Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Dr Poulter]

I am very sympathetic to the point made by my hon. Friend. The chief inspector has indicated that he will look at how individual wards are run on a granular level to ensure there is the right skills mix to look after patients on any particular day, with proper accountability for patient care.

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

The chief inspector of hospitals says he will monitor levels of unanswered call bells, but not the ward staffing levels that cause the bells to be unanswered. Is that not ridiculous? Is it not time that Ministers changed their minds on this important issue, as Robert Francis has now done?

[Dr Poulter]

As the hon. Lady will be aware, on the basis of the Francis report the Berwick review considered that issue in detail and highlighted the fact that safe staffing levels are not about ticking a box for minimum staffing, but about developing tools that recognise the individual needs of patients on the ward. The previous Government went down the route of tick-boxes in health care. I worked on the front line during that time and that route did not deliver high-quality care. We need the right tools to support front-line staff so that they make the right decisions in looking after patients. It is not about tick-boxes; it is about good care.

Accident and Emergency Departments

Barbara Keeley Excerpts

Tuesday 10th September 2013 Commons Chamber

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

It appears that the Secretary of State is not listening to the Health Committee, which has looked into the issue. The Chair, the right hon. Member for Charnwood (Mr Dorrell), has made it clear that he does not think the 2004 GP contract is to blame for these issues, but we found out that only 16% of hospital trusts have the recommended level of emergency consultants, and we noted that nearly £2 billion has been taken out of adult social care. When will the Secretary of State deal with the staffing cuts and budget issues that are actually causing the A and E crisis?

[Mr Hunt]

My right hon. Friend said to the House that he largely agreed with the changes that I wanted to make to the GP contract. I always listen very carefully to what the Select Committee says, but I point out to the hon. Lady what Professor Keith Willett, who is the person at NHS England who is in charge of all A and E departments, said. He said that between 15% and 30% of the people attending A and E departments could be looked after by primary care. If we ignore that—I am afraid that what Labour did in 2004 has made the problem a great deal worse—we will not solve the underlying problems with A and E.

Tobacco Products (Plain Packaging)

Barbara Keeley Excerpts

Tuesday 3rd September 2013 Westminster Hall

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

It is a pleasure to speak in the debate under your chairmanship, Mr Hollobone. As an MP for Salford, I want to speak because smoking, smoking-related deaths and lung cancer rates are all too high there. One in four of the population in Salford smoke, which is a much higher rate than the average of one in five people in England as a whole. Consequently, we have much higher rates of smoking-related death and a higher incidence of lung cancer, with 175 new cases of lung cancer diagnosed each year. The worst statistic is perhaps the Cancer Research UK estimate that around 1,000 children in Salford start smoking each year; that addiction will kill one in two of them, if they become long-term smokers.

Early evidence from Australia on the introduction of plain packaging suggests that branded cigarette boxes can influence the perception of smoking among young people and that plain packaging might help the fight against starting smoking, which is what is important to me. In a study there, 70% of those interviewed who smoked from plain packets said that they thought that the cigarettes were “less satisfying”, and they rated quitting as a higher priority than those who continued to smoke from a branded pack. In an important separate online study, 87% of the children interviewed rated plain packets as “uncool” and said they would not want to be seen with them.

There is, therefore, 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 is why it is really important that we take action to introduce plain packs.

In the previous Parliament, we introduced a ban on smoking in public places and it made a difference. I visited Copenhagen earlier this year, and found myself in public places where people were lighting up. 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 stinking of smoke, but worse is the effect of second-hand smoke on health. Since 2002, tobacco advertising has been banned from TV, billboards and sports such as Formula 1; the next step is to tackle the advertising on the packaging.

In 1950, 80% of men and 40% of women smoked. Cigarette advertising at that time used images of doctors and celebrities to promote the different brands. One brand even used images of Santa Claus smoking.

[Chris Ruane]

I mentioned two packs earlier. One I was not able to get hold of for today, despite my trying. It is a lovely 1950s retro pack, which opens up to show nice pink cigarettes inside—very appealing to a 12-year-old. What does my hon. Friend think about that kind of retro advertising by the tobacco industry?

[Barbara Keeley]

It just shows that all these methods are being used to attract smokers—particularly, and sadly, young smokers. To think that we once used Santa Claus to claim that a brand was easy on the throat. We have heard of the damaging impacts and the dreadful way in which people die.

I congratulate the stop smoking services in Salford, particularly for their programme that focuses on reducing smoking in families with children under 16. Research has shown that, 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 families. I think it is true that most smokers do not want their children to start smoking.

All the advertising is pernicious. It focuses on young people, and on young women who want to remain slim and, for heaven’s sake, in the past, it used Santa Claus and doctors. It is time we moved on to take the next important step to close down cigarette advertising by introducing plain packs. It is time to prevent children and young people from starting smoking—I do not want to continue to see 1,000 children a year in Salford starting to smoke—and to reduce the large numbers of people affected by smoking-related illness and early death, in my authority and across the country.

--- Later in debate ---

[Anna Soubry]

I suppose that I am sort of grateful for that intervention. It was not the most helpful, but it was a fair one and it is a good point that needs addressing. I have no difficulty in waiting for the evidence to emerge from Australia. It is on that point that I agree with the hon. Member for North Antrim (Ian Paisley). However, it is the only point on which we agree on this matter. It is important that we consider the evidence. Of course we know that the Irish Government have also said that they want to introduce this measure. Again, we will wait and see. It is no simple matter to introduce standardised packaging. There will be many challenges that the Irish will face in their attempts. It is right and fair that we wait to see all of that as it develops.

[Barbara Keeley]

rose—

[Anna Soubry]

May I make some progress, because it is really important that I make the matter clear? The coalition Government have made no final decision. As I have said, we wait to see the evidence as it emerges from both Ireland and Australia. It is important to say that standardised packaging is no silver bullet. There is no simple solution to the problem of persuading both the remaining 20% of the population to give up smoking and our youngsters not to smoke.

I want to deal if I may with some of the excellent points that have been made. I, like many other Members, have talked about the power of the package. The hon. Member for Vale of Clwyd (Chris Ruane) helpfully brought in some packets. He mentioned the cigarettes that are deliberately targeted at young women. My hon. Friend the Member for Banbury (Sir Tony Baldry) asks why children, in the face of the overwhelming evidence and the health messages, take up smoking. He is right to say that we need to do more research. We know many things.

We know, for instance, the power of parents. If a child is brought up by parents who smoke, they are likely to smoke because they will see it as the norm. One of the great benefits of the legislation that was introduced by the previous Administration—I pay full credit to them for introducing that ban on smoking in open places—was that it made smoking less socially acceptable. Effectively, it turned many of us into modern-day lepers. If we wanted to smoke, we were reduced to standing outside, ostracised from our workmates, and that was a powerful reason why so many of us gave up smoking. Many of us remember with shame, as I do, sitting in restaurants thinking that we had some God-given right to smoke next to people who rightly found it deeply offensive, and who were trying to enjoy their meals. It is astonishing to look back at films and television programmes of only a few years ago to see how acceptable smoking was and how the previous Parliament changed that.

I absolutely agree with all those who are trying to nail the falsehood in two important parts of this argument about standardised packaging. The first is whether it is plain. I concede that one of the great failings of this debate is to explain what we mean by “standardised”. That goes back to the point that was inaccurately made by my hon. Friend the Member for Bury North. I never said that packaging would be glamorous or glitzy, but that, as I think my hon. Friend the Member for Harrow East also tried to say, under the regulation and legislation holograms can be put on standardised packaging—not to be attractive but as part of the argument against the claim that anybody will be able to counterfeit it.

