Women’s Health Strategy for England

Caroline Dinenage Excerpts

Wednesday 20th July 2022 Commons Chamber

[Steve Barclay]

While this strategy sets out a number of future steps, there are also steps we have already taken, including on maternity services. The hon. Gentleman will be aware that we have announced an extra £127 million of support for the NHS maternity workforce and £95 million to recruit an additional 1,200 midwives and 100 consultant obstetricians. Steps have been taken, and more steps are set out in this strategy.

[Dame Caroline Dinenage (Gosport) (Con)]

As one of the former Health Ministers who carried the baton on this strategy for some time, I warmly welcome my right hon. Friend’s words and his commitment. It is so important—not least the commitment to addressing some of the fertility inequalities across the country. I met with his predecessor because my constituency is one of those most severely affected by that postcode inequity.

As my right hon. Friend says, there are some real health inequalities in the services provided—not just for women, but between women, particularly those women who are vulnerable and hardest to reach. It is not just about money, which is why I am pleased with his commitment to hubs, but about ensuring that integrated care systems have a focus on place and on the needs of local communities. I would love him to commit more to that.

Since 2015, there has reportedly been a 42% real-terms fall in contraception spending, so I would also like to have my right hon. Friend’s commitment that this document will align with the sexual and reproductive health action plan. That is important because for every £1 spent on those services, we save £9 on other public health spending.

[Steve Barclay]

I am grateful for the work that my hon. Friend did as a Health Minister in championing this agenda. She is right to highlight the difficulty, often, of accessing contraception, which is very much at the heart of the responses we had on the fragmented service that many women have experienced. She will be aware that a key part of our approach is the health and wellbeing funds and working with the voluntary and community sector on support in areas such as pregnancy loss.

A key part of this is the visibility of the women’s health strategy. Putting that to the fore in terms of a women’s health ambassador is, as she says, part of these conversations with the integrated care systems to ensure that this gets greater prioritisation within commissioning. A key part of securing that is having the data to demonstrate its importance and benefits.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 19th July 2022 Commons Chamber

[Steve Barclay]

That is why we have launched a range of initiatives, such as surgery hubs and diagnostic centres, to address the very real backlog resulting from the pandemic. Indeed, the NHS has published its delivery plan for tackling the covid-19 backlog of elective care, and that is focused on four areas: increasing health service capacity, prioritising diagnosis and treatment, transforming the way that NHS provides elective care, and providing better information and support to patients.

[Dame Caroline Dinenage (Gosport) (Con)]

I welcome both the Secretary of State and the new Minister to their places and warn them that the one statistic that they will hear me say time and again is that cancer is the biggest cause of death of children under the age of 14. Both of their predecessors met my constituent Charlotte Fairall, who lost her daughter, Sophie, to a very aggressive form of rhabdomyosarcoma. Their story inspired the speech that the former Secretary of State, my right hon. Friend the Member for Bromsgrove (Sajid Javid), gave when he launched the 10-year cancer strategy. With that in mind, I would really appreciate it if the new Secretary of State restated his commitment to that strategy and to including a childhood cancer mission at its very heart.

[Steve Barclay]

The House recognises how my right hon. Friend has championed this issue over many years. There can be few more emotive issues than the one she draws to our attention. Of course, in keeping with my predecessors, I would be very happy to engage with her on this important issue.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 14th June 2022 Commons Chamber

[Gillian Keegan]

I completely agree with the hon. Lady that we, of course, must treat all those living with dementia—and all those caring for people with dementia, which is a lot of people in the country—with respect and do everything we can to support them. That is why we will, as I say, be setting out our plans for dementia in England for the next 10 years and why the Secretary of State mentioned dementia in a speech very recently. I will personally commit to attending the APPG. I am very happy to work with her on this issue to understand what more we could be doing and what more we can do to inform the 10-year plan for dementia in England.

[Dame Caroline Dinenage (Gosport) (Con)]

I am really grateful to my hon. Friend for her commitment to train social care staff in dementia. Timely and accurate diagnosis is really important to ensuring that people living with dementia get on the right care and support pathway. A lot of my constituents are still struggling to get the face-to-face appointments that are so crucial in that. What is she doing to ensure that GPs in my local area are equipped to recruit, train and be resourced to get early diagnosis in place for people?

