Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

I know that they do that, and I know that people recognise that access is a critical issue. That is why the Prime Minister introduced a £50 million fund last year that has been taken up by 1,100 of the 8,000 surgeries across the country to improve access in evenings, at weekends and by e-mail and Skype. I hope that those will benefit his constituents.

[Bill Esterson (Sefton Central) (Lab)]

SSP Health runs a number of GP practices in my constituency and across Merseyside. When it took over, it promised full-time GPs and an improvement in services, yet after well over a year several of the practices are still run by locums. We have seen vulnerable, elderly people unable to get appointments for many days, if not weeks, and those who can have gone to other practices. Will the Secretary of State look at what is going on with SSP Health in and around Merseyside and give me and other hon. Members an answer?

[Mr Hunt]

I am happy to do so, because the service that he describes—I have not seen the details—sounds totally unacceptable.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Jeremy Hunt]

I think they absolutely should be, and the changes that we introduced in the Care Act 2014 relating to the transparency of the inspection regimes apply to private providers supplying services to the NHS just as they do to NHS providers. Let us be absolutely clear: poor care is poor, whether it happens in the public sector or the private sector, and we must clamp down on it wherever it happens.

[Bill Esterson (Sefton Central) (Lab)]

The Minister said that he was dealing with the chronic shortage of staff who help vulnerable children and young people, who cannot get access to mental health services. Will he tell us when there will be enough staff delivering those services to that important group?

[Norman Lamb]

I mentioned that NHS England will very soon publish a report following its analysis of existing facilities across the country, so the hon. Gentleman will get the answer in the next few weeks.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 1st April 2014 Commons Chamber

[Dr Poulter]

I know that the staff at my hon. Friend’s maternity unit work tremendously hard to look after patients, and it is important that we gave them the right facilities in order to do so. I am delighted that, like over 100 other birthing units in the country, they have received money to make sure that women are treated with greater dignity and that the quality of care is as high as it can be.

[Bill Esterson (Sefton Central) (Lab)]

I cannot speak highly enough of the staff at Southport hospital who cared for me when I spent three days there as a patient last month. They told me that GPs now routinely send older patients straight to A and E because their funding has been cut and that community services are no longer in place to support people in their own homes, which is all leading to a crisis at A and E. Is not the sad reality that what is happening at Southport is being repeated up and down the country as a result of the Government’s disastrous reorganisation and cuts to front-line services?

[Mr Jeremy Hunt]

I am very pleased about the excellent treatment that the hon. Gentleman received. The problems that the nurses talked about are exactly why, from today, we are reintroducing named GPs for everyone aged 75 or over to bring back the kind of personal care and personal responsibility for patients that I am afraid was so sadly abolished previously.

Care Bill [Lords]

Bill Esterson Excerpts

Monday 10th March 2014 Commons Chamber

[Grahame M. Morris]

I echo the sentiments of other hon. Members about the lack of time we have been allocated. I appreciate that it is not your fault, Madam Deputy Speaker, but we have so much to get through and the shortage of time means that although I would like to speak in support of a raft of amendments and new clauses, I will limit my remarks to a discussion of new clause 9.

I am supportive of the Care Bill—changes that make care simpler and fairer are to be welcomed—but there are real concerns about the sustainability of the changes this Bill seeks to make. I do not doubt the integrity and good will of the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), but with all the good will in the world the proposals in the Bill can be implemented successfully only if they are properly funded.

Other hon. Members have raised concerns about the funding implications, and the original Dilnot report, one of the foundation stones of the Bill, made it clear that insufficient funding would hamper the effectiveness of any attempts to implement reforms, including the ones in this Bill, and that long-term social care funding will work only if the current crisis in social care is addressed first. So we must not forget that the success of the Bill will be jeopardised by laying reforms over a system that is underfunded. I do not have time to go into the figures, save to say that adult social care budgets alone have been reduced by £2.7 billion over the past three years—that amounts to 20% of average council budgets.

The impact of such cuts is compounded by rising demand resulting from demographic changes. It has been estimated that to meet the demographic pressures the nation needs to spend another £400 million a year. So local government has real concern that the implementation costs and ongoing running costs of the reforms being implemented through this excellent Bill have not been fully costed and will not be funded, other than as new burdens.

