Points of Order
Barbara Keeley Excerpts(10 years, 2 months ago)
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Barbara Keeley (Worsley and Eccles South) (Lab)
On a point of order, Mr Speaker. Last week we learned that insurance actuaries had been able to obtain 13 years of hospital medical records on every NHS patient in the country. A report on the use of the data said that the 188 million records were at individual episode level, and the hospital data obtained had many identifiers, including diagnosis, age, gender, area where the patient lived, date of admission and discharge. On Thursday, in a debate in Westminster Hall, the public health Minister, who is in her place, said that she wanted to put it on the record that the data released to the insurance actuaries were publicly available, non-identifiable and in aggregate form. The Minister’s comments on the data released are at complete variance with the reported facts, which were also discussed extensively at the Health Committee last week. There is now a further damaging story in the news that that released patient data were made available online. I understand that the Health and Social Care Information Centre has today had to ask a company to take down a tool that used that hospital patient data online.
May I ask you, Mr Speaker, whether the public health Minister has sought your permission to correct the record from Thursday’s debate. Furthermore, has the Health Secretary asked to make a statement about NHS patient data being made available online?
Mr Speaker
Not at the moment. I can say to the hon. Lady that the public health Minister did indicate to me a willingness to respond to her intended point of order. The Minister is in her place, and we should hear from her now.
Oral Answers to Questions
Barbara Keeley Excerpts(10 years, 2 months ago)
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The Minister of State, Department of Health (Norman Lamb)
I thank my hon. Friend for that question and pay tribute to the agencies in Portsmouth that are coming together to hold the summit and discuss that critical issue. The Prime Minister’s challenge on dementia has made real progress in improving diagnosis rates and the way that society treats dementia, and I would be happy to meet my hon. Friend to discuss the issue further.
Barbara Keeley (Worsley and Eccles South) (Lab)
T4. Further to the answer given earlier to my hon. Friend the Member for Wansbeck (Ian Lavery), the lobbyist John Murray and an organisation funded by large pharmaceutical companies led a consultation and co-wrote a report for NHS England on the future of commissioning for £12 billion of NHS services. Will the Secretary of State tell the House whether it is now Government policy to have lobbyists and big drug companies drafting reports that directly influence the commissioning of NHS services?
Mr Jeremy Hunt
Let me say this to the hon. Lady: we have very clear rules, and for people who are involved in industry and have a self-interest we have important protections to ensure there is no conflict of interest. Let us be clear: the private sector has an important role to play in the NHS, but it grew far faster under the previous Government than it has done under this one. We are not going to take any lessons about being in hock to the private sector.
NHS
Barbara Keeley Excerpts(10 years, 3 months ago)
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Mr Hunt
I am afraid that my hon. Friend is absolutely right. Perhaps the situation is put into perspective when we know that those PFI deals are costing the NHS more than £1 billion a year: £1 billion that could have been spent on providing compassionate care and looking after patients with dignity and respect, but instead is having to finance Labour’s appalling mismanaged PFI contracts.
Let me return to the issues raised by the right hon. Member for Leigh. I think that a much more substantive argument relates to the things that he chose not to say. This is the day before the anniversary of the Mid Staffs report, and this is the day on which hospitals are finally putting behind them Labour’s appalling legacy of poor care. We have 14 hospitals in special measures—all of them, incidentally, with A and E departments—making encouraging progress after a very difficult year, with 650 additional nursing staff and 50 board-level replacements between them. Every single one of those hospitals had warning signs under Labour, but rather than sorting out the problems, Labour chose to sweep them under the carpet, sometimes because they had arisen during the run-up to an election. There are 5,900 more clinical staff in the NHS than there were a year ago, and there are 3,300 more hospital nurses than there were at the time of the last election. All those people are vital to the functioning of our A and E departments.
Bullying, harassment and intimidation were perhaps the ugliest features of Labour’s management of the NHS. Now we have seen courageous A and E whistleblower Helene Donnelly being given a new year honour, alongside brave campaigner Julie Bailey, who was literally left out in the cold when she came to lobby the right hon. Member for Leigh about poor care at Mid Staffs.
There is much to do—poor care persists in too many places—but with a new Ofsted-style inspection regime, in England but not in Labour-run Wales, we can at least be confident that poor care in A and E departments and throughout hospitals will be highlighted quickly, and not hidden away. We will keep people out of A and E departments in the first place—that is something to which the right hon. Gentleman referred—with the return of named GPs for the over-75s and integrated health and social care through the better care fund: precisely the joined-up, personal and compassionate care that was envisaged when the NHS was founded 65 years ago.
Barbara Keeley (Worsley and Eccles South) (Lab)
Was not one of the key points that Francis made about transparency? The Secretary of State is making claims about staffing numbers which are not recognised. Ministers have had the opportunity to go along with a better scheme of transparency in hospitals, whereby they display every day on the ward their staffing ratios—as Salford Royal does. The Secretary of State will not accept that, however. If he thinks that putting out the totals of staff once a month is an adequate way of dealing with the Francis recommendations, he is fooling himself.
Mr Hunt
We on the Government Benches will take absolutely no lessons about transparency in the NHS from Labour after what it did for so many years. I think what we are introducing is a huge step forward, because for the first time every hospital in the country will, as a minimum, have to publish their ward-by-ward staffing ratios every single month. They can publish more—they can do what Salford does—but for every hospital in the country to do that every month is a huge step forward.
Grahame M. Morris
I am grateful to the right hon. Gentleman for that intervention, because his point is germane to my argument. I shall develop that subject in the few minutes I have left when I talk about the consequences of what is happening in social care. I certainly feel that some of the policies that his Government have supported have contributed to the crisis. For example, the top-down reorganisation has had a damaging effect on A and E performance. I will address that point in a moment.
Other hon. Members have spoken today, in interventions on my right hon. Friend the Member for Leigh (Andy Burnham), about patients being ferried to hospitals in police cars. That has certainly happened in County Durham, and it must be a cause for concern. The A and E crisis can largely be placed at the Government’s door, because they have not faced up to some of the problems. It has rightly been pointed out that the number of admissions had risen by 633,000, not least because of demographic changes involving more older people and people with core morbidities and multiple conditions. That is placing a huge amount of extra pressure on A and E departments, but that pressure is being compounded by damaging cuts to local authority budgets.
My own local authority, Durham county council, is experiencing cuts of £222 million between 2011 and 2017. I know that Ministers will say that social care is ring-fenced and that £3.8 billion is being transferred to the home care fund, to be made available to clinical commissioning groups and local authorities, but what that means in real terms for the people living in Easington is that EDPIP—the East Durham Positive Inclusion Partnership—which supports frail elderly people and young people in vulnerable families, is closing down because of a lack of funding from the local authority. Similarly, East Durham Community Transport, which provides transport to take the frail elderly—including my mother, incidentally—to day centres and elsewhere, has been severely curtailed.
The Government have been warned by experts that cutting the staggering £1.8 billion from council social care budgets in the first three years of this Government would have a knock-on effect for the NHS, particularly in accident and emergency departments. That point has been made in expert witnesses’ evidence to the Health Select Committee, on which I have the honour to serve. Because of the cuts to social care, fewer older people are getting adequate support in the community, and are therefore visiting A and E departments instead. The impact of that is twofold. First, it means that those with care needs are not getting the treatment they need. Secondly, it means that our A and E departments are being put under great strain. Directly and indirectly, the Government have ignored warnings that by slashing social care they would make it difficult to discharge patients with care needs because it would be unsafe to send them home.
Barbara Keeley
Perhaps it would be pertinent at this point to mention the comments of Sir Bruce Keogh to the Health Committee’s inquiry into urgent and emergency medicine. When I asked him if the cuts in social care bothered him, he said:
“Yes, it does bother us and I think it bothers everybody. We are trying to maintain a stable and improving service in the NHS at a time that our colleagues in social care are taking a massive hit to their baseline.”
Paul Burstow (Sutton and Cheam) (LD)
May I start by agreeing with the right hon. Member for Rother Valley (Kevin Barron)? The issue of alcohol has been ducked by successive Governments for a very long time. He is absolutely right to campaign on it, and I absolutely agree that we need to see the introduction of minimum unit pricing. However, we should not in any way give the impression that that of itself is the entire solution to what is a broad societal problem. None the less, it most certainly would make a significant contribution. I hope that, at the next election, it will be part of my party’s platform on public health issues.
My hon. Friend the Member for Stafford (Jeremy Lefroy) was right to call for a debate on the Francis report. I hope we will be granted Government time to debate it. If not, I would certainly join him in an application to the Backbench Business Committee for a debate on the Floor of the House. We should have the opportunity to bring Ministers here to debate the report.
Before addressing some of the comments made by the shadow Secretary of State, I wish to place on the record my thanks to the staff at my local hospital, St Helier, for all the work they do not just over the winter period when the pressure is undoubtedly at its most acute, but right across the year. Having been in the hospital over the Christmas period singing carols, which hopefully did not discomfort people too much, I saw for myself just how that pressure can build. I also saw how well the staff are perceived by their patients.
I want to register a frustration with the Minister today about something that has been going on in my patch for several years now. For almost as long as I have been an MP, clouds have from time to time gathered over the future of my local hospital. In 2010, the previous Labour Government signed off an outline business case for the rebuild and refurbishment of St Helier’s hospital. That was great news, and a culmination of work by my right hon. Friend the Member for Carshalton and Wallington (Tom Brake), the hon. Member for Mitcham and Morden (Siobhain McDonagh) and me. We secured funding from the Government worth some £219 million. Then there was a change of Government; a coalition came in. Given the spending review and the desire to tackle the public borrowing problem, it was far from certain whether that funding would stay in the Budget. Again, the three of us lobbied hard, and we were delighted when my right hon. Friend the Chief Secretary to the Treasury was able to confirm the funding.
However, in the dying days of the primary care trusts, a review was launched of accident and emergency and maternity services in south-west London. It was called Better Services Better Value, but it offered neither. It has been an absolutely crystal clear case study of everything that is bad and wrong about NHS change management. There are some really good examples of change management, stroke care in London being the exemplar. However, we have to refer to that example too often, as there are too few other really good examples of change having been managed well. All too often the public feel left out of such processes, and it is no wonder they mount the barricades to oppose change of which they feel no ownership.
My right hon. Friend the Member for Carshalton and Wallington and I were repeatedly told during the process by the then chief executive of the primary care trust, Ann Radmore, that the rebuild of St Helier was a fixed point in the whole process. It was not to be touched; it was sacrosanct and the rebuild would happen regardless. I have to say, however, that the events of the past three years have left me feeling betrayed and lied to. As a result of the uncertainty caused by BSBV, three years on—despite GPs having now declared BSBV’s proposals unviable, and having gone back to the drawing board—my local trust and clinical commissioning group are saying they cannot proceed with that £219 million. They lack the will and vision to take it forward, and I hope the Minister can confirm today that the £219 million is still in the Department’s budget lines and that he will encourage my local NHS to work with my local councils and Members of Parliament to bring forward these plans.