Far from being a counterfeiter’s charter and dream, standardised packaging is a counterfeiter’s nightmare. I wish that I had with me some of the packets that have been produced by Australia. If we had them, Members would see that they are far from plain. On the contrary, they have colour in them, but they have the standardisation, which takes away this incredibly powerful marketing tool and the attraction for young people.

[Barbara Keeley]

On the point about waiting for the evidence, it is not 20% of people who smoke in Salford but 25%, and much more in some areas, and it is 1,000 children. As we wait, 1,000 children every year will start smoking in Salford. Why are we waiting?

[Anna Soubry]

I think I have explained why we have waited. My understanding of the statistics is that it is 20%, but it differs in different parts of the country. I also want to make the point that the Government have not stepped away from taking action against the harmful effects of tobacco. We have a tobacco control plan for England that sets out our national ambitions and our comprehensive evidence-based strategy of national and local actions to achieve them, including high-profile marketing campaigns. Our Stoptober campaign, which was hugely successful last year and which we will be running again this year, provided help and assistance to smokers, the majority of whom want to quit.

I also want to pay tribute to local authorities, which now have responsibility for public health. I have met members and representatives from councils in the north-east who are doing some terrific work persuading people to stop smoking or not to take it up, and that shows good local action.

As ever, the clock is against me, but I hope that I have made the Government’s position absolutely clear. I congratulate again everybody who has spoken in this debate. My own views are clear, but it is right to wait to see the evidence. I assure Members that the wise words from so many different parties today will be taken back to the Government and will be listened to. It is to be hoped that in due time, standardised packaging will be introduced.

Managing Risk in the NHS

Barbara Keeley Excerpts

Wednesday 17th July 2013 Commons Chamber

[Andy Burnham]

As so often with the spin that we hear from Government Members, it is our achievements they are trying to claim credit for. I left behind the plans for the training of those doctors, but we do not hear much credit coming in this direction, do we? Government Members are happy to take the credit and then they try to cast off all the blame for everything else. My point is that criticism must be fair and made with care. We all have a duty to point out the failings of the NHS, in our own constituencies and nationally, and that is what I did when I did the Secretary of State’s job. However, we have to do that responsibly and fairly, especially for hospitals and those who manage them.

Hospitals are not the architects of all the problems we read about. For example, they are all struggling with the fallout of severe cuts to social care budgets, the appalling cost of which I recently revealed: a 66% increase over two years in the number of over-90s coming into A and E via blue-light ambulances. In human terms, more than 100,000 very frail and frightened people have been speeding through the streets of our communities in the back of ambulances. Hospitals have to absorb that extra pressure and also struggle with longer delays in getting people back home. We are in real danger of asking too much of our hospitals by allowing them to be the last resort for people who would be better supported elsewhere. Without a greater understanding of that situation in the current debate, and if the trend towards the vilification of NHS managers continues, who will take on the job of running our acute trusts? Good people will walk away and no one will want to do the job. Again, the NHS simply cannot afford that.

This crude blame game is an election strategy with two components: run down the NHS; and pin all the failings on the previous Government. The NHS cannot take 20 months of that until May 2015. It has been destabilised and demoralised already; if the Government are not careful, they will push it over the edge.

The Secretary of State needs to change course and find a way of bringing people back together, so the purpose of the debate is to put forward two constructive proposals to manage risk in the NHS—one for now, the other for the long term. First, I turn to the immediate proposal. It is clear that the best way to draw a line under recent events and unify people would be for the House to embrace today the analysis and main recommendations of the Francis report. The motion highlights the three most significant recommendations: benchmarks on safe staffing; a duty of candour on individual NHS staff; and the regulation of health care assistants. If all parties endorsed those proposals, it would send staff a message of support and recognition of the pressure that they are under, while the patients who have suffered poor care would receive the positive message that the parties are working together to prevent that from happening to others.

Given the tragic events that lie behind them, public inquiries should, when possible, produce consensus. It is extraordinary that, having commissioned a three-year public inquiry, the Government have slowly been distancing themselves from the Francis report’s analysis and conclusions ever since its publication. It is hard not to conclude that the report did not deliver what the Government wanted and that they have spent the past five months rewriting it. They have come up with their own recommendations on chief inspectors for hospitals, general practice and social care, yet dragged their feet on the actual recommendations. They have substituted the verdict of Francis on Ministers in the previous Government with that of the kangaroo court of Lynton Crosby. We do not oppose chief inspectors, but if the Government believe that ever-tougher central regulation will bring about the culture change locally that everyone agrees is necessary, they are mistaken. We need change that will have an immediate effect on the ground, and that will support staff and improve care for patients.

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

My right hon. Friend has probably been in the Chamber on most of the occasions when I have raised the question of safe staffing with the Secretary of State. It was cited in the Francis and Keogh reviews, and the Care Quality Commission tells us that one in 10 hospitals has unsafe staffing levels. The Secretary of State dances around the issue again and again, but he will not take action. Yesterday, I asked him to introduce transparency to the process so that hospitals do not have wards with ratios of two staff to 29 patients, but he refused to answer my question. Does my right hon. Friend agree that if hospitals were transparent about their ratios, that would be the way forward, because we would know where we were?

[Andy Burnham]

The Keogh report exposes alarming ratios at my hon. Friend’s hospital and others. We have been warning the Government for months—years, in fact—about cuts to nursing numbers. It is neither right nor fair to criticise nurses for being uncaring when too many of them are unsupported and are working in conditions in which they have to make compromises that they would rather avoid.

Staffing emerged as the main concern arising from the Keogh report, but the problems go way beyond 14 trusts. The CQC says that one in 10 trusts in England does not have adequate staffing levels. Can we agree today that the staffing in all hospitals must urgently be brought back up to adequate levels, as defined by the commission, with clear benchmarks set for the future? [Interruption.] I am pleased if the Secretary of State is agreeing, because that represents progress, so I look forward to finding out how his plan will be delivered.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a great pleasure to rise to speak in support of the amendment tabled by my right hon. Friend the Prime Minister.

Both sides of the House believe in our NHS, the staff who work in it and the care they provide for patients. I am also sure that both sides recognise that, in the wake of the Francis inquiry and yesterday’s report from Sir Bruce Keogh, the 65th year of the NHS has been its most challenging and that we need to face up to those challenges.

This debate has had three key themes: the importance of the NHS, the staff who work in it and the care they provide for patients; the importance of making greater productivity gains in the NHS to improve care and make sure that we do more with our resources; and the importance of openness and transparency and the need to learn lessons from things that have gone wrong, so that patient care can be improved.

Back Benchers have made some high-quality contributions. It is always a pleasure to hear the hon. Member for Walsall South (Valerie Vaz) and the right hon. Member for Holborn and St Pancras (Frank Dobson). The hon. Member for Halton (Derek Twigg) made a very strong case for his local health care services. I pay particular tribute to the right hon. Member for Cynon Valley (Ann Clwyd), who has done some tremendous work in looking at how we can improve the NHS complaints procedure. She read out a number of examples of things that have gone badly wrong, from which we need to learn lessons for the future. The work she is doing at the moment is hugely important and valuable, and the Government look forward to receiving her report shortly.

My hon. Friend the Member for Bracknell (Dr Lee) highlighted some of the challenges with the existing NHS estate and the need to modernise facilities and make some of the older buildings more fit for purpose to meet the needs of patients in the modern world. My hon. Friend the Member for Bristol North West (Charlotte Leslie) made a very brave speech. She spoke at great length—and rightly so—about the importance of involving the medical royal colleges in deciding how hospital inspection processes should be implemented and about the importance of clinical leadership and involvement in those inspections to help understand what good care looks like. After all, those colleges are centres of excellence in their fields and it is right that we listen to what they have to say.

My hon. Friend the Member for Southport (John Pugh) made a particularly thoughtful speech. He called for good management and spoke of the need for good managers in the NHS. He also made the important point that, in all our debates on patients who have been let down, the regulators have often not played their part. That is why we need to ensure that the regulators continue to come to the table and that the improvements at the CQC continue. The regulators need to remain fit for purpose.

