Oral Answers to Questions

Debate between Barbara Keeley and Paul Burstow

Monday 12th May 2014 Commons Chamber

[Paul Burstow]

Listening to the hon. Member for Copeland (Mr Reed), it struck me that the Care Bill could be described as a Bill that was full of ideas that were proposed by the Labour party when it was in government, but was a modest measure. In some ways, I find those two positions contradictory, unless of course the last Government were not the bold, revolutionary Administration whom they often told us they were when they were in office. If we are indeed in a zombie Parliament, that is characteristic of the languid nature of opposition offered by the Labour party.

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

rose—

[Paul Burstow]

I hope the hon. Lady will forgive me, but I will make some progress, just as the hon. Gentleman did earlier.

Amendment 11B concerns the Human Rights Act, and I thank Ministers for keeping an open mind and for listening seriously to the concerns raised by Lord Low and others, and to me and other hon. Members who were concerned that an opportunity was being missed to close a gap. Legislation under the previous Government partially but not completely closed the gap, as a result of which those cared for in their own homes did not have the benefit of Human Rights Act protection. The amendment, which was agreed without a vote in the other place, gives that protection. It is the end of a story of seven years of dealing with a gap in the law that was opened by a court judgment. I am grateful that, notwithstanding the difficulties of our bicameral parliamentary process, it has worked at its best on this occasion, because it has meant that concerns raised through the Joint Committee that I chaired, through the Joint Human Rights Committee’s report and by Members in the other place, have now been comprehensively addressed.

Having said that, will the Minister confirm that a person who avails themselves of provisions in the Bill that allow them, as a self-funder, to ask their local authority to arrange their care at the point at which they start to benefit from the means-testing arrangements, and therefore have some support from the local authority, will then be covered by the Human Rights Act?

I would also like to thank the Minister for listening carefully to what has been said at each stage in the passage of the Bill, in both Houses, in respect of the trust special administration regime. It is important to emphasise that the approach set out by the previous Labour Government recognised that trust special administration was a last resort. Earl Howe has emphasised that in the other place. He was very clear that there are powers available to the Trust Development Authority and to Monitor to intervene as necessary in order to avoid trust special administration ever being triggered in the first place. I commend to Members the passage in House of Lords Hansard in which he sets out clearly all the steps that would need to be taken:

“Trust special administrators would be appointed—and I make this point emphatically—only when all other suitable processes to develop sustainable, good healthcare have been exhausted.”—[Official Report, House of Lords, 7 May 2014; Vol. 753, c. 1496.]

It is worth picking up on the point made by the hon. Member for Copeland. Having been given the opportunity to chair a committee looking at the guidance, I think that some of the points he made in his amendments today are exactly the sort that ought to be given proper consideration in the guidance. I hope that he, other Front Benchers, and indeed other hon. Members who have experience of the only two trust special administration processes that have taken place to date, will offer the committee their views and insights so that we can ensure that the advice we give the Government on guidance is as good and as clear as possible.

As was made very clear in the other place, we are not talking about a power that will effectively enable a wholesale reorganisation of the health economy. The Bill is very clear that this is about those matters that might require necessary and consequential changes. The amendments that were agreed in the other place, without a vote, make it clear that the essential services of trusts that find themselves drawn into a trust special administration process will be a proper consideration in the decision-making process.

It is curious that the Labour party now seems to want us to look at access in a different way from the way in which the trust special administration process that it put in place provided for. In other words, why was there no test on access with regard to the trust that was in special administration under its arrangements? Why did that not matter then but does matter now?

I think that the Government have listened very closely to what has been said and changed the Bill in a way that reflects the concerns that I described on Report. We will have the chance to comment further on the guidance—I hope that the hon. Member for Lewisham East (Heidi Alexander) and others will offer input into that—which will give us another opportunity to ensure that it is as tight and effective as possible on those very rare occasions when it is used.

I hope that consideration of the Bill will be concluded today and that it will make the difference to well-being, as a central principle, and to parity between those who receive care and those who give it. That is what the Bill does, and they are great things, and it is about time that they were on the statute book.

Care Bill [Lords]

Debate between Barbara Keeley and Paul Burstow

Tuesday 11th March 2014 Commons Chamber

[Barbara Keeley]

In my early career, I worked as a systems programmer and engineer for IBM. I do not usually have much opportunity to mention that, but it is probably appropriate in this debate. I have been struck in recent weeks by how many people with an IT background—as well as those with medical backgrounds—have serious concerns about care.data and the plans of the Health and Social Care Information Centre.

The Minister was not keen to take interventions last night, so I will ask my questions now. I want to touch on the important issue of consent for the uses of patient data. As I said earlier in the debate, the hospital episodes statistics database was originally an administrative database. When did any of us sign up to having our data used to recalculate the cost of insurance cover for long-term illness? Given the points I made about the use of our confidential hospital patient data in commercially chargeable systems in the US, when did we sign up to have our data used on a chargeable basis by companies such as BT and MedRed on their cloud systems in the US? I do not recall doing that, and I suspect no one else does either. Does the Minister agree that patients should have the option of having their data used only for clinical care and for commissioning that care? If the genie is not completely out of the bottle yet, that is a question worth asking.

[Paul Burstow]

The hon. Lady is making important points about the need to be clear about what these data are used for. There is an argument that anonymised and properly controlled data have a part to play in the area of medical research. Does she think that should be out of scope, or can we have safeguards that enable it to be in scope? Understanding whether a medicine works in a particular way with a population is a very powerful use of such data. In her view, is that appropriate or not?

[Barbara Keeley]

In the concerns I am listing, I am not touching on the use of data in medical research. My concern is about the revelations we have had in recent weeks. I am citing commercial uses. Those data are being used on a chargeable basis and the companies involved seem to be crowing about it.

Can a project such as care.data guarantee that what patients sign up to now—or at any point in time—will not mean something different in future months when new datasets are gathered? The hon. Member for Totnes (Dr Wollaston) touched on some of the exciting possibilities for data, but new uses are being planned all the time. I mentioned systems in the US, but the Health Secretary recently signed a memorandum of understanding with the US Health Secretary for secondary uses sharing. The Minister last night said that he would not comment on a US system, but our hospital patient data is on those systems being used on a chargeable basis. Should patients have the right to withdraw their consent if new uses are developed that they do not approve of? The data have gone, and people are developing new uses for them, way beyond what any patient may have felt they consented to.

My right hon. Friend the shadow Health Secretary raised the issue of lack of transparency over the patient’s right to opt out. He asked about the junk mail leaflets— as they have been called—that were not even delivered to every household. What do Ministers propose to do to explain to all patients about the extraction of their identifiable personal data, and what precisely the dissent codes mean? We touched on this in our Health Committee inquiry sessions, and it was not clear, although some people thought they knew. It is a pity that Ministers have not taken the opportunity to answer the questions that were put to them in Health questions—the information changed on the HSCIC database on the very day we had Health questions in the morning.

We know that NHS England and the HSCIC can require GPs to upload patient data in an identifiable form from every GP practice in England, to be linked with the hospital episode statistics and other datasets. That is concerning enough, because it is a powerful new use of a lot of data, but the hon. Lady suggested that the HSCIC is talking about free text. That is a concern, because that is the place where people open up to their doctor and might give information that they do not want to be shared.

