investigation. They had a specialist surgeon there who operated on him on Thursday and told him that the surgery had saved his life—four days to save a life in the NHS after a Labour Government had run it for 13 years versus a desperate two-year wait back in 1997 under a Conservative-run Government.

The Health and Social Care Bill challenges the NHS’s founding principle that access to services should be based on need, not ability to pay. I know that my constituents do not want these changes. Many of them have asked me to be here for this debate and to vote for the motion. I am happy to do so.

In conclusion, I join my hon. Friend the Member for Easington (Grahame M. Morris) in mentioning the brave participation of Dr Clive Peedell and David Wilson in running 160 miles in six days to draw attention to the growing campaign to drop the Health and Social Care Bill. It is time the Government listened.

[Henry Smith (Crawley) (Con)]

I am grateful to be called, Mr Deputy Speaker. I had three reasons for writing to Mr Speaker requesting to take part in this debate. The first is that I genuinely wanted to hear, in this Opposition day debate on the NHS, what the Opposition’s plans really are for the future of our health service. The second reason is that I want to describe the experience that my constituents went through, over 13 years of a Labour Administration. Finally, I want to talk about how already, in anticipation of the Health and Social Care Bill becoming law, clinicians in Crawley are working to deliver a better national health service.

I do not mind telling the House that I am forgoing an invitation to a dinner this evening, so great was my desire to hear exactly the official Opposition’s view on the NHS. What I have heard this evening is incredible—or, so that I am not misunderstood, not credible. It is amazing that a party that massively increased the PFI programme during its tenure, spending billions of pounds of taxpayers’ money in an inefficient way through the national health service, should come to the House this evening and try to claim that what we are trying to achieve in the Health and Social Care Bill will somehow privatise the national health service. Let us be quite clear: this Government are committed to providing a national health service that is available regardless of the ability to pay. The difference, I contend, between Government Members and Opposition Members is that they are ruled by some sort of centralist dogma that says that if the Department of Health has not willed it, it cannot happen, whereas the Government are trying to introduce a pragmatic approach, in which outcomes are far more important than the strict processes that a dogmatic system for delivering health care should produce.

I said that I wanted briefly to mention the experience of the NHS during what we are often led to believe were the golden years of the health service, under the previous Government. Those years were not so golden for my constituents, because in 2001—a decade ago—we regrettably saw the downgrading of maternity services at Crawley hospital. Crawley is a growing town; indeed, its motto is, “I grow and I rejoice”. However, there was not much rejoicing when its maternity services were taken away and transferred almost 10 miles up the road to East Surrey hospital, where there is now increased pressure on maternity services, as it is having to cope with the increased number of people from not only east Surrey, but the north-east of West Sussex.

To add insult to injury, in 2005 Crawley hospital saw its accident and emergency department closed. Again, it was moved miles up the road to East Surrey hospital, even though there is little public transport between that hospital and Crawley—a growing and ageing town, with increasing health needs and major transportation links, not least the nation’s second biggest airport, London Gatwick—and single-carriageway roads. At best, that is inconvenient for patients and for families wishing to visit them in hospital; at worst, it is potentially fatal. That is my constituents’ experience.

[Barbara Keeley]

The hon. Gentleman is making a defence of A and E and maternity services, but does he not recognise that, despite the promises made by the current Secretary of State during the election campaign, many hospitals have, for clinical reasons, done the very same thing? They include Salford Royal, which has lost its maternity services, and others in the north-west, even though the Secretary of State promised that that would not happen to them. Does the hon. Gentleman not see that those things are going on now?

[Henry Smith]

The principal reason behind the closure of the accident and emergency unit at my local hospital was the European working time directive, which had a massive impact across the national health service. The NHS as an institution will of course evolve, the better to serve patients up and down the country. That is absolutely right.

That brings me to the third point that I wanted to make: the opportunity that the Health and Social Care Bill will provide for greater localisation in decision making on the future of health care services. I am delighted that the clinicians and GPs in Crawley have already come together to form a GP commissioning body, which is very ably chaired by Dr Amit Bhargava. It is brimming with ideas for innovative ways in which patients can be provided with much better services. For the first time in many years, decisions about the future of health care in Crawley are being made by Crawley clinicians, in conjunction with their patients and in the light of their patients’ needs. The group is working in conjunction with the local authorities—West Sussex county council and Crawley borough council—which, incidentally, will be providing oversight of some of the private sector contracts in the national health service, as envisaged in the Bill. The provision of that democratic oversight for the first time will achieve a localisation of services that is more relevant to the needs of the local communities, as well as a far greater degree of oversight.

I reject the motion before us, and I welcome the Health and Social Care Bill. It will be better for patients and better for democratic oversight. Ultimately, we should be talking about, and delivering, better outcomes for health care in this country, not remaining wedded to an outdated dogma which does not deliver services as efficiently as it could and should deliver them.

Breast Implants

Baroness Keeley Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

My hon. Friend is right. When Sir Bruce and his colleagues are considering the establishment of a wider registry, they will consider not only the possibility of self-registration but the possibility of making clinical professionals responsible for the publication of such data. The responsibility should not rest solely on providers or manufacturers.

