Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 10th May 2016 Commons Chamber

[Alistair Burt]

The better care fund has been adjusted to recognise that not all councils can raise a similar amount of money through the social care precept, so the issue that the hon. Lady raises has been noted and recognised. The only way in which the NHS can achieve better outcomes and meet the challenges of rising demand is through an increased focus on preventive community health and social care, and closer working with local authorities. That is what the pooled budget is designed to deliver, and that is what it will do.

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

Indeed, good morning, Mr Speaker.

A big challenge for local authorities and adult social care is how to fund the increases in the minimum wage that care providers have to pay. As my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah) just detailed, the 2% social care precept does not cover all the increased costs and, indeed, in some areas, it is not even being passed on to care providers. The Local Government Association asked Ministers for £700 million from the better care fund to help with that increased cost this year and next year—not in 2019. When will Ministers listen to local councils and agree to bring forward that much needed funding to support what is effectively their own policy in the care sector?

[Alistair Burt]

I do not think that anyone fails to recognise that the next couple of years in social care will be very tight, but that is why the better care fund is there. Work has been done to increase the amount of money available to meet the challenges that the hon. Lady raises. I have to repeat that to fund this properly there has to be a sufficiently strong economy. There has to be the commitment to funding that the Government have been able to make almost uniquely in the House. I sometimes think it would help if she recognised the strength of the economy that has been able to do that by assisting local authorities, rather than complain about the amount of money available.

Contaminated Blood

Baroness Keeley Excerpts

Tuesday 12th April 2016 Commons Chamber

[Diana Johnson]

My right hon. Friend makes an important point.

Fourthly, there are concerns that under the plans money will be used to pay for new drugs to treat hepatitis C, which will be bought separately from the NHS budget, so will cost more. Under guidelines from the National Institute for Health and Care Excellence, everyone with hepatitis C should be eligible for treatment with a new generation of drugs from the end of February 2016, so when funds are allocated for treatment, that means once again that money does not go directly to those who need financial support.

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

Does my hon. Friend, who is making an excellent speech, agree with my constituent, who is affected and feels that the changes are deliberately punitive and exceedingly cruel, as they use requests for changes to support schemes to affect people in that way? My constituent has had to use the ex gratia payment from the Government to fund treatment refused by the NHS, as many other people have had to do. His annual payment will decrease over time and he will lose the additional support that is currently provided. People such as my constituent are hit again and again, so how can the consultation on reform go ahead on that basis?

[Diana Johnson]

I shall move on and complete my speech.

Fifthly, there is concern about the fact that beneficiaries in England will be worse off than beneficiaries in Scotland. The Scottish proposals are far more generous to hepatitis C stage 2 and HIV sufferers, who will receive £27,000 per annum or £37,000 if they are co-infected, which is welcome, but are much less generous for hepatitis C stage 1s, who will receive an additional lump sum payment but no ongoing support. The Scottish proposals have been broadly welcomed, partly because of the way in which the consultation was conducted in Scotland, and the clear acknowledgement, for example, that the existing trust structure will be scrapped.

--- Later in debate ---

[Sir Gerald Kaufman (Manchester, Gorton) (Lab)]

Thank you for calling me to speak, Mr Deputy Speaker. I would like to join other Members of Parliament in thanking my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) for her work on this matter, which, among other things, has enabled us to take part in this debate.

Everything that we deal with in this House of Commons is about people, whether they are Syrian refugees or steelworkers from south Wales. Whatever we do deals with the lives of people, and we are somehow led to believe that the larger the number of people involved, the more important the issue will be. That is a basic problem about this issue. There is not, sub specie aeternitatis, a huge number of people who are affected by blood contamination, but those involved have been affected in a way that damages their lives every minute of every day. I would not have known about this issue if it were not for a person in my constituency called Mohibul Islam, who has been in contact with me year after year—I now have a file of correspondence so enormous that I could not bring it into the Chamber—and who has asked me to participate in the debate and to ask a specific question.

Let us be clear about this: I do not accuse the Government of being heartless. It would be easy to do that, given the suffering of the people involved. However, the Government do not seem to grasp the fact that a process that should have been followed to produce an effective outcome has been left in such a way that we still cannot believe that we are going to get a result. We still cannot believe that the outcome will be known to, and potentially satisfy, the relatively small number of our constituents who are suffering in this way. Also, when I say that this involves a small number of people, I must stress that it occupies 100% of their lives.

It may well be that every Member in this Chamber has in her or his family someone who suffers from some deeply upsetting illness, but unless one knows about blood contamination, it passes us by. The Government have not given the matter the active attention that it deserves, and that may simply be because the number of people affected is relatively small. This is not in any way an accusation against the Government—I will make accusations against them when I need to—but there are no votes in this, because the number is small. However, the numbers suffering cannot be pinned down by statistics. Unless any of us in the Chamber have actually suffered from blood contamination or its consequences, we do not really know about it, even if we are told.

Mohibul Islam has asked me to put a specific question to the Minister, and I will ask her to respond to him, so that I can let him know that his voice has been heard in the House of Commons. He wants to know why, instead of raising payments and bringing them above the poverty threshold, the payment for the dual-infected group is being cut substantially, leading to some people being £7,000 a year worse off. For someone with tax relationships with Panama, £7,000 may not seem like a large sum of money, but it is everything to somebody who needs the money and goes day after day without any prospect of alleviation.

[Barbara Keeley]

We have heard Government Members say that money is tight, but like my right hon. Friend’s constituent, my constituent Mr Dave Gort has had to cover the cost of his own treatment and is facing a decrease in the annual payment. He will also lose additional support such as winter fuel payments and the prescription prepayment programme. Those affected also have issues with insurance, for example, with premiums being loaded even when the virus has cleared. I support my right hon. Friend’s points about hardship and the hit that the change represents.

[Sir Gerald Kaufman]

What my hon. Friend says is remarkably valid and I concur with it. As a consequence of what she and other Members have said and, most of all, of my communications from Mohibul Islam, I want to know why the Government cannot at least provide parity with Scotland. That would not solve the problem, but it would to some extent alleviate the financial consequences.

As I said, every one of us in this House, either personally or through someone in our family, has suffered the effects of some kind of health-related problem. In my case, my brother and one of my sisters died in suffering after a long experience of Alzheimer’s disease. There are many ways in which the human condition can be hurtful or troublesome. I am not looking for a solution—frankly, I do not believe that there is a solution in health terms—but I am looking for the Government to show that they care, that there will be an outcome, and that that outcome will, as a minimum, alleviate the anxieties and concerns of those who live with this affliction every single day.

Dementia and Alzheimer’s Disease

Baroness Keeley Excerpts

Tuesday 12th April 2016 Westminster Hall

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

It is a pleasure to speak in this debate with you in the Chair, Mr Stringer. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate. I recognise the remarkable amount of work that he does on social care and carers, and I thank him for that. We have had some excellent contributions from 14 hon. Members—almost too many to mention, so I will not mention them all. We are making some progress but we have a long way to go to improve care for people with dementia and support for their carers.

The Labour Government launched the first ever national dementia strategy, appointed the first national clinical director for dementia, and commissioned the National Institute for Health and Care Excellence to develop the quality standard for dementia. Together, those began the process of establishing memory clinics, providing better training for GPs and improving the quality of dementia care for people in hospital. I thank the hon. Member for Charnwood (Edward Argar) for mentioning that record. It is welcome that the Government are carrying on that work through the Prime Minister’s important challenge on dementia 2020. I am sure that hon. Members here today agree with the aims of that challenge but we have to accept that there is a long way to go before they become a reality.