It is important that we know exactly how the HSCIC is funded. In the spirit of transparency, will Ministers request full disclosure of all funding sources of the HSCIC, including outside earnings from third parties for the use of data? I have talked about seeing our hospital data now being used on a chargeable basis by companies such as BT in the US. Who pays for the HSCIC’s staff? Are staff seconded to the HSCIC? Who pays the transaction costs? We have seen examples recently of networks of private organisations coming into NHS England to write and fund reports and lead consultations. Who pays for staffing and transaction costs, if it is third parties, is a key aspect of transparency.

The Health Committee has held an initial inquiry into care.data, and I and other Committee members expressed real concerns about the scheme and the impact it could have on the trust between patient and doctor. Our concerns have been compounded by news that commercial companies have been allowed to pay for NHS patient data, and use them for purposes unknown to the public. The use of our data has gone beyond our control, the data are in other countries and uploaded to cloud servers, and we do not know where they are.

Care Bill [Lords]

Debate between Barbara Keeley and Paul Burstow

Monday 10th March 2014 Commons Chamber

[Paul Burstow]

Organisations that have supported the new clause, which I have drafted, include people with a legal background, social workers, Age UK and Mencap—those who often provide a voice for the voiceless. One of my concerns is that the people whom the Bill seeks to benefit are very likely to be those who are under duress and therefore unlikely or unable to express an opinion. That is why the new clause has been crafted to try to ensure that the necessary safeguards are built in.

New clause 3 addresses the issue of carers, particularly the identification of carers. Carers are the backbone of our care and support systems. Without them, those systems could not function in delivering the quality of care that we would expect. Those carers make huge sacrifices to care for their loved ones. Their health, their wealth and their lives are often sacrificed as a result of what they do. We know from the census that a carer is twice as likely to be in bad health as a non-carer.

The Government should be applauded for the fact that in this Bill and in the Children and Families Bill they have taken great strides to improve the rights of adult carers, parent carers, and young carers. They have listened, engaged and responded to the concerns that Members in all parts of this House and in the other place, and many carers’ organisations, have raised with them. However, all this hinges on whether carers are aware of these new rights and whether their council is successful in its new duty of identifying them, as required under the Bill. The problem is that the NHS is still left untouched. Millions of people caring for someone with a health problem may never come into contact with their council or be aware that that would be the next step in coping with their situation.

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

I welcome the right hon. Gentleman’s conversion to the identification of carers by NHS bodies, because when he was in the role of Minister he did not support that. I hope that he can convert the current Minister. Is it not the case that, as Macmillan Cancer Support has said, 95% of carers for people with cancer, who may care for only a short time but for people with terminal illness, do not have any contact with local government and do not have a carers’ assessment, and is not that the key? Are we just going to let those people struggling in those difficult circumstances carry on doing so?

[Paul Burstow]

The hon. Lady is not a convert. She has been consistent and clear in her pursuit of this provision, both with her own Government and with this Government, and I hope that eventually her persistence will pay off. It has persuaded me, along with many carers’ organisations, of the need for such a change.

Institutionally, the NHS is not good at grasping the different responsibilities it has towards carers compared with those who are its immediate concern—the patients. As a result, it lets carers down institutionally, and that is what the new clause says we need to address. We need to change the NHS’s mindset institutionally to make sure that it recognises its responsibility for millions of people with caring responsibilities and asks the necessary questions. Macmillan Cancer Support has found that 78% of health care professionals have come across a cancer patient who has been admitted because their carer could not cope at home. Here is why the NHS must fully engage with carers: only one in three professionals who sees an accompanied patient always goes on to check whether the person with them is their carer.

NHS

Debate between Barbara Keeley and Paul Burstow

Wednesday 5th February 2014 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

May I start by agreeing with the right hon. Member for Rother Valley (Kevin Barron)? The issue of alcohol has been ducked by successive Governments for a very long time. He is absolutely right to campaign on it, and I absolutely agree that we need to see the introduction of minimum unit pricing. However, we should not in any way give the impression that that of itself is the entire solution to what is a broad societal problem. None the less, it most certainly would make a significant contribution. I hope that, at the next election, it will be part of my party’s platform on public health issues.

My hon. Friend the Member for Stafford (Jeremy Lefroy) was right to call for a debate on the Francis report. I hope we will be granted Government time to debate it. If not, I would certainly join him in an application to the Backbench Business Committee for a debate on the Floor of the House. We should have the opportunity to bring Ministers here to debate the report.

Before addressing some of the comments made by the shadow Secretary of State, I wish to place on the record my thanks to the staff at my local hospital, St Helier, for all the work they do not just over the winter period when the pressure is undoubtedly at its most acute, but right across the year. Having been in the hospital over the Christmas period singing carols, which hopefully did not discomfort people too much, I saw for myself just how that pressure can build. I also saw how well the staff are perceived by their patients.

I want to register a frustration with the Minister today about something that has been going on in my patch for several years now. For almost as long as I have been an MP, clouds have from time to time gathered over the future of my local hospital. In 2010, the previous Labour Government signed off an outline business case for the rebuild and refurbishment of St Helier’s hospital. That was great news, and a culmination of work by my right hon. Friend the Member for Carshalton and Wallington (Tom Brake), the hon. Member for Mitcham and Morden (Siobhain McDonagh) and me. We secured funding from the Government worth some £219 million. Then there was a change of Government; a coalition came in. Given the spending review and the desire to tackle the public borrowing problem, it was far from certain whether that funding would stay in the Budget. Again, the three of us lobbied hard, and we were delighted when my right hon. Friend the Chief Secretary to the Treasury was able to confirm the funding.

However, in the dying days of the primary care trusts, a review was launched of accident and emergency and maternity services in south-west London. It was called Better Services Better Value, but it offered neither. It has been an absolutely crystal clear case study of everything that is bad and wrong about NHS change management. There are some really good examples of change management, stroke care in London being the exemplar. However, we have to refer to that example too often, as there are too few other really good examples of change having been managed well. All too often the public feel left out of such processes, and it is no wonder they mount the barricades to oppose change of which they feel no ownership.

My right hon. Friend the Member for Carshalton and Wallington and I were repeatedly told during the process by the then chief executive of the primary care trust, Ann Radmore, that the rebuild of St Helier was a fixed point in the whole process. It was not to be touched; it was sacrosanct and the rebuild would happen regardless. I have to say, however, that the events of the past three years have left me feeling betrayed and lied to. As a result of the uncertainty caused by BSBV, three years on—despite GPs having now declared BSBV’s proposals unviable, and having gone back to the drawing board—my local trust and clinical commissioning group are saying they cannot proceed with that £219 million. They lack the will and vision to take it forward, and I hope the Minister can confirm today that the £219 million is still in the Department’s budget lines and that he will encourage my local NHS to work with my local councils and Members of Parliament to bring forward these plans.