The motion moved by the shadow Secretary of State today feels a bit thin, and a little like a re-editing of its previous two incarnations in an attempt to create the sense of a febrile environment of a looming and predicted crisis and calamity that is about to engulf us all. That tactic has been adopted by the Opposition time and again, and time and again it has not been borne out on the ground. The analysis of the right hon. Member for Leigh (Andy Burnham) is deeply political, and let me give just one example. He lays the blame for delayed discharges principally at the door of budget pressures on social service departments. That is not true. If he looks at the figures, he will see that the bulk of the pressure is caused by delayed discharges in the NHS, not social services. I do not pretend for one moment that there are not parts of the country where social service cuts are impacting on delayed discharges, but the picture is more nuanced and complicated, and I wish the shadow Secretary of State had the courage to say that, rather than repeating a uniformly gloomy picture that is not true.
Barbara Keeley
I refer the right hon. Gentleman to the Select Committee on Health’s report on the matter. The data were completely conflicted. Again and again, individuals from the NHS told us that social care was the problem, as Sir Bruce Keogh, whom I quoted earlier, said to me just a few weeks ago. Our report said that NHS England should sort this out. There are figures that the right hon. Gentleman could quote and figures that my right hon. Friend the Member for Leigh (Andy Burnham) could quote, and we should not be confused about this.
Paul Burstow
I entirely agree that if there is any doubt about the figures, it needs to be resolved, but there seems to be a disconnect between what people think is happening and what the figures show. I have been to events at which clinicians have said that the problem is the local social services, but when they are shown the figures they are surprised. Perhaps that is why we need, as the hon. Lady says, to ensure that there is an agreed way in which such things are reported, which is what, I think, was put in place by the previous Labour Government. These figures have been collected for a long time, and they have consistently shown that social care is not the principal driver of delayed discharges.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Health Committee has held a number of inquiries into urgent and emergency services. The College of Emergency Medicine told us in its evidence that increased demand, combined with a more complex case mix, was the driver that had led to departments struggling to meet the four-hour target. We were told that type 1 emergency departments, which offer a consultant-led 24-hour service with full resuscitation facilities, had
“reached the limits of their compensatory capacity.”
We heard that there were
“more people out of hours, more after midnight, more ambulance and more elderly.”
I checked that with the chief executive of Salford Royal hospital and have checked again in the past 24 hours. He told me that the trends that I first reported in our debate last summer have continued at the hospital. There are now 14 more ambulance arrivals each day—reflecting sicker patients, not self-referrals—which is an increase on last summer. There has been a 13% increase in admissions for stays lasting longer than 72 hours, with a drop in shorter stays, a 31% increase in triages into the hospital’s resuscitation area, and an 11% increase in admissions into critical care. There is now a different mix of patients being admitted. The chief executive, Sir David Dalton, tells me that those trends now appear to be year-round, rather than a purely seasonal impact of winter pressures. He said—my hon. Friend the Member for Stretford and Urmston (Kate Green) might touch on this—that Salford Royal is also now experiencing additional pressures from north Trafford patients.
I am concerned that the current crisis in A and E will continue, and indeed worsen, as a result of continued cuts to social care budgets. We have heard a certain amount of complacency from Ministers today about this winter. It has not yet been a hard one, and there is plenty of time for flu pandemics. Sandie Keene, the president of the Association of Directors of Adult Social Services, has warned that
“it is absolutely clear that all the ingenuity and skill that we have brought to cushioning vulnerable people as far as possible from the effects of the economic circumstances cannot be stretched any further, and that some of the people we have responsibilities for may be affected by serious reductions in service—with more in the pipeline”.
That is the really worrying point, because we are not even at the end of the cuts we have to make.
As I have said before—I make no apology for mentioning it again—my local authority has already lost £100 million in funding since 2010, and it will lose another £75 million by 2016. It has had to cut its adult social care budget by 20%. This is a crunch year for us, because we have had to change our eligibility criteria from “moderate” to “substantial”, which is a difficult cut to make. About 1,000 people are predicted to lose their council-funded care packages, and another 400 who would have qualified under the “moderate” eligibility criteria will not now do so.
The work to reassess those people is ongoing, but Sir David Dalton tells me that
“following the initial scoping there is clearly a risk of more frequent attendances, increased admissions and a prolonged length of stay for this cohort of patients.”
Salford Royal is having to review the possible increased work load for community nursing teams, especially the district nurses, who the chief executive feels
“may need to pick up increased duties for these patients.”
It is clear that there is a straightforward shift: as those people in Salford lose their care packages, the hospital is having to pick it up.
Nationally, the number of people over 65 receiving publicly funded care has fallen from 1.2 million to fewer than 1 million. All across the country there has been a serious fall in the number of older people receiving publicly funded care. Some of those who have lost that care will fund it themselves, but in other cases the work load will fall on unpaid family carers. We have been warned about that in surveys. Carers UK found that 55% of carers are caring for someone who has been admitted to emergency hospital services in the last three years, and a significant number of them said that additional support could have prevented the emergency admission.
We also know—this is a worry for those who are concerned about carers—that full-time carers are themselves more than twice as likely to be in poor health as people without caring responsibilities. The Care Bill has not yet completed its passage through the House, but it does not do enough to support full-time carers, particularly given the funding situation for social care. Carers are the first line in prevention, so properly identifying and supporting them can prevent an escalation in demand. However, identification of carers is not happening and the Care Bill does not do enough to change that.
Macmillan Cancer Support has found that 70% of carers of people with cancer come into contact with health professionals. GPs and hospital doctors should identify carers and signpost them to information and advice, but in many cases they do not. Many hon. Members will encounter such people in their casework. The Care Bill gives a carer a right to a local authority carer’s assessment, but that is meaningless for a carer who has no contact with a local authority. In fact, 1,000 fewer families this year will have that constant contact with, and support from, their local authority.
Carers UK yesterday published a report on caring and family finances, which found that almost half of carers are cutting back on food and heating and that over half have reported that money worries are starting to take a toll on their health. The report quotes one carer:
“With the cuts I have cut down to eating one meal a day so I can ensure my husband has enough food to keep him well.”
We know that the caring that unpaid carers do saves our economy billions of pounds every year, but we have to face the fact that they are choosing between heating and eating, and in some cases eating only one meal a day. As was noted earlier, there is also the lack of funding to pay for prescriptions. Carers UK has warned—we should take note of this—that if this country’s 6.5 million carers are not supported, we will be pushing them to breaking point. In my authority, for example, if they are left unable to care, they will not be able to go to social care and will have to go straight to the NHS.
We know that the NHS is struggling in the wake of unnecessary reforms that redirected £3 billion from the front line. The cost of living crisis is clearly starting to have an impact. This is cold homes week, and it is estimated that people suffering from the cold costs the NHS an extra £1.36 billion a year, and that figure might continue to rise with fuel bills.
Last Friday I met a couple in their 50s who said that they could afford to have their heating on for only an hour a day—last Friday was absolutely freezing, as Thursday had been. It is interesting to reflect on how we could maintain our health if we could afford to have the heating on for only an hour a day. Since 2010, 145,000 more older people have had to receive hospital treatment for cold-related illnesses and respiratory or circulatory diseases, which is a real worry.
On NHS staffing, the Health Committee inquiry highlighted the fact that only one in five emergency departments have the right level of consultant cover for 16 hours a day. That worrying situation is not set to improve because, despite increased recruitment, very few higher trainee posts in emergency medicine are being filled—156 out of 193 such posts were left unfilled in the latest recruitment round. Even Salford Royal, which is an excellent hospital, is experiencing recruitment difficulties. I understand that it still has 2.3 full-time vacant posts, against the eight consultant posts it should have in emergency medicine. That is a good record compared with 52% of posts that are vacant in most hospitals.
As my right hon. Friend the Member for Leigh (Andy Burnham) said earlier, the president of the College of Emergency Medicine feels that we are suffering “decision-making paralysis” across the NHS. The college said recently that it felt that its position was akin to that of
“John the Baptist crying in the wilderness”.
It is a great pity that the warnings it made three years ago about understaffing were overlooked while attention was focused on NHS restructuring. I do not think that the recruitment drive the Secretary of State keeps talking about is the answer, because it will not address the high drop-out rate. We have to recognise that the increasing pressure on A and E will remain a strong disincentive to a career in emergency medicine.
In conclusion, the Government’s unnecessary and costly NHS reforms, combined with the swingeing cuts to social care budgets, are responsible for the crisis, and accident and emergency departments have been left to try to pick up the pieces. I support the motion and urge other Members to do the same.
Valerie Vaz (Walsall South) (Lab)
I am grateful to the hon. Member for Strangford (Jim Shannon) for being so concise in his remarks. It is always a pleasure to follow him.
This debate takes place against a background of confusion and contradiction in the NHS. I hope that we will not end up with a national health disservice. We read all the documents and hear all the announcements about efficiency savings, but we still have not heard the lesson that people and patients should be at the heart of the NHS.
Many of the policy makers in the health service who appeared before the Health Committee warned us that there was not much detail in the lead-up to the Health and Social Care Act 2012. There was no pre-legislative scrutiny and then there was a pause. Not for the first time, the Government rushed to get legislation through without proper scrutiny and without an electoral mandate.
That played into the hands of the people who think that this Government and this country are up for sale to the highest bidder, and that there is no commitment to the people of this country. The Shard is an example. I understand that a number of its floors have been allocated to a private hospital. That is somewhere where pearly kings and queens cannot afford to live—they cannot even afford to go up to see the view.
I am pleased to see a number of my colleagues on the Health Committee in the Chamber. We hear a lot of first-hand evidence. At a time when there are concerns about A and E, the Government seem to be intent on fiddling about with name changes. The NHS Commissioning Board is now known as NHS England. The integration transformation fund is now known as the better care fund. Interestingly, the Chancellor announced in the spending review in July that the £3.8 billion that has been allocated to the integration transformation fund—aka the better care fund—will only be available in 2015-16. However, the problem needs to be addressed now.
That £3.8 billion is not extra money, but money that has been underspent in the NHS over the past few years. The underspend was £2.2 billion in 2013 and £1.4 billion in the previous year. When I asked the Secretary of State on 26 November last year why the underspend was not used for the NHS, he said that I should ask that question of Labour Ministers. I do not know whether he meant that I should do so in 2015. As I pointed out in an aside, which was not picked up by the Official Reporters, I am not a time traveller like Dr Who and was only elected in 2010. The rules of the House say that I should have had a proper response, rather than a dismissive one.
Another issue is that people have been fired and then rehired. One in five of the 19,000 staff who have been given redundancy payments has returned to the NHS. That is more money that has been wasted and that should have been spent on patients. Primary care trusts were disbanded and then re-formed with a different name. Urgent care boards were set up—their name was then changed to working groups—to ensure that there was a forum to replace the PCTs. All of that has strained resources and made staff suffer, without any increase in pay. There is job creation. However, it is not in front-line services, but in the appointment of a chief inspector, which was not suggested by the Francis report, and of assistant chief inspectors. There may well be assistant assistant chief inspectors as well.