Dementia is a distressing condition. In the long term we should be aiming for a cure, but while working to find a cure we must put equal emphasis on the care provided to people with dementia and the support provided to their families and carers. Carers UK reminds us that the symptoms of dementia can make providing care particularly difficult. People with dementia—we have heard about this in the debate—can grow agitated and violent, and night-time wandering and shouting can disrupt carers’ sleep.

Families report challenges in finding services that have the expertise to provide the right care and support. Of course, that means that it is more difficult for carers to get practical help or to take essential respite breaks as they do not have, or they lose confidence in, the quality and appropriateness of the care available. I welcome the strong case made by my hon. Friend the Member for Burnley (Julie Cooper) for better support for carers.

The care sector has a turnover rate of 25% so even when a care package at home is arranged, high staff turnover makes it harder to build familiarity and trust. For people with dementia, receiving care each day from someone they see as a stranger can be upsetting and confusing, and can make them more likely to refuse support, putting further pressure on their family carers. It is clear that improvement is needed, so can the Minister say whether the carers of people with dementia will be a key strand of the upcoming carers strategy?

I applaud the Alzheimer’s Society “Fix Dementia Care” campaign, which wants to ensure that people with dementia receive the highest standards of care in hospital, in care homes and in the home. It is of great concern that a survey of carers of people with dementia found that only 2% believed that hospital staff understood the specific needs of people with dementia, more than half felt that the person they cared for was not treated with understanding and dignity in hospital, and nine out of 10 felt that the person with dementia became more confused while in hospital.

The Alzheimer’s Society is calling for all hospitals to publish an annual statement of dementia care. In my area, it was pleasing that Salford Royal recorded information for patients with dementia and that the records showed that Salford Royal’s performance on a number of elements of care was better than national averages. However, other local hospitals did not record that information so there is much to do to bring that up to standard.

As part of improving hospital care for dementia patients, listening to carers would be a step forward. Nicci Gerrard is leading John’s Campaign for the right for family carers to stay with people with dementia in hospital, as we heard earlier. Nicci’s father John suffered a significant decline when he was in hospital for five weeks. Although the family felt that individual nurses and doctors were kind, conscientious and respectful, restrictions on waiting times meant that the family could not sit and talk to John, read to him, make sure he ate or keep him attached to the world.

John’s Campaign calls for the families and carers of people with dementia to have the same rights as the parents of sick children. They should be allowed to remain with them in hospital for as many hours as they are needed or are able to give. I understand that 272 hospitals across the UK have pledged their support to John’s Campaign. Will the Minister outline what is being done to improve hospital care for dementia patients and whether she supports John’s Campaign?

As well as improving hospital care, there are real concerns about the state of social care. The Association of Directors of Adult Social Services reports that £4.6 billion has been cut from adult social care budgets and that 300,000 fewer people are receiving publicly funded services than in 2009-10. Social care has been an easy target for cuts. I am concerned now that the Chancellor’s aim to find a further £3.5 billion in savings by 2019-20 will hit council and social care budgets even further.

The Government have stated that, by 2020, they want to see an increase in the number of people with dementia being able to live at home with more personalised support available to them and their families. That is a laudable aim, but the Channel 4 “Dispatches” programme last week showed just how poor home care can be, with time clipped from care visits, careworkers working very long days and not being paid for travel time, care needs neglected, and no time for the careworker to talk and listen to the person receiving care.

This year and next year are tough years for social care funding because home care and residential care providers bringing in the so-called national living wage have estimated they will face costs of £330 million in 2016-17 with no additional funding for this Government policy. The better care fund only provides £100 million extra next year, so this year is a problem. It is not surprising that careworkers say that issues with their pay and conditions prevent them from delivering good quality care. Unison found that three quarters of domiciliary careworkers do not have enough time to provide dignified care and that 84% of service users not getting enough time for care are people with dementia.

Caring for someone with dementia is not just about aspects of physical care. It is about conversations—knowing the person and knowing what is a comfort to them. Across hospitals, primary care and home care, we need to improve staff training and understanding of how to support people living with dementia and how to support and work with their family carers.

Carers UK reminds us that carers are the experts in the care needs of the person they care for, so it is heartening that today, Dr Julie Wray of the School of Nursing, Midwifery, Social Work and Social Sciences at the University of Salford is launching her book, “Supporting families and carers: a nursing perspective”. I hope that her nurse colleagues use the book to develop their knowledge of how to work with carers of people with dementia. They are the people who make such a vital contribution to the care of all those people.

[Graham Stringer (in the Chair)]

I call the Minister. Would you leave a couple of minutes for Jim Shannon to sum up?

National Minimum Wage: Care Sector

Baroness Keeley Excerpts

Wednesday 23rd March 2016 Westminster Hall

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

It is a pleasure to speak in the debate with you in the Chair, Mr Rosindell. I congratulate my hon. Friend the Member for Sheffield Central (Paul Blomfield) on securing the debate and on the excellent way in which he opened it.

I want to talk about what I describe as the funding crisis in social care. Many providers are struggling to provide good-quality care—even if they want to, as they should—against the backdrop of years of cuts to local authority budgets for adult social care. The increased costs associated with the national minimum wage and the so-called national living wage are going to place providers under additional financial pressure, and that is of great concern. The Local Government Association has estimated that introducing the so-called national living wage from April will cost at least £330 million for home care and residential care providers. There was no additional funding for that in the Budget. There is a risk that too many providers will become financially non-viable. We do not want care providers to cut staff numbers even more, threatening the quality of care.

The social care precept is not the answer to finding enough funding for what is a Government policy change. My local authority, Salford City Council, needs £2.7 million to pay for the minimum wage increases in our local care sector, but the council can only raise £1.6 million from the social care precept. The Government are not providing funding for their own wage policy. In my area, the people of Salford are finding the money, from their council tax. I am sure that there will be agreement in the Chamber that care workers should be paid the national minimum wage. Care work is a demanding job that requires skilled workers who are compassionate and who provide empathy and good-quality care. It is completely unacceptable that a job that historically has been undervalued is still being exploited today, and that those workers are not being paid the basic wage.

I give credit to Unison for its work interviewing care workers and finding out in detail the constraints on them, such as having to rush between calls and reduce the amount of time spent with individuals who are socially isolated. We are concerned about social isolation among older people, and the fact that there is no time to care. Staff sometimes work from 7 am until very late in the evening, but they have dead time that they do not get paid for; and they do not get paid for travel time. The Cavendish review highlighted the impact of non-payment for travel time on care provision:

“Some low paid Home Care Assistants and support workers will…keep going as long as they feel they are still giving good care. But the advent of zero hours contracts, fee cuts and no payment for travel time”

is really to blame because it

“is making it financially prohibitive for some domiciliary care workers to struggle on.”

The Government agreed that the statutory guidance should require councils to include payment for travel time in provider contracts, but that guidance is clearly not being complied with. There are even examples, in an excellent Unison study, of a home care worker being given 20 minutes to visit an old lady of 102, to help her shower and get dressed, make food, tidy her kitchen, give her medication and put her bins out. That is not enough time to give safe and dignified care. Tackling non-compliance should be a priority. The Government must consider the impact of their policies and act on the chronic underfunding of the care sector that I outlined.

My hon. Friend the Member for Sheffield Central made a number of suggestions about how to improve national minimum wage compliance. We must have monitoring of the commissioning practices of councils; it should be a priority. Employers and commissioners could also publish, or provide employees with, a statement that they comply with the national minimum wage, increasing transparency. As he said, we must improve the protocol for supporting whistleblowers who bravely tell the story of what is happening. It is only when care staff are valued and paid adequately that service users will receive the good-quality, compassionate care they need. As he said, we should be ashamed that we trade on the good will and commitment of our home care workers.