The motion moved by the shadow Secretary of State today feels a bit thin, and a little like a re-editing of its previous two incarnations in an attempt to create the sense of a febrile environment of a looming and predicted crisis and calamity that is about to engulf us all. That tactic has been adopted by the Opposition time and again, and time and again it has not been borne out on the ground. The analysis of the right hon. Member for Leigh (Andy Burnham) is deeply political, and let me give just one example. He lays the blame for delayed discharges principally at the door of budget pressures on social service departments. That is not true. If he looks at the figures, he will see that the bulk of the pressure is caused by delayed discharges in the NHS, not social services. I do not pretend for one moment that there are not parts of the country where social service cuts are impacting on delayed discharges, but the picture is more nuanced and complicated, and I wish the shadow Secretary of State had the courage to say that, rather than repeating a uniformly gloomy picture that is not true.

[Barbara Keeley]

I refer the right hon. Gentleman to the Select Committee on Health’s report on the matter. The data were completely conflicted. Again and again, individuals from the NHS told us that social care was the problem, as Sir Bruce Keogh, whom I quoted earlier, said to me just a few weeks ago. Our report said that NHS England should sort this out. There are figures that the right hon. Gentleman could quote and figures that my right hon. Friend the Member for Leigh (Andy Burnham) could quote, and we should not be confused about this.

[Paul Burstow]

I entirely agree that if there is any doubt about the figures, it needs to be resolved, but there seems to be a disconnect between what people think is happening and what the figures show. I have been to events at which clinicians have said that the problem is the local social services, but when they are shown the figures they are surprised. Perhaps that is why we need, as the hon. Lady says, to ensure that there is an agreed way in which such things are reported, which is what, I think, was put in place by the previous Labour Government. These figures have been collected for a long time, and they have consistently shown that social care is not the principal driver of delayed discharges.

Care Bill [Lords]

Debate between Barbara Keeley and Paul Burstow

Monday 16th December 2013 Commons Chamber

[Paul Burstow (Sutton and Cheam) (LD)]

I want to echo the remarks made by the right hon. Member for Salford and Eccles (Hazel Blears): we must keep the dignity and well-being of those who need care and, indeed, their carers at the forefront of our thinking in this debate and as we seek to implement the Bill.

Like the right hon. Lady, the hon. Member for Worsley and Eccles South (Barbara Keeley) made a very interesting speech. I thank her for her service on the Joint Committee that scrutinised the draft Bill. I had the pleasure to chair that Committee, which had a very strong team from both Houses. It made some recommendations to which I will return in a minute.

What struck me during the speech from the Opposition spokesman, the right hon. Member for Leigh (Andy Burnham), is that if so much in the Bill appears to be wrong, surely he should have the courage of his convictions and go through the Lobby to oppose it. There is apparently so much awful stuff in it—so much of it is inadequate, does not reach far enough or does not do enough, or if it does enough, there will not be enough money—that the Opposition should perhaps have the courage of their convictions.

At the same time, we have heard really interesting examples of where social care should be celebrated. Too many speeches have suggested that the picture of what is being done on the ground is uniformly bleak, but examples have been given of dementia-friendly communities, Unlimited Potential and the “garden needs” scheme in Salford. Those are just a few examples, and I am sure that every hon. Member could go back to their constituency and find such initiatives. Many of the initiatives do not require substantial resources because, as the hon. Member for Sheffield, Heeley (Meg Munn) just said, they can lever in additional resources by enabling communities to respond to need. That is an essential part of the Bill.

[Barbara Keeley]

Will the right hon. Gentleman give way?

[Grahame M. Morris]

Will the right hon. Gentleman give way?

[Paul Burstow]

I give way to the hon. Lady because she tried to intervene first.

[Barbara Keeley]

It is about a year since the right hon. Gentleman and I started four months’ work on the Joint Committee, and I was prepared to commit that time although I still find some aspects of the Bill disappointing. The reality of our situation in Salford now and over the next year is that—week in, week out—I, as a local MP, will find that people and their carers have lost care packages. I invite him to think about the situation of the very many MPs who now see the heart-breaking decisions that families face when they suddenly find themselves without care, respite care or support.

Carers

Debate between Barbara Keeley and Paul Burstow

Thursday 20th June 2013 Commons Chamber

[Barbara Keeley]

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

[Paul Burstow]

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

[Barbara Keeley]

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

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

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

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

Health and Social Care

Debate between Barbara Keeley and Paul Burstow

Monday 13th May 2013 Commons Chamber

[Barbara Keeley]

I agree with my hon. Friend: it is about carers knowing where to go for that help and support when they are so desperate.

In contrast to assessments, projects that work within primary care to help identify carers are producing outcomes that are genuinely helpful to carers. I spoke at an event last Friday organised by Salford carers centres for staff from those teams. The staff will help to identify carers and refer them to help and support. They will have a list of agencies and know where to go.

[Paul Burstow]

The hon. Lady is making important points about carers—an issue on which she has campaigned consistently. Would she join me in welcoming the announcement from the Royal College of General Practitioners over the weekend about the priority it wants attached to carers and the guidance it is now issuing to GPs to ensure that they do more? One in 10 of a typical practice’s patients are carers, so they could do a great deal more by identifying them.

[Barbara Keeley]

Very much so, but the difficulty is that GPs do not have to do it. It is good that some of them are, but they do not have to. We have a duty of assessment, which is an excellent thing, but we also have GPs who might not be doing it.

One important group of carers in great need of being identified is young carers. As we have heard, young carers are in a unique position, being directly impacted on by the health and independence of adults. The care provided to that adult should help to sustain the whole family and reduce the impact of any caring requirements on the child. We know that if care services ensured that all adults needing care received it, that would help the children in the family, but frequently, we must admit, they do not get it, and the person needing care then starts to rely on the child providing it, which impacts on the child’s well-being.

That is where improved identification and support for young carers is valuable, because it can prevent negative and harmful outcomes for those children and reduce the cost of expensive crisis intervention. We spent much time on this in the Joint Committee, and the Care Bill now provides a unique opportunity to ensure that young carers have equal rights. We shared the concern of our witnesses that it appeared that clauses in the draft Bill applied only to adult carers, leaving young carers with lesser rights. Some amendments have been made, but it has not progressed as much as it should have done, and I found it disappointing that in a recent Committee debate on the Children and Families Bill, the Under-Secretary of State for Education, the hon. Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, did not accept the amendments on young carers put forward on a cross-party basis.

My hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) made the case for the amendments very powerfully. Interestingly, the children’s Minister argued in response that the draft Care and Support Bill already allowed for the assessment of adults with care and that that could be linked to other assessments, which he thought would allow for consideration of the effects of adult support needs on the rest of the household, but that is not happening on the ground. Only 4% to 10% of referrals to young carers services are from adult social care, so that route is not working. He said he wanted more adults to be given the support they needed in order to protect children from excessive caring, which is a fine sentiment, but the reality for young carers is that life is getting harder as adult care services fall away.

Oral Answers to Questions

Debate between Barbara Keeley and Paul Burstow

Tuesday 17th July 2012 Commons Chamber

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

15. What steps he is taking to bring forward legislative proposals on the funding of social care.

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

The draft Care and Support Bill contains clauses that support our commitment to introduce a universal deferred payments scheme and a national eligibility threshold. We have set out our intention to base a new funding model on the principles of the Dilnot commission model and we will take a decision in the next spending review.