The Select Committee heard evidence that the pay policy was significant in enabling the NHS to fill the gap, and NHS England said that, so far, around 25% of efficiency gains had come from pay. Ask A and E doctors who are struggling with working unsocial hours while locums without continuity in patient care are paid more, and they will say, “We need more staff; it is more money wasted on locums and agencies.” Perhaps Ministers should think about golden handcuffs for A and E staff, or the equivalent of an A and E special allowance to recognise the work of those doctors and staff in A and E. That might go some way towards ensuring that we keep them in their place and provide a safe service while doctors are trained. The College of Emergency Medicine has made repeated calls for such measures, and the emergency medicine taskforce made recommendations in 2011, yet we are still waiting for action.
Many Members will know from their own hospitals that patients are suffering from delayed discharge. I have seen that first hand at Manor hospital after the closure of the accident and emergency department at Stafford hospital, where perhaps the relationship with local government is not at the same stage as it is with the local authority in Walsall, for example, and it takes longer to discharge patients. We are still waiting for the £4 million that is needed because we have had to take the strain of the closure at Stafford hospital.
When giving evidence, Sir Bruce Keogh, the NHS medical director, acknowledged that 20% to 25% of people in hospital should have been discharged. The Secretary of State said that himself, having spoken to chief executives of hospitals with approximately two wards full of people who could be discharged. Our House of Commons Library says there have been £1.8 billion of cuts in social care, but apparently, the boffins at NHS England have not “dissected out” why people are in hospital when they do not need to be there. They are working on it now—that serious work on delayed discharges has apparently only just started, despite there being a problem for some time.
The urgent and emergency care review suggested that there should be emergency centres and major emergency centres. Sir Bruce said that NHS England was still listening to that proposal, but in a contradictory view, the Committee was told in the same evidence session that the clinical commissioning groups and other working groups are organising their networks to ensure that that is the outcome. Worse still, it was admitted that they have no intention of stopping any reconfigurations during that review.
Valerie Vaz
I am sorry; I have no time. The Secretary of State wants to reconfigure but he does not want a national debate. He gives himself extra powers if he does not like what the courts and local people say. We need that debate. We need to tell people the truth based not on ideology but on fact, because it impacts on the type of medical work undertaken, and on how we train the next generation of doctors, nurses and health care professionals and what specialties there will be.
The Nuffield Trust gave evidence to the Select Committee and said that people have made the easy savings and now they are running out. People’s memories are long. They have paid their taxes and expect the state to look after them when they need it; not to have to show their credit card as soon as they walk into an emergency centre, or a major emergency centre—whatever it will be called. People do not want prime NHS property in the centre of a city to be sold off so that they have to travel further to get to hospitals.
Chaos, confusion, contradiction, and finally, from the Secretary of State an admission. In evidence last December he said that hospitals want to employ another 4,000 nurses compared with a year ago—an admission that 4,000 nurses have gone missing on his watch. The shadow Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), made it clear that he does not want a further top-down reorganisation, and he started the conversation about whole-person care in the 21st century in a speech in January last year. Finally, Margaret Mead the anthropologist said:
“Never doubt that a small group of committed citizens can change the world…indeed, it’s the only thing that ever has”
We have in the staff, patients and people of this country a group of citizens who want to save their NHS.
Oral Answers to Questions
Barbara Keeley Excerpts(10 years, 3 months ago)
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Robert Flello (Stoke-on-Trent South) (Lab)
13. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances.
Barbara Keeley (Worsley and Eccles South) (Lab)
16. What recent assessment he has made of the effect of social care budget changes on accident and emergency attendances.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Although councils have reduced social care budgets, the evidence suggests that this is not having an impact on the NHS. In fact, the data published by NHS England show that councils are getting better at getting people out of hospital at the appropriate time.
Dr Poulter
There is always a lot of political smoke around this, but spending has roughly been flat in cash terms according to the Association of Directors of Adult Social Services survey and councils are budgeting to spend more this year than they were last year on social care. In addition, we are setting up the integrated care fund of £3.8 billion to better join up health and social care, and that will help to improve the care available to patients as well as reduce pressure on budgets.
Barbara Keeley
But Government budget cuts have forced Salford local authority to change its eligibility criteria. For 1,400 people it is going to be zero-day social care, not seven-day social care, and even our excellent Salford Royal hospital is going to struggle when those 1,400 people find that the hospital is the only option for them. Age UK says these cuts make “no financial sense” and are “morally wrong”. When are Health Ministers going to see that point?
Dr Poulter
I make two points. First, the eligibility criteria began to change under the previous Government, so it is wrong of the hon. Lady to try to make political points which do not stand up to scrutiny. Secondly, I am disappointed that she is unable to recognise that there is very good integration of health and social care in Salford, in her own constituency. That is a model that we could look at to see how good care can be delivered elsewhere.
Accident and Emergency
Barbara Keeley Excerpts(10 years, 4 months ago)
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Mr Hunt
I want to make some progress on this because it was the central point of the shadow Health Secretary’s speech. The reason the 48-hour target was scrapped is very simple: access was getting worse, not better, under that target. On the right hon. Gentleman’s watch, the proportion of people getting an appointment within two days fell, while 25% of people who wanted an appointment more than two days ahead could not get one. They would call wanting an appointment for the following week and be told, “You can only get an appointment by calling less than 48 hours in advance.” But do not take it from me. This morning—
Barbara Keeley (Worsley and Eccles South) (Lab)
We know that rising demand is concentrated in those aged over 85. Cuts in social care budgets are now widely acknowledged as contributory factors in rising admissions, and the Select Committee’s inquiry heard that from witnesses again and again.
Salford city council has made cuts of 20% to its adult social care budget since 2010, given the cuts it has had from the Government. This year, the city council is changing its eligibility from moderate to substantial, and social care staff estimate that the number of people receiving council-funded care will fall this year by 1,000, from 8,500 to 7,500. That is a very big change to happen in one year.
Cuts already made to the NHS locally have also had an impact. We have seen the closure of two walk-in centres, including one in Little Hulton, a deprived area in my constituency that was under-doctored. The walk-in centre was popular and successful. The Minister’s predecessor will have heard my plea about this again and again. The local primary care trust, when we had one, axed the pilot of an active case management scheme for people with long-term conditions. Those things were done under the umbrella of NHS efficiency savings, but they achieve the opposite. More older people will not be receiving council-funded care, and that will have an impact on family carers. We have no walk-in centres and no active case management for people with long-term conditions.
I want to refer briefly to the Carers UK survey of 3,500 carers conducted earlier this year. Some 55% were caring for people who had been admitted to hospital emergency services, with a significant proportion of those carers referring to support that could have prevented those emergency admissions. We have seen exactly the same message in the CQC state of care report.
I want to take this opportunity to congratulate Salford Royal hospital on its excellent inspection report from the CQC. The hospital was found to demonstrate exceptional leadership qualities at all levels across its staff, but even excellent hospitals such as Salford Royal are now feeling the strain of extra emergency admissions. The chief executive told me that in the winter quarter last year it had 10% more ambulance arrivals, patients were sicker, there was an increase in people staying longer than 72 hours, and there was a significant increase in co-morbidity among the patients. And all that happened before the cuts and loss of council funding of care to 1,000 patients this winter.
I want to touch briefly on the shortage of emergency doctors, which the College of Emergency Medicine has been warning about since 2010. That situation is not going to improve. The fill rate of higher trainee posts has been running at 40% or less since 2010. The latest recruitment round for ST4 trainees filled 37 posts out of 193 vacancies. There is some talk today of increasing the number of vacancies for emergency medicine trainees, but people are voting with their feet. The career pressures in A and E are just too great, and they are putting people off having careers in emergency medicine.
In conclusion, £2.68 billion has been cut from adult social care since 2010. We are seeing the cuts in our budgets in Salford, and 1,000 people will lose care. That will put pressure on their health and that of their families. The Secretary of State briefly mentioned the integration transformation fund, but there is no new money in that fund—none at all. Health Ministers need to think again about the impact that cuts in social care are having on the NHS. Pooling budgets with the same amount of money in the integration fund will not help. They need to deal with the crisis in A and E staffing and try to make it a career that people want to go into. As the motion states, they need to restore the 48-hour appointment guarantee. I support the motion.
Care Bill [Lords]
Barbara Keeley Excerpts(10 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Hunt
I am delighted to do so, Mr Speaker, and I know that you would think it was legitimate of me to hold the Labour party to account for its decision if it is voting against today’s Bill or declining to support it, as its amendment clearly states.
However, today is a day to rise above party political considerations, as Mr Speaker has just said, and recognise that putting these things right is overwhelmingly in the interests of patients. If the Labour party continues its stubborn refusal to support legislative underpinning for a new chief inspector of hospitals, which is in today’s Bill, how will it ever be able to look patients in the eye again? Perhaps the most shocking thing about Mid Staffs, which is one of the reasons we have so many provisions in the Bill, was not just the individual lapses in care but the fact that they went on for four long years without anything being done about them.
Mr Hunt
I am going to make some progress.
When problems are uncovered, action must be swift. Robert Francis cited confusion over which part of the regulatory system is responsible for dealing with failing hospitals, so this Bill makes it clear where the buck stops. It is the CQC’s job to identify problems and instigate a new failure regime when it does so. Monitor and the Trust Development Authority will then be able to use powers to intervene in those hospitals, suspending foundation trusts’ freedoms where necessary to ensure that appropriate action is taken. If, after a limited period, a trust has failed significantly to improve, the Bill requires a decision to be taken on whether the trust needs to be put into special administration on quality grounds—and, yes, where necessary, a trust special administrator will be able to look beyond the boundaries of the trust and consider the wider health economy. As we know from Lewisham, that is not easy, but we will betray patients if we do not address failure wherever it happens.
Mr Hunt
As the hon. Gentleman knows, we considered that matter carefully. We decided that the best way forward is to strengthen the professional duty of candour on individual doctors and nurses through their professional codes. After extensive consultation, which was supported by the medical profession, including the British Medical Association, we decided that that was a better way of ensuring that we had the right outcomes and did not create a legalistic culture that could lead to defensive medicine, which would not be in patients’ interests.
If supporting the Francis measures in the Bill is too awkward or embarrassing for Labour Members, can they not see the merits in the parts of the Bill that deal with out-of-hospital care? I am talking about not just vulnerable older people, but carers, for whom we need to do more. We need to do much more to remove the worry that people have about being forced to sell their own home to pay for their care.
Mr Hunt
I want to make some progress.
At Committee stage, we intend to table amendments to enable the creation of a £3.8 billion better care fund in 2015-16. That represents the first significant step any Government have ever taken to integrate the health and social care systems.
Mr Hunt
I will give way in a moment, but let me make some progress first.
I commend the right hon. Member for Leigh (Andy Burnham) for championing integration, although he chose not to do anything about it when he was in office. How, then, when a Government take steps to do that for the first time, can he possibly justify not supporting it?
Mr Hunt
I am going to make some progress.
Thanks to our reversal of Labour’s 2004 GP contract, vulnerable people over 75 will have an accountable, named GP responsible for making sure they get the wraparound care they require.
The collapse of Southern Cross showed the risks to people’s care when providers fail, so through the Bill we are introducing provisions to help ensure that people do not go without care if their provider fails, even if they pay for their own care. The CQC will monitor the financial position of the most difficult-to-replace providers in England to help local authorities provide continuity of care in a way that minimises anxiety for people receiving care.