The problem with mandatory staffing ratios is that they would just provide another tick box that would not necessarily bear a relation to what good clinical care looks like. There is a clear difference between mandatory staffing ratios and appropriate staffing levels, as the Francis report indicated. We need staffing levels that reflect the needs of the patients on the ward. Those will vary from ward to ward and will change on a daily basis according to the needs of different patients. It is important that we consider the patients who are in front of the doctors and nurses on the day. It may not be nursing care that is needed, but care from other members of the multi-disciplinary team such as physiotherapists and health care assistants. That is why it is wrong to use mandatory staffing ratios as a measure of good care.

[Barbara Keeley]

The point that I keep raising with the hon. Gentleman, other Ministers and the Secretary of State is that there must be transparency in the numbers. Ratios of 2:29 have been reported to me, which nobody would be comfortable with. My excellent local hospital puts information about staffing ratios on the boards in each ward. Does he not think that we should move rapidly to provide transparency on this matter? I am asking not for mandated ratios, but transparency so that patients and their families can see what the ratio is.

[Dr Poulter]

The hon. Lady makes a very good point about the importance of having staffing levels that are appropriate to the needs of the patients. That is why NHS England is considering toolkits that will help hospitals to build the right care in the right place and at the right time for patients and to adapt care so that it is provided by the appropriate professionals, according to patient need.

The debate has rightly focused on transparency and openness. We have not got that right in the NHS since the Bristol heart inquiry, which took place under the previous Government. Both the Government and the Opposition believe that we need to support staff who feel that they need to speak out and that there needs to be greater transparency and openness. I believe that the steps that the Government are taking will make a difference. We are introducing a contractual right for staff to raise concerns and issuing guidance on good practice in supporting staff to raise concerns. We are strengthening the NHS constitution and have set up the whistleblowing hotline to support whistleblowers. We are also amending legislation to secure protection for all staff through the Public Interest Disclosure Act 1998. We are doing good work and it is right that we continue to do all that we can to support staff in raising concerns about patient care, where that is appropriate.

We must focus on improving productivity in the NHS so that we can do more with the resources that we have. As the Secretary of State outlined, that is about improving the technology in the NHS so that we can spend more money on care and free up staff time. If we use technology to better join up health and social care, staff will spend less time on paperwork and more time with patients, which will improve patient care.

It is important to consider the fact that there are higher levels of morbidity and mortality at weekends and in the evenings. There needs to be more consultant cover and out-of-hours cover at those crucial times to ensure that the service is more responsive to patients. The Government are addressing that.

In conclusion, at the beginning of this debate, the right hon. Member for Leigh (Andy Burnham) rightly highlighted the long-standing problems in our NHS. Although Labour is now talking about social care, it was the last Labour Government who cut the social care budget between 2005 and 2010. Although Labour is now talking about the risk register, the last Labour Government refused to publish it.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 16th July 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is right to highlight the fact that the figures show that last year alone 50,000 bed days that would otherwise have been wasted were saved by investing in social care and implementing the service transformation that we all require. However, this is about making all NHS and social care budgets go further, and recognising that if we are to improve the care of older people, particularly frail elderly people, we have to invest in more community prevention and community-based care, which is what this Government are doing.

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

As we have heard, two thirds of NHS leaders have said that the shortfall in social care spending is having an impact on their services. The Minister can try to get rid of that and talk it away, but in week after week of taking evidence in our inquiry into emergency care, the Select Committee on Health has heard the same thing. We know that elderly patients now form a much larger proportion of admissions—40% of admissions to emergency units are people aged 65 to 85. Is not the £1.8 billion cut in spending now really hitting NHS services and making the emergency care crisis worse?

[Dr Poulter]

I am afraid that the Opposition are very confused about their figures. As I explained earlier, the £2.7 billion—or 20%—figure represents the savings that councils have made to meet demand, and real-terms spending next year is expected to go up. The point from the ADASS and other surveys is that integration works. This Government are investing in integration. According to the Dilnot report, it was the last Government who cut in real terms the amount of spending going to social care between 2005 and 2010—and the hon. Lady was a member of that Government.

Hospital Mortality Rates

Barbara Keeley Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

I very much hope that that acquisition can proceed and I agree with my hon. Friend that it is the way forward. Although we have to ensure that that happens properly, Northumbria can give North Cumbria the leadership that it badly needs, so the process would be positive.

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

Since the publication of the Francis report, it seems that we have been going round and round the question of safe staffing levels, which I have raised several times. Ratios of two nurses to 29 patients, or worse, have been reported to me—I do not think that they are uncommon—and the CQC tells us that one in 10 hospitals has unsafe staffing levels. It must be accepted that the number of nurses has reached unsafe levels in these 14 hospitals and many parts of the country. The Secretary of State cited Salford Royal hospital, but will he act now to ensure that all wards in all hospitals publicise their staffing ratios, because I would not want a relative on a ward with a ratio of 2:29?

[Mr Hunt]

The right ratio of patients to nurses depends on the type of patients in a ward, because different wards have different requirements. Salford Royal has a good model through which it ensures that it has the right number of nurses. As I said to the hon. Member for Rotherham (Sarah Champion), I accept what Francis says about safe staffing, but he did not recommend the Labour party’s policy of minimum mandated national staffing levels. I am following the recommendation of the Francis report, which I think is the right way forward.

Tobacco Packaging

Barbara Keeley Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

If I were in court, I think I would have to plead guilty to that one, Mr Speaker. In all seriousness—it is a very serious point—one of the things in the EU directive that we specifically looked at was the percentage of the package that should contain health warnings. It is now going up to 65%. There will be no flavourings. Again, this is very important in tobacco products. All this is designed for the next generation.

It is really important to add this: standardised packaging was about making cigarette smoking unattractive to young people. It is the next generation; that is the fundamental aim. That is why it is really important, even for those who use that aim to argue in favour of standardised packaging, that we find out what the evidence is in Australia, which is doing it. That is why my hon. Friend is right to say that good, evidence-based legislation is always the best.

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

I am proud that the Labour Government in 2006 gave a free vote on the legislation for smoke-free workplaces. That was an important step forward. Perhaps the Minister should be thinking in those terms now, because today’s decision to take no action will really disappoint the 190 health organisations, including the royal medical colleges and the World Health Organisation, that have supported the move to standardise packaging on tobacco products. Will they not now be drawing the conclusion that the Government, as my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) has said, have given in to vested interests and entirely lost their way on public health?

[Anna Soubry]

I do not give in to pressure from anybody, and neither does anybody else in my Department or indeed in my Government. We have taken a decision to wait for the emerging evidence from Australia, and that is the right thing to do.

Health and Care Services

Barbara Keeley Excerpts

Wednesday 3rd July 2013 Commons Chamber

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

I thank the Chair of the Select Committee, the right hon. Member for Charnwood (Mr Dorrell), for the way he opened the debate.

The context of our debate on public expenditure for health and care is, as we have heard, not just the substantial upward cost pressure on the NHS, but substantial cuts to the budgets of local councils, which are affecting their social care budgets. Adult social care directors tell us that £2.7 billion has been cut from care budgets since 2011, representing a significant 20% of those budgets. That level of cuts now means actual service reductions, as well as increased charges for service users—a fact brought home to me week in, week out by the cases I am now seeing in my constituency. My local authority of Salford had maintained eligibility criteria of “moderate” until this year and has been pushed by cuts into changing it to “substantial”. That is very sad.