[Paul Burstow]

It does not need legislation to sort out the amount of money that goes into social services; it does need legislation, however, to put in place a universal deferred payments scheme. We have made it clear that we will fully fund the commitment that we have already announced and we will work with the Local Government Association and others on its detailed design and implementation.

[Barbara Keeley]

The verdict of the Care and Support Alliance on the delay in introducing legislation to reform social care funding is this:

“Each day of delay condemns greater numbers of older and disabled people to the risk of isolation and neglect,”

trapping people in hospital and pushing many more carers to “breaking point”. Just when will the Government realise the damage done by delaying the decision to do anything about funding social care?

Health and Social Care Bill

Debate between Barbara Keeley and Paul Burstow

Tuesday 20th March 2012 Commons Chamber

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

Will the Minister give way?

[Paul Burstow]

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

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

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

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

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

--- Later in debate ---

[Paul Burstow]

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

[Barbara Keeley]

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

[Paul Burstow]

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

--- Later in debate ---

[Barbara Keeley]

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

[Paul Burstow]

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

Adult Social Care

Debate between Barbara Keeley and Paul Burstow

Thursday 8th March 2012 Commons Chamber

[Paul Burstow]

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

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

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

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

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

[Barbara Keeley]

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

[Paul Burstow]

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

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

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

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

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

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

Social Care Funding

Debate between Barbara Keeley and Paul Burstow

Thursday 10th November 2011 Westminster Hall

[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.

Oral Answers to Questions

Debate between Barbara Keeley and Paul Burstow

Tuesday 18th October 2011 Commons Chamber

[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.

Southern Cross Care Homes

Debate between Barbara Keeley and Paul Burstow

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.

Diabetes (Young People)

Debate between Barbara Keeley and Paul Burstow

Wednesday 15th September 2010 Westminster Hall

[Mr Burstow]

I will come shortly to the point, which was absolutely well made, and certainly line up with the right hon. Lady’s comments on that. As has been mentioned, the Minister for Equalities has done a sterling job on behalf of the Government to place the issue at the front and centre. She has not resiled from the issue and will continue to pursue it as she has done so far. I was more anxious about that concern being aligned with the Government’s direction of travel on GP commissioning, which I will return to because it was raised, quite fairly, in the debate.

We have heard today about type 1 diabetes—a complex, lifelong, progressive condition that requires careful long-term management to prevent the severe and sometimes fatal complications that have been described. A 2009 survey of children with diabetes in England revealed that 23,000 children and young people currently have type 1 diabetes. There has also been a national diabetes audit, which included a separate report on paediatric diabetes that gives us a fair picture of the extent of childhood diabetes and how well it is being managed. Although Britain has one of the highest numbers of children diagnosed with diabetes in Europe, we have one of the lowest numbers of children controlling their diabetes well, and we have heard what the implications can be for those children and their families. That is extremely worrying, because poor glucose management increases the chance of the child experiencing complications. I echo the view, expressed by many Members in the debate, that that is an area where we can make significant and sustained improvements. I want to describe what we are trying to do about that.

The first question is: how can we ensure that more children receive an early and accurate diagnosis of diabetes? The challenge for GPs is that type 1 diabetes can be difficult to spot. A child might present with the vague symptoms of extreme tiredness and weight loss, which can be mistaken for other illnesses. Type 1 diabetes is quite rare, so GPs might not come across many cases in their practice. That explains why there have been instances of the sort that have been described today: tragic cases of symptoms being overlooked and children diagnosed only after becoming seriously ill.

The National Patient Safety Agency is currently looking at a number of reports of misdiagnosis and delayed diagnosis and is working with the national clinical director for diabetes to look at what we can do to improve diagnosis rates and reduce emergency admissions. Clearly, we will have to look at protocols and how they might serve as a tool that can be used, but we need to ensure that the work is properly concluded before we decide whether that is an appropriate mechanism.

It is true that building professional awareness is key to improving diagnosis rates. We need GPs and A and E staff, in particular, to consider diabetes as a possibility when they see children with appropriate symptoms, and we must ensure that they are equipped with a range of diagnostic tools to do so. NHS Diabetes, the improvement body for diabetes care, is working with various royal colleges and other bodies to improve professional standards and ensure that best practice is reflected in their training curricula. NHS Diabetes is also working with Diabetes UK to publish best practice guides on how a child with type 1 diabetes should be cared for. Therefore, material is being generated that will help a wide range of professionals not only in the NHS, but in education and social services, to recognise the symptoms and understand what good care looks like. In addition, the Juvenile Diabetes Research Foundation has been placing posters in GPs’ surgeries, highlighting the signs and symptoms to help people recognise the condition.

Once diagnosed, children need a combination of high-quality clinical care and wider support to ensure that they manage their diabetes effectively. I concede that across the NHS we have a mixed picture, as has been well described. That is the picture the Government have inherited, and we are determined to improve it. Children with diabetes often need multiple referrals to different specialist services, so well integrated multidisciplinary care is crucial to service delivery.

The right hon. Member for Knowsley broke the ground for the building of the centre in Aintree that he described, which I understand will bring diabetes clinics closer together and make it much easier to access those services. We want to see more such centres of excellence. I welcome that development but stress, rather as he did, that too often the focus is on how many hospitals, doctors and nurses there are. Beds and buildings are not as important as good services, particularly when it comes to managing long-term conditions such as diabetes, as well co-ordinated and well thought-out services that are closer to the patient and can respond to their personal circumstances and fit around their lives will meet their needs better.

[Barbara Keeley]

While preparing for the debate, I noted that my right hon. Friend the Member for Knowsley (Mr Howarth) and the hon. Member for Torbay (Mr Sanders) are lucky enough to represent the two parts of the country where integrated health and social care is thought to be working the best. While talking with the King’s Fund the other day, I learned that there are only six places in the country where it is judged to be working that well. On GP commissioning—several Members touched on this point—how can the Minister ensure that that will improve, because our fear is that that major, top-down reorganisation will mean that those five or six places will be the only ones in the country?

[Mr Burstow]

Had I turned to the next page in my brief, I would have reached an answer to that question, so I will come back to it in a moment. My final point about care is that the latest paediatric diabetes service survey suggests that the picture is improving. It is important to stress that there is movement in the right direction, but there are still deficiencies.

On the question of GP commissioning and how we better integrate the commissioning and joining up of services, a point that the hon. Lady and others have missed in much of the commentary on the White Paper is the clear intention for local authorities to hold a new role in assessing population need. That assessment will be critical to the future of the commissioning of health and social care and to the new role of local authorities in public health, which is key to early prevention of type 2 diabetes. The notion that there is fragmentation and atomisation is far from the truth. The intention is to ensure that we have that alignment of services, which would be much better achieved through the partnership between local authorities and GP consortiums.

--- Later in debate ---

[Mr Burstow]

The right hon. Gentleman and the Juvenile Diabetes Research Foundation seem to be in different places. The foundation takes the view that the condition is best managed through primary care. As I said, we must upskill, ensure that the signs and symptoms are better understood, and use the clinical skills of GPs more effectively.