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

I understand that a number of private clinics will not even scan a patient with PIP implants without charging. However, these goods were counterfeit. They were not of a medical standard, and they could be injurious to health. Should not the NHS be prepared to help women who must be worried sick, and perhaps cannot even afford to have a scan to reassure them? I cannot believe that the NHS would turn its back on a patient who was suffering after drinking counterfeit vodka, so why should it turn its back on these patients?

[Mr Lansley]

I am sorry that the hon. Lady framed her question in that way, because I thought I had made it clear that the NHS would always be there to support women. We will seek to recover the cost to the NHS if the original provider was a private provider: that approach has been adopted for years, and I am sure that it would have been adopted by my predecessors. No woman should have to feel that she will not be looked after, but I am making a different point—namely that, in the first instance, women should be looked after by the original providers, who have a continuing duty of care. They also have legal obligations—as well as the moral obligations to which I have referred—but it is not for me to advise on those.

Social Care Funding

Baroness Keeley Excerpts

Thursday 10th November 2011 Westminster Hall

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

I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) on securing this debate and on the way in which she opened it. I am sure that we all agree with her final comment about caring for those who served in and lived through the second world war. It is important that we not only debate social care here, but ensure that a much wider debate on the current and future funding of social care takes place across the country.

The Dilnot commission was tasked with making recommendations on how to achieve an affordable and sustainable funding system for care and support. No one here today will be able to go into too much detail about the report, but I should like to talk about some of the things that the report confirmed, including things that have been repeatedly said about social care for years. These are some of the key points. The current adult social care funding system in England is not fit for purpose and needs urgent and lasting reform. The current system is unfair and unsustainable. Without reform, it will deliver ever poorer outcomes for individuals and families. The funding of social care is inadequate—people are not receiving the care and support that they need. Indeed, there is an unacceptable level of variation in eligibility for services; we have 152 different adult social care systems. For a number of years, care has been rationed through the fair access to care system, but that system is now seen to lack transparency, consistency and clarity. Assessments for care are not portable. Given the variations in eligibility, the problem causes frustration and worse than that when people needing care have to move to a new local authority.

The provision of information and advice is poor quality and very limited. People struggle to find financial information and advice, and there is little information and advice for carers. While there are significant overlaps between funding streams for housing, benefits, the NHS and social care, the systems that administer them are not joined up, which means that we do not have integration, that we have poor co-ordination and that people have to suffer multiple assessments. Perhaps worst of all—Andrew Dilnot rightly drew attention to this—the system is so complex and difficult to understand that most people do not plan for or think about the future provision of care that they may need. I am sure that many right hon. and hon. Members will have had cases of constituents who thought that social care was free and were shocked when they discovered that it is not and that they will be faced with paying the costs of care.

All those points are a disturbing appraisal of the system of care and support on which millions of people depend because they are frail, elderly or have a disability or long-term condition. We have known about all those problems for some time and I have spoken out on these issues since I came into the House in 2005, with a variety of different people filling the role that the Minister now occupies.

In 2009 and after much consultation, my party brought forward plans to establish a national care service. Given the pressing needs of those people with the greatest care needs, we also passed the Personal Care at Home Act 2010 to provide free personal care at home for the 400,000 people with the greatest care needs. It was not a perfect solution, and I do not think that anyone thought that it was, but it would have provided financial peace of mind to 400,000 individuals and their families.

My party’s proposals were treated as political footballs during the general election campaign. There were some regrettable political attacks on the proposals for social care, which was unfortunate.

[Glyn Davies]

Does the hon. Lady not accept that the way in which those proposals were treated before the last general election was massively damaging? I was not a Member of Parliament then, but I was ashamed of some of the language that I heard coming out of the House. It is wrong to attribute the matter to any particular party. If we are going to deal with this issue properly, we have to set aside that sort of language because it serves no purpose and damages our reputation with the public.

[Barbara Keeley]

Indeed. As ever with interventions, that was almost the next thing that I was going to say. I was going to say that the whole incident was unfortunate. I am chair of the all-party group on social care and I want to see a consensus built in this Parliament to take forward a solution to the funding of care and support, so I very much agree with the hon. Gentleman.

We must set our minds to the fact that, this time, the debate must be different. We need to build consensus across the parties and across the country. The need for a solution is more pressing than ever. We know that requests for support are increasing. In 2009-10, there were 2.1 million contacts from new clients to social services, an increase of 4% from 2008-09 and of 8% from 2004-05. We also know that many hundreds of thousands of people never have their needs assessed.

At the Health Committee this week, I asked a question of the president of the Association of Directors of Adult Social Services about levels of unmet need. He seemed unable to quantify it. How can we plan for provision of social care if we do not know the levels of unmet need? Research by Age UK showed that 82% of local authorities now provide care only to those with “substantial” or “critical” needs. I am glad to say—I think that the hon. Member for Truro and Falmouth also has a council in her constituency that is perhaps doing a bit better—that my own local authority, Salford city council, is among the 18% of councils in the country that still provide care for those with “moderate” needs.

I welcome the commitment of my Labour council colleagues to try to meet the needs of the more vulnerable members in our communities. I understand how difficult the position is, but I value all those councils that are rightly taking the decision to protect social care. We know that vulnerable people in other areas are not so fortunate. Recent studies by the Office for National Statistics and the Economic and Social Research Council Centre for Population Change have looked at the issue of unmet need for social care. The centre concludes that, regardless of the data source used

“there is significant unmet need for care among older people.”

