NHS (Private Sector)

Barbara Keeley Excerpts

Monday 16th January 2012 Commons Chamber

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

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

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

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

[Mr Lansley]

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

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

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

[Mr Lansley]

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

[Barbara Keeley]

Will the Secretary of State give way?

[Mr Lansley]

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

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

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

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

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

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

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

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

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

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

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

having

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

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

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

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

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

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

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

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

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

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

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

[Henry Smith (Crawley) (Con)]

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

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

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

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

[Barbara Keeley]

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

[Henry Smith]

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

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

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

Breast Implants

Barbara Keeley Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

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

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

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

[Mr Lansley]

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

Social Care Funding

Barbara Keeley Excerpts

Thursday 10th November 2011 Westminster Hall

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

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

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

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

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

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

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

[Glyn Davies]

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

[Barbara Keeley]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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[Neil Carmichael]

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

[Barbara Keeley]

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

[Neil Carmichael]

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

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

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[Tony Baldry]

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

[Barbara Keeley]

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

[Tony Baldry]

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

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

[Tony Baldry]

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

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

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

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

[Barbara Keeley]

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

[Tony Baldry]

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

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

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

--- Later in debate ---

[Heidi Alexander]

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

[Barbara Keeley]

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

[Heidi Alexander]

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

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

--- Later in debate ---

[Liz Kendall]

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

[Barbara Keeley]

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

--- Later in debate ---

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

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

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

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

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

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

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

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

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

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

[Barbara Keeley]

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

[Paul Burstow]

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

NHS Care of Older People

Barbara Keeley Excerpts

Thursday 27th October 2011 Westminster Hall

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Barbara Keeley]

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

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

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

[Sarah Newton]

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

[Barbara Keeley]

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

[Andrew George]

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

[Mr Clive Betts (in the Chair)]

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

[Barbara Keeley]

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

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

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

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

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

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

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

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

National Health Service

Barbara Keeley Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

The hon. Gentleman was not listening. The social care transfer comes in for the years 2011-12 to 2014-15, but I was talking about the year 2010-11 and, in the year ended, there was a real-terms cut to the NHS, as confirmed by Treasury figures. This debate is about that fact. He and his hon. Friends stood at the election, with those airbrushed posters all around them, promising that they would not cut the NHS, but in their first year in office, they delivered a real-terms cut to the NHS.

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

Is it not the case that, whatever Government Members say, 82% of councils offer social care only in critical and substantial cases, that thousands of people up and down the country are suffering the loss of their services, and that that will have a real hit on the NHS in years to come?

[Andy Burnham]

My hon. Friend makes a very important point. That was precisely why I said it was irresponsible for the Conservatives to promise increases to the NHS in the way that they did, on a much-reduced public spending envelope. That has led to precisely the consequences that she describes. Indeed, that hidden cut to adult social care has been quantified at £2 billion.

I remember well Conservative party claims before the election about death taxes, but what about the dementia taxes that the Conservatives have loaded on to vulnerable older people up and down this country, who are now paying more out of their own pockets to pay for the care that they desperately need? That is the effect of cutting adult social care and cutting council budgets in that way.

We today the nail the position once and for all. The real position is worse than the one I described because of spiralling inflation, which in effect means even deeper real-terms cuts for the NHS this year and in all the years that follow.

--- Later in debate ---

[Paul Farrelly]

rose—

[Barbara Keeley]

rose—

[Mr Lansley]

In this motion, there is nothing to recognise the contribution from NHS staff; it just denigrates them. It says nothing about people who rely on the NHS to care for them.

[Joan Ruddock]

rose—

[Barbara Keeley]

rose—

[Mr Lansley]

Next, the motion fails to offer any—[Interruption.]

--- Later in debate ---

[Mr Lansley]

I will not delay the House at length with further explanation of what I wrote in my letter, as the hon. Gentleman quite properly raised the matter with me at topical questions. It is our intention to move to more consistent commissioning of primary care across the country through the NHS Commissioning Board, but the driver for that is still local decisions about what GP services should be available in an area and which practices are involved. The hon. Gentleman knows from my letter that this is the view of the local primary care trust. In future, it will be for the health and wellbeing boards, not least the clinical commissioning groups, to look at whether primary medical services can be provided with or without the sort of facilities that the hon. Gentleman mentioned.

[Barbara Keeley]

The Secretary of State asked for some examples of the impact on constituencies; I can give him two. First, the savings being forced on Salford PCT have led to the shutting of the NHS walk-in centre in one of our most deprived wards, which was serving 2,000 patients a month. Secondly, there is the serious issue of the closedown of active case management for long-term conditions. Patient services in Salford are being downgraded as a result of the savings and cuts that have to be made.

[Mr Lansley]

The hon. Lady will forgive me for not commenting in detail on that. If my memory serves, that has been the subject of a referral by the local authority to me, which I have sent to the independent reconfiguration panel for initial advice. It would be unhelpful and improper for me to prejudice that.

--- Later in debate ---

[Chris Skidmore (Kingswood) (Con)]

It is remarkable that we are having this debate today. As the Secretary of State has said, the Opposition’s motion is a remarkable own goal, especially as it has been confirmed that the Government will be increasing funds in real terms by 0.4% over the course of this Parliament. The shadow Secretary of State is shaking his head, but that will mean an extra £12.5 billion, which he has opposed today. It also remarkable that we have had confirmation from him of his comments in The Guardian on 16 June 2010, when he stated:

“It is irresponsible to increase NHS spending in real terms within the overall financial envelope”.