[Barbara Keeley]

Will the Minister give way?

[Mr Burstow]

I will give way in just a moment—I want to pick up on another point. I am surprised that the hon. Lady keeps going on about GP commissioning, when it was her Government who introduced practice-based commissioning. We are building on those reforms, and see them as an essential way of ensuring that taxpayers’ money is most effectively geared to delivering the best possible health outcomes for people with diabetes and other conditions.

[Barbara Keeley]

I do not think that Opposition Members are alone now that the Royal College of General Practitioners has expressed major concerns about GP commissioning and is pleading with the Health Secretary to put the reforms back.

I want to raise a point about local authorities and coterminosity with PCTs. We have a better coterminosity situation—and have struggled to get to it—but I know that some local authorities around Greater Manchester will be faced with having not one but two, four or five GP consortiums. As I said, health and social care integration is working in places such as Knowsley and Torbay, where great work has been done to bring things together. The fragmentation is coming out because of the nature of the reorganisation.

[Mr Burstow]

Again, I do not recognise that characterisation, in that coterminosity does not exist in many parts of the country under the current model. As the hon. Lady has rightly said, integrated models of care, and collaborative approaches and behaviours are not present in many places. The desire and intent behind the White Paper is to make them the norm.

I want to do justice to this debate. We could have a debate about the White Paper, and I am sure that at some point the Opposition will choose to do so. If they do that, we would be only too happy to meet them point by point, but I want to talk about some of the key developments that will bear down on this problem and really help to transform lives.

The coalition Government want to make a significant move in respect of their commitment to introducing a much stronger payment system for children’s diabetes services, which will help to bring them out of the shadow of other NHS services. As a start to the process, a new mandatory tariff, which we plan to introduce in stages from April 2011, will recognise paediatric diabetes care as a clear and discrete specialism within the NHS, and will provide a clear funding stream to support such services over the long term.

At present there is a non-mandatory tariff, which was rushed in for April 2010, but it is wholly inadequate because it fails to take into account the complex nature of paediatric care, which this debate has articulated. As a result, under the current system, many paediatric diabetes services either continue to be under-resourced—we have heard about that today—or are funded through other budgets. Hence, they can sometimes be relegated to a second-class status in the NHS. The new tariff, as part of a more patient-focused funding model, will help to put us on the right track.

Oral Answers to Questions

Debate between Barbara Keeley and Paul Burstow

Tuesday 7th September 2010 Commons Chamber

[Mr Burstow]

I am very happy to give that confirmation.

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

It is of great concern that medical charities such as Rethink tell us that most GPs that they have surveyed feel that they lack the expertise needed to commission mental health services, and also that campaigning groups such as the Muscular Dystrophy Campaign feel that GPs have too little knowledge of muscle wasting conditions to commission services for their patients. Given Government plans to hand commissioning over to GPs, to abolish primary care trusts and, according to the White Paper, to reduce the role of the Department of Health in training, can the Minister say more to the House about how the considerable shortfall in expertise in commissioning services will be tackled over the next year or two?

People with Learning Disabilities (NHS Treatment)

Debate between Barbara Keeley and Paul Burstow

Wednesday 14th July 2010 Westminster Hall

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

I thank the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) for securing this debate, because it is a timely opportunity for the new coalition Government to set out their intentions and approach to the issue. I also pay tribute to him because I know from my time in the House, over the past 13 years, that he has been a true and consistent campaigner on behalf of people with learning disabilities and their families. He has brought many issues to the attention of the House and regularly challenged Ministers of the previous Government—I am sure that he will continue to do so with this Government—to strive to achieve better outcomes for people with learning disabilities.

I made it my business to attend the first meeting of the all-party group on learning disability after the general election to signal my intention and commitment as a new Minister. Despite the fact that I could not make yesterday’s meeting, I hope that my good faith and my desire to collaborate with the all-party group will be recognised. I also pay my respect to Lord Brian Rix who, along with the right hon. Gentleman, provides exceptional leadership in that area.

I also thank the hon. Member for Kingswood (Chris Skidmore) and the hon. Member for Worsley and Eccles South (Barbara Keeley), who speaks for the Opposition, for their contributions to this debate. I will clearly have ample time to respond to their many points and questions. If I miss anything out, I will write to right hon. and hon. Members later. It is right that such issues should arouse strong feelings and that they should be kept at the top of the agenda. The right hon. Member for Coatbridge, Chryston and Bellshill drew attention to the Disability Rights Commission report “Closing the gap” and the impact that it had when it came out. No one should be in any doubt of the extent to which the Mencap report “Death by indifference” provided a wake-up call to the NHS and the Government of the day. The health ombudsman’s report has also been very important in alerting us to the failings in the system.

Four years on, a great deal has been written and said about this subject. None the less, despite the “Valuing People Now” strategy and the many worthy efforts to improve services, there are still some parts of the NHS that are not delivering well enough for people with learning disabilities. We have inherited that legacy and we are determined to take action on it. I welcome and support the principles set out in Mencap’s “Getting it right” charter, and we will try to collaborate with the charity to ensure that we address and take forward the additional challenges. I want to work very closely with Mencap to ensure that we translate the words on the page into real change in hearts, minds and practice across the country.

The right hon. Gentleman and the hon. Member for Kingswood were right to pay tribute to the work of many dedicated NHS staff around the country. Constructive feedback also needs to be part of any good process of continuous improvement, and is certainly essential when it comes to the NHS. My hon. Friend the Member for Kingswood put his finger on the pulse when he said that one of the key things that the Government White Paper on the NHS will do is provide a far better focus on early intervention, early diagnosis and prevention. Prevention will be an important part of this Government’s agenda in the delivery and improvement of health care.

I want to make it clear that this Government support “Valuing People Now” as a strategy. Our approach to it is one of continuity and change. I will not be reinventing the wheel, but I will be doing everything I can to make the wheel spin faster—if I can put it that way—because we need continuity but we also need to accelerate the pace of change on the ground.

I have listened very carefully to the points that have been made by right hon. and hon. Members during this debate and I will try to respond to those points. I will start with the point about evidence and information. Gathering evidence and information must be a key part of informing the development of practice on the ground. The right hon. Gentleman and the hon. Member for Worsley and Eccles South, the shadow Minister, were right to say that this is an area where we must do more. Gathering better information and evidence is vital. We need better information and evidence to subject the NHS to proper scrutiny and so that the NHS can conduct proper self-appraisal; consequently, any shortcomings in care can be identified and acted on quickly, both at a local and a national level.

I can confirm that we are pressing ahead with the confidential inquiry and the public health observatory that were recommended by Sir Jonathan Michael’s inquiry. The confidential inquiry will ensure that premature and avoidable deaths of people with learning disabilities are investigated and that lessons are properly learned and applied at a national level. The public health observatory will give us a much stronger evidence base about the needs of people with learning disabilities and the difficulties that they face, which in turn will inform better practice. I am particularly pleased that we will have representatives from Mencap, the National Forum for People with Learning Difficulties and the National Valuing Families Forum on the group that will scrutinise the progress of both the confidential inquiry and the public health observatory.