--- Later in debate ---

[Chris Stephens]

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

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

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

[Barbara Keeley]

Many practices have been talked about during this debate, but we have not addressed the new practice of paying care staff by the minute—minute rates. I do not know of any other group of people paid and measured by the minute.

[Chris Stephens]

I am not aware of that either, but it is an important point. Bad employers will try such methods. I am concerned to hear about companies that are trying to get around paying the living wage by taking premium payments off staff. That is another important point that this Parliament will need to address.

Mixed messages are coming from the Government in this regard. Ruby McGregor-Smith, the leader of a home care company that the BBC had revealed was not paying its home care workers the national minimum wage, was recently elevated to the House of Lords. In August 2015, the Prime Minister commented to The Times:

“So to unscrupulous employers who think they can get labour on the cheap, the message is clear: underpay your staff, and you will pay the price.”

Also in the summer of 2015, HMRC launched a national minimum wage campaign that allows employers that have not been paying the national minimum wage to escape punishment. The Government have been saying to companies that HMRC

“will not undertake an enquiry or investigation on your National Minimum Wage records”.

That is a mixed message.

That leaves an over-reliance on workers making complaints to HMRC. As has been revealed during this debate, many care workers fear reporting their employers because reprisals can include dismissal or having their hours cut. As was stated earlier, many home care workers are on zero-hours contracts.

Action needs to be taken. I hope that the Government will give a commitment that where a company is non-compliant, HMRC will extend its investigation to cover that company’s whole workforce. HMRC should publish results regularly, carry out assurance checks in the sector and allow third-party reporting. We have heard from many Members who have spoken so far about the vital role that the trade union movement is playing in the sector. HMRC should maintain records of the number of employees who contact it through the helpline, and there should be a formal protocol for HMRC to ensure that no action is taken against whistleblowers.

Minimum wage rates exist to protect working people and their wages, with a legal floor that stops wages going below a certain level. The insidious practice of not paying the national minimum wage must end, but it can end only if the Government are willing to ensure that compliance with minimum wage rates is monitored rigorously.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Rosindell. I start by congratulating the hon. Member for Sheffield Central (Paul Blomfield) on bringing this debate to the House. It has been a very helpful opportunity to focus attention on this important area, and it gives me a chance, on behalf of the Government, to make clear our commitment to ensuring that this issue is properly dealt with. I know he is a robust champion of workers in the care sector, and I want to praise him for his work in representing them here today.

I also pay tribute to the right hon. Member for Oxford East (Mr Smith), the hon. Members for Brighton, Pavilion (Caroline Lucas) and for Hampstead and Kilburn (Tulip Siddiq) and others who have taken such an interest in this issue. Opposition Members may be surprised to hear me single out and congratulate Unison and the Resolution Foundation, which have done really good work on behalf of workers in the sector by shining a light on the complex issues and some of the completely unacceptable practices that have gone on for too long.

I take this opportunity to pay tribute to our nation’s 1.5 million care workers, who, as hon. Members have said, work tirelessly to provide invaluable support to some of our most vulnerable citizens. Without their support in caring for the frail, the disabled and the elderly, we simply would not be able to cope as a society with the pressures of an ageing population. Hon. Members are right that we must ensure care workers are treated fairly by their employers and receive the money to which they are legally entitled—and that is a priority area for the Government, for this Minister and for the Minister for Skills, my hon. Friend the Member for Grantham and Stamford (Nick Boles), who leads on this within the Department for Business, Innovation and Skills.

Perhaps I could take this moment to make it clear, lest anybody watching the debate is in any doubt, that this generation of Conservatives in government strongly supports the national minimum wage. We are very proud that we have gone further and introduced the national living wage, as well as increasing penalties from £5,000 per employer to £20,000 per employee, which last year saw one investigation lead to a fine of half a million pounds.

We have also increased the budget for compliance by 50% since 2010 and strengthened the naming and shaming provisions. Let me send the strong signal that we will not tolerate non-compliance with the national minimum wage. It applies across all sectors, and the nature of the work that these care workers do, in a fragmented, challenging and geographically difficult sector, is no excuse for non-compliance.

I want to make it clear that any employer who treats the Government’s commitment to this space with contempt needs to be very careful. I am very disappointed to see that the Business, Innovation and Skills Committee’s request for Mike Ashley from Sports Direct to come and give evidence has not been responded to. Let me take this opportunity to say that contempt for this area of law is not acceptable, and to welcome the recent court case in which Caroline Barlow successfully prosecuted MiHomecare. It led to the court ruling that she and, by implication, others should have been properly paid. I welcome that, and the signal should go out very clearly to businesses, councils and all those who employ the low-paid that they have to abide by their duties under the law.

[Mr Philip Hollobone in the Chair]

[Barbara Keeley]

Most Members here would agree with the Minister about Mike Ashley, I am sure, and would applaud the Chair of the BIS Committee and the Speaker for the way in which they are handling the situation.

The key point I want to make is this: although it is good that the Minister is proud of the Government’s policy on the minimum wage, does he not think that the Government should have funded that? Is not the key problem the one that I outlined: the 2% precept will only raise £1.6 billion, but my local council will need £2.7 billion just to deal with these pressures? We cannot get to a position in which those in the care sector can pay the minimum wage unless there is funding for it, and that is the Government’s responsibility.

[George Freeman]

I will come on to the funding of social care, which is a major issue that we all face as a society and will require some pretty deep thinking over the years ahead. I will also describe the extra money that the Government have put in. Although there is never enough money, we have made this priority very clear.

It may help if I review how we got to be where we are today. In 1999, the national minimum wage came in. It was the first time that legislation had been introduced in the UK to ensure a minimum level of pay for virtually all workers. Its aim is to help as many low-paid workers as possible, end extreme low pay and ensure a level playing field for employers. We are absolutely clear that anyone who is entitled to be paid the national minimum wage or, from 1 April, the national living wage must receive it.

--- Later in debate ---

[George Freeman]

Perhaps I can come back to the hon. Lady on specific cases—I do not have them to hand. I just want to talk about what we are doing to deal with the issues that have been raised, but she makes an interesting point.

In the care sector, we have a particularly high incidence of workers who have not been paid the national minimum wage in the right way. Other sectors are hairdressing and retail, and there is some dispute about where the worst practice exists, but the care sector clearly has a major historical problem. That is in part attributable to the fact that many of the more complex rules on calculating working time are prevalent in the sector—for example, the calculation of travel and sleeping time. On those points, although I am sure that Members will appreciate that I cannot comment on individual cases, I want to restate the Government’s position: when workers are performing work under their contracts, they must be paid the minimum wage.

It is also worth noting that there is no perfect measure of non-compliance within the sector, and there is a possibility that current estimates of non-compliance overestimate work time and underestimate pay, because the information is reported by workers themselves. That is why we are continuing to work with the Low Pay Commission, the Office for National Statistics and others in order to improve our estimates and better understand the scale of the problem.

On the point that was mentioned by the right hon. Member for Oxford East (Mr Smith) and others, the Low Pay Commission’s proposals on transparency merit serious consideration, and we are looking at those and a number of its other recommendations. We are determined to continue to drive forward and send the very clearest signal to companies and employers that we are becoming less tolerant of non-compliance, and we want them to recognise that.