He agreed with that and I am delighted that he has put that on the record now that he has a second bite of the cherry, as the shadow Secretary of State for Health. He had an opportunity to make amends, and I thought he would, but unfortunately he has not. He also stated in the New Statesman on 22 July 2010:

“They’re not ring-fencing it. They’re increasing it.”

He was talking about the NHS budget and the fact that the Government were increasing it.

We have heard from the Secretary of State today that if there is an underspend, it has come entirely from the central departmental budgets. What is wrong with that? Does the shadow Secretary of State disagree that we might have cut down on costs such as the £115,759 he spent on a personal chauffeur during his time as Secretary of State? Does he oppose an underspend, given that during his time at the Department it spent £3.65 million on almost 26,000 first-class rail tickets? We have slashed that cost by more than 70%. Does he deny that he and the Department spent £1.7 million on luxury hotels during his time there? What is wrong with cutting such spending? What is wrong with the fact that Ministers are no longer using hotels such as the Hotel President Wilson in Geneva as they did in 2008 when the bill was £548.87 a night? If we are making those cuts to the central budget, I quite welcome our doing so.

[Barbara Keeley]

I wonder that the hon. Gentleman is not more worried about issues such as those I raised earlier. The real cuts being experienced in my constituency are in NHS walk-in centres and in the active management of long-term conditions. That is a real downgrading of patient care. I am surprised that he is bringing up these expenses; I think he should focus on what is happening in the NHS.

[Chris Skidmore]

I entirely agree that we need to integrate better social care in the NHS, and part of the reason why we have £2 billion going into social care is to tackle that problem. It is interesting that the hon. Lady does not deny that those spends have happened and that she does not apologise for the fact that the previous Government made those spends. Personally, I think they are a disgrace. Obviously, Opposition Members do not have a problem with spending £600 on a hotel in Switzerland, but I do. I say to the shadow Secretary of State, “Don’t build a greenhouse and then throw stones out of it.” Let us remember that it was the Labour party that gave us an NHS IT system at a cost of £12.7 billion—450% more than the original cost. It was the Labour party that gave us private finance initiative deals that were so badly drafted that they were worth £11.4 billion but cost £65 billion to pay off. What did the shadow Secretary of State say when he was the Secretary of State?

--- Later in debate ---

[Rosie Cooper]

I fell for that last time and did not get to the end of what I had to say.

I will not go on about the rest of the problems that I see with the Bill—the financial challenge, the fact that we are open to European competition regulation, or the fact that the chair of the NHS Commissioning Board believes the Bill is unintelligible. I believe the Bill has been driven forward as an ideological exercise, rather than by an ideological desire to improve the quality of health care available.

[Barbara Keeley]

Will my hon. Friend give way?

[Rosie Cooper]

Forgive me; I need to get to the end of my speech.

My right hon. Friend the Member for Leigh dealt with the finances and the myth of real-terms growth in the NHS budget. My local trust is being asked to go beyond the 4% savings compounded over the next four years and will be expected to achieve 6% or £8.5 million in this financial year. On top of that, Monitor expects trusts to make a 1% profit. People who have given evidence to the Select Committee have said it is clear that there will need to be hospital closures in order to release money back into the wider health service. We are told that this is all part of managing demand and redesigning pathways—two horrible phrases that appear to be back in vogue.

I want to deal quickly with the re-banding of nurses to reduce budgets, which the Health Secretary appears to have little understanding of. I am sorry he is no longer in his place. He clearly told the Health Committee that he was unaware that re-banding was taking place. His problem is that Janet Davies from the Royal College of Nursing told the Committee that, although the RCN does not release conversations, that issue was clearly discussed. I really worry about that. Does he have a twin he is sending into meetings on his behalf? Does he simply not listen? It would not be the first time. Or is the truth even worse, and should he be described in terms that Mr Speaker would call unparliamentary? The Secretary of State said earlier that he stood by his answers to the Committee. He has also claimed that he did not receive a letter from me, but I can confirm that he received it at 11.57 on 13 October, and I have confirmation from his office.

--- Later in debate ---

[Dr Poulter]

I thank my hon. Friend for clarifying an earlier point.

I will not engage in mud-slinging, but will talk about what hon. Members on both sides of the House want to emerge from the NHS. The right hon. Member for Leigh (Andy Burnham) was absolutely right that some service reconfiguration is necessary to deliver services in communities, improve community care and build an integrated health service with integrated health care. The right hon. Gentleman spoke specifically about an integrated system and better integrating adult social care, especially for the elderly, with current NHS providers, breaking down some of the silos between primary care, the hospital sector, and adult social services.

[Barbara Keeley]

Was the hon. Gentleman as concerned as I was at the Select Committee on Health on Tuesday when I asked Richard Humphries of the King’s Fund how the Health and Social Care Bill will impact on integrated commissioning? Richard Humphries said that there is a danger to integration because people are leaving PCTs, working relationships are being disrupted and broken up, and partnerships are being disrupted. As my right hon. Friend the Member for Leigh (Andy Burnham) said, we face years of disruption. That is the danger. Progress on the integration agenda was slow, but it is chaotic now.

[Dr Poulter]

I thank the hon. Lady for her intervention. Any period of transition will be difficult, and must be managed. Will the mechanisms and bodies that the Health and Social Care Bill will put in place be better able to deliver community-focused, integrated care than the existing system? I want to consider two matters that we will come to later: health and wellbeing boards, and basing commissioning fundamentally in the community. Both are good mechanisms for delivering better integrated care, and I will return to that.