It gives the example of a group of people aged over 65 who needed help with bathing. Of that group, 66% were not receiving any help with bathing. That example was based on 2008 data. Since 2008, we have had front-loaded cuts to local authority budgets, which will have caused greater levels of unmet need.

My hon. Friend the Member for Lewisham East (Heidi Alexander) referred to local authority budget cuts and now the Association of Directors of Adult Social Services has reported £1 billion of cuts to social care budgets in 2010-11, with a similar or greater level of cuts being predicted for next year. What impact those cuts will have is of concern to us in Parliament.

The NHS Confederation reminds us that when people’s needs for social care are not met, they turn to the NHS. The NHS Confederation says that that will mean increasing numbers of unscheduled and emergency admissions to hospital, as well as delayed discharges from hospital. Indeed, recent figures from the Department of Health show that the number of delayed discharges from hospital was 11% higher in September and October this year than in the same two months in 2010. Clearly, delaying discharges from hospital is an expensive solution to the problem of inadequate social care. Indeed, the NHS Confederation says that, without reform, the NHS will ultimately buckle under the pressure of demand from patients who need social care.

The problem of unmet need is getting worse and of course much of the extra burden will fall on unpaid family carers, many of whom are already overburdened. I will cite two examples of unpaid family carers that Carers UK has told me about.

One is Eric from Lancashire, who has cared for his wife, Diane, for 20 years. She has multiple health conditions and needs constant support. Eric had to give up work 15 years ago to care for her full-time. When his local council provided 10 hours of support each week, Eric could get out of the house, have some time for himself, do the shopping and even do some volunteering with local charities. Earlier this year, however, council cuts meant that Eric and Diane’s care package was cut in half, despite the fact that Diane’s health has not improved. Eric is worried about his own health, because he needs to use all of the time that he has free from caring for Diane, which is now only five hours each week, to run basic errands, and he no longer has any time for himself. We can all imagine how difficult that must be.

The second example is of an unpaid family carer who is in perhaps an even more difficult situation. Joyce, aged 58, cares for her husband Robert, who is 71 and has dementia. She gave up work as an accountant four years ago to care for Robert full-time. With their savings and Robert’s military pension, they are over the means test threshold for local authority support. Robert is doubly incontinent, and easily confused and distressed, so he cannot be left alone. Just to go to the supermarket, Joyce has to pay £12 an hour for a sitter. For longer breaks, she has to pay £18 an hour for specialist care. Paying for a day of replacement care or for a weekend away means that costs escalate, because Joyce has to pay for multiple care workers and even a nurse. It is important to note that the charges that Joyce is paying have risen by 20% during the past four years. Joyce gave up work to care for Robert and her only income now is from the carer’s allowance of £55 a week. She knows that residential care, when Robert needs it, will cost thousands of pounds a month, which makes her very fearful of the future.

I said earlier, and I think that it is the case, that there is clear agreement that our social care system is no longer fit for purpose and that reform of the funding system is overdue. However, the important point is that none of the people I have referred to in those examples would be helped with their current issues by the Dilnot report’s recommendations, because they offer little for overburdened family carers who are caring for people at home.

A report by the Strategic Society Centre suggests that the “capped cost” model recommended by Dilnot will pose a dilemma to policy makers and could create resentment among family carers. Carers such as Joyce save the state many thousands of pounds by providing informal care. However, when the person they care for enters residential care, they will still be liable for the first £35,000 of care costs. That does not seem fair.

The recommendations of the Dilnot commission are an important step on the path to reform, but we must look widely at what is needed. We must focus on the gap in funding, which exists under the current system as well as in the projections of future funding needs. We must also have the widest possible debate on the options that are available. It seems that there is a problem in getting a debate on these issues that is wide enough to build the consensus that Members from all parties have talked about in Westminster Hall today.

I know that the Minister who is here today is involved in an engagement exercise and that leaders from the care and support community are helping to lead those discussions. However, I want to ask whether and how we can debate this issue more widely. There are 6.4 million carers who have a stake in the issue. There are 1.6 million staff who work in the provision of social care, which is more than the number of staff in the NHS. We should perhaps not be surprised that those people find it harder to be in contact with MPs and Ministers to give their views. They do not have the time in their busy and pressed lives to go along to consultation events; it is very difficult for them to do so. It says much about the isolation of carers and of the staff who work with people who need care that they have few opportunities to get together and put forward their views and comments, so it is our job to find out about that, and to talk to and build a consensus with those people.

After the launch of the Dilnot report, the all-party group on social care asked how the public debate on future funding of social care would develop. We asked a Health Minister—it was Earl Howe, as the Minister who is here today was unable to attend that meeting—whether Andrew Dilnot and the other commissioners could continue to play a role, and whether the secretariat for the commission would continue.

In July this year, I, as the chair of the all-party group on social care, and the chairs of 11 other all-party groups associated with social care wrote to the Prime Minister, the Health Secretary and the Minister with responsibility for social care, who is here today. The MPs and peers in those all-party groups stressed the need for action. We asked the Government to accept the urgent need for reform, but we also asked them to provide resources to support meetings across the country to promote the debate on social care, facilitated by members of the Care and Support Alliance, which is the umbrella group of more than 50 charities that represent older people, disabled people and those with long-term health conditions, as well as their families.