None the less, increasing compliance with the minimum wage in the sector remains a top priority for us and we are taking a number of steps to promote compliance and take stronger action against those who break the law. First, HMRC continues to focus on tackling non-compliance, but that activity is no longer reliant on worker complaints and instead targets employers with the highest risk of non-compliance, based on a range of intelligence and information. HMRC can now analyse information from, for example, other Departments, trade union representatives and the Low Pay Commission, and the evidence indicates that this targeted approach in the care sector is working. From April 2013 to January 2016, HMRC opened 443 cases in the social care sector and closed 308 of those. Of the 308 closed cases, underpayment of the national minimum wage was found in 32% of investigations—for total arrears of £442,000 to 3,000 workers, with penalties issued for a total value of £100,000.

Members have also raised the important issue of affordability within the sector, given the introduction of the national living wage. That pay rise for the lowest paid could be seen to be a threat in terms of increasing non-compliance. That is partly why we are taking steps to signal strongly our commitment to clamp down on it.

With an ageing society, social care funding is a major strategic issue for the country and this Government. We are engaging closely with all the relevant stakeholders on that issue to ensure that councils recognise the need to increase the price that they pay for care in order to cover costs and to reflect rising costs and, not least, the national living wage. That is partly why we are giving local authorities access to an extra £3.5 billion of new support for social care by 2020, to be included in the better care fund. Councils will also be able to introduce a new social care precept, allowing them to increase council tax by 2% above the existing threshold. Taken together, the new precept and the additional better care fund contribution mean local government has access to the extra funding that it will need to increase social care spending in real terms by the end of this Parliament.

[Barbara Keeley]

I thank the Minister for giving way again, but there is a two-year gap. There is nothing from the better care fund this year, only £100 million next year, and—as I said in giving the example from my local authority—the 2% social care precept only covers about half of what is needed. Nationally as well as locally, that is the problem and that is why the Local Government Association asked the Government to bring forward £700 million.

[George Freeman]

I understand. These things are never straightforward or simple. As the right hon. Member for Oxford East pointed out, a lot of creativity is required from councils and the healthcare sector. There is best practice across the country to ensure that health and care are better integrated. [Interruption.] It is all very well for Opposition Members to shake their heads as if this were an easy problem to solve. It is a problem we inherited from the last Government. I am trying to be reasonable in setting out our commitment to deal with it, but it should be remembered that we inherited the problem from the Members who are shaking their heads and suggesting that it is easily solved. I hope that the measures I have set out provide reassurance that we are taking the matter seriously.

Perhaps I may conclude by framing the central elements of the package that we are putting in place. We have toughened up the sanctions and made it easier to name and shame. We have now named 490 employers, raised over £1 million in penalties and recovered over £30 million in unpaid arrears. We are now running at a 94% rate of naming since our revisions to the code in 2013.

Several hon. Members made the point about four-year delays, including my hon. Friend the Member for Dudley South (Mike Wood). I think that that is completely unacceptable. Although we are seeing progress in the speed and rate at which investigations are being pursued, I will talk to the Minister for Skills to make sure the very strongest signal is sent to HMRC saying that we cannot tolerate such delays.

As I have signalled, we are seriously interested in looking at the Low Pay Commission’s recommendation on payslip transparency. It is important that employers are held to account and that employees, particularly when it comes to individual elements of time, can see clearly what time they are being paid for.

I want to highlight the fact that the advice available for employees is free and confidential and that we have introduced important measures to ensure that, when HMRC has information from a third party to carry out an investigation, it keeps the complainant’s identity confidential and that that should trigger a whole workforce investigation.

I also want to highlight the fact that HMRC offers a free service to any employee who believes they are not being reimbursed properly. HMRC also has powers to enforce the reimbursement of expenses. That gives me the chance to highlight the fact that all expenses properly incurred by care workers in the course of doing their duty, often in a sector that requires them to travel extensively across large areas, should be, must be and the Government expect will be, properly reimbursed.

I hope that that helps to set out the Government’s real commitment to tackling the issue. I again thank and congratulate the hon. Member for Sheffield Central on raising it and giving me the opportunity on behalf of the Government to set out how strongly we support cracking down on non-compliance.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Ben Gummer]

I happily congratulate the staff at my hon. Friend’s local hospital. This shows where good constituency representation, reinforcing the efforts of local people working in local hospitals, can produce improvements in staff morale and therefore in the experience of patients, which is something from which Labour Members would do well to learn.

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

In a recent survey, 70% of GPs warned that their workloads were becoming unmanageable, and 55% said that the quality of the service they provided had deteriorated, with too few patients getting appointments, treatment and the range of services needed. We now hear reports of a large decrease in applications for GP training places, and this is one of the last cohorts to be fully trained by 2020. Unless the Minister takes urgent action to address these issues affecting GP morale, workload and recruitment, patient care will just get worse. What is he going to do about it?

[Ben Gummer]

The hon. Lady raises the issue of GPs. We are ensuring that there will be 5,000 additional GPs by the end of this Parliament, which addresses precisely the issues that she raises.

[Barbara Keeley]

indicated dissent.

[Ben Gummer]

I do not know why the hon. Lady is shaking her head. She asked what I am doing, and 5,000 additional GPs will help to solve her problem. Secondly, we are putting a greater proportion of funding into general practice, by comparison with the proportion of the NHS budget as a whole, than any previous Government. Thirdly, we are increasing the number of GP training places. I am pleased to report that we are doing well in ensuring that more people in training positions are choosing to become general practitioners.

End of Life Care

Baroness Keeley Excerpts

Wednesday 2nd March 2016 Commons Chamber

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

I join other Members in thanking the Chairs of the Select Committees for the work on the reports that we are debating today. I was a member of the Health Committee when it produced the end-of-life care report.

Although Ministers have talked of rising to the challenge of improving palliative care, they have yet to take the action needed. They have not responded to the independent panel’s “Choice” review report published in February 2015. I know that the Minister and his colleagues repeatedly promised to respond to that report by the end of 2015, although I note that the Minister has recently changed to saying they will respond “soon”. The hon. Member for Strangford (Jim Shannon) noted that 48,000 people have experienced poor end-of-life care since the “Choice” review was published. Given that figure, we need a swift Government response now, and I ask the Minister to tell us when he expects that response.

As many Members have mentioned, the palliative care workforce works extremely hard to provide good care for people nearing the end of their life. We owe a debt of gratitude to our hospices, palliative care staff in hospitals, and Macmillan and Marie Curie nurses, because when end-of-life care is delivered well, the benefits to the patient and the family are immeasurable; when it is delivered badly, it can cause considerable pain and distress to those involved.

Even though we have the excellent St Ann’s hospice in my constituency and we have one of the best hospitals in the country in Salford, I have dealt with cases in my constituency where end-of-life care has not been delivered as it should have been, leaving bereaved family members distressed and anguished. The National Council for Palliative Care has said that despite high aspirations,

“there is still unacceptable variation, which would not be tolerated in any other area of practice.”

The ombudsman’s report shows us the consequences of people dying without access to high-quality care and support.

In my constituency I have had cases with similar failures to those that the ombudsman highlights—not recognising that the patient is dying, not responding to their needs, poor symptom control, poor communication and inadequate out-of-hours services. One of the cases I dealt with happened in 2005 and was included in a previous report by the ombudsman. Another occurred in 2013. It worries me that I have had constituents suffering the same heartache caused by poor end of life care when it is clear what needs to be done to improve their care.

My constituents died without dignity and in pain. Their carers and family members were left to run around trying to find suitable pain control for them, which meant that they lost the chance to spend precious time with the family member who was dying. The SNP spokesperson, the hon. Member for Central Ayrshire (Dr Whitford), has just highlighted for us how important it is to have those last few hours with a loved one. The Health Committee report recommended that a named clinician support the co-ordination of care. Clearly, that would help in so many cases, and the idea was supported by the right hon. Member for Wokingham (John Redwood).