In addition, all areas of the country have completed, or are in the process of completing, the new health self-assessment framework. That framework brings together strategic health authorities, primary care trusts, hospital trusts and people with learning disabilities and their families. Those organisations and individuals are coming together to assess local NHS progress and to ensure that health services continue to improve for people with learning disabilities. Their work will be shared with the public health observatory to inform its work. The framework offers a strong means of ensuring accountability and it can help us to ensure that NHS services are making the right adjustments in line with their duties under the Disability Discrimination Act 2005 and other legislation, which is a point that has quite rightly been made by all right hon. and hon. Members who have contributed to this debate.

[Barbara Keeley]

As I think all of us who have been involved in today’s debate understand, there will be a great deal of churn in the organisations that the Minister has referred to, such as the SHAs, the PCTs and the hospital trusts. Greater accountability for, and greater scrutiny of their work is clearly important, but those organisations are now threatened with closure. People will be leaving their jobs, so I want to ask the Minister if there is a follow-on plan for when those organisations expire, as it were?

[Mr Burstow]

The hon. Lady must have a copy of my speech in front of her, because the answer to that question is in the next paragraph. She is absolutely right. In executing the change that the White Paper sets out, which means removing the sense of central dictation and direction that we have seen in the NHS for the last 13 years, ending that sense of command and control and making the system one that is about delivering outcomes and one that is facing the patient and working alongside them to deliver those outcomes is an important transformation. Therefore we need to ensure that, in the transition planning that is now well under way for the change that will take place during the next two to three years, the institutional knowledge and learning in the existing system properly migrate to the new system, and that best practice is firmly embedded in the front-line services. Those services will remain as they are now, but they will receive more support and investment to do even better.

[Mr Burstow]

I am very grateful to the right hon. Gentleman for his intervention and his question. He raises a point that I will move on to shortly, but I certainly see advocacy as being very important in this area. Looking forward, we will need to ensure that we reflect what we are learning from the work that is going on at the moment in the new commissioning landscape and in the new frameworks for accountability at a local level.

Both the right hon. Gentleman and the shadow Minister have referred to annual health checks, so let us look at that issue. It is quite encouraging that many more people with learning disabilities are now receiving an annual health check from their GP. Last year, just over one in five people with learning disabilities received an annual health check and the latest figures show that two in five people with learning disabilities have received their annual health check within the last 12 months. However, that is clearly not good enough, as it means that three in five people with learning disabilities still do not receive an annual check. As a Government, we are determined to push that process forward to ensure that the training and development that has taken place delivers in that regard.

I have heard many stories about how those health checks have identified, for example, cataracts or cases of diabetes. Furthermore, as has already been said in this debate, if we put ourselves in the position of a person having such a health condition but being unable to communicate the symptoms, we can begin to understand the difference that these health checks can make. I am therefore certainly keen to see annual health checks continue for people with learning disabilities, and we are looking at the most cost-effective way of ensuring that.

Reference was also made to the training of staff in relation to carrying out health checks. Undertaking training is certainly part of the requirement for all the GP practices that are delivering the annual health checks for people with learning disabilities. That training is about raising awareness of people with learning disabilities and their families, and particularly about ensuring that communication issues are understood, that advocacy is provided and that there is also liaison with staff in the acute sector. So there are a number of aspects about training and I will say more about that shortly.

The right hon. Gentleman referred to the training, as did the hon. Member for Kingswood. Reference was made to the recent Mencap poll, which makes disturbing reading as it shows the number of staff who have not had training to help people to make reasonable adjustments to different situations.

The shadow Minister talked about the need to look at people in the round, so that we do not only look at either their learning disability or their physical needs but at both elements. In that way, we will not allow diagnostic overshadowing to take place. That issue must be properly addressed in training. Therefore I wanted to ensure that right hon. and hon. Members were aware that the Council for Health Regulatory Excellence is working with professional bodies to support better training and to improve professional standards. That relates to a point that the hon. Member for Kingswood made about the need for professional ownership of that training, so that it is not just something that is imposed from the top but is seen by professionals as an essential way of learning to do their job better.

As a Government, we are working with the council to reach not only doctors and nurses but the full range of health care professionals. That is clearly important when it comes to meeting the often complex needs of people with learning disabilities. For example, speech and language therapists have a key role in tackling feeding issues of the type that the right hon. Member for Coatbridge, Chryston and Bellshill talked about. However, he referred to a case that I fear I cannot talk about any further, because it is before the courts. Occupational therapists are also important in helping people to develop the skills that they need to live independently, so I am pleased that all the regulatory bodies are reporting progress on that work and I will certainly keep in touch with them to ensure that that progress is maintained. I also want to ensure that that learning is embedded as we move towards delivering the vision that is set out in the Government’s health White Paper published on Monday.

Meanwhile, at a primary care level staff in all GP practices that are delivering annual health checks now have the appropriate training. The Royal College of General Practitioners is due to publish additional training materials for all GPs this summer, which are about getting health checks right for people with learning disabilities. I hope that that reassures right hon. and hon. Members that the Government are not about to shelve the issue of training but are determined to see training programmes develop.

[Barbara Keeley]

I think that the point about annual health checks has been emphasised. Does the Minister see those checks continuing? Will there be funding for them to continue? He has helpfully quoted some figures that show that we have moved from a situation in which one in five people with learning disabilities receive an annual health check to a situation in which two in five receive such a check. Does he know whether that gap—a gap that means that three in five people with learning disabilities do not receive an annual health check—exists because those people are not known to services or because GPs are just not carrying out those checks? In other words, is there an information gap or is there a practice or provision gap? If he does not know now, perhaps he can tell me in writing later.

[Mr Burstow]

Regarding the hon. Lady’s point about funding, given the tone and the substantive nature of what I have said about annual health checks it would be surprising if the Government were not determined to see those checks being continued. However, we are obviously in the middle of a spending review and therefore we must ensure that we achieve value for money in those checks. I think that this debate underscores that point only too well. I will write to the hon. Lady on the other point, because I want to get the answer absolutely right, and I will ensure that other hon. Members involved in this debate are copied in.

The hon. Lady also mentioned the value that we all rightly attach to the contribution made by family carers. I hope that she and others, while perusing the White Paper during the past two days, will have seen that one thread running through it from principles to practicalities is the value that this Government attach to the role of carers. For the first time in a Government White Paper, we have stated clearly that we see carers as partners in recovery and the provision of good care, which we want to ensure is provided appropriately in different circumstances. It is an important signal that we hope will be taken on board.

On annual health checks, the hon. Lady will know that the Government are in the midst of a series of pilots to evaluate the best way to implement health checks for carers. We will await the outcomes of the pilots before making further decisions about their wider roll-out.

On engagement, which all hon. Members have mentioned, it is crucial that patients and families are at the heart of all health care services at all levels. The White Paper makes that clear by borrowing from an important past report. We want the aspiration “No decision about me, without me” to inform how the health service develops. We need people with learning disabilities to be fully involved in the planning and design of services at a local level. If we can create an NHS that genuinely listens and responds to patients, in line with the White Paper, we will ensure that people with learning disabilities get the support and advocacy that they need to make their voices heard. That is clearly important, just as it is important to ensure that the values and principles behind the Mental Capacity Act 2005, which I supported during its passage through the House, are understood and translated into practice.