We have too many silos in the NHS. The primary care sector often does not integrate with the secondary care sector as well as we would like. For example, hospitals are paid by results, but they have no financial incentive to ensure that they prevent inappropriate hospital admissions. We talk about better looking after the frail elderly and about ensuring that we prevent people with mental health problems from reaching crisis point and having to be admitted, but there are no financial incentives and drivers in the system to ensure that that is achieved to the extent we would like. A and E admissions in many hospitals are rising year on year—in rural areas that is partly because we do not have an adequate out-of-hours GP service—and far too often the frail elderly are not properly supported in the community.

If we put the majority of commissioning into the community with local commissioning boards, that will provide a more integrated and joined-up approach to local commissioning, which will undoubtedly help to prevent inappropriate admissions. We no longer want an NHS in which people with mental health problems or the elderly present in crisis because they have not been supported in the community. That must be the focus of care, and the focus of delivery of services.

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[Debbie Abrahams]

I am not going to give way—I am sorry.

In this year’s Budget, the Office for Budget Responsibility’s higher inflation forecast meant that NHS spending is now falling in real terms. House of Commons Library calculations show that it will fall by about 1% in real terms over the next four years—a loss in spending power of more than £1 billion by 2015. In the light of the recent inflation figures—[Interruption.] To help hon. Members out, last year’s figure was 5.6% based on the retail prices index. As inflation is at a three-year high, the loss in spending power is likely to be even greater. To keep his election promise, the Prime Minister would have to spend at least £1 billion more than he is doing.

This month’s King’s Fund report on NHS performance shows the effects of these financial pressures on the NHS, with the majority of finance directors saying that they are very or fairly pessimistic about the financial future of their local health economy. The Health and Social Care Bill, which is being debated in the other place, very conveniently sets out ways to help struggling foundation trusts. First, they can borrow money from the City to invest. Secondly, because foundation trusts will have to repay the money they have borrowed by treating more NHS patients and more private patients, they have been helped by the abolition of the cap on private patients’ income. However, as my right hon. Friend the Member for Leigh said, by raising income in this way they become economic enterprises and open themselves up to part B of EU competition law, so that they have to compete for every tender with private sector companies such as Capita, United Health, and so on. Incidentally, seven trusts, including in the Secretary of State’s constituency, have already said that they will be increasing the private bed cap. There is a private hospital in the Cambridgeshire University hospitals foundation trust area. Finally, when—not if—a foundation trust still ends up in financial meltdown, the Bill’s new failure regime means that they will be able to sell off NHS publicly owned assets to private equity companies. There are direct parallels with Southern Cross.

The impact of that is already being felt in patient care. In addition to what is said by constituents attending my and many of my hon. Friends’ surgeries, the King’s Fund report showed that the proportion of patients waiting more than 18 weeks for treatment has increased nationally. Over a quarter of NHS trusts admitted fewer than 90% of their patients within 18 weeks. In my constituency, Pennine acute hospitals trust is able to treat only 70% of patients within its 18-week targets. That is more than double the number of trusts failing to meet the 18-week target in 2010.

I am afraid, however, that an increase in waiting lists is what the Government want; it is one of the intended consequences of the Bill. This increase in demand is feeding the growing private health care and insurance market. We know from the US that as people on low incomes will be less likely to be able to afford these products, there will be a direct impact on the inequalities that the Secretary of State says that he wants to reduce.

[Barbara Keeley]

My hon. Friend is concerned about health inequalities. Is she as worried as I am about changing the weighting of health inequalities in allocations of funding? In Salford, our experience is that that can push GP practices in deprived areas into the red in their indicative budgets, so they will be cutting down referrals and reconsidering treatments—another way of denigrating and cutting the benefits of services to patients.

[Debbie Abrahams]

My hon. Friend is absolutely right. I will come to that in a minute.

In fact, that is broken promise No. 2. Last week in Health questions, I asked the Secretary of State why, in December last year, he made a political decision, against the advice of the Advisory Committee on Resource Allocation to maintain the health inequalities component of PCTs’ funding allocation at 15%, and instead reduced it to 10%. He replied that he had made no decision against the advice of that Committee. However, it is quite clear from last September’s letter to him from the chair of the Committee that that is exactly what he did:

“I would like to draw your attention to ACRA’s position in relation to the health inequalities adjustment. We recommend that the current form of the adjustment is retained”.

The

“current form of the adjustment”

was 15%, and the Secretary of State made a political decision to reduce that. He should be apologising to the House for misleading us in his response to my question. The effect of that reduction is to shift funding from poor health areas to good health areas. The Secretary of State owes an apology to the people in those areas, as well.

I turn to broken promise No. 3. Although the move of public health to local authorities is welcome in principle, the timing could not be worse. Already, we are seeing plans that jeopardise the public health function as they move into local authorities besieged with cuts. As Labour has consistently argued, our health and social care system needs to balance the treatment and care of people who are poorly with creating supportive environments that enable all our citizens to live as healthily as possible for as long as possible—focusing upstream on stopping people falling in rather than on pulling them out further downstream, to use a familiar metaphor. That is absolutely key, but unfortunately the current approach means that it is not going to happen. For example, public health budgets, said to be ring-fenced, are not being ring-fenced. The shadow budgets that were being provided to public health departments for 2012 were supposed to increase from 3.7% to just over 4%, but further analysis showed that that increase was due to merging the public health and drug action team budgets, and not to any new moneys. There was, in effect, no real increase in public health funding.