Often what are described as efficiency savings in social care budget cuts are actually cuts to the fees paid to care providers. Some 45% of the adult social care directors polled by the Association of Directors of Adult Social Services said that they did not increase fees to care homes to cover inflation this year, while nearly half said that providers in their areas were now facing financial difficulties as a result of savings made in fees paid to councils. In many cases, this has led to the poor care that we have had described in so many reports, and to which the right hon. Member for Charnwood has just referred. We hear of care tasks timed down to the minute, and paid care workers earning less than the minimum wage because they are not paid for travel time or costs.

The social care directors also warned that worse cuts are still to come, given that further cuts to local council budgets are still planned. Sandie Keene, the president of ADASS, warned Ministers that further cuts could have seriously adverse consequences for families. She said:

“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 over the next two years.”

Not surprisingly, the Local Government Association has warned the Government that they need to ensure protection for adult social care in future. Zoe Patrick, chair of the LGA’s community wellbeing board—so perhaps the most senior wellbeing board in the country—has said:

“We need an urgent injection of money to meet rising demand in the short term and radical reform of the way adult social care is paid for and delivered in future, or things will get much worse.”

Both the LGA and the Society of Local Authority Chief Executives have warned that the planned cuts will get in the way of implementing the Dilnot proposals and the measures in the Care Bill. They also say that the Government’s impact assessment for the Bill significantly underestimated the likely cost to councils of the new duties under the Bill—an issue that came up repeatedly on the Joint Committee considering the draft Bill. I hope that as the Care Bill makes it way through Parliament—and certainly by the time it reaches the Commons—issues to do with the cost on local authorities will be dealt with.

Some £1 billion of funds from NHS budgets was earmarked for transfer to councils responsible for adult social services in the 2010 comprehensive spending review. However, three years into a four-year process, much of the funding continues to be spent in a short-term way—there was much focus in our report on that fact—and not on the systemic transformation that social care needs if it is to ensure sustainable services in future. Let me give an example. Of the £648 million transferred in 2011-12, 18% was used just to maintain eligibility criteria, with £284 million spent on offsetting pressures and cuts to services and another £149 million allocated to working budgets. As we have heard, that is not the sort of systemic transformation that the Health Committee would like to start seeing.

Of course, this firefighting is not surprising given the cuts to local council budgets, which I have touched on, but it is not sustainable if our aim overall is the transformation necessary to achieve the integration of health and care services. We have seen a downward spiral in social care funding. It is clear that more must be done to move from using scarce resources when they are allocated as a sticking plaster to cover the costs. They should instead be used to build more joined-up services. With another £2 billion a year moving from the health budget to social care from 2015, it is extremely important that we start to get this right. I fully support the call made in the Committee’s report for a ring fence to protect social care funding. That is important.

As for health spending, the Department of Health says that it managed to save £5.8 billion in 2011-12, but evidence provided to our Committee by the National Audit Office shows that much of that was made through one-off savings, such as pay restraint and other staff cost savings, reducing payments to NHS providers and some savings that were truly one-off, such as land sales, which cannot be repeated. Those savings are not sustainable and cannot continue in the long term. There is an argument, which we keep coming back to, that a lead needs to be taken as soon as possible to transform how services are delivered.

I welcome the suggestion of a pooled budget for health and social care services to help older and disabled people. I see that as a move in the right direction. Indeed, the shadow Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), has repeatedly made the point that integration is the future direction of health and social care. Mike Farrar, the chief executive of the NHS Confederation—I guess this was the expression of an NHS view—said of pooled budgets:

“This allocation should help address the need to join up services and provide the right care for people, allowing them to stay in their own homes. But NHS organisations will want to have strong assurances that the money going to social care does the job it is meant to do.

Rather than see local health and social care budgets as separate, we need to support integrated care by bringing together providers and commissioners to look at how we can spend our money to the best effect.”

That must be what we start to see.

Creating joint budgets has the potential to facilitate a move towards more joined-up working, but as the right hon. Member for Charnwood outlined, there need to be safeguards. In fact, we need to be clear that the money intended for social care should definitely be spent on it. Labour’s whole-person care approach is a vision for a truly integrated service—not just battling disease and infirmity, but aspiring to give people a complete state of well-being across all the services, physical, mental and social. Shared budgets are one small step towards that, but we want to see a people-centred service, strengthening and extending the NHS in this century, not whittling it away.

Let me turn to the long-term funding of social care to avoid catastrophic costs falling on certain groups of people, particularly those with long-term conditions or dementia. Support will be given in such a way that people must meet thresholds and a spending cap. First, people must meet eligibility criteria, which, we know now, the Government plan to set at the “substantial” level. Secondly, they must fall below a means-tested threshold. I understand that the upper level is to be set at £100,000, but the lower level is still set at £14,250, with an assumption that assets between those thresholds attract interest, which affects the calculation of social care funding.

After all that there is the cap, set at the—in my view—high level of £72,000, plus accommodation costs of £12,000 a year. I feel that the £72,000 that individuals must contribute to their care before they exceed the cap is not as it seems. That is how the figure is expressed, but the metering will take account only of the costs that the council would pay for care. Many thousands of families are already paying a top-up for care. Cuts to council budgets, which I touched on earlier, will continue to depress the rate at which they pay towards providers, yet that is the rate that would be taken into account in the calculation of the metering.

My hon. Friend the Member for Leicester West (Liz Kendall) has analysed the plans and said that

“families will face losing even more of their homes than they do now”.

Since she pointed that out, we have learned that in 2016, with accommodation costs of £12,000 a year and councils at that point paying about £500 a week, it would take about five years to reach the care cap. Even at that point, we now know that care needs would have to be at the “substantial” level. Families using nursing homes charging more than the local authority rate will therefore have to pay the extra cost, as they do now.

I have had constituents paying £40,000, plus interest, for care costs, which were taken out of the value of their home, which was eventually sold for only £60,000. There are people in my local authority area who have homes valued at only the £50,000, £60,000 or £70,000 mark who surely will look at the cap set by the Government and think that it would help them. It is unfair not to tell people that what they think is a cap set at £72,000 will, for many of them, turn out to be much higher.

The Health Committee has committed to look at the implications of the Government setting the cap at a level higher than that recommended by the Dilnot commission. I hope that the review shows that this is not a policy to brag about straightforwardly, as the Prime Minister did today. I understand that the number of people likely to be helped by a cap set at that level is around 110,000. I am sure that many people would be surprised by that low figure. However, I am pleased that the direction of travel for Government policy is towards what the Health Committee has repeatedly set out in its reports on social care and the whole-person approach set out by my right hon. Friend the Member for Leigh. Pooled or joint budgets are a small step on the way. I hope that Government policy will start to move further towards addressing some of the other vital issues in social care that I have outlined. Unless we solve those issues in social care, we cannot move forward on the whole picture.

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[Andrew Gwynne (Denton and Reddish) (Lab)]

May I begin by thanking the Health Committee and its Chairman for the report and the clarity with which he presented its findings, and Members from all parties for the thoughtful way in which they have debated the issues today? The right hon. Member for Charnwood (Mr Dorrell) is known for his diligence and attention to detail, and his speech clearly illustrated those instincts.

Before I address the points raised by the report, let me put on record our gratitude to the many thousands who work in our health service. As we approach the 65th anniversary of the NHS, we should take a moment to pay tribute to those staff who are doing a tremendous job, often in difficult and challenging circumstances.

With the indulgence of the House, I would also like to place firmly on the record my support for and appreciation of the dedicated doctors, consultants, nurses, carers and support staff in Tameside general hospital, many of whom will be feeling battered and bruised today. Tameside general hospital serves most of my constituency and today’s media reports highlight some of its failings. Deep-seated issues need to be grappled with urgently, but we should also recognise and listen to the many decent, good and hard-working staff who work there, because they often have many of the solutions and have not been listened to in the past.