As we have already heard today, the future of social care is of national importance and it should involve the millions of people who depend on social care and the staff who provide care services. Can the Minister tell us what resources the Government will allocate to promote the debate on social care, including providing support to the members of the Care and Support Alliance to run meetings and take the debate forward?

Finally, can the Minister update us on the level of commitment that he believes exists in the Government and more widely to take forward the issues that have been raised today, and to take action to deliver what we said in our letter to the Prime Minister and others we want to see, which is a fairer system of charging for care that is matched by a financial settlement for local authorities so that they can deliver that fairer system?

--- Later in debate ---

[Neil Carmichael]

Absolutely. I take the point that young people can also have dementia—that is certainly true—but the point I was making was that young people are caring for people once they return from school. That is a measure of the challenge we face in dealing with the role of carers, so the Government have to think carefully about the structures around carers and about the ability to give these people appropriate support and respite.

[Barbara Keeley]

It is good for us to be concerned about young carers, but is the hon. Gentleman concerned about the loss of education maintenance allowance? When I talked to the young carers project in my constituency, it told me that all but one of its young carers had been receiving EMA, and they were really afraid that they would lose all their incentives to stay in education. There is therefore an issue about support for young carers.

[Neil Carmichael]

This is certainly becoming a surprisingly wide-ranging debate. We have thrashed out the issue of EMA very carefully and thoroughly in the House of Commons—indeed, those of us on the Education Committee produced a useful report on the subject—but the Government have to think about wider issues in connection with post-16 education and so on. However, that is a separate issue; the important point here is that people who are going to school are carers, and I want the Department of Health to register that.

Another important aspect is the number of people with Parkinson’s. That problem is increasing all the time, and it is right that we focus our attention on it. The reason I mention such difficulties—not to the exclusion of others—is that it is important that we think carefully about personalised budgets so that people get tailor-made provision that they are happy with, and so that we join the NHS up with social care. I made that point in an intervention on my hon. Friend the Member for Truro and Falmouth but I want to repeat it, because part of the answer is to ensure that fewer people end up in hospital, and we can do that by ensuring that the social care structure spots problems before they become serious or overwhelming and prevents problems from starting in the first place. If the social care system dovetails completely with the NHS system and is accessible and transparent, people who need care, and families with members who require care, will feel they are being properly listened to.

--- Later in debate ---

[Tony Baldry]

That is a helpful update for the House, and I am grateful to the Minister.

[Barbara Keeley]

Does the hon. Gentleman share my concern—this may be the theme that he is developing—that there is a conflict between localism, the removal of ring-fencing and ensuring that a local authority delivers adequate social care? I find it hard to see, when exhortations are clearly not working with local authorities, how we can ensure that some authorities do not just cut their social care budgets to the bone and give people inadequate services. It is quite clear, with £1 billion in cuts this year, that they are not doing as the Minister would like.

[Tony Baldry]

I see the situation rather differently from the hon. Lady. Local authorities such as Oxfordshire are committed to delivering good-quality social care for elderly people. The challenge for them is to ensure that the increasing number of elderly people, often with increasing needs, receive appropriate care, whether at home or in residential care. A tight budget presents them with a significant challenge, but it is a challenge to which they are committed.

I appreciate that the hon. Lady comes from a unitary authority, but for two-tier authorities in shire counties such as mine, social care is now their most significant contribution. Increasingly, schools and education are running themselves, so authorities are going to be judged on the quality and the way in which they deliver social care.

[Tony Baldry]

I am not entirely sure where the hon. Gentleman is going with that point, so if the House will excuse me, I will not follow him down that particular line.

I do not think there is any lack of local accountability as far as the national health service is concerned. The Oxfordshire joint health overview and scrutiny committee is meeting today and will consider, for example, possible service changes at Horton general hospital in my constituency. The committee will, I am sure, vigorously interrogate the senior management from the Oxford University Hospitals NHS Trust and from the Oxfordshire and Buckinghamshire PCT cluster.

In the debate on social care, we must not underestimate the burden or the toll on carers of the task of looking after elderly people with age-related difficulties. Carers UK has found that carers providing significant amounts of care are twice as likely to suffer from ill health as non-carers. In 2008, a survey of heavy-end carers showed that more than half of those caring were in debt, and nearly three quarters were struggling to pay household bills. A large number of carers, about 1 million, have given up work or reduced their working hours because of caring. The peak age for carers is between 45 and 65, which is often the age at which they would be at the peak of their training, skills and career experience. That can be a cost not only to the carer, but to businesses and employers as they lose key people who have to care for relatives.

We have seen some excellent organisations such as Employers for Carers, which was set up by Carers UK and seeks to bring together numerous employers, generally larger ones, to promote flexibility and workplace support for employees juggling work and care, but that is not always possible for small and medium-sized employers. There is also a cost to the NHS. Sometimes, if we are not careful, there is a trade-off between the quality of social care, the provision of sufficient beds in nursing homes and residential care homes, and the need to prevent delayed discharges and bed blocking in hospitals. We had a debate on that not long ago, to which I contributed. In Oxfordshire, we are grappling with the issue of delayed discharges. If we are not careful, the cost to the NHS of delayed discharges will be significant, particularly at a time when more and more hospital treatments can be offered as elective day treatments. Generally, people are spending less time in hospitals, so delayed discharges add particular cost to the NHS.