I anticipate a future broken promise in relation to what the Secretary of State has said about privatisation: I think it will be a case of “Watch this space.”

--- Later in debate ---

[Stephen Pound]

May I thank the hon. Gentleman? I do not know how anyone persuaded him to bowl me that patsy ball that I can immediately crack to the boundary. He is absolutely right. Dr Hill, the radio doctor, opposed the national health service. Aneurin Bevan said that he had had to

“stuff their mouths with gold”.

Of course the producer interest opposed the beginning of the national health service because it was about the consumers—that was its major difference. Of course the vested interests opposed the creation of the national health service—that is no surprise. But that was then.

The national health service was born in compromise. I was born in July 1948, as was the NHS. For many years I was suspected to have been the first child ever born on the NHS, in Queen Charlotte’s hospital, but somebody in Salford beat me to it.

[Barbara Keeley]

Trafford.

[Stephen Pound]

Trafford. I beg your pardon. However, the year before I was born, my parents had a son who died at the age of seven months. The year before that, they had another son who died at the age of eight months. I was born on 5 July 1948, two days after the health service, and I have my five brothers and sisters alive to this day. It is that important.

When I worked as a porter for 10 years at the Middlesex hospital, where my sister and wife were nurses and one of my brothers was an ambulance driver—half the family seemed to be employed there—we realised the consequences of the pragmatic approach to the health service. We had a private patients wing where people like myself, paid by the national health service, did work for people who paid money to a difference source, and where doctors trained under the NHS got personal recompense. One of the single most important aspects of our lives has been political from day one.

Each of the Health Ministers will remember, as I do, that we have sat in the same House as an hon. Member who lost his seat over a hospital closure. Let us never forget Wyre Forest and Kidderminster hospital. It is almost impossible to be objective about this issue. When the Turnberg report was published, it proposed an entirely sensible reconfiguration of London’s acute general hospitals, but it was opposed by almost everyone because of parochial and local issues. When polyclinics were proposed under the previous Government—one of the most logical, sensible, rational and helpful ways of providing primary health care—they were violently opposed by the Conservative party.

The situation now is that there is no consensus. However, I have not often seen anything quite so consensual, positive and forward-looking as the reference in today’s motion to an offer made by the Leader of the Opposition and the shadow Health Secretary of

“cross-party talks on reforming NHS commissioning.”

What could be better for the country, and for the reputation of this House, than our recognising that the NHS is not a political football or an issue on which we can strike postures? Yes, there are ideological differences between us, and Opposition Members may wish to see a greater infusion of finance-led choice, more and more commercialisation and an end to the Whitley system, which has survived for so many years. They may wish to see local pay bargaining setting hospital against hospital, clinic against clinic and clinician against clinician, with a constant stream of industrial disputes as localised pay bargaining bursts out all over the place in some industrial conflagration that attracts even more attention. At the moment we have one of the lowest numbers of hospital managers anywhere in Europe, and we will inevitably have to spend more and more on a greater and greater number of managers to deal with all that localised bargaining.

Oral Answers to Questions

Barbara Keeley Excerpts

Tuesday 18th October 2011 Commons Chamber

[Anne Milton]

As my right hon. Friend the Secretary of State said earlier, the Health and Social Care Bill proposes the introduction of the first ever legal duty for the Secretary of State to have regard to the reduction of health inequalities. That covers both NHS and public health functions. We are also addressing the health needs of some of the most vulnerable people through the “Inclusion Health” programme.

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

My right hon. Friend the Leader of the Opposition and the officers of 12 all-party groups associated with care have urged the Government to commit themselves to the urgent reform recommended by Dilnot. Will the Minister update the House on the Government’s response to the Dilnot recommendations, and tell us when the cross-party talks will begin?

[Paul Burstow]

I know that the hon. Lady follows these issues closely. In September we published a plan for consultation on the proposals, which includes looking beyond the Dilnot commission’s recommendations at issues of quality, regulation, and many other aspects of how we can secure a comprehensive reform of social care. Today my right hon. Friend the Secretary of State wrote to Opposition Front Benchers with the aim of resuming the discussions across parties to ensure that we get the conversation going with the new Opposition Front-Bench team as soon as possible.

Health and Social Care (Re-committed) Bill

Barbara Keeley Excerpts

Tuesday 6th September 2011 Commons Chamber

[Mr Dorrell]

My understanding is that the Government have clarified that foundation trust board meetings should be held in public and that, in future, it will be a requirement of licensing by Monitor. On the much broader point, I absolutely agree—the hon. Lady, who is another member of the Select Committee, knows that I agree—that providers of care to NHS patients, whether public or private, ought to have an obligation to provide information on the outcomes that they achieve and certainly on any complaints and other processes initiated by patients about the care they receive. That was one of the strong recommendations that the Select Committee made following its work on complaints. I think that that obligation ought to rest on all providers of care to NHS patients, whether they are foundation trusts or any other form of provider.

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

Will the right hon. Gentleman provide some clarification? I think that he said “should” and not “must”. For other functions, particularly relating to local government, the Government seem to be into dropping standards and codes of conduct—that is certainly the case in local councils—but surely trusts “must” have meetings in public, not “should”.