I also apologise for leaving the Chamber briefly during the speech of my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley). There was no discourtesy intended to either her or the House: I was dealing with the BBC’s breaking news that both the chief executive and the medical director of Tameside general hospital have resigned, which I support. Sadly, it has come three years too late—I called for it to happen three years ago—but, nevertheless, it is a step in the right direction to ensure that Tameside general hospital has a safe and secure future.

[Barbara Keeley]

We heard from the hon. Member for Southport (John Pugh) about the value of executive leadership. Our conurbation of Greater Manchester has one of the best and safest hospitals in the country. The Salford Royal hospital is the seventh safest in the country and has an excellent chief executive. Today the leadership of Tameside hospital has changed and I hope that the people of Tameside will end up with an excellently led hospital. I agree with the hon. Member for Southport. My example shows the difference between a hospital that is well led and one that is not.

[Andrew Gwynne]

I agree with my hon. Friend. Had she been listening to BBC Radio Manchester this morning, she would have heard me making precisely that point. The situation at Tameside is incredibly frustrating for me and my hon. Friends the Members for Stalybridge and Hyde (Jonathan Reynolds) and for Ashton-under-Lyne (David Heyes). Whenever we meet the chief executive and chair of Tameside hospital—we do so frequently—they always give us excuses as to why Tameside is different from the rest of Greater Manchester because of the industrial legacy and poor health outcomes in the borough, but one could make exactly the same arguments for Salford: there is no reason why one part of Greater Manchester should have an excellent hospital while another has one with long-term problems.

Following that slight indulgence, I want to turn to the report and focus on four key areas. First, the right hon. Member for Charnwood made some pertinent points about the Nicholson challenge. To be fair, in previous reports the Health Committee has taken the consistent view that the Nicholson challenge can be achieved only by making fundamental changes to the way in which care is delivered. It makes that argument in this report too. It states:

“Too often…the measures used to respond to the Nicholson Challenge represent short-term fixes rather than long-term service transformation.”

The Select Committee is right about that.

If we are to sustain the breadth and quality of health and care services, we need a fully integrated approach to commissioning—something that the right hon. Member for Charnwood and others have spoken about powerfully. The Opposition agree with that. I hope that the right hon. Gentleman will agree that we have put forward bold proposals for a genuinely integrated NHS and social care system that brings physical health, mental health and social care into a single service to meet all our care needs.

We know that that approach works. In Torbay, integrated health and care teams have virtually eliminated delayed discharges. Partnerships for older people have helped older people to stay living independently in their own homes and have delayed the need for hospital care—something that my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) rightly referred to. Where physical and mental health professionals have worked closely together, they have shown that a real difference can be made.

An integrated, whole-person approach is the best way to deliver better health and care in an era when money remains tight. As the Committee’s report notes,

“the care system should treat people not conditions.”

The right hon. Member for Charnwood was right to point out that developing the role of health and wellbeing boards is the best way to plan such integrated care. He reaffirmed that he is “happy to endorse” the Burnham plan. We were happy to hear that. He is right that there is an issue with single commissioning budgets without checks on local government. As somebody who has a background in local government, I think that he is right about the need to extend the ring fence to social care spending. Unless those budgets are protected, there will be a temptation to siphon off the money that is needed to provide the integration that we all want to see.

Carers

Barbara Keeley Excerpts

Thursday 20th June 2013 Commons Chamber

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

The number of carers is growing, as is the impact of caring on the lives and health of carers. The right hon. Member for Sutton and Cheam (Paul Burstow) has touched on some of those issues, but I will go further.

Analysis by Carers UK of data published from the 2011 census has shown that the number of carers has increased substantially, by 11%, since 2001, and there are 35% more carers over the age of 65. We know that carers often combine paid work with raising their own children, as well as caring for other family members. In fact, one in four women and one in six men aged 50 to 64 have caring responsibilities for family members who are older or disabled. If we think about that for a moment, we start to realise the difficulties. Of course, many of us know people in that situation, or may be in it ourselves. Some 3 million carers juggle caring with paid work, so it is not surprising to learn that full-time carers are more than twice as likely to be in poor health as people without caring responsibilities.

Given all these stresses, carers should be getting advice and information to help them care, but it is becoming ever clearer that they are not. During the recent carers week, to which the right hon. Gentleman referred, Members met carers to find out about their issues. Last week I went to a speed networking event, as I think it is called, here in the House, at which I met six carers. Two were carers of family members with cancer, two had cared for a partner or family member at the end of their life, and two were carers of spouses with Parkinson’s. Despite the differences in their caring, the one thing they shared was not having been given the information, advice and support they needed to be carers. As the right hon. Gentleman touched on to an extent, Macmillan Cancer Support tells us that carers of people with cancer come into contact most with health professionals, by whom they need to be identified and signposted. However, 95% of cancer carers are not getting a carers assessment.

It was revealing to talk to carers of people with cancer about how this had affected them. Cancer patients, as we know, may have long days of treatment in hospital, yet no one had told the carers I spoke to that a discount was available on expensive hospital car parking costs. One of the carers had to buy a hospital bed for use at home by her daughter, yet she was given no advice on where to buy one.

Similar issues crop up for carers of people with a terminal illness, but those carers are also juggling with the knowledge that they only have a limited time with the person for whom they are caring. Carol and Lucy were the two carers I met. One had cared for a partner and the other for her mother, both through to the end of their lives. Both said how much financial hardship they had had to accept to undertake that caring. The carer of her terminally ill mother could only get unpaid leave from her job and took it for 11 months. She lost her flat because she could no longer afford to pay the rent. It seems wrong that carers have to struggle on unpaid leave while caring for someone who is terminally ill. She never told her mother that the leave was unpaid or of the difficulties she was having.

Carers of people with cancer and of people who are terminally ill both cited the same issue: as carers, they were mainly ignored by the health professionals they encountered. They rarely asked them if they were coping and they did not signpost them to carers centres or carers associations for help and advice. In the cases of the very few carers of people with cancer who managed to have a carer’s assessment, that had most often been prompted by a referral from a GP. As the right hon. Member for Sutton and Cheam says, 70% of cancer carers surveyed had come into contact with a GP, doctor or nursing staff, but they are in the health world—the NHS world—not the local authority world. Very few of them have contact with local authority staff.

I think I met the same people at the event as the right hon. Gentleman, because I met John and Karen, who were each caring for a spouse with Parkinson’s. We have already heard some of the points that those carers made, but John said:

“In more than 30 years caring for my wife, my own GP has never asked how I am. He provides excellent support for my wife, but has never asked me how I am coping as her carer”.

Karen cares for her husband, who has Parkinson’s and was diagnosed only shortly after they were married. She says:

“I gave up work to help support him. I’ve never been told about a carer’s assessment nor has my GP asked how I am. It’s as if you are invisible.”

Parkinson’s is a long-term condition, but despite the fact that they might be caring for many years, only one in 10 Parkinson’s carers have been offered a carers’ assessment. Parkinson’s UK tells us that most are full-time carers, caring for someone for more than 50 hours a week—even up to 24 hours a day as the Parkinson’s progresses. Such carers are those most in need of advice, support and respite care or breaks.

That all matters because the Care Bill puts great emphasis on carers’ assessments rather than the identification of carers and the need to signpost them to sources of advice and support. Last September, I introduced a private Member’s Bill, the Social Care (Local Sufficiency) and Identification of Carers Bill. Three sponsors of that Bill are in the Chamber. The Government, sadly, did not support my Bill and their Back-Bench Members talked it out. The clauses on the identification of carers would have ensured that NHS bodies had the procedures in place to identify carers, promote their health and well-being and ensure they receive information and advice. Those are the exact areas from which the carers to whom I have talked would benefit. As I said during the debate on the Bill, I believe that the key focus in identifying carers should be those with the heaviest caring commitments.