It is unacceptable—and it will damage public confidence and trust—to pretend that new standards will be able to be met if the resources are not in place to deliver them. That is why it is so important that an additional reporting mechanism is in place, such as new clause 9 would establish, to provide assurance that the social care system and reforms in the Bill are adequately funded. If the Government really intend the Bill to be their flagship piece of legislation on social care, we need to know that the numbers add up. Despite councils’ best efforts to protect front-line services, the reality of cuts on this scale has meant that adult social care has not been immune to their impact.

A number of hon. Members have indicated the scale of the impact in their own areas, but the eligibility criteria level for social care has risen dramatically across a range of authorities. It is unclear how the new eligibility threshold will work in practice, both in terms of the effectiveness of care that older and disabled people will receive and the impact that the threshold will have on local government finances. But it is a concern that an eligibility threshold set at “substantial” will, as the hon. Member for Totnes (Dr Wollaston) has said, fail to create a preventive care system—that is what we all want, along with well-being.

A failure to create a preventive care system could result in a false economy in the long term—my hon. Friend the Member for Leicester West (Liz Kendall) mentioned the figures from the Deloitte study. By not delivering the £1.2 billion of investment needed to lower the national eligibility threshold, central Government could be missing out on savings as great as £700 million. The well-being principle of the Bill will fail to become a reality as many old and disabled people will be ineligible to have their needs met, so it is important that the effectiveness and sustainability of the eligibility threshold is reviewed and changed when appropriate.

We have a unique opportunity to improve care, which is why I am in favour of establishing the joint care and support reform programme board set out in our new clause 9, which provides for a report on performance and implementation. A failure to do so could render the well-intentioned reforms in the Care Bill meaningless.

[Bill Esterson (Sefton Central) (Lab)]

Social services are under huge funding pressure, which has a knock-on effect on the NHS. New clause 9 highlights the crucial issue of funding and will contribute to addressing it. Just 10 days ago, I experienced at first hand those pressures on the NHS. I would have added my name to this new clause, but I was unable to be here because I spent three days in Southport and Formby district general hospital. I saw the pressures in the accident and emergency department resulting from beds not being available for the transfer of patients to the wards; the pressures arising from chronic staff shortages; the difficulty in helping patients to return home because of a lack of support in the community; and general practitioners sending older people to A and E with complex needs as there was a lack of other choice or care available. In large part, the cuts in social services funding meant that I saw all those things. Meanwhile, staff in the NHS are working incredibly hard, often doing double shifts to look after patients, for which I am extremely grateful, as are many others. I take this opportunity to thank them and everybody in the ambulance service for what they did for me and have done for many other people.

The evidence I collected during those three days shows just why we need to be confident that funding is in place. Unless the funding is adequate, both in social care and in the NHS, the challenges faced day by day, hour by hour in our NHS will grow worse. We need greater integration, provided through the all-party approach advocated by Sir John Oldham in the report by his Independent Commission on Whole Person Care. As the report says, practice needs to move on so that we can see more care provided at home, with professionals working closer together in the interests of the individual. The whole-person care approach would reduce the number of hospital admissions; it would keep more people at home for longer, reducing hospital admissions and avoiding the huge pressures that I witnessed. In the context of the Bill, we need to be confident that the funding is sufficient to deliver the new responsibilities, which is why we tabled new clause 9. I hope that Members will support it this evening.

New clause 19 calls for health bodies to promote the health and well-being of carers. As the independent commissions report states:

“Most care is delivered by people themselves and their families.”

That makes the health of carers vital. My dad cares for my mum, and his health is a major concern. Carers up and down the country face declining health as they care for loved ones. Caring for the people who care is also a vital aspect of care provision, and paid staff in the health and social care sectors are also carers. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) talked about priority treatment going to volunteer carers—family members, friends and other volunteers. We should also consider that approach for everyone who works in the NHS or in social care. If we read the new clause in its widest sense, we should consider paid carers too, be they in the NHS or in social care.

Some 1.3 million people work in the NHS, and 1.5 million in social care. We should promote the health of NHS and social care staff as well as that of unpaid carers who do a fantastic job up and down the country. I hope that new clauses 9 and 19 receive the support of the House.