[Mr Dorrell]

Ministers can correct me, but my understanding is that, under the obligation being introduced, they “must” meet in public. I have no authority to speak for the Government, but I believe that that is what the Government intend. For myself, as a patient of a trust or other NHS provider, whether in the public or private sector, my interest lies in ensuring that the information about my—

--- Later in debate ---

[Frank Dobson]

If the hon. Gentleman—and, for that matter, the Secretary of State and the Chair of the Health Select Committee—had ever listened to what I say, they would know that I think that we need change. We need organic change, however, rather than structural change, because structural change generally costs more than it provides. If the hon. Gentleman thinks that introducing a system in which virtually every transaction will be a legally binding document, with herds of lawyers grasping their share of proceedings, will reduce the amount spent on administration, he obviously believes in Father Christmas and various other mythical figures.

[Barbara Keeley]

Before we get into any more claims of more being spent, I want to touch on two examples of cuts, caused by the cuts and efficiency savings, which I raised with the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow). The most deprived ward in my constituency is losing its NHS walk-in centre and all the people with long-term conditions are losing active case management. I raised those two cuts made by Salford PCT with the Minister in an Adjournment debate, to which I have received no answer. There is no answer. People in the most deprived wards with the greatest health inequalities are suffering from these cuts. I will not hear any more about more investment being made, because all I see as a constituency MP is less investment.

[Frank Dobson]

I agree entirely with my hon. Friend. A further point is that I doubt whether there is a single constituency anywhere in the United Kingdom of Great Britain and Northern Ireland that has seen more change in health provision than mine. There are not many places where a virtually trouble-free amalgamation of two major and famous teaching hospitals into one has taken place successfully. There are not very many places that have seen more small GP practices getting together in one location and improving their performance. Those things have always been done with my strong support, even when on some occasions, at least at the outset, the ideas were not popular with some local people. Therefore, I do not accept that I do not believe in change. I believe in sensible change, not stupid change, but stupid change is what we seem to be getting.

--- Later in debate ---

[Frank Dobson]

I entirely agree with my hon. Friend. I think that nowadays those who call themselves members of the Conservative party only purport to be Conservatives. The basic Conservative approach in this world is, broadly speaking, not to make great changes without being absolutely certain that substantial benefits will result from them. A proper Conservative recognises the problems that arise during the process of change, and the unpredictability of things in human life. What we have now, certainly in relation in health and possibly in other spheres, is a Government who are going ahead with something which—good God!—cannot be regarded as well thought out, given that they have tabled 1,000 amendments on Report.

[Barbara Keeley]

I winder whether my right hon. Friend heard the Leader of the House say to the Hansard Society that

“it has simply become too easy for the Government to sideline Parliament; to push Bills through without adequate scrutiny; and to see the House more as a rubber-stamp than a proper check on executive authority.”

He also said that, in the Government’s view,

“a strong Parliament leads to a better Government.”

Does my right hon. Friend believe that the Bill, and the very shortened debate on its recommittal, constitute a good illustration of that?

[Frank Dobson]

In fairness, I think that given the accuracy of the present Government’s aim, if they tried to rubber-stamp something they would probably miss.

--- Later in debate ---

[Grahame M. Morris]

We had this exchange many times in the Committee on a variety of clauses. We need to give some credit to the previous Government. I am old enough to remember when people routinely waited a year, 18 months or longer for life-changing operations such as knee and hip replacements. It is a real quality-of-life issue if someone has cataracts and has to wait a long time for an operation. I accept that Labour used the private sector. I am a socialist and make no apology for that, and I want the provision to be public sector. I was not a Member of Parliament and did not vote for the commissioning of private providers, but I acknowledge that the private sector played a role in bringing extra capacity and some innovation to the service.

[Barbara Keeley]

My hon. Friend is making a wonderful speech. I wanted to make this point when my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) was speaking about the number of operations and the improvements during Labour’s term of office.

In the 1997 general election when I was campaigning in Wythenshawe and Sale, East constituency, I met someone who had been told that he had to wait two years for vital surgery and was desperately worried that he would die while he was waiting. I met someone in my constituency in last year’s general election campaign who received a diagnostic test on Monday, found he had cancer on Tuesday, went into hospital on Wednesday and was operated on on Thursday and his life was saved. From two years to four days—I thought that was the best testament to the improvement that Labour had brought about in the NHS.

--- Later in debate ---

[Mark Simmonds]

I give way first to the hon. Member for Worsley and Eccles South (Barbara Keeley).

[Barbara Keeley]

The speech of my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) is one of the best I have heard in the Chamber, as I think Opposition Members would agree. People outside the Chamber are saying that too.

On repetitiveness in the points that are being made, Report stage allows Members who did not serve on the Committee to say the things that they want to say. It is our chance right across the House to comment on the Bill, so that is not a valid criticism of what is going on in the debate.

[Mark Simmonds]

I hope the hon. Member for Easington has a better intervention to make.

--- Later in debate ---

[Barbara Keeley]

I think that a few Labour Members are quite surprised by what the hon. Gentleman has said, and the Hansard writers might ask him where it came from. He cannot get away with making a statement like that and not saying where it came from—he should be quoting it. He is saying that the majority of people working in the NHS surveyed in 2009 did not put patient care at the top of the list, and he should quote where that information comes from.

[Dr Poulter]

The point is—I speak as a front-line doctor who still practises in the NHS—that far too often we see form-filling that gets in the way of our doing our job as doctors in hospitals, and that is not for the benefit of patients.

[Barbara Keeley]

Will the hon. Gentleman give way?

[Dr Poulter]

No, sit down. The hon. Lady should listen to this, because it is important. The point is that doctors and nurses need to be allowed to get on and do their jobs.