The 2001 census found that 10% of all UK carers were caring for more than 50 hours a week. By 2011, that figure had more than doubled to 22%. It is worth noting, as I said during the debate on my Bill, that the proportion of carers in Salford who provide full-time care at that level has been higher for all of the last decade. It has not just changed, and I am sure that it is related to health inequalities.

Two wards in my constituency have high numbers of people caring for people with stroke disease, heart disease or cancer, which means that they have the heaviest caring commitments. We know that full-time care can take a toll on the carer’s health, and the health needs of those carers must be recognised. We know that those caring for more than 50 hours a week are twice as likely to suffer ill health and that those caring for a person with dementia or stroke diseases are even more at risk. Early identification and support for those carers would mean that they can maintain their health and sustain their caring role better.

The Carers Trust has a centre in Salford with a project to identify carers within primary care and at the Salford Royal hospital. Let me take this opportunity to pay tribute to that centre for its work in identifying carers, which it has been doing within primary care for many years. GPs and primary health care teams in my constituency have started to tackle the task of identifying carers, but there is much more to do. The manager of the centre tells me that having established a network of links within GP practices to identify carers, local GPs made 300 referrals last year, but we have 20,000 carers in Salford, 5,000 of whom will be caring at the heaviest levels. So we need to ensure that health bodies take action that meets the scale of the task of identifying carers and referring them to advice and support.

Young carers are the most hidden of all carers, and my Bill would have required local authorities to have a policy in place for identifying young carers and providing support for pupils in schools who are young carers. It would also have placed a duty on colleges of further and higher education to identify students who are carers and have in place policies to support them. Young adult carers at university or college have to balance giving care with their academic studies and learning. Some do that by caring at a distance, returning home at weekends or holidays to provide care, whereas others have to balance care and study by continuing to live at home and travelling to their local university so that they can maintain their regular caring roles. Hardly any of the carers I have talked about in my speech are in contact with local authorities or are likely to have had a carers assessment from a local authority. So the duty on carers assessments in the Care Bill would not help the carers I have met recently—the carers of people with cancer or of people who are terminally ill. And, as I have said, the local authorities are reaching only one in 10 of carers of people with Parkinson’s disease.

Young carers are also not being reached or supported adequately. The Carers Trust feels that the current law surrounding identification, assessment and support for young carers is complex and incoherent. Young carers are vulnerable and compared with other children they are at risk of poorer outcomes if they take on excessive and inappropriate caring roles because the adult’s needs are not being met. We know that inappropriate caring roles have an adverse effect on a child’s educational and emotional development.

The current position we have reached on that issue is most unsatisfactory. In its evidence to the Joint Committee on the draft Care and Support Bill, the Law Commission made it clear that it felt that young carers should be given the same rights as adult carers, so that the Bill became a single statute covering carers. Yet, young carers still do not have the same rights as adult carers in the Care Bill and there is no mention of them at all in the Children and Families Bill. That is not acceptable. The care services Minister and the children’s Minister have been making reassuring noises about meetings they have had to discuss this and about their intentions, but they have so far ignored a cross-party consensus among MPs and peers that they should act to improve young carers’ lives. Young carers should not be left with unequal rights compared with adult carers.

[The Minister of State, Department of Health (Norman Lamb)]

The hon. Lady said that we have so far ignored what she has been arguing for in terms of action. I just wanted to reassure her that I have absolutely not ignored that. I have said, I believe in the debate on the Queen’s Speech, that I would seek to meet the Minister dealing with the Children and Families Bill, and I have done that. I take the point the hon. Lady makes very seriously and I want to see action to address the concerns that she and others have raised.

[Barbara Keeley]

I thank the Minister for that point, but I have to tell him that he and the children’s Minister have to start to accept that making reassuring noises and having meetings is not enough.

[Paul Burstow]

The hon. Lady is absolutely right to be pushing this issue forcefully. We were given a commitment by the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson) last week that amendments would be drafted, and presumably they will be tabled in the House of Lords. It would helpful for us to know, and to hear from this Minister, that the Government will shortly be publishing the amendments that will be made to the Care Bill as well as those that will be made to the Children and Families Bill.

[Barbara Keeley]

I thank the right hon. Gentleman for that point. I am, however, going to push the matter with the Minister because there was an opportunity in this regard. New clauses were moved during the remaining stages on the Children and Families Bill last week that were copies of clauses from my Bill, and they would have required those bodies that I talked about to have policies in place. We are not talking about a large financial commitment; we are talking about bodies having policies in place. Our schools, our colleges and our higher and further education institutions should have policies in place to recognise young carers, but up and down the country they do not have those. The disappointment that organisations outside here that support young carers will have felt results from the fact that the debate was managed last week so that those new clauses were not reached. That does not show good faith, and if I were a member of the coalition of organisations that support young carers, I would look at that and say, “I don’t know what the Government are going to do.” The Minister will have to accept that they are still disappointing people who have not been protected sufficiently by the law.

I conclude by touching quickly on the financial context of social care and how it affects carers. Giving carers rights in the Care Bill is indeed a positive step, but the Local Government Association reminds us that the Government’s austerity programme and the need for further savings do not fit well with the aspirations of the Bill. Councils have had to reduce their adult social care budgets by 20% over the past three years. At least a quarter of those cuts are from reductions in services and increases in charges. Almost 90% of councils only meet needs that are at the substantial or critical threshold.

Staff at our local carers centre told me that carers are being affected by the bedroom tax, the increase in the value of non-dependent deductions, fewer sources of grant funding, and reductions to care packages that appear to be driven by cutting costs, not by changes in need. That is particularly true where they are caring for somebody with a learning or physical disability. Worries continue into the future when the change from disability living allowance to the personal independence payment starts to affect carers. The Government’s own impact assessment published in February indicated that almost 10,000 fewer carers will be entitled to carers allowance by 2015 as a knock-on consequence of the loss of disability benefits following the introduction of PIP. Carers UK has calculated that this represents a £31 million cut in support to carers. We should bear in mind that if those carers were left unable to care as a result of not having access to those carers benefits, replacing the care that they provide would cost at least £300 million in replacement adult social care services. That is a serious point.

This morning I asked a question about the loss of £28.3 billion of income for disabled people over the next five years through the combination of the welfare changes being made. We must take on board the fact that that loss of income will hit the carers of those disabled people. Carers, as we learned during carers week, are prepared to care. We must do better in supporting them.

--- Later in debate ---

[Sir Tony Baldry]

That is an extremely good point. These things are organic. A few years ago big employers such as Sainsbury’s would not necessarily have been involved in that way. Having been involved in carers policy over the years, what I find encouraging is that each year a further step is achieved.

[Barbara Keeley]

I had not intended to make this point earlier, but I will make it now because so much has been said about employers. The Independent Parliamentary Standards Authority does not allow MPs’ staff to take compassionate leave; it allows MPs to give only sick leave or maternity leave, as I discovered late last year. Given all the good work that has been done with employers, that is an issue the whole House should take forward.

[Sir Tony Baldry]

One of the non-executive members of the IPSA board will shortly be work-shadowing me for a day, so I will certainly raise that valid point with her. I will give her lunch, out of my own taxed income, along with other colleagues who might want to talk with her, and the hon. Lady would be very welcome. I think that the board’s non-executive members have to take some responsibility for the way IPSA functions.

--- Later in debate ---

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), the hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on organising this debate. I am grateful for the opportunity to speak after such thoughtful contributions. I want to focus on unpaid carers; I will leave others to talk about the care system as a whole.

As we have heard, carers play a vital role, not just for their family members and friends but for the country. In the past decade, the number of carers has grown from just under 5 million to nearer 7 million. By 2037, it is estimated that the number will have increased to nearly 9 million. In my constituency, there are 11,076 unpaid carers, nearly a quarter of whom provide care for more than 50 hours a week. As has been said, we know that this is an underestimate of the actual number who provide care. My hon. Friend the Member for Worsley and Eccles South talked about the lack of information and advice, which has certainly been identified in my constituency. Age UK in Oldham recently opened an information and advice centre, and I hope that people will avail themselves of that. Like other Members, I, too, have had the plight of carers increasingly brought to my attention in my surgeries. Their situation is a growing problem.