[Gillian Keegan]

My hon. Friend is absolutely right. We had been meeting our dementia diagnosis target consistently at the national level from July 2016 until the end of March 2020, when, obviously, we all know what happened. The diagnosis rate dropped below our target for the first time in almost four years, and reflects the impact the pandemic had on memory assessment services and GP referrals into those services. In the last financial year, we allocated £17 million to specifically address dementia waiting lists and increase the number of diagnoses. That was spent in a range of ways, including on investing in workforce to increase capacity in memory assessment services and on improving access to pre and post-diagnostic support and carer support.

Childhood Cancer Outcomes

Caroline Dinenage Excerpts

Tuesday 26th April 2022 Commons Chamber

[Dame Caroline Dinenage (Gosport) (Con)]

I beg to move,

That this House has considered improving outcomes for childhood cancer.

I am grateful to the Backbench Business Committee for allowing us this debate, and to all the medical professionals, scientists, charities and, above all, the bereaved parents who have helped to inform it.

This debate is in honour of Sophie Fairall. Sophie was just 10 years old when she died last September, 12 months after having been diagnosed with a very aggressive form of cancer, rhabdomyosarcoma. During her illness, Sophie created a bucket list. It included lots of fabulous things. She wanted a pair of high heels and she wanted to cook with Gordon Ramsay. But Sophie’s list was very special, because she also wished for improvements in the way we look after others who were in the same position that she was. She wanted better play facilities for children in hospital wards. From her bed she painted ceramics, which were sold to raise £6,000 to buy new toys for her ward. Most hospitals only have play specialists at very limited hours. No data is even collected on the numbers of play specialists working in the NHS. So, on Sophie’s behalf, I ask the Minister to look at the provision of play specialists.

Sophie also wanted better hospital food for poorly children. She was worried about the parents who spent hours at the bedside and often did not get to eat at all. Often during her own treatment Sophie felt poorly at set mealtimes. Later, when she was feeling a bit better, there was no capability at the hospital to make her anything to eat. That is little surprise, because in Portsmouth hospitals the meals get sent from Wales, 200 miles away. In October 2020, following a review led by Prue Leith, the Government launched a new blueprint for hospital food. Can the Minister provide an update on how that work is progressing and how they plan to ensure nutritious, child-friendly food that can be delivered flexibly during children’s treatment in hospital?

After Sophie’s death, her fantastic mother, Charlotte, vowed to continue to highlight all the failings and missed opportunities she experienced in how we research, detect, treat and care for children with cancer, and how we improve cancer outcomes. Charlotte Fairall is here today and I pay tribute to her determination and devotion to that cause. [Hon. Members: “Hear, hear.”] I want to start with a spoiler alert for the Minister. Today, I am going to be asking for a new childhood cancer mission, a concerted effort to bring together the very best in research, genomics, training, treatment, philanthropy, medical and allied health professionals, the brightest and the best, to really change our approach to childhood cancer once and for all.

Childhood cancer is often referred to as rare, but it is the biggest killer of children under the age of 14. In this age group, there are around 1,800 new cancer cases every year. One in 320 people will be diagnosed with cancer before their 20th birthday, and 12 children and young people diagnosed every single day in the UK. How can that be described as rare?

The most overwhelming concern is around diagnosis. Early detection is the next frontier in adult cancer and for children it is even more vital, yet for so many children that diagnosis comes far, far too late. Sophie had suffered for a few months with tummy problems. The GP first suggested Gaviscon and then that it could be irritable bowel syndrome, but when Sophie started bleeding her very worried mum was advised that she might have started her periods. Sophie had just turned nine. By the time her worried parents took her to accident and emergency, the paediatrician found a 12 cm tumour in her little tummy.

Sophie’s story is not unusual. Over 53% of childhood cancers are picked up through A&E rather than through primary care, compared to 22% of adult cancers. In terms of diagnosing advanced cancer, as a nation we rank near the bottom of the European league tables. There is little or no training for general practice and let me reiterate that we are talking about the biggest killer of children under the age of 14. There are also no national referral guidelines for GPs with concerns that a young person may have cancer. A local GP from Gosport, who has practised for over 30 years, told me that he has no specific training on childhood cancer and would readily attend any training available. The Government are investing in 100 new diagnostic centres, but there must be robust referral guidelines in place, specifically regarding children, to help ensure that that improves the diagnosis of paediatric cancers.