A key focus is not just about putting more money into front-line patient care but making sure that we have clinical leadership of services. Form-filling for the sake of it does not benefit patients; what benefits patients is allowing doctors to treat those in front of them. Under the perverse incentives that were created previously, the four-hour wait in A and E means that a patient with a broken toe is just as much of a priority as someone with potentially life-threatening chest pain. That is the problem with the service that we have, and that is why the clinical leadership and focus that this Bill is bringing will be so important.

Southern Cross Care Homes

Barbara Keeley Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

As I have made clear, given the current stage of the announcements on this solvent restructuring, we appear to be in a position where the scenario the hon. Gentleman asks about will not come to pass.

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

There are more than 300 residents in seven Southern Cross care homes in Salford, and their quality of life is our primary consideration. What assurance can the Minister give to those residents and their families that future providers will not play for short-term profit, but will truly consider their quality of life? Reassurances will not mean much if a new provider gets into the same business model and same way of carrying on as Southern Cross.

[Paul Burstow]

The hon. Lady is right. As we move forward and achieve a successful conclusion to this process, we must put in place the necessary measures to ensure that this cannot happen again. We must take a critical look at the regulatory environment in which this particular business model was allowed to grow—a business model that thrived during a boom, but that was predicated on the assumption that there would never again be a bust. There was a bust however, and that is why the company is in this mess.

Reform of Social Care

Barbara Keeley Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

My hon. Friend makes a fair point. It was clear that had we sought to publish a White Paper before Christmas, the net effect would have been that we did not give the public, stakeholders or the official Opposition the time needed to discuss the issue and to do the job properly .

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

It is clear that there are two issues: not just the future funding of social care but the current funding—the crisis referred to by my hon. Friend the Member for Birmingham, Erdington (Jack Dromey). Only 15% of councils are now meeting moderate need, but that figure used to be 50%. The Secretary of State cannot say that there is no crisis. It seems to me that building a future funding solution rests on not letting current provision deteriorate much further—but it is deteriorating rapidly. What, then, will Ministers do beyond the excellent cross-party work that probably will go forward to do something about the resources that are leaking away and the current crisis in provision?

[Mr Lansley]

I do not believe I did say that there was no crisis. The hon. Lady and the House must recognise, however, that last year the Dilnot commission, in an interim report, sought additional support specifically for social care and that we provided it through the local government grant and a transfer of resources from the NHS. She says that few authorities now provide social care for those with moderate needs, but that has been the product of years of change—it has been happening for many years. That creates a risk, but we are addressing that risk through the transfer of NHS resources and by helping people with lower levels of need through home adaptations, community equipment and reablement if they leave hospital, in order to make certain that we avoid the risk that we are running: of large numbers of people with moderate need falling rapidly into severe need.

Caring Responsibilities

Barbara Keeley Excerpts

Wednesday 15th June 2011 Westminster Hall

[Tony Baldry]

I am sorry, but I will not give way any more because these exchanges demonstrate why I need to read into the record for future debates the three paragraphs that I mentioned earlier. We would all love to have lots more money that we could spend, but alas that is not the case.

With regard to this particular debate, it seems to me that there is a lot more that can be done to help and support carers without necessarily spending a huge amount of extra money. The first thing that we ought to do, or at least we ought to make a much greater effort to do, is to identify which people are carers and to encourage carers to see themselves as carers. Local authorities provide considerable services for carers, but of course they can only provide those services if people identify themselves as carers.

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

Will the hon. Gentleman give way?

[Tony Baldry]

I will not give way, as I just want to make a little more progress.

I was quite interested in a note from Sainsbury’s. Sainsbury’s has been pursuing an initiative in Torbay to help to identify “hidden” carers. It was working with the Torbay Care Trust and it sought to identify customers in its supermarkets who might have caring responsibilities. Staff talked to customers and if it seemed that a customer might be a carer, they were asked if they were in fact a carer. If the customer said, “Yes”, they were then directed to a trained member of the Torbay Care Trust. In a very short period, that initiative led—in just one supermarket—to 140 new people signing up with the Torbay carers’ register.

Sainsbury’s is going to expand that initiative to other stores across the country. I suspect that huge numbers of people who act as carers do not know that that is what they are, for example, husbands and wives who look after loved ones, and young people who look after parents. We should be working as hard as possible to help people to recognise that they are carers. Considerable help and support are available for people who know they are carers. In carers week, one can see that a range of organisations have come together—

[Barbara Keeley]

Will the hon. Gentleman give way?

[Tony Baldry]

I will give way to the hon. Lady in a moment.

A range of organisations that provide advice and support have come together, including Age UK, Carers UK, Counsel and Care, Crossroads Care, Dementia UK, Macmillan Cancer Support, the Multiple Sclerosis Society, Parkinson’s UK and the Princess Royal Trust for Carers, but they obviously cannot give advice unless people actually recognise that they are carers.

[Barbara Keeley]

I agree that identifying and supporting carers is important. Will the hon. Gentleman therefore communicate to the Minister with responsibility for care services that he should support my Carers (Identification and Support) Bill, which the Government have indicated they would not support? The Bill would provide a basis for the proper identification of carers by NHS bodies, local authority bodies and schools. It is more appropriate that public bodies help to identify carers, rather than the task being left entirely to supermarkets such as Sainsbury’s.

[Tony Baldry]

I do not dissent from that, and in a second I will come on to the Law Commission’s report. It is important that we recognise carers, and if statutory bodies can help to identify them, that too is important.