We also need to improve the training of health care assistants and social care support workers. For the first time, health care assistants will have a new care certificate to ensure they get training in compassionate care and the Bill allows us to appoint a body to set the standards for that training. That means that the public can be assured that no one will be assigned to give personal care to their loved ones without appropriate training or skills. My hon. Friend the Minister of State, who is responsible for care and support, will have more to say on those elements of the Bill when he closes the debate and I thank him for his outstanding work on raising standards in that area.
We also need to address the funding of care. At the moment, people fear being saddled with catastrophic costs and even having to sell their home at the worst possible time to pay for their care. The Care Bill significantly reforms the funding of care and support, introducing a duty on local authorities to offer a deferred payments scheme so that people will not be forced to sell their homes in their lifetime to pay for residential care.
We will also introduce a cap on people’s social care costs, raising the means test at which support from the state is made possible and delivering on the recommendation of the independent Dilnot commission.
Andy Burnham
I was about to explain that those charges are increasing quite quickly, but first I will give way to my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), who has done so much to raise these issues.
Barbara Keeley
I thank my right hon. Friend for giving way and I am surprised and disappointed that the Secretary of State would not give way.
My local council, Salford local authority, is one of the many that are reluctantly having to cut their eligibility criteria this year. Salford tried to stick with the moderate level and this is the third year of cuts. The council has lost £100 million over the past three years and it will lose another £75 million before the Bill’s reforms are implemented. That is a 20% cut in adult social care. How can any of the Health Ministers, whose southern local authorities are not affected in the same way, think that our northern councils can afford this?
Andy Burnham
Those are the facts. The councils that are still trying to provide support to people with moderate needs are not all, but by and large, Labour councils. They are still trying to do that, but they have lost significantly more per head under this Government than councils elsewhere. The situation is about to get a lot worse, because NHS England will meet tomorrow to consider a major change to the NHS resource allocation formula, which will reduce the weighting given to health inequality and increase the weighting given to age. That will have the effect of taking more money out of Salford and Wigan and giving more money to areas where healthy life expectancy is already the longest. The Government are making it impossible for people who want to do the right thing.
Andy Burnham
I say again, with all respect to the Chair of the Health Committee, that I was proposing a fundamentally different scheme to that in the Bill. I was proposing a universal all-in scheme, and several steps were put forward to get us to that. The right hon. Gentleman knows that because the Conservative party and those on the Government Front Bench put posters up about that scheme before the last election. Does he remember that? [Interruption.] He nods, right—that was my proposal, but it is not the Government’s proposal, which is different. I proposed various steps to get to my scheme. Is it about time the Government started answering for their proposal, rather than for mine?
Barbara Keeley
My right hon. Friend is being generous in giving way, and I guess we ought to move on shortly. There is all this harking back to our policies, but I understand—I was here—that steps were taken towards Labour’s national care service, including the Personal Care at Home Act 2010 that would have helped 400,000 people, not the 100,000 who will be helped by this Bill—if, indeed, it ends up being 100,000. Is my right hon. Friend, like everybody else, totally disappointed with the Government’s lack of ambition to help people?
Andy Burnham
I completely agree, and it is unfair that older people have not been given a full picture. People need proper information to plan for the future, and they have not been getting that today. People need the facts. Spin is of absolutely no use to them whatsoever, but that is all that is on offer from this Secretary of State. The truth is that in the end, the Bill will not stop catastrophic care costs that run into hundreds of thousands of pounds, or stop people losing their homes. It will not improve services now as it promises only a vague review of the practice of 15-minute visits, and strips the Care Quality Commission of its responsibility to inspect local authority commissioning, which is often responsible for such things.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Care Bill already seems like a wasted opportunity. I worked for four months, alongside right hon. and hon. Members of this House and Members of the other place, on the Joint Committee that scrutinised the draft Care and Support Bill, and I pay tribute to its members for their work. We now have a Bill that contains some measures that are welcome but others that are seriously flawed.
I will talk first about the burdens the Bill places on local authorities and argue that they must be resourced by the Government. Some people—Ministers or Government Members whose southern local authorities are not being cut in the same way that ours are, for instance—might think that perhaps times are okay, but there could not be a worse time to place extra financial burdens on local authorities. Indeed, the situation for my local authority, Salford city council, will be even bleaker in 2016, the planned date for implementation of the Bill’s reforms. As I said earlier, Salford has already lost £100 million in funding since 2010, and it knows that it will lose another £75 million by 2016. I hope that the Minister is listening—he does not seem to be—because funding for adult social care in Salford has fallen by 20%, from £67 million in 2010 to £53 million this year.
Robert Flello (Stoke-on-Trent South) (Lab)
My hon. Friend has already alluded to the fact that that is the picture up and down the country. The Special Interest Group of Municipal Authorities has said that Stoke-on-Trent has been hit the hardest, but the impact is on constituents across the country.
Barbara Keeley
I agree with my hon. Friend.
Changing eligibility from “moderate” to “substantial” this year will mean that the number of people in Salford receiving council-funded care packages will fall by 1,000, to 7,500. To give credit to Salford city council—my right hon. Friend the Member for Salford and Eccles (Hazel Blears) has already done so—it held off making the eligibility cut until the third year of Government budget cuts, but now it must join the nine out of 10 local authorities setting eligibility at the higher level. I am afraid that the Secretary of State’s earlier claim that they do not have to set it at that level will have sounded very hollow indeed.
Talking of things that sound hollow, the new rights for carers set out in the Bill will sound very hollow to carers in my constituency at a time when many of them are losing the few hours of support they have that give them a break. I want to cite the example of an elderly couple in Salford who have cared for their adult son for over 30 years and who have relied upon respite care for a rest or a break. At the last review of their son’s care package, the respite care element was reduced, which has had a detrimental effect on their physical and mental well-being. They are now not even sure whether they can carry on caring for him. I fear that my right hon. Friend the Member for Salford and Eccles and I will hear many more such cases as 1,000 people in Salford lose their care packages over the next year.
Many organisations involved in social care have raised fears about the crisis in care and their view that the eligibility level should be set at “moderate”, rather than “substantial.” Over the past five years, the number of people over 65 receiving publicly funded care has fallen from 1.2 million to less than 1 million, and for people aged 18 to 64 it has fallen from £570,000 to £470,000. That is a serious fall in the number of people receiving care. Some of those who have lost publicly funded care have funded the care themselves, but in other cases the care workload will have fallen on unpaid family carers.
The number of unpaid carers caring for more than 50 hours a week has increased by over a quarter in the past 10 years. As my right hon. Friend said, Carers UK has told us that 1 million carers have given up work to care, which costs the Exchequer £1.3 billion a year in extra carer’s allowance and lost tax receipts. I believe that reliance on unpaid family care with those heavier carer workloads might also have an impact on the health of those carers, particularly those caring at the heavier end.
The Government plan to set the national eligibility threshold at “substantial”. The Care and Support Alliance says that this means that 105,000 working age disabled people will be left without the support they need to live independent lives. That issue was raised by my hon. Friend the Member for Stretford and Urmston (Kate Green), and she is right to do so. We focus an awful lot on adult social care and older people, but we need to think about working-age disabled people as well.
Norman Lamb
I absolutely respect and appreciate the hon. Lady’s concern for carers; she has campaigned vigorously on their behalf for a very long time. Does she accept, though, that when her party left office, 108 councils set “substantial” as the eligibility criterion for support from local authorities? Do we not all face the same incredibly difficult financial circumstances and have to examine the innovation that the right hon. Member for Salford and Eccles (Hazel Blears) talked about? There is not simply a pot of magic money that will appear if ever Labour returns to government.
Barbara Keeley
I do not agree at all. These cuts are far too swingeing, and there is nowhere else for my local authority, Salford, to go. After 20% cuts, the £100 million loss of funding that we have sustained cannot be found with any amount of innovative thinking. Ministers are now at the point of kidding themselves. I am sure that the Minister, like all his predecessors, goes round the country and is shown all kinds of examples of innovation, but innovation without funding will not work.
The eligibility issue interacts with the cap on care costs. The vast majority of older people will fail to benefit from the £72,000 cap on care costs; it will help only those with the most complex needs. As has been said—we need to keep repeating it—a cap set at £72,000 ignores Andrew Dilnot’s warning that it would work only if it were set at a much lower level and if the underfunding of social care were addressed. It is clear from the Government’s own impact assessments that the number of people whose costs will be capped are a tiny minority. It is estimated that just over one in 200 people aged over 65 will be helped in 2016 and that fewer than one in 200 will be by 2026. It is an incredibly sad reflection of this Government’s ambition that they will have spent the whole of a five-year Parliament—in fact, longer than a five-year Parliament—introducing measures on the long-term funding of social care that eventually help only one in 200 people. My right hon. Friend the Member for Salford and Eccles talked about being ambitious; this is not ambition.
On the support needs of carers, I will repeat some of the things that we heard from the right hon. Member for Banbury (Sir Tony Baldry). Full-time carers are more than twice as likely to be in poor health as people without caring responsibilities. I point out to the Minister that this Bill does not do enough to support those full-time carers. The Government have said that carers are the first line of prevention in that properly identifying and supporting them prevents the escalation of demand on statutory services. Given the A and E crisis, we need that prevention. However, identification of carers is not happening and the Bill does not do enough to change that. Macmillan Cancer Support, which has been carrying out surveys on this, tells us that 70% of carers of people with cancer come into contact with health professionals, who are the people who should be identifying them and signposting them for information and advice. Only 5% of that group of carers receive a carers assessment, and only one in three of those surveyed by Macmillan had even heard of a carers assessment. It is meaningless to suggest to people that they have a right to something they have never heard of and are not going to get.
In Salford, we have a project run by the Carers Trust centre to identify carers within the primary care system. I want to pay tribute to the work that the centre does and to mention its manager, Dawn O’Rooke, who is leaving this month after several years of work in this field. Over the years, the project has established a network of links within GP practices to identify carers. Last year, GPs made only 300 referrals to the carers centre, yet we have 23,000 carers in Salford, over 5,000 of whom will be caring at the heaviest levels. The Carers Trust tells us that, nationally, GP practices are identifying only about 3% of carers, but it should be 10% or more. Health bodies must be required—this Bill is the place to do it—to take on the task of identifying carers and referring them for advice and support, because carers are mainly seen in health settings and not by local authorities. The figures I gave about people losing packages mean that 1,000 fewer people in Salford will be seen by, or go anywhere near, the local authority because the person they care for is not getting a care package.
The Minister is aware of my private Member’s Bill, the Social Care (Local Sufficiency) and Identification of Carers Bill, which had clauses to tackle that issue. I am happy to show them to him again and explain how he could go about tackling the issue in his Bill. The clauses would ensure that NHS bodies have procedures in place to identify carers and ensure they receive information and advice. The Government’s own care and support White Paper stated that there is
“still an unacceptable variation in access to tailored support for carers”
and that NHS organisations should
“work with their local authority partners...to agree plans and budgets”.