Some parts of the country are already doing great work in that area by, for example, bringing in user-led organisations to advise staff and help them offer patients the right advocacy. We want to see more of that. We will also work through the new body proposed by the White Paper, HealthWatch, which will not only handle patient complaints but be responsible for providing advocacy and support in pursuing them. HealthWatch will have a key role in ensuring that the voices of those whom we are discussing are heard fully across the NHS. It will be a powerful champion for people who are not always heard.

Hospital passports have not been mentioned, but they none the less address some issues raised in this debate. The hon. Member for Kingswood discussed, among other things, the role of liaison nurses. Hospital passports are another helpful development and were one of the top suggestions in Mencap’s charter. The passports are short, accessible booklets that can be carried by people with learning disabilities to give NHS staff information about their medical history, any drugs that they are taking and their likes and dislikes. They are a low-cost but effective idea and are offered by many hospitals throughout the country. I want to see them spread to every hospital. I suspect that the case mentioned by the hon. Gentleman involving poor communications in hospitals might have been avoided if such a passport had been available.

Clearly, acute liaison nurses also have a role to play. All strategic health authorities recently reported on the issue to the Department of Health, and all referred to the value of acute liaison nurses. The number of posts is increasing as such nurses demonstrate their value. They play a part in building capacity, training colleagues, raising awareness across the work force, improving the patient experience and, importantly, reducing length of stay and getting people back into the community appropriately.

I have mentioned commissioning structures. As we migrate from the old system to the new, we must ensure that the learning is carried over. That creates opportunities and possibilities for organisations such as Mencap and others to play their part in ensuring that they work alongside commissioners at a local level to deliver it.

[Barbara Keeley]

While the Minister is on that point, will he enlarge on how the commissioning of the services that we have been discussing will take place? Will they be locally commissioned, or will the NHS independent board commission them from GPs?

[Mr Burstow]

The NHS commissioning board will commission the family practice services that GPs provide, but the GP commissioning consortiums will be responsible for a wide range of commissioning services, some of which they may do collectively at a sub-regional or regional level, while others will be discharged by the NHS commissioning board. The important thing is the expertise available, and we say in the White Paper that GP consortiums will have access to that expertise in a number of ways. They might choose to bring it in-house, use their local authority’s commissioning expertise—some local authorities have exceptional expertise—or work with third sector organisations. There are already examples of that happening, such as with Turning Point. I suggest that opportunities exist for organisations to offer commissioning expertise in order to develop services that are much more in tune with the needs of particular patient groups.

The right hon. Member for Coatbridge, Chryston and Bellshill was absolutely right to flag up the wider societal challenges of discrimination, particularly the discrimination faced by people with learning disabilities. He was therefore right to identify, as the Government do, that we must not approach the issue in a narrow, health-focused way. We need a wider social perspective in taking forward strategies on the matter, and that will be part of our thinking throughout.

The right hon. Gentleman also asked me about the Mansell report, which I know was the subject of discussion last night at the meeting of the all-party parliamentary group on learning disability. I thank Professor Mansell for his important work, not least because I understand that the work reported yesterday was commissioned by the Department of Health. It demonstrates the vital importance of improving services and outcomes for people with learning disabilities and provides important examples of good service and good practice that we must ensure sit firmly in the strategy going forward. My officials will work further to ensure that we see how the findings fold into the ongoing work on the strategy.

The right hon. Gentleman asked about the DVD. We are happy to ensure that it can be accessed on the website and to discuss other ways we can collaborate to maximise awareness of it and the Mansell report. We are keen to ensure that people have access to it and will do what we can to achieve that.

I am told that financial matters, to which the right hon. Gentleman referred, were discussed last night at the all-party group meeting. How can we maintain and accelerate progress in the straitened financial circumstances that the Government have inherited? Part of the answer is that the NHS has benefited from this Government’s commitment to real-terms growth. However, we have inherited a debt legacy that must be tackled, and we have made it clear that the sick should not have to pay the price for that, nor should people with learning disabilities. The NHS will have to be even more creative and willing to work in new ways with the third sector and other organisations to maintain and quicken the pace of reform. I am confident that we can do things differently and achieve with less, and that we can do more for people with learning disabilities.

Ultimately, we need to achieve real change to make an impact on the ground. Yes, we need better training, evidence and engagement but, ultimately, we need better services driving better outcomes for patients. We need services that are integrated—the White Paper provides a way forward on that—as well as more responsive. They must be built around the individual needs of patients and families, meet their expectations and give them a say in their treatment and ongoing care.

In conclusion, the NHS White Paper can be the catalyst that we need to drive change. The message is simple. We want an NHS that is focused on outcomes and judged by what really matters to people: the extent to which it helps them live longer and healthier lives. We will need to consider how we measure those outcomes in the right way for people with learning disabilities, and I look forward to working with the all-party group, Mencap and many other organisations on that. Reducing preventable mortality might, for example, be a helpful starting point, and we want to consult on that.

The shift away from process-led measures towards outcomes will bring a cultural shift in care and help the NHS to shake itself free of any of the lingering discrimination that has been talked about in this debate—any sense of looking at the disability rather than the individual as a whole in terms of how treatments are decided. That is the opportunity the Government’s White Paper presents and I am determined to work with the right hon. Member for Coatbridge, Chryston and Bellshill, the all-party group, Mencap, families and others to ensure that we grasp that opportunity and deliver the best outcomes possible.

Supporting Carers

Debate between Barbara Keeley and Paul Burstow

Thursday 1st July 2010 Westminster Hall

[Mr Burstow]

I absolutely agree with that point, and that is why we will not promise to pay cash sums into the NHS baseline that therefore cannot be delivered to where Ministers claim that they will be delivered, and it is why we will ensure that we, as a Government, will provide both leadership and, when appropriate, direction to deliver the sorts of things that hon. Members on both sides of the Chamber have outlined today.

This helpful and useful debate will help to take our thinking forward as we begin our work on refreshing the carers strategy. Hon. Members cited many examples of good practice on the ground, and they offer beacons of hope for how services might look across the country. Challenging those who commission services locally to ensure that they learn from such examples of good practice is a task for not just the Government, but everyone. Examples of best practice do not come from the statutory sector alone, even though the most innovative parts of that sector are themselves beacons. As many hon. Members have said, we also have to applaud and encourage the social enterprises and social entrepreneurs who have spotted opportunities to do something for their communities and found the resources to do so.

I have identified a number of key issues from this debate: what we can do better to identify carers, whether they are young, old or from ethnic minority communities; what we can do to provide information and support for carers so that they can navigate their own way through the system; and what we can do to make the system simpler so that it is not the maze of benefits and complex rules about which we have heard so much in the debate. We realise that people who wear the label “carer” are not all the same. Carers are unique individuals confronting unique circumstances that require individualised and personalised responses. I agree entirely with hon. Members’ points about the need to empower carers as well as the people being cared for.