We know that each year around 500,000 people die in England and Wales and half of those deaths occur in hospitals, so we must make sure that end-of-life care is fit for purpose in all settings and that staff are trained to recognise when someone is nearing the end of life. However, the End of Life Care Coalition tells us that NHS England has made no substantial move to invest in palliative or end-of-life care. Investment in those services is essential to ensure that they are co-ordinated and that people receive the correct care wherever they are.

The Health Committee report asks the Government and NHS England to set out how universal, seven-day access to palliative care could become available to all patients, including patients with a non-cancer diagnosis. Marie Curie tells us that only one in five trusts in England provide face-to-face access to specialist palliative care seven days a week from nine to five, despite this being the National Institute for Health and Care Excellence standard since 2004, and only 2% of trusts provide a 24/7 face-to-face service. People should not have to die in pain and distress because trusts are not complying with a decade-old NICE standard.

A common theme in the Health Committee’s reports has been the need to ensure that choice is on offer. People want to have choice. Will the Government review the choice on offer for children and young people at the end of their lives, as they have done for adults? I have a further concern that without proper investment in community services and specialist palliative care services, choice will remain restricted. In the previous Parliament the number of district nurses fell by 2,400, and many other community nursing posts, particularly senior posts, were cut. With such a hollowing out and deskilling of the community sector, I am concerned that the nurses who provide end-of-life care services are coming under increasing pressure, without the time or specialist skills to provide the quality care and compassion needed at the end of life.

My hon. Friend the Member for Burnley (Julie Cooper) raised the serious issue of the level of cuts to adult social care. We know that we have already lost £4.6 billion from adult social care budgets since 2010. The King’s Fund, the Health Foundation and the Nuffield Trust have said that there will be a gap of around £3 billion in social care by the end of this Parliament. As we approach the Budget, it is important to acknowledge that the Government’s funding plans will not address that gap. The Local Government Association reported last week that councils are looking at council tax options that will raise only £370 million this year, which is less than the Government predicted. The promised better care funding is back-loaded, with nothing this year and only £100 million next year. In my local authority area, Salford, we will raise only £1.6 million this year, compared with cuts of £15 million since 2010.

GPs are also finding that they are under increasing pressure. In a recent survey, around 70% said that their workload is sometimes unmanageable, and over half said that the service they provide has deteriorated in the past year. One factor that is key to providing quality end-of-life care—we have heard about this in this debate—is ensuring that doctors and nurses have time to have the conversations needed with patients, families and other care providers, but the funding and staffing pressures I mentioned will not help staff to have time for those conversations.

The Health Committee’s report called for free adult social care at the end of life, and we made that a commitment in the Labour party manifesto, as my hon. Friend the Member for Luton North (Kelvin Hopkins) mentioned. In recommending that, there is clearly the issue of where we find the funding that we have talked about in this debate. It is clear that offering better support in the community would mean fewer hospital admissions. Too many people approaching death are forced to spend long periods of time in hospital owing to a lack of social care or alternative support options, and that is unsustainable.

The Chair of the Health Committee referred to the Nuffield Trust’s evaluation of the Marie Curie nursing service, which found that people cared for by a Marie Curie nurse had total care costs of around £500 less per person, and hospital stays and costs were often avoided. Only 8% of Marie Curie patients died in hospital, compared with 42% of people without a Marie Curie nurse. The End of Life Care Coalition thinks that those results can be replicated in other palliative care nursing services. Free adult social care at the end of life could also help to reduce the inequalities that currently exist in end of life care services due to age, gender, diagnosis, geography and deprivation, as has been mentioned.

We have heard that 88% of palliative care in-patients and 75% of new referrals were for people with a cancer diagnosis, even though cancer accounts for only around 29% of deaths. Older people receive less specialist palliative care than other age groups: only 16% is provided to people aged 85 or over, although 39% of deaths occur in that age group. We should be delivering services that enable someone living with dementia and someone living with cancer to receive the same quality of end-of-life care.

Will the Minister tell the House whether the Government will implement free social care for people nearing the end of life? The Opposition believe that altering the funding criteria for NHS continuing healthcare is not enough. He said in response to an earlier debate on end- of-life care:

“We have enough paper evidence. We know what looks good, how to make it happen and that it needs to happen, and we know that many people die in circumstances that leave much to be desired.”—[Official Report, 4 November 2015; Vol. 601, c. 1089.]

We need action. We need a response to the “Choice” review, describing what action the Government will take on the key issues of choice, funding for end-of-life care and social care services, co-ordination and the identification and support of carers. If end-of-life care is the litmus test for health and social care services, we are currently failing it for too many people. We need good quality, compassionate end-of-life care to be available so that each person nearing the end of life can feel supported and safe in the knowledge that they will receive the very best care.

--- Later in debate ---

[Barbara Keeley]

It sounds as though the Minister is about to conclude his remarks, but he has not yet said when the Government will respond to the “Choice” review, which I asked about, as did several other Members. That is very important.

[Ben Gummer]

As I have made clear publicly, we will respond in short order to the “Choice” review, but I want to get this right. It is important that we make the content of the response as good as possible, and I do not want to compromise on that. Moreover, the hon. Lady’s party did not bring forward such a review.

This has been a very good debate on all sides. I am delighted by the cross-party support for the need to make changes. I hope that we will return to this debate in the weeks and months ahead and will be able to continue making a real change in the way that we approach death and end-of-life care in this country.

Community Pharmacies

Baroness Keeley Excerpts

Tuesday 23rd February 2016 Westminster Hall

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

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Member for St Ives (Derek Thomas) on securing this important debate. I join the Scottish National party spokesperson, the hon. Member for Kirkcaldy and Cowdenbeath (Roger Mullin), in sending good wishes to Pauline Cafferkey, which I am sure we all wish to do. It is very disturbing to hear that she has become ill again.

In what has been a wide-ranging debate, we have had heard from Members about the importance of community pharmacies to their constituents. I thank my hon. Friend the Member for Ealing North (Stephen Pound) for not only giving us an impressive list of the additional services available from community pharmacies but, importantly, discussing the role that they can play in under-doctored areas, which is an issue in my constituency. We must of course consider rural areas, but urban areas can also be very short of services. In my constituency, we have lost walk-in centres and other forms of community support, such as active case-management pilots. It is a pity that such excellent services that keep people away from GPs and hospitals are being cut.

As we have heard again and again in the debate, community pharmacies provide an essential service in dispensing both medication and the essential information and advice that can prevent people from having to visit their GP for common health problems. On 17 December, the day the House rose for the Christmas recess, the Government announced a £170 million cut to community pharmacy services, with further cuts to follow. That initial 6% cut in the funding for community pharmacies will put significant financial pressure on many of them and will result in closures and job losses. Can the Minister assure us that the service offered to patients will not suffer due to the cuts? It is hard to see how there will not be a loss to patients. Will he comment on the additional pressures that will be placed back on the NHS as a result of that loss?

As my right hon. Friend the Member for Rother Valley (Kevin Barron) said, the Minister had a meeting with members of the all-party parliamentary group on pharmacy. I understand from the note of that meeting that he estimated that between 1,000 and 3,000 pharmacies, out of the overall total of 11,700, could close. He also recognised that smaller pharmacies are likely to be squeezed. Such a significant number of pharmacy closures will have a substantial impact on the way that the pharmacy sector operates. The sector called the cuts a “profoundly damaging move”, so it is important that the Minister updates us on the number of pharmacies at risk of closure. The Government failed to outline funding plans for subsequent years, raising concerns that there could be even deeper cuts later in this Parliament. Will the Minister tell us what further cuts are planned?