The right hon. Member for Banbury made that point. Why are there not more robust measures in the Care Bill to make sure that this happens? As things stand, it will not happen. The NHS has been going through an agony of reorganisation and is now going through an agony of finding efficiency savings, and its staff do not have the time, unless they are directed to the right procedures, to take this task on.
As has rightly been said, clause 2, with its requirements for local authorities to provide preventive services, makes no explicit mention of the NHS, and the only duty on NHS bodies is one of co-operation. Anyone who has tried to work in local authorities on co-operation with health bodies, as I did years ago, knows that it does not go anywhere when there is no budget and no duty. Without effective procedures and systems within health bodies, the identification and signposting of carers will stay as it is now—patchy and inconsistent. It is questionable whether cash-strapped local authorities will be able to assess the needs of large numbers of carers alongside giving information and advice to self-funders and doing a lot more assessments. They will not be able to do that in any way that makes it a worthwhile exercise for carers, and carers will not bother with it if it is not doing anything for them. Indeed, the Joint Committee on the draft Bill received many comments via its web forum from people who said that local authority assessments are of little practical help in their caring role.
GPs and other health professionals are best placed to help carers when they start caring, which is when they most urgently need help and advice. During carers week here, I met carers who told me about a whole variety of things that they needed help with but nobody helped them. Nobody told them that there were schemes to help them with the cost of parking at the hospital. One mother had to buy a hospital bed and nobody told her where to find one; she was looking for one on eBay. She had no advice and support on that whatsoever. GPs deal with dementia patients, stroke patients and patients with cancer. The GP and primary health care team is best placed to establish whether there is an unpaid family carer or whether they live in another town or city. The GP can then refer them to sources of advice and support and, if they are local, give them regular health checks. A new duty on the NHS professionals is the only thing that would make it easier for social care and health services to work together to support carers. I believe that that is wanted by Members in all parts of the House.
Given everything that we are talking about, carers are clearly being placed under ever greater strains. It is essential that the Bill is used to ensure that carers are identified and signposted towards the support they need. It is clear from all the statistics that unpaid carers are the most vital providers of care in this country. I urge Ministers not to miss this chance to improve the support that we give them.
Paul Burstow (Sutton and Cheam) (LD)
I want to echo the remarks made by the right hon. Member for Salford and Eccles (Hazel Blears): we must keep the dignity and well-being of those who need care and, indeed, their carers at the forefront of our thinking in this debate and as we seek to implement the Bill.
Like the right hon. Lady, the hon. Member for Worsley and Eccles South (Barbara Keeley) made a very interesting speech. I thank her for her service on the Joint Committee that scrutinised the draft Bill. I had the pleasure to chair that Committee, which had a very strong team from both Houses. It made some recommendations to which I will return in a minute.
What struck me during the speech from the Opposition spokesman, the right hon. Member for Leigh (Andy Burnham), is that if so much in the Bill appears to be wrong, surely he should have the courage of his convictions and go through the Lobby to oppose it. There is apparently so much awful stuff in it—so much of it is inadequate, does not reach far enough or does not do enough, or if it does enough, there will not be enough money—that the Opposition should perhaps have the courage of their convictions.
At the same time, we have heard really interesting examples of where social care should be celebrated. Too many speeches have suggested that the picture of what is being done on the ground is uniformly bleak, but examples have been given of dementia-friendly communities, Unlimited Potential and the “garden needs” scheme in Salford. Those are just a few examples, and I am sure that every hon. Member could go back to their constituency and find such initiatives. Many of the initiatives do not require substantial resources because, as the hon. Member for Sheffield, Heeley (Meg Munn) just said, they can lever in additional resources by enabling communities to respond to need. That is an essential part of the Bill.
Paul Burstow
I give way to the hon. Lady because she tried to intervene first.
Barbara Keeley
It is about a year since the right hon. Gentleman and I started four months’ work on the Joint Committee, and I was prepared to commit that time although I still find some aspects of the Bill disappointing. The reality of our situation in Salford now and over the next year is that—week in, week out—I, as a local MP, will find that people and their carers have lost care packages. I invite him to think about the situation of the very many MPs who now see the heart-breaking decisions that families face when they suddenly find themselves without care, respite care or support.
Liz Kendall (Leicester West) (Lab)
Today’s debate has been about one of the most important issues facing Britain today: how we care for the increasing number of older and disabled people. The Care Bill is the result of the Law Commission’s review of adult social care legislation, which was initiated by the previous Government. The Opposition welcome the Bill’s emphasis on prevention, promoting well-being and new rights for users and carers.
I want to pay tribute to the work that has already been done to improve the Bill by members of the Joint Committee on the draft Care and Support Bill and by Members of the other place. It now promotes the integration of care and support with health and housing, which is really important, and requires local councils and the NHS to work together in relation to the needs of young carers and, in that regard, I want to thank my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), in particular, for her tireless efforts.
The right hon. Member for Banbury (Sir Tony Baldry), my hon. Friend the Member for Blaenau Gwent (Nick Smith), my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr Clarke), my hon. Friends the Members for Edinburgh East (Sheila Gilmore) and for Hayes and Harlington (John McDonnell), the hon. Members for Pudsey (Stuart Andrew), for Strangford (Jim Shannon) and for Totnes (Dr Wollaston), and my hon. Friends the Members for Washington and Sunderland West (Mrs Hodgson) and for Worsley and Eccles South all spoke about further changes that should be made to the Bill, for example to ensure that NHS staff identify carers, to support parent carers, to improve the safeguarding of people in social care, to improve the assessment process and advocacy, to ensure an effective transition of support from childhood to adulthood, to transform end-of-life care and to deal with portability, particularly of community care packages, in the devolved Administrations. I am sure that we will return to those issues in Committee.
The main concern, raised repeatedly by hon. Members today, is that the Bill does not address the fundamental issue facing elderly and disabled people and their families or put in place the really bold reforms we need to tackle the growing care crisis in England. It is true that council care budgets have been under pressure for many years, but this Government’s decision to impose the biggest reduction in any Department on local councils has the pushed care services that hundreds of thousands of people rely on to “the brink of collapse”—not my words, but those of Age UK.
Adult social care budgets have been cut by £2.7 billion under this Government. The result is that fewer people are getting the care they desperately need, particularly at home, which is the key issue for the future, as my hon. Friends the Members for Sheffield, Heeley (Meg Munn) and for South Shields (Mrs Lewell-Buck) pointed out. Frail, elderly people are receiving home visits that last barely 15 minutes, or in some cases only five or 10 minutes, as we have heard. Disabled people are being trapped in their homes, denied the basic opportunities to work, train, volunteer or have a social life that other people take for granted, a point powerfully made by my right hon. Friend the Member for Stirling (Mrs McGuire). Paid care staff on zero-hours contracts are not even earning the minimum wage, let alone a living wage, and unpaid family carers have been left struggling without the help they need to look after their loved ones, which means that their own health suffers, too. At the same time, more people are being charged more for vital services such as home visits and meals on wheels, which are up by £740 a year since the election.
Reducing care budgets by that scale hurts some of the most vulnerable people in society. It is also a false economy, because as more elderly people do not get the help they need to stay at home, they are ending up in hospital in increasing numbers, which costs the taxpayer far more. Delayed discharges from hospital have soared by 42% since the election, as my hon. Friend the Member for Easington (Grahame M. Morris) rightly said. Delayed discharges have costs taxpayers £225 million this year. That could have paid for almost 17 million hours of home care. It is spending money in the wrong place in a way that is not good for the people using the services and does not provide value for money.
Families are also paying the price. As my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said, one in three carers now has to give up work or reduce their hours because they cannot get the help they need to look after their loved ones, and this costs the Treasury £1 billion in lost tax revenues alone. The Bill will not solve these problems. The new rights it contains and the new focus that it places on prevention and well-being risk being meaningless as care budgets are reduced to the bone.
Nor are the Government being straight with people about their plans to reform long-term care funding in future. Any measures that protect people from catastrophic care costs are welcome, but Ministers have not spelled out the reality of their plans. They have repeatedly claimed that no one will have to pay more than £72,000 for their care, but this is not the case. People’s care costs will start to count towards the so-called cap only if they are assessed as having eligible care needs. Nine out of 10 councils provide care only for those with “substantial” or “critical” needs. If someone needs help to stay living at home but their council assesses their needs as “low” or “moderate”, what they pay for home visits will not count towards the cap.
With regard to residential care, the cap will not be based on what someone actually pays for their home care but on the standard rate paid by their local council. I see that the Secretary of State is being informed by the Minister about the reality of these plans, so I hope that he listens to more of my speech. The standard rate paid by local councils is currently, on average, about £470 a week. Government Members, as well as Labour Members, will know that many of their constituents pay far more than £470 a week for their care home, but these extra costs will not count towards the so-called cap. People will also, rightly, have to contribute towards their hotel and accommodation costs. The Government are setting this contribution at £230 a week—much higher than Andrew Dilnot recommended—and these costs will not count towards the cap either. Taking both those factors into account, it will take elderly people almost five years, on average, to hit the so-called cap, during which time they will have clocked up, on average, £150,000 for their care home bill, and much more in many cases. Because elderly people stay in a care home for about two and a half years, on average, six out of seven people will be dead before they hit the cap.
Ministers have repeatedly claimed that people will not have to sell their homes to pay for their care; again, this is not the case. The Bill puts a duty on councils to offer deferred payment schemes—care loans that will have to be paid back by selling the family home after the person has died. The loans will not be universally available, as Andrew Dilnot recommended, but means-tested. Interest will be charged on the loans, but that interest will not count towards the cap. Although the Government are raising the upper level of the means test, that will not help many pensioners on average incomes because of how the test works, whereby councils take a notional income from the remaining assets in a person’s house and add it to what they get from their pension and any savings or second pension. For many pensioners on average incomes, this combined total will take them over what their local council will pay for care, and they will therefore not qualify for any extra support.
Elderly people and their families deserve to be told the facts about the Government’s plans so that they can properly plan for the future rather than have Ministers attempt to pull the wool over their eyes. One of the main claims made by the Prime Minister about the Government’s reforms is that they are so clear and straightforward that lots of insurance products will emerge so that people can insure themselves to pay for their care in future. I would be very interested to hear from the Minister how many of these new insurance products have emerged so far.
Barbara Keeley
I chair the all-party group on social care and when the Dilnot recommendations were made we implored the Government to have a national debate so that all the issues my hon. Friend is raising so well could be explored. Judging by the look on the Secretary of State’s face, he needs to be given some of that information, too, so perhaps we need a national roadshow on what his Bill will actually do.
Liz Kendall
My hon. Friend makes her points diplomatically. It is only owing to the efforts of Members in the other place that the Bill includes a requirement for councils to provide people with clear information. These are huge issues for elderly people and their families. We are asking the Government to be straight and I hope that when the Minister responds he will confirm what I have been saying.
On top of everything—I hope the Minister will also address this—we learned in June that the Government will top-slice £335 million from existing council budgets to pay for the start-up costs of the new scheme in 2015-16. They propose to take money from existing users who are already desperately struggling to pay for reforms that will benefit a small number of future care users in five, six or seven years’ time. I think that many people will be astonished, particularly after the Government had claimed that all the additional costs for their proposals would come from elsewhere. I hope the Minister will explain whether I am correct in saying that that £335 million will be top-sliced from council budgets.