The game changer would be paediatricians in primary care, which so many other countries have. Until then, we need childhood cancer training for healthcare professionals. We need national referral guidelines specifically for children, and we need an education campaign for parents on the signs and symptoms of childhood cancer. I know that is not straightforward. There are 88 types of childhood cancer with various symptoms, but we only need look at the success of the training and publicity surrounding the signs and symptoms of meningitis, which has seen numbers fall, with 461 cases of meningitis last year and 30 deaths. It is time to do the same with childhood cancer.

[Hilary Benn (Leeds Central) (Lab)]

I congratulate the hon. Lady and colleagues on securing this debate. She is making an outstanding case. One of the cancers that affects children is brain cancer. If we take glioblastoma, the five-year survival rate for children is only 20%. I am sure she recognises that not only do we need improved diagnosis—the point she is making—but more research. That is what the Tessa Jowell Brain Cancer Mission is about: more research to understand the make-up of those cancers, so we have more effective treatment and more children may survive.

[Dame Caroline Dinenage]

The right hon. Gentleman is absolutely right. I shall talk about research in a moment, but childhood cancer research is currently the Cinderella of cancer research and we need to do much more to address that.

Once a child has been diagnosed, the gruelling process of treating the cancer begins. Between 1997 and 2018, only 18 new drugs were approved for 22 paediatric oncology indications, and they were generally for quite specific or relapse cases. That means many children are often given the same treatments as adults—incredibly aggressive chemotherapies and radiotherapies—and in many cases children’s treatments have not changed for decades. Even if the cancer is beaten, the child’s body is often so ravaged by the treatment as to leave long-term impacts from which they may never recover.

[John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)]

My hon. Friend is speaking remarkably passionately about this important issue, about which many of my constituents have been in touch with me. They include Julie and her son George, and Leah and her son Toby—both children are suffering and living with cancer. Does my hon. Friend agree that much more needs to be done when children finish the course of treatment to support not only the child but the family, in terms of their recovery from the physical and emotional impact of the treatment?

[Dame Caroline Dinenage]

My hon. Friend makes an excellent point: there is such a huge impact on families who support a child through cancer and we need to look at how we support them in the round.

I have heard from parents of children who are known as cancer free—so they are probably counted as a success statistically—yet some of them are still in hospital because of the disastrous impact of the treatment itself. Very many survivors are left with long-term hormone deficiencies, some of which are life threatening. Survivors can also experience neurological, behavioural, cognitive and visual impairment. The St Jude Hospital in the United States takes an annual survey of former patients. By the age of 50, they all—100% of them—have life-altering health issues, from fertility issues to severe neuro-disability. I would love to know whether similar surveys happen here and whether the conclusions are the same.

As other Members have said, it is vital to find better treatments specifically for children, which means better research is vital. Children’s cancer is fundamentally different from adult cancer in that so much of it is developmental rather than environmental. The good news is that progress is within our reach—there is so much potential in immunotherapy and genomics—and the even better news is that the UK has a fantastic research community and the most comprehensive database of childhood cancer genomes anywhere in the world. The bad news is that paediatric oncology research is the absolute backwater of cancer sciences. It does not have the focus, the money, the public relations or the prestige of other forms of research. Until there is a concerted effort to change that, children like Sophie will be failed.

I expect the Minister to tell me today that great progress has been made on the cancer survival rate among children. Seventy years ago, children simply did not recover or survive a cancer diagnosis; now around 80% do. But the figures belie the fact that for many cancers, including the rhabdomyosarcoma that killed Sophie, the survival rate is as low as 20%. For another cancer, DIPG—diffuse intrinsic pontine glioma, which is a form of brain tumour—the survival rate is 0%. It is literally a death sentence. Can you imagine being that child? Can you imagine being that parent?

There is no doubt that research investment drives survival rates. Since 1960, the survival rate for childhood leukaemia has improved from 10% to 80%. By contrast, only two multinational clinical trials have ever taken place for rhabdomyosarcoma. With only 60 cases diagnosed in the UK per year, there is very little scientific evidence or appetite to develop and complete clinical trials. It is of no interest to big pharma. So we need to look much more imaginatively at how the National Institute for Health and Care Research can encourage more research in such types of cancer.