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

I share the frustration of many Members at the shortness of time that we have had to discuss such important issues.

Part 1 of the Bill brings in a long overdue and fundamental reform of care and support. It has been brought before the House after around five years of one of the most collaborative processes ever used to develop legislation, and I am very proud of this historic set of reforms.

I hope to have time to explain Government amendments 1 to 7 and 14, relating to clause 123 on regulations, but before that I shall try to address some of the key points that have been made. I fear that I do not have time to do justice to all the points, but I shall do my best.

On new clause 1 on power of access, which was tabled by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), it is my view that there is no gap in powers that would prevent care or other professionals from accessing those in urgent need of assistance. I am not alone in that view. The Association of Chief Police Officers says:

“Powers of entry are provided to us under both common law and PACE and I am satisfied that these would afford us access to premises where vulnerable individuals are considered to be at risk.”

The Association of Directors of Adult Social Services, which is an important organisation, agrees:

“We have no evidence that the proposed powers of entry would add significantly to the range of tools currently available to practitioners, rather we are concerned that this would encourage a coercive rather than negotiated approach to complex and difficult situations, and increase risk of harm or abuse. Any such power would not assist the complex next steps in assuring and supporting individuals, who have capacity, to stay safe.”

That view is confirmed by the chief social worker for adults, who said:

“An additional power of entry or access on its own would be insufficient, and indeed could make the situation worse.”

The inherent jurisdiction of the High Court to intervene provides a crucial final safety net. Beyond that, the critical thing is to issue, as we intend to do by the end of March, clear guidance on existing powers to ensure that all professionals working in this important area understand what powers they have available to them. I know that my right hon. Friend has been assiduous in pursuing that issue, and I am happy to involve him in the process of confirming those final guidelines that we intend to publish by the end of March.

On amendment 27 about the definition of abuse, the Joint Committee on the Draft Bill stated:

“Abuse is an ordinary English word, capable of being understood without being defined…to attempt an exhaustive definition always has the danger of omitting something which, as subsequent events make clear, should have been included.”

We agree and believe that the Bill is clear as drafted. Last week, I spoke to the all-party group, which is chaired by my hon. Friend the Member for South Swindon (Mr Buckland). I promised to go away and look at the matter and to talk to officials, but I am absolutely satisfied that the plain English words are very clear. The explanatory notes will be expanded to ensure that it is made clear. The guidance and explanatory notes will both have legal force, and courts will use them to interpret the intentions of the Bill.

Turning to amendment 28, the overarching well-being principle applies to safeguarding duties. Where partners become aware of abuse or neglect, it is imperative that they act, and the guidance will be absolutely clear on that point.

On new clause 26, I completely agree that police cells are a totally inappropriate place for someone in a mental health crisis. The crisis care concordat, which, for the first time ever, sets standards of crisis care, lays out our clear expectation that the use of police cells will drop by half by 2014-15. However, that must only be a start. The Home Secretary announced last year that there will be a review of the operation of sections 135 and 136 of the Mental Health Act 1983 on places of safety, and that is the right approach to take. However, I agree that we must end this awful practice of people ending up in police cells completely inappropriately.

I sympathise with new clause 11 on the Human Rights Act, but do not feel that it adds anything in terms of protection for individuals. None the less, I recognise the strength of feeling on the matter, so I expect that it will be discussed further in the final stages of the Bill’s passage in the other place. In the meantime, I am prepared to reflect on the points made and consider whether legislative clarification might be justified in order to make the Government’s position clear.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 25th February 2014 Commons Chamber

[Dr Poulter]

My hon. Friend will be aware that local commissioners take decisions on local services. I will be happy to meet him to discuss this matter further, so we can talk through his concerns and ensure that local health care services are as strong as possible.

[Bill Esterson (Sefton Central) (Lab)]

T10. The village of Melling has grown in recent years, yet its surgery hours have been cut drastically. Elderly and disabled residents now face a four-hour round trip by public transport to see their doctor. How can cuts in surgery hours, like those in my constituency, be justified if the Government are serious about having a first-class NHS?

[Mr Jeremy Hunt]

We absolutely want to make primary care more accessible and that is why we are introducing named GPs for everyone aged 75 or more from April. This is a significant and important reversal of, I think, a mistake that everyone now agrees was made in 2004 when named GPs were abolished. Its purpose is to make GPs more accessible to the people who need them the most.