Labour Members will continue to focus on the reality of this Government’s actions, not on their rhetoric, and we will continue to expose their true record on the NHS and social care. Instead of making the real reforms needed to improve front-line services, they have wasted three years and £3 billion on a back-room NHS reorganisation that nobody wanted and that nobody voted for. Instead of working with clinicians and patients to make difficult decisions on the future of hospital services, they now want to give the Health Secretary unprecedented powers to impose changes without the consent of local people. As my hon. Friend the Member for Lewisham East (Heidi Alexander) said, the Government are taking away control from the very people to whom they pretend they want to give power. Indeed, National Voices—the voice of patients—says that the proposal is
“wrong in principle and counterproductive in practice”.
Instead of championing the full integration of health and social care to enable a powerful shift towards prevention and fully personalised care, as Labour proposes, the Government’s unambitious proposals bring together only 3% of the total NHS and social care spending. Instead of holding serious cross-party talks on long-term care funding reform, the Government chose to go it alone, water down Dilnot’s proposals and spin the results beyond recognition. That is why we have tabled our reasoned amendment and why I urge hon. Members to join us in the voting Lobby tonight.
The Minister of State, Department of Health (Norman Lamb)
I thank everyone who has taken part in what has been a lively and interesting debate on a subject of the utmost importance for the future and for many very vulnerable people in our country. I absolutely share the view of the shadow Minister, the hon. Member for Leicester West (Liz Kendall), on that. Incidentally, I also share her view that it is not possible to get great care on the back of exploiting low-paid workers. We have been very clear about that.
I do not anticipate having time to be able to respond to every point that has been raised—there were many excellent contributions—but I will write to hon. Members who participated in the debate so that everyone will get a full and proper response, including on the cross-border issues raised by the hon. Members for Arfon (Hywel Williams), for Strangford (Jim Shannon) and for Edinburgh East (Sheila Gilmore) among others.
The effect of passing the reasoned amendment would be to defeat the Bill, which is why the Government are so dismayed by the decision taken by the Labour party on what we regard as a Bill that will be groundbreaking in its overall impact. It seeks to modernise the law on care and support, shifting the focus from a very paternalistic system to one that is acutely personal and focused on an individual’s well-being. The Chair of the Health Committee, my right hon. Friend the Member for Charnwood (Mr Dorrell) and my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) both focused on the important principle of well-being, which will be new in legislation, but is absolutely central to what we seek to achieve. There is also a focus on preventing ill health and—
Norman Lamb
I will just finish this point.
There is also a focus on protecting everyone from catastrophic care costs, ensuring that people will no longer have to sell their homes during their lifetimes to pay for care. The Bill reforms a fundamentally unfair system, drives up standards in GP surgeries, hospitals and care homes through the new chief inspectors, adds a new statutory duty of candour so that hospitals, care homes and other care providers are open with patients when mistakes are made, and introduces valuable new rights to carers. Of enormous significance is that it signals the first ever big step, as the Chair of the Select Committee said, towards joining up our health and care systems through the better care fund, which is worth £3.8 billion.
The best description of the Bill was in a letter forwarded to me by a Labour MP, which said that the Bill is a groundbreaking piece of legislation that has the potential to make a big difference for older people. Despite that, the Labour party is declining to give it its support.
Norman Lamb
I give way to the right hon. Member for Salford and Eccles (Hazel Blears).
Norman Lamb
I note the challenge, but I have been passionate about integrating care for many years. I made the case for it on many occasions when I was my party’s spokesman in opposition, and I remember not getting much of a response from the right hon. Lady’s party when it was in government. The Bill is really ambitious and marks the potential for a fundamental change in how our system works.
The right hon. Member for Stirling (Mrs McGuire) welcomed the principles of the Bill and rightly said that it is the duty of the Opposition to challenge and to probe. However, to use her expression, I think that many Opposition Members have been “churlish” in their response, with a few honourable exceptions, including the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke). I say that because in 13 years, Labour had two manifesto commitments, one royal commission, another promised commission, a Select Committee report, a White Paper, a Green Paper and numerous independent reviews on the issue, and what was the net result of all that talk? Absolutely nothing. In 1997, Tony Blair told the Labour party conference:
“I don’t want our children brought up in a country where the only way pensioners can get long-term care is by selling their home.”
That is exactly what happened throughout Labour’s time in government. In contrast, the coalition Government are getting on with reform.
Even now, we have no idea what the Opposition’s policy is. The shadow Health Secretary has hinted that he prefers an all-in approach—everything free, paid for by new taxes on death and by cutting hospital beds—but he has clearly failed to persuade his own colleagues about the plan or to set out how he would pay for it. Opposition Members’ criticisms can only be of any real value if they can answer the question about how they would pay for anything that costs more. So it was good to hear the right hon. Member for Salford and Eccles, who seemed to be about the only Opposition Member who recognised the scale of the challenge that we face, whoever is in power, and the fact that we need to think afresh about where money can come from. Her ideas about innovation using social investment bonds are welcome, and I would like to talk further to her about them.
We want to reshape care and support so that it is focused on enabling people to live more independent lives and giving them a good life. The Bill provides a new framework that places people’s well-being right at the centre and empowers them to take control of their care and support. It consolidates 60 years of legislation and pulls a dozen Acts together into a single legal framework, and it has been roundly welcomed. The King’s Fund has said:
“The government’s proposals for funding reform are an important achievement against the odds in a daunting fiscal and economic climate.”
Baroness Pitkeathley of Carers UK has described the Bill as the “most significant development” in the history of the carers movement.
Norman Lamb
I did not get much of an impression of that in the hon. Lady’s contribution, but I give way to her.
Barbara Keeley
I thank the Minister for eventually giving way. I am surprised and disappointed that he is repeating the same type of inaccurate information that we heard from the Secretary of State earlier. Will he think about the point that I made in my speech? How hollow is it to talk to carers in Salford, 1,000 of whom are involved in families who are losing their care packages, about new rights? What rights are there for someone whose family member has lost their care package? That is what people face this year.
The Minister has also just repeated the ridiculous notion of the £3.8 billion for the integration of health care. That is not new money. It includes care—
Oral Answers to Questions
Barbara Keeley Excerpts(10 years, 5 months ago)
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Norman Lamb
The Care Bill will introduce a right to an assessment for all carers, which I think is an incredibly important advance for them. We are also giving money—£1.5 million—to the Royal College of General Practitioners and other bodies, including nursing bodies, to raise awareness of the vital role of carers in working with GPs to improve the care of those who need it.
Barbara Keeley (Worsley and Eccles South) (Lab)
I think the Minister is missing the point, though, in that carers of people with cancer do not have contact with local authorities. Macmillan Cancer Support found that half of those carers are not getting any support at all and do not know where to go for it. They do have contact, however, with GPs and hospital doctors, so what is the Minister going to do to make sure that GPs and hospital doctors identify carers and make sure that they get that support and advice?
Mid Staffordshire NHS Foundation Trust
Barbara Keeley Excerpts(10 years, 5 months ago)
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Mr Hunt
My hon. Friend is absolutely right to focus on those pressures. We have been thinking about this very hard. Over the summer we announced £250 million to be distributed to the 53 A and E economies where the most difficulty is being experienced in meeting high standards for the public, and we are doing more. We are talking to the College of Emergency Medicine. Anything that my hon. Friend can do at a local level will be greatly appreciated. This is going to be a difficult winter and we need to stand full square behind our front-line staff.
Barbara Keeley (Worsley and Eccles South) (Lab)
The Secretary of State just said that Salford Royal hospital is one of the best hospitals in the country and we should learn from what it does. What it does is support minimum safe staffing levels for patients and then publish the actual-versus-planned staffing levels on the wards every day. Staffing levels published on websites is a little step forward, but it is not enough. Why do we not learn from what Salford Royal does? I do not think that patients and their families are interested in what the staffing levels were a month ago; they are interested in what they are today.
Mr Hunt
We have based our recommendation today precisely on what Salford Royal does. It uses the kind of model to ensure minimum recommended staffing levels on every ward that we want every hospital to use. We say that we want those data published monthly, but that is a minimum. Salford Royal publishes them every day, which is very impressive. Given that most hospitals are not using tools anything like as sophisticated as that, it will be a big step up for most hospitals to do that. We want to do it. What is significant about our announcement is that we want to assemble those data for every trust in the country so that they can be compared on a monthly basis and so that people can know how many wards and how many shifts are being safely staffed at their local hospital compared with neighbouring hospitals.
Urgent and Emergency Care Review
Barbara Keeley Excerpts(10 years, 5 months ago)
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Mr Hunt
I have to gently say to the hon. Gentleman that recruiting nurses from the Philippines did not happen for the first time under this Government. One reason why those nurse vacancies have gone up is that the Government decided to conduct a public inquiry into what happened at Mid Staffs. The system reacts to that by wanting to hire more nurses, and I think that he should welcome that, not criticise it.
Barbara Keeley (Worsley and Eccles South) (Lab)
The report by the Health Select Committee on the A and E crisis found that only 16% of hospitals had the right level of consultant cover in A and E. Yesterday, we learned that half the vacancies for senior A and E doctors are unfilled, as doctors move to work overseas. The issue of staffing in A and E has been understood for the past three and half years, and there have been repeated warnings and reports. What has the Secretary of State done to address it and make sure that A and E wards have sufficient staff cover?
Tobacco Packaging
Barbara Keeley Excerpts(10 years, 6 months ago)
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Mr Barron
It is indeed. The packages themselves are there to attract young women. I have an empty packet in my office that demonstrates exactly that. The idea that packaging is not used to sell products or advertise them effectively is nonsense. The Silver Slide design is intended deliberately to undercut the health warnings that the law now requires on each packet.
The hon. Member for Ribble Valley talked about adverts and bill posters, and said that he could only understand the part at the bottom. When I introduced a private Member’s Bill in 1994 to get rid of tobacco advertising and promotion, it was pretty clear that most of the adverts on billboards were not understood by some people. They were deliberately designed for the inquiring mind. There would be a picture of a piece of silk with a cut halfway down the middle. The advert did not say Silk Cut cigarettes; it did not have to. However, who are the ones with inquiring minds? They are young people. Tobacco companies did that deliberately for many years, and the G. K. Chesterton quote is to get young people to say that they can take this on, and that they are not bothered about what people say.
In Australia, it has been decided that there should be no branding on tobacco packaging other than the product name shown in a standard font, size and colour. No other trade marks, logos, colour schemes and graphics are permitted. Colours and graphics have been selling cigarettes in this country for decades. In Australia, cigarette packs should not carry attractive designs and should therefore come in standard shape, size and colours, and the colours should be as unattractive as possible. There should be prominent health warnings front and back, in pictures as well as writing, and there should be a phone number and web address on every pack to help smokers to access quit services.
There are 100,000 premature deaths a year from tobacco smoking in this country. If those deaths had been caused by anything else in the 30 years that I have been in Parliament, this House would have been sitting 24 hours a day, seven days a week, until we could find a way to stop it. It is no good the Government saying that they will wait. We know what tobacco marketing has been like for decades. We have stopped most of it, and we should stop this advertising at the point of use as well.