[Barbara Keeley]

I thank the hon. Gentleman for giving way again; he is being very generous with his time. Does he have any thoughts on the point that I made earlier about the Dilnot commission and the £35,000 that must be paid out by the individual in the shared-costs model, which does not recognise informal care? He is making the point that people are giving up work to become carers, which has a huge financial cost. They may be struggling to pay bills but, even so, when their loved one goes into a care home, they will still have to pay £35,000. There is no recognition of everything that they have done that has helped the state save money. Does he agree that that is not fair?

[Tony Baldry]

We all have to recognise that there is only so much, on a cross-party basis, that Ministers will be able to do in the White Paper, which I hope will come out next spring. If the White Paper contains a sustainable funding process for residential care, we will all consider that to be a substantial step forward. We must not forget, however, that a number of issues will still be relevant to carers, particularly because, in order to maintain costs and keep them down, most local authorities are trying to keep people at home for as long as possible. For example, in my constituency and in those of many of the other Members who are present, it was previously the case that frail, elderly, but mentally alert people lived at home, but that has become increasingly true of people with age-related illnesses such as dementia or Parkinson’s, and it will continue, because however much the funding for residential care is increased, there will still be that population at home.

Another point that I want to reinforce to the Minister—I am sure that he will take it on board—is that a number of organisations concerned with social care are in consensus in supporting the recommendations from the Dilnot commission, particularly the recommendation on protecting families from catastrophic care costs by capping lifetime care bills because, at present, families coping with long-term conditions can face bills of tens or hundreds of thousands of pounds to pay for home and residential care. There are fears of unaffordable bills forcing families to provide round-the-clock care, and two thirds of carers end up spending their own income to pay for the care of the person for whom they care.

Those of us on the all-party group on carers welcome the Dilnot commission’s clear recognition of the need for additional resources for social care, to overcome an historic shortfall and to recognise the growing demand. We need a new national system of eligibility and portable assessments to create a more standardised system across England and to remove some of the uncertainty that families face as they deal with different systems in different council areas. We also need a new awareness, advice, information and advocacy strategy, to help families plan for care and access private, state and voluntary sector support. I think that there is strong consensus on those points, and I hope that the Government will adopt the proposals in the forthcoming social care White Paper.

--- Later in debate ---

[Heidi Alexander]

That is precisely the point. Families are asking questions about how this can happen. We need to have a fair system so that people know what to expect to pay for their care in later life, can have some peace of mind about it, and do not think that somebody else, who perhaps has a better knowledge of the system, can play it in a way that means that they do not have to pay out in the same way.

[Barbara Keeley]

My hon. Friend is speaking very well from her own personal experience about an issue that affects the whole country. Last week, one of my constituents questioned why he will have to pay all but £28,000 of the value of his father’s home—which, in Salford, was not a costly home—to pay for nursing care. He thought all along that nursing care should be paid for because it is nursing. He still does not understand it and is very distressed. I wonder if that example, and the example raised by my hon. Friend from her own experience, suggests that we need to get out there with this debate so that people do understand it and so that everybody is in the same place—as has been said, not just middle-class people who can plan, and people who have accountants—and knows what it might cost them and how to go forward and plan for it.

[Heidi Alexander]

I agree completely. I go back to what I said at the start of my contribution, which is that this is one of the biggest challenges we face as a society and as a country. We can talk about the crisis in the eurozone, international terrorism or climate change, but how we plan for the needs of our ageing population is incredibly important. It may not be the sexiest debate out there, but we need to get people talking about it so that they can understand and contribute to how we should legislate on this issue.

In conclusion, I was at the event that the Minister attended earlier, which was organised by the Greater London Forum for Older People. It was a packed Committee room, and I heard the Minister say that this Administration will not be the Government who do not face up to this problem, grasp the nettle and tackle it. I urge him to honour the commitment he made to the pensioners in that room. For far too long, we have not tackled this problem. I fear that it will be placed in the “too difficult” box. We have already heard the hon. Member for Banbury (Tony Baldry) talk about the need to publish the White Paper in the spring. I think the Dilnot commission report talked about a White Paper in December, so I put it to the Minister that perhaps we are already a little behind that timetable. The key issue, as I was discussing earlier with my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), is to have a Bill in the next Queen’s Speech. Will the Minister commit to that today? If he and the Government were to say that they will legislate on this matter in the next parliamentary session, that would be a sign that the Government take the issue seriously and that we can tackle the problem, which has, for too long, eluded us.

--- Later in debate ---

[Liz Kendall]

I am under no illusion about the scale of the funding challenge to meet the needs of our ageing population. Funding the current, unfair and ineffective system of social care will cost £12 billion by 2025. The Dilnot proposals, on top of that, cost more than £3.5 billion. Dilnot is an important step that we want to have genuine talks about, but it will not solve the entire problem that we face about the future of social care. Yes, we can make a big difference by looking at how we join up health, social care, housing and other spending, but there are clear implications for all parties in taking the matter forward, and we all need to be aware of them.