Children and Families Bill

Bill Esterson Excerpts

Monday 10th February 2014 Commons Chamber

We can debate whether we should replace the words “smoking in cars” with the words “smoking in enclosed public places”. However, the arguments that are made by Government Members are all too often the wrong arguments and they are being left behind by society, which wants us to move again. That is why I support the Lords amendments.

[Bill Esterson (Sefton Central) (Lab)]

Protecting children is one of the most important responsibilities that we have. We know that smoking kills, we know the dangers of passive smoking and we know that children are more at risk than adults from the effects of smoke.

Half a million children are exposed to potentially toxic levels of second-hand smoke in family cars each week, according to the British Lung Foundation. Children’s lungs are smaller and children have faster breathing rates. They are therefore particularly vulnerable to second-hand smoke, especially in a confined space such as a car.

Children have no choice but to travel in a family car. Would it be good if car drivers, including parents, chose not to smoke when children were present? Absolutely. However, in the case of seat belts, it took a change in the law to ensure that there was a change in behaviour. The proportion of people wearing seat belts went up from 25% to more than 90% after legislation was introduced.

As I said, protecting children is one of our most important responsibilities. We can exercise that responsibility today. We have to choose between the right of an adult to do as he or she chooses in the privacy of his or her car and the protection of the health of children. Throughout the passage of the Bill, Government Members have rightly agreed that the protection of children is paramount. I hope that all Members will agree that we should make it an offence to smoke in a vehicle when children are present.

[Mrs Main]

I have never heard of a more illiberal, nonsensical and unenforceable proposal than Lords amendment 125. I am sorry that it is being proposed by the Government and that Members are being asked not to consider the detail, because the devil is in the detail.

As has been said, the word “vehicle” refers to a broad spectrum of containers, if I may put it like that, including motor homes, Traveller caravans and, potentially, narrow boats. The proposal suggests that smoking while driving an open-top car, to which my hon. Friend the Member for Shipley (Philip Davies) referred, is more injurious to health than a mother smoking while pregnant. I find that impossible to accept.

I do not know how the police will arbitrate between two 17-year-olds in a car if one of them has been smoking. I do not think that we should be considering using this resource if we are not banning cigarettes, full stop. I do not smoke and have never smoked. I am a mother of four children. I fundamentally believe that we should not make bad, unenforceable law.

If the Labour party represented the working class far more than it suggests it does, it would be making a very different argument, because a huge tranche of the population will see itself criminalised. We should be advising people not to smoke in front of their children. We have been winning the argument on smoking. The Government have adverts on the television that show a mum blowing the smoke out of the door and then say, “What if you could see what it does to your child’s lungs?” We will not stop those adverts because we are trying to educate people.

Under the proposal, we will be saying that a child can get into a fog-filled car after their mum has been smoking in it. As long as she is not still doing it, that will not be an offence. We will be saying that it is an offence to smoke in a van if Traveller children or others who live in transit are sitting in the back. However, if I sit in my kitchen and people can see me through the front window, fag in hand and baby over my shoulder, comforting the child, that will not be an offence. It would be easy to track down such behaviour, so why do we not say that smoking in front of children should be banned or that smoking should be banned? It is because we think that it would be illiberal to go into people’s homes. However, some people’s homes are vehicles. I look forward to people explaining that to the communities that will be affected disproportionately.

I cannot believe that we are not supposed to inquire about the detail.

Oral Answers to Questions

Bill Esterson Excerpts

Tuesday 14th January 2014 Commons Chamber

[Norman Lamb]

I thank my hon. Friend for that question, and I am immensely proud that this coalition Government are reforming a grossly unfair system—something that should have happened a long time ago and is massively overdue. This Government completely recognise the absolute importance of an awareness-raising campaign, which will be carried out by local government, national Government and the financial services industry.

[Bill Esterson (Sefton Central) (Lab)]

Ministers have repeatedly claimed that no one will pay more than £72,000 in care costs, but given that the cap will be based on the rate local authorities charge for care and not the actual amount people have to pay, will the Minister confirm that people will have to pay more than £72,000 and that the so-called cap is not a cap at all?