Barbara Keeley (Worsley and Eccles South) (Lab)
In an area such as Salford, 1,000 young people—the figure was 1,100 in Barnsley—will start to smoke this year. If I am called to make a speech, I will talk about that. Ten months, a year or 18 months of delay will cause 1,000 or 1,500 young people in an area such as mine to start smoking, and that is a tragedy.
Mr Barron
And another 207,000 nationally will start this habit a year.
One might ask why people buy a packet of cigarettes when it has a warning on it, but this is an addiction. All sorts of addictions sadly roll over common sense, and tobacco is no different. Stopping young people starting is crucial, and that is working. Smoking rates for young children are diminishing now, as are rates for adults, partly as a result of taxation and partly because we are stopping tobacco companies promoting cigarettes.
There are no figures to show that counterfeiting is more likely with plain packaging. Earlier this year, the Japanese company came to the House and told us that there would be more counterfeiting, but there is no evidence of that. It showed us—I have one in my pocket —a counterfeit packet. It looks like any other Benson & Hedges packet, so counterfeiting happens now. Standard packaging could include features to protect against counterfeiting, and it is for the House to regulate to introduce them. Hon. Members should not use the arguments that have been sold by the tobacco companies year after year. When it was found that tobacco related to massive numbers of deaths, the companies were still questioning that decades after the event—they still do now. They use this House to do it on occasions and, I have to say, it is wrong. When there are 100,000 premature deaths a year, we as legislators have some responsibility to alleviate the problem. I know that smoking is addictive and it is difficult for people to stop.
Barbara Keeley (Worsley and Eccles South) (Lab)
I congratulate the hon. Member for Harrow East (Bob Blackman), my hon. Friend the Member for Stockton North (Alex Cunningham), my right hon. Friend the Member for Rother Valley (Mr Barron) and the right hon. Member for Sutton and Cheam (Paul Burstow) on securing the debate on this important subject. We need to keep focusing on the issue because it has a great impact on the health of our constituents and most of all on the children and young people in our constituencies.
As an MP representing Salford, I want to speak today because, as others have said about their constituencies, smoking, smoking-related deaths and lung cancer rates are all too high in Salford. One in four of the population in Salford smoke, which is higher than the national average of one in five people in England as a whole. As a consequence, we have much higher rates of smoking-related death in Salford and a higher incidence of lung cancer, with 175 new cases of lung cancer diagnosed each year. The right hon. Member for Sutton and Cheam said that it was estimated that 530 children in his borough would start smoking this year. In Salford, sadly, the figure is nearly 1,000—almost double.
As we have heard in the debate, so many smokers— estimated at eight out of 10—start by the age of 19 and one in two of those young people will die of smoking-related diseases if they become long-term smokers. We know and we should continue to reflect upon the fact that this habit is the biggest cause of premature death in the UK and long-term smokers have a life expectancy that is 10 years shorter than non-smokers.
There has been some debate about the early evidence from Australia on the introduction of plain packaging. It suggests to me that branded cigarette boxes influence the perception of smoking among young people, and that plain packaging can help in the fight against starting smoking. That is why the issue is important and it is largely what I shall speak about here. As the right hon. Member for Sutton and Cheam said, 70% of those interviewed in a study in Australia who smoked from plain packets said that they thought the cigarettes were “less satisfying”. That is an important finding. They rated quitting as a higher priority than those who continued to smoke from a branded pack did.
A separate study found that 80% of children interviewed rated plain cigarette packs as “uncool”. Members who have spoken so far have rightly focused on how much packaging influences that perception of cool, because brands are very important to young people. Those are powerful findings from Australia.
I believe that there is weight behind the argument that cigarette packaging is the last legal form of tobacco advertising and that it has an influence on young people’s perception of smoking. That in itself is why we should take action to introduce plain packaging.
In the excellent Westminster Hall debate on 3 September —we have already touched on this, but it is worth reflecting on—the then Health Minister, the hon. Member for Broxtowe (Anna Soubry), talked about the power of packaging. She said:
“I have never forgotten the first time that I bought a packet of cigarettes.”
She deliberately chose a particular brand
“because they were green, gorgeous and a symbol of glamour.”
She said:
“I distinctly remember the power of that package. It was the opening of the cellophane and the gold and the silver that was so powerfully important to many people who, as youngsters, took up smoking.”—[Official Report, 3 September 2013; Vol. 567, c. 23WH.]
That was a very honest admission from a Health Minister, but she still went on to adopt the “wait and see” approach that we are getting from the Government. The health of our young people does not have time for wait and see.
In the previous Parliament we introduced a ban on smoking in public places, and I was very pleased to be a Member of this House when we voted for that. I visited Copenhagen earlier this year and found myself in public places where people were lighting up cigarettes. I was surprised, because it is easy to forget how unpleasant it is to be in a public place where people are smoking and to come home with clothes and hair reeking of smoke. It is very unfamiliar to us now. Much worse, of course, are the health impacts for the people in those places who do not want to inhale smoke.
My hon. Friend the Member for Barnsley Central (Dan Jarvis) outlined the steps that have already been taken to make smoking less attractive. Tobacco advertising has been banned from TV, billboards and sports such as Formula 1. Surely the next step is to tackle the advertising on the packaging.
In 1950 the figures were much higher: around 80% of men and 40% of women smoked. Amazingly, cigarette advertising at the time used images of doctors and celebrities to promote the different brands. One brand even used images of Santa Claus smoking—imagine that in the run-up to Christmas—to prove that it was easy on the throat. In the Westminster Hall debate my hon. Friend the Member for Vale of Clwyd (Chris Ruane) told me about a cigarette pack currently being sold—we have heard today from the right hon. Member for Sutton and Cheam about some of the packs available—and described it as
“a lovely 1950s retro pack, which opens up to show nice pink cigarettes inside”—[Official Report, 3 September 2013; Vol. 567, c. 18WH.]
Those packs are targeted at young teenage girls, and that is very cynical advertising. As I have said, the early evidence suggests that the attractiveness of the brand does have an impact, especially on young people, who are so impressionable. We know that the colour pink is being used because it is attractive to young teenage girls.
Early reports suggest that plain packaging can make such a big difference by changing perceptions of smoking. That is important for our children. A review commissioned by the Department of Health and the Public Health Research Consortium showed that standardised packaging was less attractive, more effective in conveying messages about the health implications of smoking and more likely to reduce the mistaken belief that some brands are safer than others, the old idea that flavourings or menthol make it less damaging, which is also untrue. All the evidence suggests that plain tobacco packaging greatly reduces the attractiveness of cigarettes for children, and Australia’s stance is supported by the World Health Organisation.
I want briefly to congratulate stop smoking services in Salford, particularly on their programmes focused on reducing smoking in families with children under 16. If children do not see their parents smoking, they are less likely to start smoking themselves. Many of our programmes in Salford are targeted at those families.
All the tobacco advertising I have talked about is pernicious. However it is done, whether with slim packages, colouring or making it look like perfume, it focuses on young people, and particularly young women who want to remain slim. It is almost unbelievable that tobacco companies used to use Santa Claus and doctors to promote smoking and tried to persuade us that it was safe. I do not want to continue to see 1,000 young people in Salford start smoking each year. It is time we took the next important step to close down cigarette advertising by introducing plain packs. It is time to prevent our children from starting smoking. It is time the Government supported the amendment to the Children and Families Bill that will take that important step. Above all, it is time to reduce the large numbers of people affected by smoking-related illness and early death, both in Salford and across the country.
Guto Bebb (Aberconwy) (Con)
It is a pleasure to follow the hon. Member for Worsley and Eccles South (Barbara Keeley). I congratulate my hon. Friend the Member for Harrow East (Bob Blackman) on securing the debate and the other Members who went to the Backbench Business Committee to ensure that it took place. However, my comments will not be particularly supportive of my hon. Friend’s views on the issue. I look at the matter from the perspective of a member of the Public Accounts Committee, which recently produced a significant report on the impact of tobacco smuggling on the loss of tax revenue in the UK. Having seen the evidence, I came to the strong conclusion that the case for plain packaging is certainly unproven.
The hon. Member for Worsley and Eccles South said that she wanted to ensure that 1,000 children in her constituency do not take up smoking. I wonder what the evidence is to suggest that those 1,000 children will not take up smoking simply because of a change in the product’s packaging. The right hon. Member for Rother Valley (Mr Barron) explained that he started smoking by stealing cigarettes from his father. I wonder whether his father’s choice of brand had any significant impact on his decision to steal a single cigarette. When I was growing up in Caernarfon, when people wanted to smoke they went to a local post office to buy singles. I suspect that they gave no consideration whatsoever to the brand; the point was that they could buy cigarettes very cheaply, usually one at a time. It was an important development when that was made an illegal practice that would not be tolerated. However, it is still the case that the driver is the price, not the branding. That is what I want to talk about.
When the Public Accounts Committee researched the smuggling of tobacco products into the UK, some of the information that emerged from that work was shocking. For example, in the top 10 recognised consumer brands of cigarettes in this country there are often two or three that are illicit and that it is illegal to supply in this country—for example Jin Ling, Richman and Raquel. Strictly speaking, those brands should not be available and so they would not be affected by legislation on plain packaging, yet independent consumer surveys show that those brands, despite being illicit and illegal, are recognised by the public.
The question we must ask, therefore, is why and how those brands are gaining a foothold in this country. Clearly it is unacceptable that they are smuggled into the country, and at such a rate that they are now recognised consumer brands. The key point we must recognise is that the driver for the sale of those products is not the branding or the so-called attractive packaging; it is the price. A packet of 20 cigarettes costs between £7.50 and £8. My son, who is lucky enough to have a paper round, would have to spend half his weekly wage if he decided to buy a packet of cigarettes legally, yet he could go out to any estate or high street in my constituency and, if he was switched on, find a packet of illicit tobacco for between £2 and £2.50.
I therefore argue that the driver encouraging young people to start smoking is more likely to be the price than the branding. If a young person can buy a packet of 20 cigarettes for 15% or 20% of their weekly paper round wage, they would be more tempted to do so than if they could buy it for 50% of their wage. By concentrating on plain packaging, we are ignoring an important fact: price is a driver for the sale of these products.
Time and again hon. Members have argued that plain packaging is about protecting young people, yet in university towns the young people often smoke roll-your-owns. The figure for roll-your-own tobacco is absolutely atrocious. In my constituency, which has no higher education facility, 48% of loose-leaf tobacco will be smuggled and illicit. The vast majority will not be recognised UK brands. In any town with a university or further education college, the percentage of illegal and smuggled loose-leaf tobacco will be even higher. What is the driver? What is persuading young people to buy tobacco products that are not officially marketed in the United Kingdom? The answer, I argue, is price.
Barbara Keeley
The hon. Gentleman seems to be arguing that people who are already addicted, such as older students, will smoke anything, but that is not surprising. We have repeatedly argued that young people get addicted in their early teens, and his arguments do not negate that.
Guto Bebb
The hon. Lady completely misrepresents my view. I said clearly at the outset that the temptation for young people is much enhanced if the product is affordable, and I think she fully understood my point.