We also need to look at how new treatments can be brought forward much more quickly. I met Kevin and Karen, who lost their son Christopher just days before his sixth birthday from an aggressive form of brain tumour. They raised concerns about the EU paediatric regulations, which they feel are outdated and do not reflect the latest technological advances. Now that we have left the EU, we have the opportunity to produce new legislation that will incentivise world-leading pharmaceutical products, especially for children, and we need to take that opportunity.

Today, I ask the Minister to start a children’s cancer mission. We have seen from the incredible work on brain cancer inspired by our much-loved former colleague Tessa Jowell how much progress can be made when we are galvanised to bring together the best of Governments, charities, research, academics, medical and science into centres of excellence.

[Steve Brine (Winchester) (Con)]

My hon. Friend is speaking beautifully and powerfully, as always. When the late Baroness Jowell came to see us at the Department of Health, we got the clear impression that she would not take no for an answer. She recognised that although research funding was important, the thesis around which the research proposals were then taken forward was the key. She galvanised the brain cancer and tumour charities into bringing that forward, and that has revolutionised the number of proposals on which they conduct research. Does my hon. Friend agree that we need to do that across the board in cancer, but specifically in paediatric oncology?

[Dame Caroline Dinenage]

My hon. Friend makes an excellent point. I know that, as a former Minister responsible for this issue, he cares about it deeply. I want to bring everybody together in centres of excellence to make sure that we can galvanise everything to that point. I assure my hon. Friend that we will not take no for an answer either.

I am keen for the Government to look at progress in the Netherlands, where the Princess Máxima Centre for paediatric oncology has brought together the care for children and their families, scientific research, and an academy for health professionals, all under one roof, along with a foundation. The centre has a mission: to cure every child with cancer with optimal quality of life. The Government’s 10-year plan for cancer is a once-in-a-generation opportunity to move the dial on cancer outcomes. Will the Minister agree, as part of that work, to look at a children’s cancer mission? Will she bring together a working group of paediatric oncologists, charities, parents and young cancer survivors to formulate a plan to drive forward the work on how we detect, treat and care for children with cancer?

[Several hon. Members rose—]

--- Later in debate ---

[Dame Caroline Dinenage]

I thank all hon. Members from both sides of the House who have supported this debate. In some cases, they have shared their own experiences and, in other cases, they have shared the incredibly sad and touching stories of their constituents. Other hon. Members wanted to be here to raise their own cases, including my hon. Friend the Member for Moray (Douglas Ross), who wanted to talk about Abbie’s Sparkle Foundation.

The stories have been incredibly difficult to listen to, but as hard as they are to hear, they are infinitely harder to go through. Families up and down the country who have been supporting children with cancer go through that every single day. I would like this debate to be a tribute to those children. The hon. Member for North Antrim (Ian Paisley) said that we have to be the voice of the voiceless, which is what we are all here for. It is not enough to pay tribute or say that we have listened. Actions speak louder than words.

The Government’s 10-year plan for cancer is a once-in-a-generation opportunity to move the dial on children’s cancer outcomes. It is a chance to shine a spotlight on this often devalued and much neglected area of medical research. The Minister talked about the research that is ongoing, but it is nowhere near the research that is going on in many other forms of cancer. It is a Cinderella and a backwater of research, which is not good enough.

The 10-year plan is a chance to introduce the mission on childhood cancer, which could really make a difference and save lives in future. It is a chance to introduce Sophie’s mission, Rayhan’s mission, Ebony’s mission, River’s mission, Alice’s mission—a mission for every single child whom we have heard about today and all the others yet to come. We have to stop failing children like this.

Question put and agreed to.

Resolved,

That this House has considered childhood cancer outcomes.