In today’s terms, the role played by carers saves the economy £119 billion a year. That is more than the total NHS budget and nearly six times the adult social care budget. The country could not survive without the work that carers do, and that is even more so today, with the crisis that social care is facing. We are facing the double whammy of an ageing society—it is great that we are, on the whole, living longer, although austerity is certainly having an impact on life expectancy—and a meltdown in social care in local authorities, with cuts to their budgets having an impact on social care budgets. Unfortunately, carers are picking up the tab. A recent Carers UK survey showed that a third of those caring for more than 35 hours a week have no support at all. Although 3 million carers juggle work with caring responsibilities, one in five has been forced to give up work.

In addition to the lack of support for caring, carers across the UK are starting to see the impact of the Welfare Reform Act 2012. Changes to financial support with housing and council tax in some areas mean that many families are experiencing reduced financial support from more than one of the changes. The discretionary funding set aside by councils to support people affected by the bedroom tax is enough to help only one in 10 disabled people. Carers who require an additional room because they cannot share with partners who sleep in hospital beds, or parents of disabled children who need the space for care workers to provide overnight care are being seriously let down. More than 5,000 families with care needs are faced with either moving or finding an extra £700 a year.

The cumulative effects of the economic downturn, a squeeze on wages and the increasing costs of essentials such as food and fuel, along with the cuts in social security support, are making it more difficult for carers to manage. More than four in 10 carers in the Carers UK survey said they had been in debt as a result of caring. This year will see other changes to the benefits system, as the transfer of disability living allowance to the personal independence payment and the universal credit are introduced, which is also of considerable concern to many carers. DLA was the gatekeeper to carer’s allowance. The changes mean that 10,000 fewer carers will not be entitled to carer’s allowance. Many of us have already called on the Government to review these changes and undertake a cumulative impact assessment of the effects of these welfare reforms. For many, they will be the tipping point.

In addition to that, and as a consequence of debt and a lack of support, there are significant effects on the health of carers. Eight out of 10 carers report that their caring role affects their physical health and nine out of 10 say that their mental health has suffered. This is not only a human tragedy; we are storing up problems for the future by not caring for our carers.

I know about that from my personal experience of caring for my mum—I have spoken about her before—who died of Alzheimer’s last September. She had Alzheimer’s for 10 years, and for the last three years was unable to communicate or to feed or toilet herself. Although my mum lived in the States, I provided respite care during leave, so I can personally attest to the physical and emotional toll that it had on me. In the last few months of her life she was bedridden. I am little, but I am fairly fit and strong, yet physically trying to lift her to bathe her or change her continence pads was something I found really difficult to manage. The worst thing was the emotional toll, however, as I worried how everyone was coping.

I want to spend the last few minutes talking about young carers. One of the last research projects I worked on before I was elected to this place concerned the effect on young carers’ health of their caring role. Many people will be surprised to learn that, according to recent census figures, there are more than 178,000 young carers in England and Wales. Those are the official figures, but we know that they are an underestimate. Children as young as five are looking after family members who are physically or mentally ill or disabled, their roles ranging from doing household chores to providing nursing or personal care.

The effects on those children and young people are immense and lifelong. Because of their caring responsibilities, nearly a quarter of young carers often miss school or have educational difficulties. Young carers are also more likely to grow up in poverty, to be socially excluded, to have low aspirations and achievement and to have relationship issues. Those problems can follow them throughout their lives. There is also evidence of significant effects on their physical and mental health, with anxiety, depression and self-esteem issues being particularly prevalent. It has been shown that, after a year of caring, morbidities fail to return to pre-caring levels.

Services do not always respect young carers and the role that they play. My research indicated that many young people felt excluded from discussions about their family member’s care, even though they were providing much of it. Some of the responses to questions on whether the young carers should be allowed to see their parents in hospital, for example, were quite heartbreaking. Similarly, many young carers felt that there was a lack of understanding and support from their teachers and schools. I echo what my hon. Friend the Member for Worsley and Eccles South said about this. We must ensure that schools take seriously their role in supporting young carers.

[Barbara Keeley]

I have mentioned the fact that we have a young carers project in Salford that is doing great work. It was interesting, however, that one of the schools involved came back to the project and said, “We have no young carers at all”, when the project knew that it did. The perception among some head teachers is that they do not have any. Is my hon. Friend worried about that as well?

[Debbie Abrahams]

I totally agree with my hon. Friend; that is very worrying, and we must try to do better by those young people.

I am encouraged by what the Minister has said today about the discussions, but I reiterate my hon. Friend the Member for Worsley and Eccles South’s sentiment that warm words are not enough. Will he tell us when we can expect to have the amendments included in the Children and Families Bill? The rights of parent carers of disabled children are also still in limbo, and the Government must bring forward changes to the Bill to ensure that the rights of that group of carers are not left behind. I recognise the Government’s commitment to carers’ rights, but I reiterate my earlier remarks: no matter how much we legislate for assessing carers’ needs, it is meaningless without the means to implement it. Local authority budgets have been pared to the bone, and that is having an impact on social care budgets. How are we going to deliver those assessments? A further £800 million of cuts are planned for this year alone. I would be grateful if the Minister would address that point as well.

--- Later in debate ---

[Steve McCabe]

I think I probably would agree with that, although the right hon. Gentleman must recognise that the Government are moving increasingly towards systems that do not allow for face-to-face exchange. I understand that that is one of the major disputes about what is happening in the DWP. I think it would make classic sense, however. All of us hear enough about joined-up government, and this is one area where a bit of joined-up government could save money and provide a much better service.

[Barbara Keeley]

I was at an event the other day—as was the shadow Minister, my hon. Friend the Member for Leicester West (Liz Kendall)—at which somebody from the DWP was talking about this issue. They said they had tried a project to get their data to talk to the local authority’s data, but had given up because the local authorities all used different forms. That seemed to me to be appalling. The Minister might like to think about whether there could be guidance for local authorities. If local authority forms are all that is stopping this vital sharing of data, it is about time we dealt with that.

[Steve McCabe]

One of the penalties of having been a Member of this House for quite a long time is that we get fed up with hearing such excuses. We know fine well they are nonsense; if we want it to happen, we can make it happen. That is the approach we should take.

My hon. Friend the Member for Corby (Andy Sawford) talked about older carers and carers who have been caring for older relatives, and I want to touch on one particular aspect of that. What will happen under the Government’s deferred payment equity release plans to surviving spouses who are carers, or elderly children caring for even older parents—it is not uncommon these days for a 70-year-old to be the carer for somebody who is 95 or 96, for instance? What rights will they have? In such situations, when the person who is being cared for enters residential care, what will happen to a carer whose name is not on the deeds of the house, although it may be their family home and they may well have lived there since marriage, or even childhood?

We must ensure that these carers do not end up homeless, destitute individuals with no pot of money to support them when they end up needing care themselves. I am not sure that the deferred payment scheme as currently structured takes account of the risk for those carers, and it would be the cruellest of rewards if, after a lifetime of care, we left them in this predicament.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

I am grateful to the shadow Minister, the hon. Member for Leicester West (Liz Kendall), for her thoughtful speech, much of which I agreed with. This has been a thoughtful debate in which many good points have been made and I thank Members for raising this very important issue. Many Members who have taken part in the debate have been long-standing advocates for carers and I welcome their interest and commitment. I completely understand why various Members constantly pursue issues such as those to do with young carers and will not accept my determination to help with that problem until it is dealt with. I accept that that is their role and it is their right to do so. The debate has been a good one and I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) for securing it, together with his colleagues, and for all the work and championing he has done over the years for carers.