I will try my best to answer the questions that have been put today, but if I miss anything out, I guarantee that I will write to hon. Members with a fuller response than I can give today. I will also ensure that the points that have been made, particularly in respect of benefits, are raised in cross-ministerial and cross-departmental discussions on the carers strategy at the right place and at the right time. I want them to be taken into account as the work around simplifying and modernising the benefit system is taken forward.

The hon. Member for Worsley and Eccles South (Barbara Keeley), who spoke for the Opposition, made a number of points, many of which we can work on together. Many hon. Members will be aware of her track record inside and outside the House. Elements of her speech made me feel that she expected me to take full responsibility for the things that the previous Government did not quite get right, such as the times when their implementation of a measure was flawed or when they failed to take note of representations. Although it is entirely fair for her to rehearse the points that I made in opposition—I certainly take those to heart—she will understand if I say to her that the last Government’s record left a lot to be desired, by which I mean that the improvements for which carers were hoping were not actually delivered.

Reference has been made to the huge financial pressures in many of our public services at the moment. I was struck quite strongly by the way in which the cuts that have been in train in local authorities for many months are somehow being laid at the door of this Government. In reality, those cuts were initiated and conceived under the last Government, and I just wish that there was a bit more humility and understanding of that. We have a shared challenge when it comes to dealing with the huge public sector deficit in this country. It is all well and good challenging this Government about what they will do in terms of the spending review over the next few months, but it would also be appropriate for a responsible Opposition to offer up suggestions that they believe would be painless that we could do instead.

[Barbara Keeley]

I do not know whether the Minister has experienced this during his parliamentary career, but the constituency that I represented between 2005 and 2010 covered two local authorities, and it was interesting to see the different priorities that those authorities gave to their work in social care and for carers. We heard a very good example of that in the debate, as Hammersmith and Fulham is adopting a swingeing policy that could take away a vital resource from carers, which I hope that something can be done about. I have heard the leader of Salford council hotly defend the fact that he would rather spend money on adult social care than on potholes, yet quite a lot of people in the city want money spent on potholes. Transparency and localism is one thing but, as with other aspects of health and support services, we could end up with a situation whereby a council such as Hammersmith and Fulham could remove a service, leaving its carers with nothing, while another area, such as Salford, would have excellent voluntary organisations and a council that prioritised social care.

[Mr Burstow]

The hon. Member for Hammersmith (Mr Slaughter) made some important points about the situation in his constituency and what his local authority was doing. The hon. Member for Banbury (Tony Baldry) also made references to the impact of tendering. Those are issues to consider, but I am not going to become a Minister responsible for micro-managing every single local authority and the decisions that they take on the allocation of resources—that is not a Minister’s job. However, we do need to ensure that there are not unintended consequences with respect to the rules and procedures followed by local authorities that fall under the Government’s responsibility. I will be very happy to hear further from both hon. Members, either in this debate or afterwards, to ensure that we have the correct rules. We want to support local services that are appropriate to a local community and that the community actually values.

--- Later in debate ---

[Mr Burstow]

I wish that I had not put it that way, but there we go. That is the trouble with putting things on record.

We heard about the National Audit Office report on Jobcentre Plus, and it is important that the Government pay close attention to the work of the NAO. I was a member of the Public Accounts Committee during the last Parliament, and when the NAO identifies opportunities to obtain value for money and get more out of existing resources, it is important that we take them. If the report is not already required reading for DWP Ministers and officials, it should be.

The hon. Member for Blackpool North and Cleveleys also discussed the care to share forum that was set up to consider respite. We see peer support as a powerful part of what the big society is all about. It enables people to step up and support each other, rather than seeing local authority services as the solution to everything. The right to respite has been discussed a lot in this debate. It is often not the case that a carer wants a week off; a matter of hours can make a huge difference. When I was visiting some services in Newham recently, I met the people who run a telecare project and several carers who had benefited from it. It was clear that what was important to them was the knowledge that the person for whom they cared was safe so they could have a cup of coffee with a friend, a chat and a bit of real life, as that refreshed them. We need more such opportunities for many others.

The hon. Member for Llanelli (Nia Griffith) discussed how we can ensure that carers can both stay in work and return to work. She also mentioned Alzheimer’s and dementia, and research into those diseases. I am sure that she will know that, in the coalition programme for government, we indicated a clear commitment to prioritise dementia research. I am the Minister who chairs the board with responsibility for considering the issue, and we will be making announcements about how we will take it forward in due course.

The hon. Member for Banbury said some kind things, as a result of which I now feel immense pressure—thank you very much! He also made a good point about carers week that I read in this way: carers week is not an annual event; it is every week. We need to find ways to make that not just a platitude but a reality for carers throughout our country. He spoke a lot about the role of GPs as commissioners and the difference that they can make. They are one of the universal services and they see many carers. We must ensure that all GPs understand that when someone comes to see them because of a sickness or disability, the person with them is often the carer, who needs to be identified and offered the signposting and support that will make a difference for them.

The hon. Member for Banbury mentioned the caring with confidence programme, as did several other hon. Members. I purposely included it in my opening remarks because I wanted to be up front about what I had decided to do. My view, having considered the evidence about the programme, was not that the training materials were not excellent—they are well regarded by the carers who have been through the programme—but simply that we were not getting value for money from the delivery. Not enough carers had been through the programme, and there was no evidence that delivery would accelerate significantly. Now the money will be reinvested into delivering more training—including GP training, which has been mentioned—and more support for carers. We will make further announcements in due course.

[Barbara Keeley]

As with other developments, I did not hear about this in the House; I heard about it from carers organisations. Does the Minister realise the extent to which carers support groups and organisations are concerned? They were geared up and trained to deliver the programme. Having useful materials will be a good thing, but materials are not enough to run a course. They need somewhere to run it, a trained person—probably paid—and resources during the day. It would be useful if some of the money could be diverted to training GPs, but that is a mainstream NHS matter. I emphasise that there is a great deal of concern among carers organisations about the programme, so anything that the Minister can do will be a help.

[Mr Burstow]

I am grateful to the hon. Lady for that point. I spent time earlier this week on the phone with all the carers organisations that have a direct interest in the matter. We are discussing actively with them the best way to reinvest the money to deliver good outcomes for carers. As and when that becomes clearer, I will certainly make further announcements to the House.

Oral Answers to Questions

Debate between Barbara Keeley and Paul Burstow

Tuesday 29th June 2010 Commons Chamber

[Mr Burstow]

The hon. Gentleman makes an excellent point. We shall be getting some guidance from the National Institute for Health and Clinical Excellence in a year’s time, and absolutely the answer is yes.

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

May I congratulate the Minister on his new role. As my hon. Friend the Member for Gedling (Vernon Coaker) mentioned, carers of people with autism rely on respite care. However, carers organisations are reporting that cuts to local authority funding are already leading to cuts in funding for charities and other providers of support care. How do the Government plan to deliver the promised increase in access to respite care through improved community support provision, when that is already starting to fall away?

[Mr Burstow]

The hon. Lady makes an important point, but perhaps she will be a little cautious with her question, not least because the previous Government made a lot of promises to carers in respect of the amounts of money that were to be invested, only for carers to find that on the ground the money was not delivering changes in services. So this Government are determined to ensure that we not only make promises but deliver on them. That is the commitment that this Government have made.