[Mr Deputy Speaker (Mr Nigel Evans)]

We will pause momentarily while hon. Members leave the Chamber.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 19th April 2022 Commons Chamber

[Sajid Javid]

The hon. Lady is right to talk about the importance of tackling health inequalities; on that we absolutely agree, and I hope she will contribute to the health disparities White Paper that I mentioned a moment ago. However, it is wrong of her to suggest that some of the current challenges we face are because of under-investment or because of a smaller workforce than otherwise. We have the largest investment ever going into the NHS. Its budget this year is bigger than the GDP of Greece. It is the highest amount ever, rising by billions each year. We also have more going to social care than ever before, and the highest level of workforce that the NHS has ever seen in its history.

[Dame Caroline Dinenage (Gosport) (Con)]

Surely one of the cruellest health inequalities is in fertility treatment. Of the 106 CCGs in the country, only six limit the age at which women can have in vitro fertilisation treatment to 35, and two of those are in Hampshire. Will the Secretary of State meet me to discuss how we can end that most devastating of postcode lotteries?

[Sajid Javid]

My hon. Friend is right, and of course I will be happy to meet her and discuss this further, but I can also tell her that that is one of the key things we will be covering in our upcoming women’s health strategy.

Health and Care Bill

Caroline Dinenage Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[Edward Argar]

My hon. Friend makes an important and highly relevant point. I will certainly pass his request on to colleagues in the Ministry of Justice and the Attorney General’s Office to look at that and, hopefully, meet him to discuss it further.

We are accepting amendments in a number of other areas to improve the quality of services that the NHS provides. First, we are tabling amendments to ensure the full operability of the noble Baroness Hollins’s amendment—Lords amendment 91—on mandatory training on learning disabilities and autism. We have discussed and agreed the changes with her and are content that her amendment, along with our Government amendment, will legislate that all health and social care providers who carry out regulated activities ensure that their staff receive specific training on learning disabilities and autism.

[Dame Caroline Dinenage (Gosport) (Con)]

On that amendment, will my hon. Friend join me in paying tribute to the many people who have campaigned for learning disability and autism training for health and care professionals? I think specifically of Paula McGowan—the training will be named after her son, Oliver McGowan. Training frontline health and care professionals to have a better understanding of learning disability and autism will certainly improve people’s interactions with our health and care services, and it will save lives.

[Edward Argar]

I am happy to join my hon. Friend in paying tribute to Paula McGowan and all those who have campaigned for this and other amendments that the Government have been able to accept to the Bill. It is often easier to pay tribute to right hon. and hon. Members who have championed issues in this House, but often they are merely mouthpieces for those campaigners who have done so much to raise the profile of such issues.

The Government have also taken steps to extend the storage limits for embryos and gametes, removing an existing unfairness. Currently, legislation discriminates between those who have a medical need to freeze their materials and those who do not. Amendments 82, 98, 100 and 122 remove that distinction by introducing a new scheme consisting of 10-year renewable storage periods up to a maximum of 55 years for everyone regardless of medical need. Our proposals were welcomed unreservedly in the other place, and I hope that they will receive a similar reception in this House.

The Government have also tabled a number of amendments in the other place on transparency of payments made and other benefits given to the healthcare sector. Lords amendments 52 to 54, 93, 94 and 97 all deliver on a recommendation from Baroness Cumberlege’s independent medicines and medical devices safety review. They will enable the Secretary of State to make regulations requiring companies to report information about payments or other benefits that they have provided to the healthcare sector.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

I am reminded of some training I had a few years ago, when my trainer said, “Karin, people will often thank you for your brevity at this time of night,” so I shall not detain the House for too long.

As the Minister kindly alluded to, I spent some six weeks in the Bill Committee trying but failing to alter the original Bill from the Back Benches. I therefore praise the work done by my colleagues and others in the House of Lords. The list of improvements that have already been made is impressive. Unlike in Committee, when the Minister batted away every single proposal for change, the Government have adopted some changes and there has been some progress.

We support Lords amendment 90, on palliative care, which is a really difficult and complex subject that involves distressing issues for the people affected. The Government should further consider that amendment.

On unpaid carers, we support the finely crafted solution in Lords amendment 51 to protect carers. The intent behind the amendment is to prevent any further problems with discharge to assess. We need to enhance people’s rights as carers, not take them away. I know from personal experience that the removal of an assessment prior to discharge may result in less priority being given to the assessment once someone has left hospital. Families clearly worry that patients may be “out of sight, out of mind” once they have left hospital. It would be helpful if the Minister clarified the Government’s commitment to ensuring that carers are consulted as part of the discharge process. It is vital that steps go much further than simply “involving” the carer; we need to ensure that the carer is both willing and able to provide care for the patient and that the necessary community services are in place. Community services and primary care are currently badly stretched.