We are fortunate this afternoon to have the Under-Secretary of State for Health present, and I wish to make a couple of points about carers and health. Often nowadays, when a person being cared for goes to see their GP or a specialist, the carer is treated as if they were invisible. The concept of patient confidentiality is being used as a mechanism for denying the person who is being cared for the support of their carer, whether it is children taking their aged parents to see the doctor, or a husband taking his wife or vice versa. Often, the carer is able to provide counsel and care for the person they are caring for, and they should not be seen by the GP or the health service as invisible. The NHS, GPs and the Royal College of General Practitioners need to work out a protocol for how the NHS deals with carers. There obviously have to be some balances concerning patient confidentiality, but it must be possible to work out how the NHS should deal with and respond to carers.

Carers are most concerned about the people they are caring for needing access to the NHS in the evenings and at weekends, when there are out-of-hours systems in place. The out-of-hours GP system was, as it happens, brought in by the previous Government, and it is of variable quality across the country. I think that the Minister will find that one of the growing pressures on the NHS is the number of people who self-refer to accident and emergency departments in the evenings and at weekends, because they can at least be confident of being seen, even if they do not need A and E treatment. They cannot be turned away at the door because the NHS has a duty of care when they turn up. It might be sensible to have primary care triage in A and E departments. We have a Darzi centre in Banbury, but I see no reason why one should not have primary care triage at the door of A and E so that people who do not require A and E services can be confident of accessing primary care without having to hang on on various helplines, or talk to distant voices in which they have no confidence. That would give much greater confidence to carers and to those for whom they were caring, and would significantly reduce the cost to the NHS of the significant number of inappropriate treatments and admission at weekends and in the evenings.

Another responsibility of the Department of Health are carers’ breaks, about which many carers are very concerned. One of the longest running campaigns of the all-party group on carers over the years has been on carers’ breaks. There are supposedly significant amounts of money in the system—some £400 million—for carers’ breaks but, as is the case with so much money, it is not ring-fenced. Some PCTs have been extremely good about that, but we will need to watch where the money goes, particularly as we transfer to GP commissioning. Can we develop systems of best practice? It is not just a question of talking about carers’ breaks; we also need to ensure that systems are in place.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Streeter—let us hope that we do not have too many more interruptions.

There cannot have been a more worrying time to have caring responsibilities, given the abuses at Winterbourne View; there must be a real worry that such things are happening in other care homes or hospitals. There are real worries about the future of Southern Cross, which is still very uncertain. There are also the issues that we are discussing, including the cuts to council budgets, which are resulting in the downgrading or loss of packages of care services. Carers have a range of worries and fears, some of which I want to cover, because these are serious problems for many families and it is right that we are debating them today. I congratulate my hon. Friend the Member for Edinburgh East (Sheila Gilmore) on securing the debate and on the excellent way in which she opened it.

It is 10 years since I started to meet carers in the course of research that I undertook for the Princess Royal Trust for Carers. In that work, I met many hundreds of carers, who opened my eyes to the issues with which they live day in, day out. Some time after I entered Parliament in 2005, I introduced the Carers (Identification and Support) Bill—not all Members were here when I said that I will send a copy to the Under-Secretary of State for Health, the hon. Member for Guildford (Anne Milton), and to the hon. Member for Banbury (Tony Baldry) because he seems to support the ideas behind it very much.

This year, the theme for carers week is, “The true face of carers”, and its aim is to highlight what life is like for carers and the challenges they face. New research for carers week shows that 80% of carers are now worried about the consequences of cuts to services. As has been mentioned, the survey of social service directors showed that adult social care services face cuts of £1 billion. The Minister has been asked this question, but I would like to emphasise the point: what assessment have the Government made of the impact on carers of the estimated £1 billion in cuts to social care services? I have some detail on impacts being felt in Greater Manchester.

Whatever we think about it, many councils are having to struggle with the Government’s swingeing front-loaded cuts, amounting to 27% over four years—that is the figure in the Budget. Many have found themselves having to cut grants to voluntary organisations, which is having an impact, and many are increasing or removing caps on care charges. As we have heard, the survey undertaken by my hon. Friend the Member for Islington South and Finsbury (Emily Thornberry) showed that 88% of the councils that responded were increasing charges for social care and 54% were cutting support to the voluntary sector. It is a double whammy—cuts in support and increases in charges.

Like everyone else, carers are hit by increases in the cost of living, which we must also take into account. Fuel costs and VAT affect them in the same way as they affect other people. Most carers are financially worse off than other people, because many have had to cut down on or give up work so that they can care.

For this debate, I asked local organisations in Greater Manchester to tell me exactly how cuts or fears about cuts are affecting carers. A staff member at the Bury, Salford and east Lancashire branch of Parkinson’s UK told me of her experience. She said that there had been a big increase

“in calls from people who are living on very tight budgets with no chance of increasing the family income due to disability and caring responsibilities, distressed because they can’t afford day to day living costs.”

The calls that she receives are about the knock-on effects of lack of money—stress, not eating well, relationship difficulties or breakdown, anxiety and depression. They can lead to illness worsening, and if a carer becomes ill and cannot cope, it can lead to hospital admission. She also said something that ties in with points made earlier in the debate:

“More people with Parkinson’s disease are being turned down for”—

allowances such as—

“disability living allowance and attendance allowance. There is no sense to who gets the benefit and who gets turned down…The distress this causes families is huge because they feel that they are begging. I can only imagine that families who don’t have support miss out completely. The benefit is meant to pay towards the extra costs of having a disability, the fact that genuine people are being turned down means that carers”—

would end up—

“having to do even more.”