[Norman Lamb]

People can always choose to spend more than local authorities deem it necessary to spend in order to secure care. However, we are implementing exactly the scheme that Andrew Dilnot recommended, and when he announced his proposals they were welcomed by the hon. Gentleman’s own party as a significant advance.

Care Bill [Lords]

Bill Esterson Excerpts

Monday 16th December 2013 Commons Chamber

[Mr Dorrell]

I shall come on to that point, but to react directly to the hon. Lady’s point, surely it is much better to intervene before the patient arrives in hospital in the first place, preventing the avoidable episode of care. The hon. Lady talks about discharge, and she is, of course, quite right, but how much better is it to prevent the case from arising in the first place, which is what clause 2 is about?

[Bill Esterson (Sefton Central) (Lab)]

I think that is precisely the point my hon. Friend the Member for Bridgend (Mrs Moon) was making. The money simply is not there in local government. When 20% of the adult services budget has been lost, the services are not there and the care managers are not there to do the assessment to decide whether to keep people at home or to help them get out of hospital. The service back in the community, after people have come out of hospital, is not there either. Does the right hon. Gentleman accept that that money has to go back in?

[Mr Dorrell]

Of course I accept that if we have more money, we can do more, but I do not think that that exempts us, particularly given the public finances we inherited in 2010, from the obligation to see how we can get more for the £125 billion of taxpayers’ money that is already committed to health and social care in England.

That brings me to clause 3. The only way to deliver person-centred care and early intervention to prevent avoidable cases, is to reinvent care on a much more integrated model between the national health service and the social care authorities. That is why there is the obligation in clause 3 to consider integrating health and care. In that way we will not think of the NHS as one bureaucracy and social care as another, but instead think of it, as Mike Farrar said when he was at the NHS Confederation, as a care system that provides medical support when necessary, rather than as a medical system that provides care support when it has got the money—that is how not to do it.

--- Later in debate ---

[Meg Munn]

My hon. Friend is absolutely right. I managed care services when, not the previous Government but the one before that, brought in a health and social care Act. Within the first six months, we found that every single person who ended up in residential care did so because of carer breakdown, as the carer was not getting support. That is why this support is such an important part of what we should deliver.

Care services must be personalised: they have to be about choice, as well as need. If we are to make such personalisation a reality, we need further integration of our health and social care services. The duty on local authorities under clause 3 to promote the integration of care and support with health services does not go far enough in that respect. Indeed, a recent survey of health and wellbeing boards found that most local authorities have not identified integrated care as a priority. Clearly, we must do more to drive forward the development of integrated care. Without such an approach, we will return to the days that I remember well, when there were fruitless arguments about whether a service such as bathing was required on social or health grounds.

The integration of health and social care services is crucial to ensure that we provide carers with sufficient support. As a patron of Sheffield Young Carers, I feel privileged to have seen at first hand the selfless role that even very young carers undertake in our communities, and they should be valued.

As has been said by the right hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), the Bill places a duty on local authorities to have regard to the importance of identifying carers, but that is not good enough. Some 80% of carers have contact with a health care professional, and it makes absolutely no sense to leave the NHS out of the duty to identify carers.

That matter is especially worrying as regards young carers, who quite often need a lot of support. The Children and Families Bill will strengthen young carers’ rights by providing that when a child is identified as a young carer, the needs of everyone in the family should be considered. That of course presupposes that young carers will be identified in the first place. If we do not place a corresponding duty to identify carers on health authorities, we risk young carers falling through the gaps, and we cannot continue to leave them without support.

My remarks would be somewhat lacking if I did not refer to the funding or, perhaps more accurately, the lack of funding that underpins our social care system. The proposals outlined in the Bill primarily concern redistributing the costs of care, and they will not bring any extra funding into the system.

[Bill Esterson]

My hon. Friend is making an absolutely crucial point. Does she agree that unless investment in social care is made now, it will end up costing far more in the cost of the NHS, as well as that of social care? It is the lack of ambition, as well as the lack of finance, that is really disappointing in what the Government are introducing in the Bill.