Despite the cuts, the Government say they want

“greater use of community pharmacy and pharmacists: in prevention of ill health; support for healthy living; support for self-care for minor ailments and long term conditions; medication reviews in care homes; and as part of more integrated local care models.”

As with everything else to do with care, a letter from the Department for Health suggests that the reforms can be carried out by integrating community pharmacies into a range of primary care settings. Integration is fine in itself, but it will not be achieved through funding such as the pharmacy integration fund, which is set at £20 million and will rise to £100 million by year five. I understand that the majority of the funding will focus on providing pharmacy services at GP practices, but that overlooks the wider role that community pharmacies play, which hon. Members have talked about in the debate.

My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) passed me a note about the Windmill Pharmacy in his constituency. In a couple of hours on Saturday, its pharmacists dressed an elderly man’s superficial wound, gave advice on a fungal infection, advised on vaccines and malaria tablets for people travelling abroad, counted and sorted the tablets for many patients with multiple conditions, gave an antibiotic eye drop for a child with an infected eye, gave repeat blood pressure tablets to a patient whose GP was away, and, of course, had their technicians set up the dosette boxes for patients, including those with dementia, who rely on that service. All those services are freely provided in pharmacies. That is an excellent example from my hon. Friend’s constituency. How does the Minister expect community pharmacies to improve their services and continue to do all of those things when they face a significant decrease in funding and are simultaneously being asked to provide greater support to GP practices, care homes and accident and emergency units?

It has been suggested that we should facilitate hub-and-spoke arrangements, but there are real concerns about that system. My right hon. Friend the Member for Rother Valley said:

“Warehouse dispensing, or ‘hub and spoke’, raises questions around safety, quality and access. The supply of prescription medicines cannot be treated like buying clothes and DVDs. High quality, safe dispensing depends on the opportunity for a face-to-face discussion between the pharmacist and the patient. I don’t see how that can be done in a warehouse.”

I share those worries, which were expressed very well by my hon. Friend the Member for Hyndburn (Graham Jones), who asked some important questions about warehouse chemists’ practices and the data security implications of what they do. Most importantly, the Government must tell us how they will ensure that the essential face-to-face contact between pharmacists and patients is maintained.

Pharmacy Voice outlined the negative consequences of the cuts to community pharmacy services. It is concerned that the funding cuts will increase the risks to patient safety and will decrease patient access to medicines and vital support. The cuts risk job losses and will diminish community assets and the long-term potential of community pharmacies. Pharmacy Voice also warned that the cuts are likely to undermine existing health improvement plans and recent initiatives to integrate and develop community pharmacy services. We heard about some wonderful examples of integration and new ways of working in this debate, but all of that will be dashed.

Sue Sharpe, the chief executive of the Pharmaceutical Services Negotiating Committee, said that the plans

“can only impair pharmacies’ contribution to keeping people well and out of GP and urgent care settings.”

The Government are, in her words,

“proposing to drive ahead to radically change the market with a real paucity of knowledge essential for good decision making.”

We want decisions to be based on better information than we have heard about here.

In my constituency, I have been in contact with the chair of the Salford and Trafford local pharmaceutical committee, Varun Jairath, who is a board member of Community Pharmacy Greater Manchester. He believes that patient safety and welfare are at risk from the planned funding cuts, which means that the community pharmacy network will have to reduce staffing levels and the services it offers for free, such as the home delivery of medication, which has been referred to again and again. I went with a delivery driver from a local pharmacy to hand out information to carers in homes who receive medication. Vital extra things such as that can be done, but only with the existing service levels.

The additional services provided by community pharmacies are at risk from the funding cuts. The minor ailments scheme, which was piloted in Eccles in my constituency, was shown to free up capacity and cash for other areas of primary care by allowing GPs to focus on the more complex patients. That service can continue at £3 per consultation only if community pharmacies continue to be funded at current levels. Such services, which improve quality and save cash, are under threat due to the proposed cuts.

As a number of right hon. and hon. Members said, one of the most worrying effects of the cuts is the potential reduction in rural pharmacy services. Access to pharmacy services should not be reduced for people who live in areas with widely dispersed populations. I ask the Minister—he has been asked this question already—what his assessment is of the impact that the funding cuts will have on rural pharmacies.

To reduce pressure on NHS services, the Government have repeatedly suggested that people should visit their local pharmacy for advice and the extra services we have talked about in the debate. Putting extra pressure on GPs through these funding cuts to community pharmacies is risky. GPs have warned that their workload is becoming unmanageable, which is likely to have an impact on patient safety. In a recent survey of about 3,000 GPs, 55% said that the quality of the service they provide has deteriorated in the past year, and 70% said they feel that their workload is unmanageable some or all of the time. I spoke to a local GP in my constituency recently in a practice whose list size had just been increased by 15%. The GPs at that practice cannot cope with that increase plus any extra that they gain from the losses that have been outlined in the debate.

We recognise the need to integrate pharmacy services better with the rest of primary care, but introducing cuts on this scale to community pharmacy services will not improve primary care outcomes. It will do the opposite. I fear that pharmacies will struggle to provide safe, good-quality services to patients. In proposing the cuts, the Government failed to recognise the value of community pharmacies and to put patients at the heart of their plans for pharmacy services. Patients will bear the brunt of these inappropriate cuts to an essential community service. A joint co-ordinated approach to planning and investment is needed across primary care to ensure that the pharmacy sector can play the important role it could fulfil, and, as I know from all the contacts I have had, wants to fulfil, and ensure that patients get the most out of both the NHS and pharmacies.

--- Later in debate ---

[Alistair Burt]

The hon. Gentleman makes a fair point, and that is indeed being done in the NHS, but we are looking at where efficiencies can be made and at what different parts of the health sector can contribute. In doing so, we can see what changes are inspired in the service provided to patients.

To emphasise where we are with pharmacy, there are 11,674 pharmacies in England, which has risen from 9,758 in 2003—a 20% increase—while 99% of the population can get to a pharmacy within 20 minutes by car and 96% by walking or using public transport. The average pharmacy receives £220,000 a year in NHS funding. On clusters, which my hon. Friend the Member for Plymouth, Sutton and Devonport mentioned, the Government contend that money can perhaps be saved in one place and used elsewhere for the delivery of new services. That is the reality of life. It would be great if new money was always coming from somewhere, but bearing in mind that the Government are dealing with an Opposition who could not commit to the extra £8 billion that the NHS was looking for, we have to make the changes that others were not prepared to make and still deliver services.

Let me move on to where we are going. Everyone in this room, Government Members included, recognises the quality of the best pharmacy services around the country. We are familiar with the valued role that community pharmacy plays in our lives and those of our constituents. I am grateful to my hon. Friend the Member for St Ives for giving me the opportunity to put on public record the high esteem that we hold them in and to set out our plans for the future.

I am a firm believer that the community pharmacy sector already plays a vital role in the NHS. I have seen at first hand quite recently the fantastic work that some community pharmacies are doing across a wide range of health services that can be accessed without appointment. Many people rely on them to provide advice on the prevention of ill health, support for healthy living, support for self-care for minor ailments and long-term conditions, and medication reviews. There is also real potential for us to make far greater use of community pharmacy and pharmacists in England. For example, I am due to speak at an event tomorrow that is looking at the role that pharmacy can play in the commissioning of person-centred care for vulnerable groups.

Our vision is to bring pharmacy into the heart of the NHS. We want to see a high quality community pharmacy service that is properly integrated into primary care and public health in line with the “Five Year Forward View”. I cannot answer all the questions that the hon. Member for Worsley and Eccles South (Barbara Keeley) asked, but she did at least mention the integration fund for the first time in the debate.