[Barbara Keeley]

My hon. Friend is making a good argument, and I am heartened by what she is saying. However, if the implications that she has just helpfully outlined exist, the debate has to be taken out to people. If there are implications for taxpayers, they have to know what they are. Many Members who have spoken today have said that it is quite clear that people do not understand or plan for care, and then the costs hit them. The debate out there, in addition to the essential cross-party talks, is important.

--- Later in debate ---

[The Minister of State, Department of Health (Paul Burstow)]

I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing the debate. By doing so, she has demonstrated the breadth and depth of her interest and expertise, and the breadth of interest across the House, in the issues. Such debates are not always as well attended as this one. As you rightly noted, Mr Bone, the Leader of the House also attended for a while to listen to our deliberations, which speaks volumes about the importance that the Government attach to the issue.

I am delighted that so many members and officers of all-party groups took part in the debate. This is the second time this week that I have had the pleasure of the company of the chairs and other officers from a number of those all-party groups. Earlier in the week, I hosted an event in the Department of Health with APG chairs to discuss with them their thinking about the way in which we need to respond to the challenging agenda and to input into shaping the White Paper that we will publish—in answer to the hon. Member for Banbury (Tony Baldry)—next spring. When I was asked at the meeting, I confirmed that we are aiming for April—that is what we mean by spring for this purpose—and I can reconfirm that today.

I very much agree with the remarks of the hon. Member for Worsley and Eccles South (Barbara Keeley), which were echoed in many contributions in this debate, about the need to have cross-party discussion and secure a cross-party agreement. One reason why we need to do that is that social care law has been very overlooked and neglected. The Law Commission report that came out this May quite rightly pointed out that our social care legislation has evolved over 60 years in a haphazard and piecemeal way. The confusing legal system is one of the reasons why social care has such a complex system, and why so many judicial reviews take place. We need a consensus to secure a legal reform that will last the test of time.

First, I would like to respond to some of the points made about the current situation of social care funding. I find it heartening that some of the points rehearsed in the debate acknowledged that the fragility of our social care system is not new—it did not start 18 months ago but is the pattern of many years, which we, as the coalition Government, are trying to address now.

I am not going to deny that things are tough, or that no council has had to make difficult decisions; it has not been an easy time for anyone. Difficult decisions have had to be made across Government because of the economic situation that we currently find ourselves in. However, the funding landscape is not as simple as I think some would like us to believe. The headline story of a Government intent on slashing social care services no doubt makes good copy, but it is not borne out by a closer examination of the facts.

In the previous spending review, which we announced last October, we provided an extra £7.2 billion over four years up to 2015 to protect social care, partly through councils and partly through the national health service. The aim was to alleviate the potential pressures on the adult social care system in what would be a challenging overall funding settlement for local government; that point has been rehearsed quite clearly by a number of colleagues in this debate.

We recognised that this year would be particularly tough. We have front-end loaded the funding for the first two years to insulate social care from cuts to local authority budgets, on which I will amplify a bit. Combined with a focus on efficiency, we believe that the additional funding that we have provided will enable councils to protect people’s access to care services. That is not just our view but the Local Government Association’s view, put forward in its submissions to the spending review. The King’s Fund also said in its report, “Social care funding and the NHS”, that central Government have put enough money in to protect adult social care services, provided that there are rigorous attempts to improve efficiency.

However, as the hon. Member for Leicester West (Liz Kendall) and other hon. Members have said, spending is falling. Budget data collected by the Department for Communities and Local Government from local authorities suggest that social care budgets are around £200 million lower than last year, which is a reduction of just over 1.5%. However, it is not inevitable that reductions in spending lead to cuts in front-line services. The hon. Member for Worsley and Eccles South quoted the Association of Directors of Adult Social Services, which had an interesting survey of their members that was published earlier this year. Boil it down a little further and what we find is that for every £1 that has been saved or taken out of spending in social care by local authorities, 70p can be attributed to efficiency savings. It is not about taking services out from the front line, but service redesign.

Yesterday, the Local Government Association released a prospectus inviting councils to take part in its productivity programme for adult social care. It said that there is scope for efficiency. In its foreword it said that if councils develop plans in line with policy objectives such as prevention and personalisation, they will minimise the impact of reduced funding for the front line, which is why I welcome the work that it is doing to recruit councils to its programme. From there, best practice can be shared with other councils to ensure that they are not making bad decisions when it comes to their budget choices.

[Barbara Keeley]

I understand the issues about efficiencies and the need to make changes such as the move to personalisation. However, from my experience—as I have said, I am in a local authority that is protecting social care—efficiency savings have caused our primary care trust to give up active case management for people with long-term conditions. Personalisation of personal budgets has meant that Age UK has not been able to conduct similar active case management for older people or to run drop-in centres for carers of people with dementia. Sometimes the change and the churn also cause loss. We have not touched today on the reorganisation of the NHS, but that has had an impact on things, too. I understand that we are in a system in which certain changes are good but can result in a loss of services that really impacts on people.