[Meg Munn]

I agree. The demand for services is now greater than ever. Our social care system is being cut to the point of breaking. As has already been discussed, should the proposed health funding reallocation for clinical commissioning groups be implemented, the situation will only get worse. South Yorkshire is due to lose £150 million by April 2014. That is staggering given that, under the proposals, other parts of the UK that already have better health outcomes and longer life expectancy will receive an increase in funding. This Bill seeks only to ration scarce resources; without a completely different approach, we will fail to meet proven need.

As a former social worker, I welcome clauses 42 to 47, which introduce a duty on local authorities to make inquiries when they suspect that an adult is at risk of or is experiencing abuse or neglect. Yet no duty is placed on care providers to report suspected abuse or neglect to the local authority. The Government contend that the present guidance is sufficient, but I disagree. In the light of Winterbourne View and Mid Staffordshire, we cannot afford to have such gaps in protection.

A recent Care Quality Commission report stated that our accident and emergency departments see 500,000 elderly victims of neglect. I am therefore far from convinced that enough has been done to address the issue. Where victims of abuse are imprisoned in their own homes by a perpetrator who denies access to adult safeguarding staff, there are no current legal means by which access can be achieved. An amendment was tabled by the noble Baroness Greengross in the other place to enable a social worker to apply for a court order to access an adult at risk. Between now and the Committee stage, will the Government reflect on that matter and introduce something to address that gap?

The Bill is an opportunity for much-needed reform of our health and social care system, but in its current form it does not make the changes that we need. For that reason, I fully support my right hon. Friend the Leader of the Opposition’s reasoned amendment.

I apologise, Madam Deputy Speaker, that I will have to leave very shortly to read in a carol service.

--- Later in debate ---

[Bill Esterson (Sefton Central) (Lab)]

The hon. Member for South Swindon (Mr Buckland) speaks with great passion and knowledge in support of children with autism. He made an incredibly important point when he asked who cares for vulnerable children once the parents have gone. Indeed, who cares for all those we care for once we are gone? That is a powerful and important point.

I agree with the hon. Gentleman that this debate is about the principle of the Bill. He talked about the need for action, which is why the Bill is welcome. We have an opportunity to improve services for many people, but Labour Members feel that the Bill should be more ambitious, which is why the reasoned amendment is so important, and it is what the reasoned amendment is saying. I also agree with him about the need to integrate what happens under the Children and Families Bill with what happens under this Bill. The crossover he mentioned between children’s service and adult services as children grow up is important. The Children and Families Bill and this Bill create significant new responsibilities for the NHS and local government, and the big question for the Government is about where the resources will come from to deliver them. I was a local councillor for more than 15 years under both previous Governments and it was a familiar story for local councils to be given new responsibilities without necessarily always being given the resources to deliver them. That is an important point about this crucial Bill.

The hon. Member for Bradford East (Mr Ward) mentioned the need for free social care at the end of life. That was an important point, but at what stage should social care be free? What do we mean by end of life? What criteria should we set? How much earlier than the end of a life should that care come? How do we fund free social care and how do we fund social care at all? That is one of the big concerns and that is why the reasoned amendment mentions our concerns about where the cap has been set.

My right hon. Friend the Member for Stirling (Mrs McGuire) mentioned the concern that the needs of disabled people may have been overlooked. The London School of Economics cites the fact that 97,000 fewer disabled people have been in receipt of social care since 2008—the figure for older people is 250,000. The LSE cites £2.8 billion as the figure required for councils to set eligibility at moderate, in the context of an overall budget spend for health and social care of £120 billion. The fact that it would take £2.8 billion to set the criteria at moderate speaks volumes about what could be done if we got this right.

My hon. Friend the Member for Lewisham East (Heidi Alexander) mentioned her family and I am going to talk about my family now. My dad cares for my mum. Let me describe my mum’s experience this year, because it is the experience of many older people and their families. In the early part of the year, she was being cared for by my dad and she gradually declined until she was rushed into hospital. I think it happened because no health professionals or social care professionals were keeping a close enough eye on her. She ended up in hospital where, happily, she received very good care. Her wish was met and she was able to go home, and the health service provided a hospital bed that she could use there.