[Barbara Keeley]

There is a difficulty, in that funding for integration should recognise that the extra work needs to be done. The point of today’s debate has been about the Government using blunt instruments, such as a 6% cut in funding, reducing the number of pharmacies in clusters, changing dispensing charges, and the warehouse pharmacy that my hon. Friends mentioned. It is the use of those blunt instruments, not the working with the sector, that is the fault.

[Alistair Burt]

That working with the sector is ongoing. That is what the negotiations with the Pharmaceutical Services Negotiating Committee are all about. I take the hon. Lady’s point, but those discussions are under way. We are consulting with a wide range of groups, not just the PSNC, including patients and patient bodies.

As part of what we are doing for the future of pharmacy, we want pharmacists and their teams to practise in a range of primary care settings to ensure better use of medicines and better patient outcomes and to contribute to delivering our goal of truly seven-day health and care services. As part of that, I want to work with NHS England to promote local commissioning of community pharmacy within the health community, so that we can ensure the best use of this valuable resource. That is why we are consulting on how best to introduce a pharmacy integration fund to help to transform the way pharmacists and community pharmacy will operate in the NHS of the future. By 2020-21, we will have invested £300 million in the fund.

While it is understandable that the focus of most colleagues’ comments today was access to existing services, little was said about where pharmacy might be going and what new opportunities there will be. That is part of the overall development that we are hoping to achieve, which will include the work not only of the access fund, but of the integration fund.

Colleagues asked several questions about access. I want to provide some reassurance. We recognise that some of the Government’s proposals have caused concern, and that will take some time to distil as the negotiations are worked through. We are committed to maintaining access to pharmacies and pharmacy services. We are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, both of which were raised today. Qualifying pharmacies will be required to make fewer efficiencies than the rest of the sector. We certainly recognise that rural pharmacies will need to be considered in that, and we want to ensure that location matters in areas of sparsity. That work is ongoing.

In conclusion, the process has some way to run. I simply put it to colleagues that, in relation to good community services on the high street, there is more for modern pharmacy to do. Looking at the proposals of the past, we hope that the profession shares the Government’s determination to move pharmacy into a new future, and I am convinced that the future will be good.

Oral Answers to Questions

Baroness Keeley Excerpts

Tuesday 9th February 2016 Commons Chamber

[George Freeman]

I would be concerned if that were true. The point is that we are facing extraordinary, exploding demand in our system. At the risk of sounding like a Monty Python sketch, what have the Government done, apart from launching the £3.9 billion better care fund and a £2 billion social care precept; fully funding the NHS five year forward view, with a front load of £3.5 billion; driving health devolution; and providing £4 billion for health technology? We are funding the integration of health and care in a way the last Labour Government never did.

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

That is really not true. Ministers are presiding over the hollowing out of social care, because their funding falls far short of what is needed. Some £4.6 billion has already been cut from adult social care, and the funding gap is growing at £700 million a year. The social care precept the Minister has just been talking about will raise £400 million a year, and the better care fund does not start until next year, when it starts at £105 million. Simon Stevens has called this “unresolved business”. When will Ministers face up to the fact that the Government’s figures just do not add up?

[George Freeman]

I think that that question could be taken more seriously, first, if the Labour party had tackled this issue in office and, secondly, if it had any suggestions. Let me summarise the pressure the system is under. Over the next 10 years, there will be a 22% increase in over-65s, and the number of people aged over 75 will rise by 90% in the next 20 years. We face extraordinary challenges. That is why we have announced the better care fund increases, why we have launched the social care precept and why we are driving devolution powers for local areas, which allow local health and care leaders to integrate. If this was as easy as Labour Members say, perhaps they would have done these things during their term in office.

NHS (Charitable Trusts Etc) Bill

Baroness Keeley Excerpts

Friday 22nd January 2016 Commons Chamber

[Jeremy Quin]

The Comptroller and Auditor General already has a very valuable role, and I would not wish to place extra burdens on him. I take my hon. Friend’s point.

The purpose of the Bill is to provide clarity, so that donors know that the boards are in control of their destiny and will look after their assets appropriately in the interests of the charitable endeavours that they serve. Involving bodies such as the Comptroller and Auditor General would merely invite bureaucracy and confusion. There are myriad auditors prepared to do a good job to support charity trustees in their work and to ensure that their accounts are kept in good order, so I do not see the need to involve public bodies. With that in mind, in particular, I beg to differ with my hon. Friend the Member for North East Somerset, and I hope that he will not press his amendment.

I congratulate my hon. Friend the Member for Aldridge-Brownhills on introducing this Bill, which I wish a smooth passage. I hope that those who have tabled amendments will think again and not press them to allow for that smooth passage.

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

I congratulate the hon. Member for Aldridge-Brownhills (Wendy Morton) on bringing her Bill through to Report. The Bill will improve the independence of NHS charitable trusts, and I am pleased to speak on it. I did not serve on the Committee, but I note that it lasted only 10 minutes. The House has obviously since developed an appetite for debating amendments, which could be seen as surprising. However, the hon. Lady dealt with them very well, so I will keep my comments short.

[Michael Tomlinson]

Will the hon. Lady give way?

[Barbara Keeley]

No, because I want to keep my comments short, as I say.

As we have heard, funding from NHS charities supports innovation and research and enables the provision of additional facilities, services and equipment for their associated hospitals. Some Members have cast a shadow of doubt over the value of NHS charities, and I want to challenge that. Salford Royal NHS Foundation Trust in my local area has its own charity, and last year it raised over £450,000, which was used to provide additional services at the hospital. As with other NHS charities, the majority of its funding comes from donations and legacies, with some from investment income; there has been a great deal of debate about how donors feel about that. In some cases, however, donations come from patients and their families who are grateful for the care that they have received. Salford Royal is an excellent hospital, so it is very good that patients and their families are able to make donations via the charity to express their thanks. That is a very important aspect.



The charity funding of Salford Royal NHS Foundation Trust has been put to good use. In the past year, it has provided additional staff training and supported medical research, with the aim of promoting health and improving the treatment and care of patients. There has been a negative aspect to this debate, with doubt being cast on the value of NHS charities, but I do not agree with that. I agree with the hon. Member for Aldridge-Brownhills that the various amendments will not improve the Bill, and I am happy to support that position on behalf of the official Opposition.

--- Later in debate ---

[Barbara Keeley]

As we have heard, this Bill will improve the independence of NHS charitable trusts, and I am pleased to speak on Third Reading. As we have also heard, Great Ormond Street hospital provides essential care for many children in the UK and across the world through its research into many child health issues. I am glad that the Bill will ensure that the trust charity will continue to be able to benefit in perpetuity from royalties and other payments in relation to performances or publications of the play “Peter Pan”. I can assure the hon. Member for Aldridge-Brownhills (Wendy Morton) that the hospital’s research and care stretch well beyond Greater London.

The Bill will also remove the requirement for the Secretary of State for Health to appoint trustees of NHS charities. I hope that reducing the involvement of the Department of Health in NHS charities will provide the organisations with more freedom to grow, and with clear independence. I hope they will be able to attract additional donors; that is important for NHS charities such as the Salford Royal NHS Foundation Trust, which I mentioned earlier. The research that it has helped to fund spans a wide range of departments, from physiotherapy and urology to a joint project with the University of Manchester looking at factors that lead to complications for patients with type 2 diabetes. That shows what an important role our NHS charities can play in potentially life-saving research. Like many others, the charity has also focused on improving patients’ experience in the hospital. Equipment has been purchased by the charity to aid patients in their recovery. For example, the charity purchased reclining chairs for patients recovering from neurosurgery, which enable them to sit in a more comfortable posture.