[Paul Burstow]

I am not seeking to hide or resile from that. What I am trying to do is demonstrate that the picture is not uniform or consistent. I want to quote some further evidence that supports that point of view, but first let me make it clear that of the £900 million that the ADASS survey identified as having been taken out of social care spend, 70p in every pound came not from cuts in front-line services but from service efficiencies and redesign. That very point was made by a number of hon. Members in the debate.

NHS Care of Older People

Baroness Keeley Excerpts

Thursday 27th October 2011 Westminster Hall

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

It is a pleasure to speak in the debate when you, Mr Betts, are in the Chair.

The full title of our debate is “NHS Care of Older People”, and the fact that that distinction is made shows that there is an issue in the care of older people by the NHS that needs to be discussed. It is right, therefore, that we are debating this matter today and I congratulate the hon. Member for Stourbridge (Margot James) on securing this debate and on the way in which she opened it.

A number of reports made to Parliament this year on the failings of NHS care of older people have shocked us. The health service ombudsman, Ann Abraham, reported in February on a

“picture of NHS provision that is failing to respond to the needs of older people with care and compassion, and to provide even the most basic standards of care”.

Her report told the stories of 10 people over 65—partners, parents and grandparents: individuals who put up with difficult circumstances and did not like to make a fuss, compared with those who, as we have heard, were difficult—who wanted to be cared for properly and, at the end of their lives, to die peacefully and with dignity. Ann Abraham tells us that what the people involved have in common is their experience of unnecessary pain, indignity and distress while in the care of the NHS.

The second of the 10 stories is that of Mr D, and it particularly focuses on the last five days of his life. He was admitted four weeks earlier with a suspected heart attack but after tests was diagnosed with advanced stomach cancer. He was to be discharged from hospital on the Tuesday after the August bank holiday weekend, but it was brought forward to the Saturday. The summary of the story in the report is harrowing. The discharge of, we must remember, a man with only a few days to live was a shambles. The report goes on:

“On the day of discharge…the family arrived to find Mr D in a distressed condition behind drawn curtains in a chair. He had been waiting for several hours to go home. He was in pain, desperate to go to the toilet and unable to ask for help because he was so dehydrated he could not speak properly or swallow. His daughter told us that ‘his tongue was like a piece of dried leather’. The emergency button had been placed beyond his reach. His drip had been removed and the bag of fluid had fallen and had leaked all over the floor making his feet wet. When the family asked for help to put Mr D on the commode he had ‘squealed…’ with pain. An ambulance booked to take him home in the morning had not arrived and at 2.30 pm the family decided to take him home in their car. This was achieved with great difficulty and discomfort for Mr D.

On arriving home, his family found that Mr D had not been given enough painkillers for the bank holiday weekend. He had been given two bottles of Oramorph (morphine in an oral solution), insufficient for three days, and not suitable as by this time he was unable to swallow. Consequently, the family spent much of the weekend driving round trying to get prescription forms signed, and permission for District Nurses to administer morphine in injectable form. Mr D died, three days after he was discharged, on the following Tuesday. His daughter described her extreme distress and the stress of trying to get his medication, fearing that he might die before she returned home. She also lost time she had hoped to spend with him over those last few days.”

The summary of this case sounds terrible, but the detail was much worse. The family were my constituents and I supported the family’s complaint after meeting Mr D’s daughter. Every aspect of this case showed the NHS in a very negative light.

Let me give a summary of the detail in Mr D’s case, as reported to the ombudsman. Mr D was not helped to use a commode and fainted, soiling himself in the process. He was not properly cleaned and his clothes were not changed until the family requested that the following day. The ward was dirty, including a squashed insect on the wall throughout his stay and nail clippings under the bed. He was left without access to drinking water or a clean glass. His pain was not controlled and medication was delayed, sometimes by up to one and a half hours. Pressure sores were allowed to develop. No check was made on his nutrition. His medical condition—the fact that his illness was terminal and that he had only a few days left—was never properly explained to his family. He was told of his diagnosis on an open ward, overheard by other patients.

I spoke about this case in a debate about the NHS Redress Bill, and I agree with the comments that the hon. Member for Stourbridge made about accountability. Where was the accountability in this hospital? Where was the ward manager or matron figure who was letting these things happen?

At this point, Mr D’s daughter, a constituent, came to me for help. She desperately needed an answer and an explanation of what had happened. As her MP, I felt the hospital needed to admit its errors and take measures to ensure that what happened to that patient did not happen to anyone else. Regrettably, in the months that followed, the hospital seemed unable to do that. In fact, the dreadful failures in care and communication were made worse by the inadequate way the hospital dealt with my constituent’s complaints, as I reported to the House in that earlier debate.

After raising her complaint with the hospital, my constituent found that responses from it were not sent in keeping with agreed time scales and often took three or four weeks longer than it had promised. Copies of responses from the hospital were never sent to me, and I had to chase every single one of those responses, which were often inadequate. That was the worst thing for this bereaved family, because the delayed answers and prevarication from those investigating the complaints left the family feeling more angry and upset. Their anger was originally due to what they perceived as delays in diagnosing Mr D’s terminal condition and the poor treatment and care he received, but the whole thing became worse because of the way the case was handled.