Once she got home, the lack of service in the community became a problem again. There was not the rehab, the physio or the support to enable her to return to some kind of active life. Now, many months later, it is too late—that will not happen. My mum rarely gets out of bed any more. For many people, such an experience is all too familiar. It happens because of how social care and health have been allowed to operate over the years, with no proper integration and without people in the two services talking to each other. My parents receive a care package now, with carers coming in. My mum’s social care needs are met but the lack of proper support has meant that things are not as they should be. I do not think that my mum’s case is the worst, by any means, but it is indicative of where things are missing.

The Government have made a proposal and they have talked a lot about integration between health and social care. I remember looking at integrated health and social care teams many years ago as a local councillor and there was success then. There has been more success recently and there are good examples of health and social care professionals working together, but cuts to social care, in particular, mean that the money simply is not there any more.

I cited the figures earlier. In Sefton, we have seen a 40% cut in local government funding. The care managers are simply not there any more. They are not there, as Members have said, to help people in the community stay in their own homes; they are not there to help people who have gone into hospital go home again. Those situations are combining to leave a crisis in A and E—we will have that debate on Wednesday, but that is what has been allowed to develop. I am afraid that the reorganisation of the NHS during the first years of this Government, with clinical commissioning groups being created, meant that administrators and managers in the health service were concentrating on setting up new structures and not on ensuring that health services were delivered properly. These things do not happen by accident. When £3 billion is spent on reorganisation and not on patient care, that is the sort of situation we end up with. The question is what should we do. We have a proposal for a £72,000 cap on care, but my hon. Friend the Member for Lewisham East described the sum that her nan had to pay, which was £130,000. For many people, the £72,000 cap will be no help, and other Members have given the details that show that.

There are a number of ways of funding social care, one of which is to have a cap. However, let me return to the comments made by the hon. Member for Bradford East. If we are considering free social care at the end of life, or, as I said, a lot earlier than that, perhaps the time has come for Members to debate free social care as part of a health and social care service that is free at the point of delivery and at the point of need, like that which my right hon. Friend the Member for Leigh (Andy Burnham) has mentioned before. Perhaps the time has come to say that that is the ambition that we, as Members of Parliament, should have.

Tinkering at the edges will not solve the problem. The debate we must have—and it must be a cross-party debate—is about how to pay for such a service. As people get older, that is what will be needed. Sooner or later, we as legislators will have to deliver exactly that service. Anything short of that will not solve the problems; things will only get worse. I put it to Members from all parties that that is what is needed. We have made a start with the Bill and tonight’s debate, but we will need to move down the route of free health and social care and of whole-person care. That is the only way we can solve the challenge of an ageing population.

--- Later in debate ---

[Dr Wollaston]

Absolutely. I welcome the fact that Torbay will be part of one of the integrated care pilots, and particularly that focus on mental health, as my hon. Friend says.

Services in Torbay have been transformed through the use of care co-ordinators, so that only one phone call is necessary. There has been transformational work in sharing information and records and in rapid response to a crisis and putting prevention in place. The challenge that Torbay now faces is financial. Unfortunately, the elastic can stretch only so far before it snaps. Torbay’s funding is set to fall from £71.2 million this financial year to £63.6 million in 2014-15. Those cuts are in addition to the demographic challenges, the challenging situation in relation to children’s services, and the fact that we know that across the country 2015 is set to be a crunch year for NHS funding.

I welcome the £3.8 billion transfer for better care. We heard in the draft Bill Committee and in the Select Committee how such joint funding arrangements are the best driver to integration. A formula for integration cannot be dictated. What works for central London or central Manchester will be very different from what works in south Devon and in rural areas, but the fund will force people to work better together in a way that fits their area. That is very welcome.

[Bill Esterson]

Would the hon. Lady advocate a single service, and has she any thoughts on how that would operate? I am interested to hear her views.

[Dr Wollaston]

Indeed. It operates very well already in Torbay, but it cannot be dictated centrally. We need to get the hurdles out of the way, allow people to work together locally and facilitate that. We heard on the draft Bill Committee that joint funding streams were the best way to move that forward.