NHS charities play a significant role in our hospital trusts. They provide funds for life-saving research and help NHS staff to provide the best care possible for patients and their families. On behalf on the official Opposition, I am pleased to support the Bill on Third Reading. It will help to ensure that NHS charities can continue their vital work supporting patients and staff in the NHS.

Vulnerable Adults: Transport

Baroness Keeley Excerpts

Thursday 21st January 2016 Commons Chamber

[Rebecca Long Bailey]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My hon. Friend and parliamentary neighbour is making a great speech in support of our local council and about the difficulties it faces. On the social care precept, does she agree that a council such as ours, which has lost £15 million from its adult social care budget, will be able to raise, at most, only £1.5 million to £1.6 million? The gap is enormous. We no longer want to hear Ministers saying that they have put extra funding into social care, because, frankly, they have not.

[Rebecca Long Bailey]

My hon. Friend is right: councils in deprived areas will have the greatest social care needs, yet they will raise less than a third of what more affluent areas raise through this approach. I really fear that any revenue we raise across the city of Salford will barely touch the sides of the funding crisis in social care. Sadly, the Minister may be hoping to say that services such as in-house transport for vulnerable adults could be funded through a future increase in the social care precept, but that is not likely to be an option for Salford City Council. As I have outlined, councils in deprived areas have already been hit the hardest, and they will be hit worst again by the measures in the latest spending review.

The Government have had since 2010 to convince us that their argument for local government austerity is necessary. In that time, they have slashed the budgets available to councils for vulnerable adult transport and other essential services, while at the same time handing out tax breaks for millionaires, slashing inheritance tax and, despite their rhetoric, doing very little to crack down on tax avoidance. In fact, only in December we heard that five of the largest banks in the UK paid no corporation tax at all in 2014, despite making billions of pounds in profits.

The Prime Minister gave the game away in an interview on Monday morning, when he said that

“if you are a Conservative, you don’t believe in a big state”.

I fear that that is what these cuts are all about: rolling back the state and going back to a time when the vulnerable relied on the philanthropic donations of wealthy people with a conscience.

The cuts that have been inflicted on my city are clearly a political choice, not an economic necessity. My and my hon. Friend’s city is living in fear, with the sword of Damocles hanging over our heads, waiting for the next savage cut to drop.

I look forward to hearing the Minister’s comments and I hope he will be able to reassure me that my fears are unfounded. I also hope that as a result of this debate he will ensure that there is a much-needed boost to local government funding, in order to provide essential services such as the one I have outlined. I hope he amazes me with what he is about to say.

--- Later in debate ---

[George Freeman]

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

[Barbara Keeley]

Will the Minister give way?

[George Freeman]

I will give way briefly, but I want to answer the questions that have already been asked.

[Barbara Keeley]

Like my hon. Friend and constituency neighbour the Member for Salford and Eccles (Rebecca Long Bailey), I want to talk about Salford. It was one of the last authorities in the country that managed to hold on to moderate eligibility for social care, but the cuts that my hon. Friend spoke about mean that we have had to move from moderate to substantial. There is not the funding in the system that the Minister is outlining.

[George Freeman]

I will come on to the numbers for Salford. I rang Salford this morning to get the very latest numbers, and they make quite interesting listening.

Let me just set the scene on the settlement. In the context of the tough public sector finances, we listened to local government and took steps to protect social care services. In the spending review, we reflected that by introducing a 2% social care precept to the council tax for authorities with social care responsibilities. It is ring-fenced: it has to be spent on social care. The precept could mean up to £2 billion of additional funding for social care by 2019-20, which would be enough to support more than 50,000 people in care homes or 200,000 people in their own homes. In addition, we have secured a further £1.5 billion by 2019-20 through extra funding for the better care fund, which brings that funding to a total of £5.3 billion. Those resources are secure, and they are in the hands of local authorities.

Let me turn to transport for disabled people in Salford. Rightly in my view, the provision of social care and the question of how to meet local need are very much matters for the local authority, as I think hon. Members would agree. That is at the heart of this issue. I understand that Salford City Council has decided that the transport needs of people who require support to get to local day care and respite care services can best be met, in the patients’ interests, by closing the in-house passenger transport unit and providing suitable alternatives for individuals.

I also understand from the local authority that a significant number of parents and carers have commented on how much better the arrangements are because they can individualise journey times. Instead of having to wait and then sit on the council bus to get to services, going on very long routes, the vast majority of users are getting a much more personal and bespoke service. It means that the users of the service do not spend significant amounts of time on transport, which used to result in some of them arriving at a day centre or home upset, agitated, delayed and frustrated.

The council has worked hard to resolve the concerns that have been expressed by care users and their families. Having spoken to the council this morning, I understand that all have now accepted the new arrangements. Indeed, the director of adult social services at Salford City Council has told me that he considers the change to be

“a success both in terms of outcomes for individuals and in delivering a saving to the council budget.”

[George Freeman]

I am not sure what the question was. It is interesting that the hon. Lady is saying that the review was the right thing to do and the service has improved, but the rationale for doing it was wrong. I beg to differ. If the rationale that we have to deliver more for less leads good councils, in this case Salford, to find a better way to deliver services that uses less money and provides a better service, that is good. It is exactly what we want councils across the country to do.

For far too long, local government has been hidebound by receiving far too much of its funding from central Government. For me, as a localist, it is anathema that the majority of local government spending comes from central Government. That is why we have begun the process of seriously rebalancing the funding settlement by providing more powers and freedoms locally to raise money that can be spent on locally agreed priorities. The social care precept and the retention of business rates locally are powerful things for which many of us have campaigned for years.

If Salford uses the full social care precept flexibility that we have just provided, it could raise £7.6 million in 2019-20. That will be on top of Salford’s additional income from the better care fund of £10.5 million in 2019-20.

This is not about cuts. It is about a Labour council making prudent decisions that not only improve the way in which services for vulnerable people with disabilities are delivered, but do so in the most cost-effective way. The council’s prudence extends to its decision to nearly double its non-ring-fenced reserves from £29.7 million in 2010 to £56.5 million at the end of 2014-15. I will just say that again: the council doubled its reserves to £56.5 million over the course of the coalition Government.

[Barbara Keeley]

The Minister is being rather complacent in the way that he is responding to this debate. Salford City Council has announced this week that it is having to use its reserves for flood victims, when the Prime Minister will not even apply to the EU solidarity fund for funds. On the point that the Minister makes about social care, the Prime Minister heard this week from the Conservative leader of Essex County Council, who pleaded with him to bring the money forward. The Minister is talking about money for 2019-20. We have to get through the time until then. The money is back-loaded and it is not enough. The situation is risky and uncertain because the money will be provided so late. I should tell him that council leaders are very worried about 2017-18.

[George Freeman]

I will take the question as being, what do I think about that statement? The hon. Lady is right that the funding ramps up, but she is not right in saying that it does not come on stream until 2020. Indeed, I have looked at the figures for Salford. The money that will go to Salford from the better care fund will be £1.1 million in 2017-18, £6.1 million in 2018-19 and £10.5 million in 2019-20. Similarly, the precept will rise over the course of this Parliament, depending on Salford’s decisions on raising it.

Salford’s reserves have gone from being £29.7 million in 2010 to £56.5 million. Those reserves are public money that is there to be used prudently. In this period when we are all having to make sure that our children do not inherit ever more debts, I do not think the fact that Salford City Council is having to dip into its reserves to ensure that it is able to provide services—which, remember, are costing less but delivering better quality—is the savage crisis that the hon. Lady referred to.