It is important to recognise the problem of illicit and smuggled products because evidence—yes, to be tested and argued about—has been presented to suggest that plain packaging will actually make it easier for these products to be made available. I am fully aware that there are arguments on both sides. However, what is being said in this debate is, in effect, that the Government’s decision to wait to look at the evidence from Australia somehow indicates that they are in league with the tobacco companies. I find that quite distasteful.
I genuinely approach this debate from the point of view that I would like the number of people who smoke to be reduced—to nothing, I hope. I have never smoked, and if any of my children smoked I would be absolutely furious. Indeed, I lost my father to lung cancer at the young age of 63. My children never saw their grandfather simply because of his smoking. If the evidence was clear that plain packaging would be the answer, I would be supportive. I find it very odd that Members are saying that looking at the evidence is somehow condemning people to die. That is emotional and unacceptable language.
When Populus recently surveyed a number of police officers about whether they thought that plain packaging would be helpful, 86% of them clearly stated that they thought it would make it easier for illicit tobacco products to be supplied and that those products would be targeted at young people who could afford them. Sixty-eight per cent. of the police officers thought that plain packaging would lead to an increase in the size of the black economy in relation to tobacco products. A full 62% thought that an increase in cheap tobacco products would result in an increase in the use of tobacco products by children. Those are very interesting and important findings from a poll of police officers. Are their views correct? We need to look at the evidence and consider very carefully whether it supports them.
Luciana Berger
That point has been made by other hon. Members in this debate. I remember from when I was a young person that children do not get their money only from their parents and that they do not necessarily buy the cigarettes themselves. Often, they see other people getting out their packs of cigarettes.
The children in the university of Stirling study who were shown a packet of Silk Cut cigarettes were found to be more than four times more likely to be susceptible to smoking. Those children had never smoked.
It is the packaging that entices children. If we want to discourage children from ever starting to smoke, we need to question whether that is an acceptable way to market a product that is highly addictive, seriously harmful and clinically proven to kill. Smokers advertise tobacco brands to other people every time they take out their pack to smoke. The packets should not be glitzy adverts, but should carry strong and unambiguous health warnings about the dangers of smoking. We should not allow those warnings to be subverted by the design of the rest of the packet.
I will move on to my second theme. We have heard a few arguments against standardised packaging in this debate. We have also heard those arguments from the tobacco industry. I will deal with each of the arguments in turn. Much of the discussion has centred around evidence. Hon. Members have said that there is no evidence that standardised packaging will work. That is not true.
Last year, the systematic review by the Public Health Research Consortium, which was commissioned by the Department of Health, looked at all the evidence on standardised packaging. The findings are clear for everyone to see. It found that standardised packaging is less attractive, especially to young people. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) rightly pointed out that it takes away the cool factor. The review also found that standardised packaging makes health warnings more effective and combats the utter falsehood that some brands are safer than others. Those findings have been backed up by 17 studies that have been published since the systematic review. Government Members, including the hon. Member for Ribble Valley, have asked for evidence. We have the evidence.
A separate study that was published in the British Medical Journal in July looked at research from Australia soon after the introduction of standardised packaging. It found that smokers who used standardised packs were 66% more likely to think that their cigarettes were of a poorer quality, 70% more likely to say that they found them less satisfying, 81% more likely to have thought about quitting at least once a day in the previous week and much more likely to rate quitting as a higher priority in their lives than smokers who used branded packs. Not only are people less likely to take up smoking when presented with standardised packs; people who already smoke are more likely to think about quitting if the cigarettes that they buy come in standardised packaging.
Barbara Keeley
My hon. Friend is being very generous with her time. The hon. Member for Rossendale and Darwen (Jake Berry) seemed to be quite satisfied with the Government’s action on this issue, although that is perhaps not surprising given the views that he has put forward in this debate. However, it is a fact that fewer people have quit smoking successfully and that fewer people have attempted to quit with NHS help over the last year. That is the first time since 2008-09 that those figures have fallen. I talked about quit services in Salford, but such services are now less successful and there must be a reason for that. Does my hon. Friend take that as seriously as I do?
Luciana Berger
I thank my hon. Friend for that important intervention. The figures that came out just the other week do show a drop in the number of people who are quitting smoking through NHS services. I am very concerned about that. As I said at the start of my contribution, 200,000 young people still take up smoking every year. That is exactly what we are seeking to address in this debate.
We have reflected a lot on the Australian experience. The former Australian Health Minister, Tanya Plibersek, reported that there was a
“flood of calls…in the days after the introduction of plain packaging accusing the Government of changing the taste of cigarettes.”
She went on to say:
“Of course there was no reformulation of the product. It was just that people being confronted with the ugly packaging made the psychological leap to disgusting taste.”
That is a significant point. Far from there being no evidence, there is a swathe of evidence.
The second claim raised during our debate is that standardised packaging would increase the trade in counterfeit cigarettes, or impact on the printing trade. Again, it is important to clarify that we are talking about standardised packaging. I have heard hon. Members use the term “plain packaging”, but we are not discussing that. I know I am not allowed to demonstrate this at the Dispatch Box, Madam Deputy Speaker, but standardised packaging is clearly printed; it is not a plain pack. Current packaging is already so easy to forge that covert markings enable enforcement officials to identify counterfeit cigarettes, and all key security features on existing packets would continue on standardised packets. Standardised packaging would make pictorial warnings more prominent and packaging harder to forge.
We heard in an important contribution that standardised packaging might lead to an increase in illicit trade, but that is simply not true. Andrew Leggett, deputy director for tobacco and alcohol strategy at Her Majesty’s Revenue and Customs, stated in oral evidence to the House of Lords European Union sub-Committee on Wednesday 24 July:
“There are a number of potential factors that weigh on counterfeit packaging”,
but that if standardised packaging was introduced, it was
“very doubtful that it would have a material effect.”
Jane Ellison
The Government are following discussions in another place closely. Beyond that, I am not able to comment in this debate, but we are well aware of those discussions and Ministers are participating in them.
Australia introduced standardised packaging in December 2012, and New Zealand and the Republic of Ireland have committed to do that. In addition, other academic studies are emerging about the effects of that policy.
The UK has a long and respected tobacco control tradition internationally, although at times in this debate it has been possible to miss that point. Under successive Governments the UK’s record has been good, and we will continue to implement our existing plan to reduce smoking rates while keeping the policy of standardised packaging under active review. The tobacco control plan for England sets out national ambitions to reduce smoking prevalence among adults, young people and pregnant mothers. As the plan makes clear, to be effective, tobacco control needs comprehensive action on a range of fronts.
I will talk a little more about this in the context of devolved powers of public health to local government, but there is a slight danger that by focusing only on one aspect of tobacco control, we forget that there are other—and indeed more—things that we could do. Even if it was possible to say today that we would do this tomorrow, we would still be debating how we could effectively control tobacco and stop children taking up smoking. As various hon. Members have said, including the right hon. Member for Rother Valley (Mr Barron), this is an ongoing battle to protect children’s health.
Barbara Keeley
Is the Minister concerned about the fact that between April 2012 and March 2013, there was an 11% decline in the number of people setting a quit date? We are concerned about children, but if they are still watching their parents smoking, it is more likely that they will start. I hope that she is disturbed by the fact that the numbers setting out to quit are falling—it is the first fall since 2008-09. The Minister should address that point.
Jane Ellison
We are aware of that, but smoking in this country has dipped below 20% for the first time ever. I am aware of the hon. Lady’s concerns and I shall talk a bit about some of the public health campaigns and the new opportunities, not just for the Government but for local government and individual Members, on tobacco control policy.
As our plan makes clear, effective tobacco control needs comprehensive action on many fronts. The Government are taking action nationally. We are committed to completing the implementation of legislation to end the display of tobacco in shops. Since 2012, supermarkets can no longer openly display tobacco. In 2015 all shops will need to take tobacco off view. Tobacco can no longer be sold from vending machines, which has stopped many young people under 18 accessing smoking.
I do not want to downplay the importance of this policy—we are conscious that it could make an important contribution—but we can do many other things. The reasons why children, in particular, take up smoking are very complex, and are to do with family and social circumstances. One policy alone will not address that. Local authorities have a vital role to play, which is why we have given local government responsibility for public health backed by large ring-fenced budgets—more than £5.4 billion in the next two years. I encourage all hon. Members who have participated in today’s debate to ask tough questions of people locally. I hope that they are talking to their public health directors, health and wellbeing boards and clinical commissioning groups about where tobacco control sits in the armoury of local government. That is why this power has been devolved. The local insight and innovation made possible by that policy will help us to tackle tobacco use at a local level as well as through policies that the Government can put in place.
Jane Ellison
I will move on as I have tried to respond to the hon. Gentleman’s point.
Our local stop smoking services are among the best in the world. The fact is that smokers trying to quit do better if they use them. Research has found that
“English stop smoking services have had an increasing impact in helping smokers to stop in their first 10 years of operation”—
although I hear the challenge that has been made on the recent drop—
“and have successfully reached disadvantaged groups.”
The latter are obviously particularly important from a public health point of view.
This year, Public Health England has launched a new dedicated youth marketing programme. This marketing strategy aims at discouraging a range of risk behaviours, including tobacco use, among our young people. In this financial year, that is worth more than £1.5 million.
Barbara Keeley
The Minister does not seem to be saying what the Government will do about the decline in quitting—the fact that stop smoking services are not reaching people to the extent that they should be. Does that concern her, and is she going to do something about it?
Jane Ellison
That is something that I will look at carefully, but I point out to the hon. Lady that obviously this issue now falls under the remit of Public Health England. It will be on my agenda for the next meeting with the chief executive, and I will write to her after I have had that discussion, if that would be helpful.
Bob Blackman
This being the first time I have spoken when you have been in the Chair, Madam Deputy Speaker, I congratulate you on your election to high office.
We have heard today from 11 Back Benchers, as well as the two Front Benchers, and hon. Members have put their arguments strongly. Clearly, I am wholly in favour of standardised packaging for tobacco products, and the quicker it is done the better. Three arguments have been advanced against its rapid introduction. The first concerns the illicit trade. In reality, the illicit trade continues now, but the evidence is that through the security marking of packaging and cigarettes themselves, and with greater vigilance from our customs and excise people, the illicit trade can be stamped on hard. The tobacco industry, which is against standardised packaging, uses the illicit trade as an excuse.
Secondly, we have heard that the big tobacco companies would use the money they currently spend on packaging to cut the cost of tobacco. My answer is to increase the tax. We must ensure that tobacco is expensive so that people are discouraged from purchasing it. Thirdly, the key argument from those who oppose the measure seems to be, “Let’s delay and prevaricate. Let’s wait and see what happens. Let’s wait for everyone else to decide, and then take action ourselves.” As we have said, 300,000 under-18s start smoking every year, so the longer we delay, the greater the number of people taking up smoking and dying prematurely.
Barbara Keeley
I imagine that the hon. Gentleman was as disappointed as me to hear the Minister’s response. There is a tendency among Health Ministers to say that everything is at arm’s length. Like me, I hope that he rejects the Minister’s claim that responsibility lies with Public Health England, local government and Members themselves. The action we need is action that only the Government can take. Does he support that view?