Unfortunately, in Torbay in the crunch year 2015 we will see the funding drop below 90% of projected expenditure. At that point, rather than driving further integration, it will cause systems to start to fall apart because people need to protect their own silos. That is a real danger. As the Bill proceeds to Committee, I hope we look very carefully at the effect of the funding gap and make sure that we are not setting a system up to fail. One of the problems with the Bill is that it sets up many new statutory responsibilities. Councils will have to fund care accounts, which will undoubtedly be complex, bureaucratic and subject to challenge. Councils will have responsibilities for carers’ assessments. There will be increasing numbers of eligible people as the thresholds and caps change. We will see safeguarding adults boards, more rights to information and advocacy, and for many, deferred payments, if they have not already been making those.

Once we create these additional statutory responsibilities, there will be less money to go around for the very things that are at heart of the well-being and prevention principle. That is what concerns me. Would it not be a tragedy if we set up carers’ assessments but there was no funding left for services to respond to needs? Voluntary organisations in my community can function incredibly efficiently on very little money. They do not need to be fully funded, but they need some funding. If that money dries up, I worry about how we will move forward with a genuine well-being and prevention principle.

I want the Bill to succeed. In the remaining minutes I shall touch on those aspects that I think are, sadly, still missing, which were recommended by the draft Bill Committee. One is how we calculate care costs according to their actual cost, not the cost to the council. For a person living in their own accommodation, it sometimes costs a great deal more to access support than it would cost a council to provide it. We need to look at that again.

There is a small but important area relating to powers of entry in exceptional circumstances for those who are subject to abuse in their own home. It would be wrong for us to ignore that possibility. Although the overwhelming majority of carers of course do a wonderful job in challenging circumstances, there are occasions, sadly, when people can be at risk from those who love them. Very often that is as a result of the intensely challenging circumstances that carers face. We need to reserve a power of entry in exceptional circumstances where there are very serious concerns about individuals who may be vulnerable and unable to communicate easily.

Another issue is free social care at the end of life. We know that 73% of people would like to be able to die at home. In my experience working as a GP in rural areas, where that broke down for most people was as a result of a lack of social care, and the challenge of caring for somebody right at the end of their life, when they may, for example, be doubly incontinent. Until people are in that situation, they may not understand how incredibly demanding it is to have to be with someone 24 hours a day, trying to stay awake and provide the intensive support they need. Allowing everybody to access free social care in those terrible final days would be a very important step forward.

Finally, the duty of candour we have introduced for foundation trusts is welcome, but I think that it should be extended to social care.

Tobacco Packaging

Bill Esterson Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

Preventing children from smoking is a major priority for the Department of Health and for the Government, and my hon. Friend is absolutely right to suggest that, irrespective of this piece of policy—important though it has the potential to be—the Government are committed to spending significant amounts on public health campaigns and all the other mechanisms available to us to prevent children from smoking.

[Bill Esterson (Sefton Central) (Lab)]

The Minister keeps mentioning the evidence, but the evidence from Australia is overwhelmingly in favour of plain packaging for cigarettes, so why on earth is she waiting? She should bring in plain packaging now to save children from taking up smoking in the first place.

[Jane Ellison]

The hon. Gentleman refers to the evidence, as have other Members. That is exactly why we have asked someone who, with all due respect, is far more expert than he is or I am to look at the evidence and report to the Government swiftly. That will be a productive way forward. It will ensure that, however the Government decide to proceed, we do so in a way that is robust.

Urgent and Emergency Care Review

Bill Esterson Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

I am always happy to meet colleagues if they have concerns about what is happening in their constituency, but I absolutely stand by what I said. There will remain an A and E at Ealing. That was the decision that I made because I wanted to give clarity, but I also said that the shape and size of that A and E may change in accordance with the announcement that is being made tomorrow by Sir Bruce Keogh. I hope that will give the hon. Gentleman further clarity and further certainty to reassure his constituents.

[Bill Esterson (Sefton Central) (Lab)]

The Secretary of State has already acknowledged that keeping people in their own home is one important way to relieve the pressure on A and E. I do not understand why, if he wants to make a real difference, he will not reinvest the NHS underspend to make up for the cuts in local government and put it into social care.

[Mr Hunt]

We have put in an additional £2 billion—that makes a total of £3.8 billion being invested to support the social care budget. That is significant because it is recurring expenditure. We have shown our commitment by continuing to support the social care system through this Parliament. The trouble with underspends is that they depend on how many resources we have in any particular year. It is therefore much harder to invest off the back of them.