The complaints the ombudsman’s report details are very serious, and I am talking about just one. In making their complaint, the family know that nothing can bring back their loved one—their father—or change the way he was treated, and families often tell us that. However, the family desperately want explanations and an apology, and they desperately want to ensure that no other parent is treated the same way.

[Sarah Newton (Truro and Falmouth) (Con)]

The hon. Lady is making an incredibly moving speech. I pay great homage to the work Ann Abraham has done in her role as ombudsman, and yet another fantastic report came out last week about the complaints procedure. Does the hon. Lady agree with the recommendation in that report that there should be far greater partnership working with organisations such as the Care Quality Commission? Does she agree that the Government could take steps in response to the findings of the consultation they have just held on the information revolution? Such measures would really help improve the complaints procedure, which would drive up standards of care.

[Barbara Keeley]

Yes, indeed. We discussed those issues in relation to the NHS Redress Bill. The difficulty we have with the most extreme cases, as I am describing in relation to my constituent, is that the medical establishment seems to close up when facing such complaints, and people become fearful that they will be sued and have problems in their careers. We must remove that way of handling such awful cases, because it is just not acceptable.

Like every MP, I understand that the Government cannot manage every consultant and every ward to make sure such things do not happen. However, they do happen, and there are many more cases than the 10 the ombudsman reports on. We must bring about a change of culture to allow for an acknowledgement of the fact that there must be better redress than there was in this case when a whole system of care and treatment fails a patient and his family, and when standards of professional practice and communication fall. The MP and the family should not have to battle the complaints system and eventually take their case to the ombudsman because only the ombudsman can ever make a hospital do what it should have done in the first place.

The family were looking for an acknowledgement, an explanation and an apology, and they wanted to make sure that these things did not happen again. It is very reasonable that they should expect that.

[Sarah Newton]

The hon. Lady is making an incredibly important point about how complaints are handled in the NHS. In highly effective organisations, complaints are considered to be gold dust, because they are part of how those organisations drive up standards and improve services. That benefits not only the patients, but staff. It is so demotivating if staff working on poorly managed wards, or in the NHS more generally, raise complaints, even through protected disclosures, and nothing happens. That can cause them stress and great personal harm.

[Barbara Keeley]

Indeed. I do not distance myself in any way from the excellent point the hon. Member for Stourbridge made in opening the debate: this is about leadership, management, training and accountability, all of which failed in the case I have outlined.

[Andrew George]

The hon. Lady is making a strong case. On the point about whistleblowing, or protected disclosure, her own research may have shown that when a nurse, for example, suggests to senior management that there is a resource problem on a ward, that does not necessarily enhance their likelihood of improving their job prospects in the hospital. Often, they are told, “Other members of staff seem to manage, so why don’t you?” Does the hon. Lady agree that we need to look at how whistleblowing can be done safely?

[Mr Clive Betts (in the Chair)]

Order. A lot of people clearly want to speak, and I do not want to stop or discourage interventions, but if they are made could they be brief and to the point so that we can keep things flowing?

[Barbara Keeley]

It is clear that what I said about culture must apply right through to things such as whistleblowing. It is a sad aspect of this case that none of the people involved with Mr D’s care or with dealing with the complaint could even rescue the situation by handling the complaint reasonably.

I understand, and we must be clear, that this case represents the NHS at its worst, but it did happen, and it happened to my constituent. I have never had a case as bad as this one again, but I have had others that have given me cause for concern, and I am currently pursuing cases with similarly bad aspects on behalf of constituents. Sometimes, however, there are cases where everything goes wrong and all the problems I have mentioned come together.

MPs’ interventions and the intervention of the ombudsman can remedy the injustice of such inadequate treatment to some extent, but we must accept that it is not possible even for such interventions, much though our constituents are grateful for them, to overcome the distress and anguish experienced by families such as my constituents. However, a swift apology would have helped, and we must have a system whereby an apology can be made swiftly, because that never happens.

The ombudsman talked about the need to listen to older people and to take account of feedback from families. One of my conclusions from having looked at this case is that it took many months—in fact, years—to get to the point where the family were anything like happy with the response to their complaint, and that made things worse.

I felt it was important to outline a case I had personal experience of, and there has not been time to touch on much else, but there are many things that could improve this situation. In the briefing for the debate, I was heartened to see a note from the Women’s Royal Voluntary Service describing ward support services it is setting up for older people, which is a wonderful idea. It wants to improve the experience of older people by using trained volunteers to support them and their families and carers. That would include training in dementia, which could be important.

Hospital support for carers is also important. The Princess Royal Trust for Carers has a carers centre in Salford, which the Minister knows, because he has met some of its staff. The centre has developed strong relationships with primary and secondary health care and works closely with Salford Royal hospital, which does excellent work—it is not the hospital I was talking about earlier; that was a different hospital. The centre supports carers in the hospital and on important issues around discharge. How could the discharge I described have happened if people had been there—even volunteers and people from a carers centre—to help the family? Such initiatives can help.

Developing awareness of family carers on hospital wards and giving them support might help to head off, or somehow deal with, dreadful situations such as the one I have described. NHS care is important, but it is important that we understand that it does not end when a person leaves hospital, particularly if they are terminal patients going home to die.

I hope the debate contributes to the improvement of NHS care for older people. As a Member of Parliament, I would never want to see another case like the one I have described.