Let me make a preliminary point. Some of the Opposition speeches, including that made by the hon. Member for Stalybridge and Hyde (Jonathan Reynolds), focused on the difficult financial circumstances for local government, the impact of welfare reforms and so on. We could have a partisan battle about the issues, condemning the Government and so on. However, the shadow Minister recognised at the start of her speech the scale of the challenge we face, not just today but in the future. The numbers of people growing older with care needs, often with multiple conditions and a mix of mental and physical health needs, just keep growing. If we are all honest, both in this Chamber and with the public outside, we must admit that any Government of any political persuasion would face this challenge.

There is no easy solution. We cannot just find a magic pot of money to throw at the problem. There is an obligation on us all, as the shadow Minister made clear, to find ways of using the money we have available much more effectively than we do. We know that there is massive waste in the system because of the care silos—between health and social care, between mental and physical health and between general practice and secondary care. There is an absolute obligation on us all to engage in a debate about using money more effectively to achieve better care and support for people and to ensure that the system remains sustainable. I want to ensure that we elevate the debate by recognising the challenges we face.

The speech made by my hon. Friend the Member for Truro and Falmouth (Sarah Newton) was, I think, really valuable. Ultimately, we need collaboration among statutory services, which should not abandon their responsibilities, the voluntary sector and, crucially, people—that is, the community, families, neighbours and friends. We need to unleash particularly the power of the many people who have entered retirement fit and healthy and want to give something back, but often do not know how to do so. An army of people out there are able and willing to help to meet the enormous challenges. Some of the schemes that my hon. Friend the Member for Truro and Falmouth alluded to in her county are happening in many parts of the country, and they point us to a better future—a more caring future, where community strength is rebuilt.

I wish to join everyone else in this debate in paying tribute to the extraordinary work that carers do, giving of themselves; it is self-sacrifice, and they get no plaudits from anywhere else. They are just committing to helping someone they love, often doing so in challenging and troubling circumstances, particularly where dementia is concerned, as the loss of recognition can be very distressing for a loved one. We also know that many carers are themselves frail, struggling to cope on their own. My hon. Friend the Member for Ceredigion (Mr Williams) mentioned the challenges in rural areas. My constituency of North Norfolk contains many elderly people who are often living in isolated communities and are struggling to get access to the services they need. We owe an enormous debt of gratitude to the work of every carer in our community. As we have identified in this debate, without carers the cost to the public purse would be enormous.

I therefore very much welcome this debate, coming, as it does, immediately after carers week. It gives us the opportunity to discuss how carers of all ages can be properly supported in their role and helped to have a better quality of life. That is what we should be focusing on: putting quality of life and well-being at the heart of the Care Bill. We should not be thinking about what service we deliver to passive recipients; we should always be thinking, “How do we make your life better? How do we make you happier in your life? What might you, as an older person, be able to offer to other people?” It should be about that, rather than about these people sensing that they have nothing more to offer and just facing dependency as they move towards the end of their life in a rather distressing way.

Carers are central to the Government’s proposals for improving care and support. The Care Bill, currently being discussed in another place, puts carers on the same footing as those for whom they care. We propose to simplify the assessment process for adult carers by extending their right to an assessment. The hon. Member for Birmingham, Selly Oak (Steve McCabe) made an absolute point: people need simplicity and they must not be faced with bureaucratic jungles to fight their way through. Our simplified procedures will consider the impact of caring responsibilities on the carer in order to help them to lead as independent a life as possible. We intend to remove the requirement that a carer must be providing

“a substantial amount of care on a regular basis”—

that is the test—in order to be entitled to an assessment. That will mean that many more carers—in essence, all carers—will be able to access an assessment. In addition, the Care Bill seeks to place a new duty on councils to meet carers’ eligible needs for support. Those measures will be underpinned by a Department of Health commitment to provide new resources for carer assessment and support, rising to £175 million per annum by 2020.

[Barbara Keeley]

Has the Minister really taken on board the message that has come from my colleagues in this debate, which is that assessment is not always the answer? A lot of carers do not go near local authorities and are not likely to know of, hear of or ask for an assessment. The people they are in contact with are GPs, doctors and nurses, so there must be much more onus on the NHS and its staff to undertake the task of identifying carers at the earliest stage and ensuring that they get information, advice and support.

[Norman Lamb]

The hon. Lady asks whether I have taken that message on board—I could not have missed it. I totally agree with what has been said and I am going to discuss the role of health professionals.

I know that there is a lot of concern about young carers, and it comes particularly from the hon. Lady. I said in the Queen’s Speech debate that I would meet the Under-Secretary of State for Education, my hon. Friend the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children and families, and I have done so. I appreciate that until something concrete happens the hon. Lady will, rightly, keep pressing. I give her my assurance, again, that I understand and accept the case she is making. My hon. Friend the Minister and I are entirely clear that our joint aim is to ensure that young people are protected from having to undertake excessive and inappropriate caring responsibilities. During debates on the Children and Families Bill, he confirmed that he and I are of one mind on the need to protect young carers by using a whole-family approach to the assessment of adult care needs.

The Care Bill itself is not the place to go into the detail of how assessments should be conducted; that will be set out in regulations and statutory guidance. A whole-family approach will undoubtedly benefit children, but I am keen that it also encompasses other significant family relationships. We need to look genuinely at the whole family, whatever the relationships are between those receiving care and those giving it.

In last week’s debate, my hon. Friend the Minister confirmed that his Department will look at what it can do to remove any legal barriers preventing young carers and their families from receiving the support they need, and how we can ensure that children’s legislation works with adult legislation to support the whole family. I am clear that we have to address the concerns, and while we significantly advance the position of adult carers, we cannot leave young carers behind. The approaches do need to be different, because we need to recognise philosophically that children should not be caring inappropriately. Of course sometimes they have to do that, but we want to relieve the caring burden as far as is possible, while recognising that sometimes there will be a caring role for some.

Care Quality Commission (Morecambe Bay Hospitals)

Barbara Keeley Excerpts

Wednesday 19th June 2013 Commons Chamber

[Mr Hunt]

That is the big culture change we need to see; we need to see Governments who are prepared, in all circumstances, however difficult and however politically inconvenient it is, to recognise that when there are safety issues, when there are terrible failures in care and compassion, we need to support the people who want to speak up, because if we do not do that, we will never root out these problems.

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

I support the comments made by my right hon. Friend the Member for Exeter (Mr Bradshaw). A real concern is being expressed by Members on both sides of the House, because a person committed this cover-up by deleting this report and we really want to know—there should be an investigation—whether they are currently working for the CQC or working in the NHS anywhere. It is vital to know that.

Today, the CQC’s chair has said that it is not currently capable of carrying out hospital inspections. The Health Secretary has talked about putting in place more specialist inspection teams, and I, of course, support that. However, CQC inspectors have had access to specialists for a long time—they have talked about it before the Health Committee—so if they are not using them, that is an issue to address. What measures will the Health Secretary put in place to ensure that from this day onwards—not at some future point—we can have the CQC competently carrying out inspections?

[Mr Hunt]

When the CQC was set up in 2009, it was decided, with full ministerial approval, to go for a generalist inspection model—a model where inspection was not carried out by specialists; the same people would inspect dental clinics, GP practices, hospitals and slimming clinics. That was the wrong decision to take. Making sure that we have enough specialist inspectors in place, with appropriate clinical expertise, takes time—it is a very big recruitment job—and that is what the new chief inspector of hospitals, Professor Sir Mike Richards, is now setting about doing. It is also expensive—it costs money—but he has said to me that when his teams are in place he will start those inspections before the end of this year. So we are going as fast as we possibly can to try to put these problems right.