My hon. Friend the Member for Edinburgh East raised carers’ eligibility for benefit, which I think is and will become the key issue due to the Government’s programme of cuts and the uncertainty. The Minister has already been asked the question, but will she tell us in this debate what the impact will be if those carers who lose their carer’s allowance decide that they can no longer afford to care? The responsibility for caring will then fall to the local council and the state.

[Jim Shannon (Strangford) (DUP)]

I do not think of my constituency as different from anyone else’s, so I am sure that the hon. Lady will agree that young carers clearly play an important role. Those who are 16 years old and under do not qualify for any financial assistance, but their role is critical for the family, parents and those they look after. Does she feel that the coalition Government should address the importance of young carers?

[Barbara Keeley]

I very much agree. I have a point to make later about that topic, because the staff who work on the young carers project in my constituency have said that they are very concerned about carers losing their education maintenance allowance. That is the one support that the state gave young carers and it is going, which is a worry.

To return to the testimony from Parkinson’s UK, the final points were about more carers contacting the staff member to ask for help finding respite because they are struggling to cope; financially, they cannot now afford a break, a treat or a holiday. I am glad that the hon. Member for Banbury raised that point. The staff member said:

“I know of one carer who has had to take on a part time cleaning job in the early evening because money is so tight. She puts her husband to bed before she leaves”—

for work—

“at 4pm so that he is safer and so she won’t worry that he will fall while she is out.”

I think that we would agree that we would rail at care agencies that put a person to bed at 6 or 8 o’clock, yet this carer has to put her husband to bed at 4 o’clock because that is the only way that she can do the cleaning job that she has to do.

I also had some input from a branch of Age Concern in Greater Manchester about how cuts to grants are affecting its dementia support service, which is important because it is another line of support. Cuts to grants of 40% over the next three years are affecting its capacity to deliver individual and group support. That goes against objectives 5 and 7 of the national dementia strategy. The staff member told me:

“Carer support groups have had to close. These are groups where carers can get a break, have a chat to other carers and get advice and information from staff. These groups help to maintain morale and prevent carers from becoming socially isolated.”

Even though there are personal budgets, which will come in in Greater Manchester, carers of people with dementia often find it hard to mix in other social groups because of the “different” behaviour of the person with dementia. Carers have described the groups as a “lifeline” and something “to look forward to”. The fact that they are being cut back is important.

The proactive support to carers of phoning them every few weeks is another aspect of Age Concern’s work that is being cut. The staff member said:

“We now have to wait for them to contact us for time-limited intervention. We know that many older people are proud and longsuffering and will often suffer in silence rather than ask for help.”

Before the cuts, branches of Age Concern in Greater Manchester ran special events for carers such as a carers day each year, parties and trips. The reduction in funding means that it can no longer offer the extras that it knows give people a better quality of life. I am very concerned to hear that carers in my area in Greater Manchester are starting to suffer.

I want to return to the two sides to the debate—values and choices. We are fortunate in Salford because, due to the way in which the cuts and the organisational turmoil in the NHS are being managed, we are not suffering as much as other areas. There are choices. Labour-run Salford city council is now one of only 15% of local councils still providing support to people with moderate care needs, as well as to those with substantial or critical needs. We are fortunate to have an excellent carers’ centre run by the Princess Royal Trust for Carers. Salford has tried to ensure that carers continue to be supported through these difficult times. As I mentioned earlier, however much the council and our local NHS bodies support carers and try to maintain what they are providing, the national changes and cuts affect our carers.

The young carers project will be affected when the young carers lose their education maintenance allowance. The centre manager told me of two other concerns: the changes to benefits and disabled people being called in to take work capability assessments. The extra worry of having to take them and of having benefits curtailed are starting to affect carers.

The centre manager also said that a major concern for her organisation was that although the carers’ centre was very well established, the service has to go out to tender through the joint commissioning process next year. She said:

“We are aware of a number of carers’ services which have gone out to tender in other areas, and bids have come in from organizations and agencies which have no experience, knowledge or expertise in carers and carer issues, including organizations from abroad.”

What reassurance can the Minister give to staff of the carers’ centre that an established, trusted and effective organisation such as theirs will not be undercut in the tendering process by organisations with no local knowledge and no experience or expertise with carers or in carers’ issues? Our carers in Salford would lose out if they lost the valuable support that they get from their carers’ centre.

The Government’s economic policies are damaging support to carers. Government cuts to local council budgets have gone too far, too fast. Councils pleaded not to have their budget cuts front-loaded. We have lost £1 billion from adult care services at a time of rising need, and we have lost billions in grants to the voluntary sector, but the worst thing is that we are only a few months into the first year of cuts, and we can already see the impact on carers. Carers are fearful about the cuts and distressed that they cannot manage financially. People with serious conditions such as Parkinson’s are being turned down for attendance allowance and made to feel like beggars if they appeal. Young carers are losing their education maintenance allowance. Carers are now unable to afford a break or holiday. It is shameful that a carer should have to take a part-time cleaning job and put her husband to bed at 4 pm.

That is not a record of which the coalition Government can be proud, and it is so early in this Parliament. I hope that carers week gives Ministers time to rethink the impact of the cuts that they are making.

[Mr Gary Streeter (in the Chair)]

Colleagues, three Members have sought to catch my eye, and we have 19 minutes before winding-up speeches begin, so can we regulate ourselves to about six or seven minutes each?