In Committee, I raised many issues relating to the membership of integrated care boards, particularly in respect of their lack of accountability to local people. None of my proposals made it into the Bill, so I was delighted to see that one proposal made it through the House of Lords. We are happy to support the approach agreed in Lords amendment 105, to give some positive recognition to parity of esteem for mental health. The broader issue of who else gets to be on an integrated care board will rumble on for years, but this is a good first step, and we expect it to happen. It is vital that there is a mental health voice on our integrated care boards, but as well as the Minister confirming that he expects that to happen, it would be really helpful if he could clarify what recourse or consequence would be available should that mental health representative somehow be blocked at a local level from serving on the ICB.

Let me turn to the broader issues. As I said in Committee, this is fundamentally another NHS reorganisation Bill. It is a restructuring of the NHS and a centralisation of power within the NHS. It does not nothing to achieve integration and nothing to improve accountability to the public, to patients and to communities. With the publication of the Ockenden report and the deeply worrying staff survey and patient satisfaction surveys, it is not a good day for the health service. It is clear that centralising control in the NHS is very much the wrong approach. Local representatives need much more power over local services, and accountability needs to be much better at a local level.

The Bill also does nothing to improve the appalling state of social care provision. No wait for care will be shortened because of this Bill and nobody excluded from care will now receive it, but we do now have a Bill that lays to rest the worst of the Health and Social Care Act 2012, the Lansley Act. Those of us who were on the other side of that Act and its implementation—in fact, it was that Act that brought me to this place, so appalling was it—and who fought and campaigned against it really should be having a bit of a party to celebrate the disappearance of some of the worst excesses of that Act.

With the changes to procurement and the many assurances given from the Government Dispatch Box, the main threats detected in the original Bill have largely been allayed. Compulsory tendering has gone; we have preferred provider in all but name. Procurement from the private sector must now be on a proper, open and transparent basis, which means no more crony contracts or jobs for friends and family, and Virgin Care and other large corporates no longer influencing commissioning.

With Lords amendment 11 excluding private interests from commissioning, we see a dramatic shift that is most welcome. We may start to get back to a public service model. That could start a journey to build an NHS where adequate investment and support means that patients do not have to start relying on the private sector.

The most serious issue in this bunch of Lords amendments has been ducked. The dead hand of the Treasury has clamped down and common sense has departed. Shoehorning the change in the calculation of contributions to the care cap into the Report stage of this Bill was parliamentary sharp practice of the highest order, designed to minimise scrutiny and stifle criticism. Our position is encapsulated by Lords amendment 80. This provision should never have been in the Bill. It is hugely significant to our constituents, and it has never been properly considered and cannot be today. I listened very carefully to the Minister outlining various scenarios. I, too, could outline various scenarios from the Dispatch Box, but I will not do so today. This is not the place to do that; there needs to be proper consideration and proper scrutiny. The Department has sneaked out the view that restricting contributions to the cap for those being means-tested for their care charges would save an estimated £900 million by 2027-28 in cash terms. Surely that means that there is time to look at this properly, and we are willing to work with the Government to do just that.

Let us be clear: if that is the true estimate, then that is what the Treasury is talking about saving from the poorest—from working-age adults with a disability and older people with few assets. That is where that money comes from. That is not fixing social care; that is asking people with less to pay more to protect the assets of the wealthiest—the less a person has, the more the Treasury will take.

Members of Parliament from across the north-east of England, Yorkshire and the Humber and the midlands really need to take note, because, from what we can gather at the moment—we do not know enough about this to be totally clear about how it impacts people—it looks like those areas will be worst hit by the Government proposals. Why are those MPs not here? Why are they not outraged by this? I suspect that it is largely because they do not know, and the Government do not want them to know. It is so hard to follow the detail of this.

It has been almost 3,000 days since the Care Act 2014—a carefully crafted piece of legislation, agreed across party lines and after a huge engagement with stakeholders— was granted Royal Assent. If the calculation towards the cap is to be changed, that change must come the same way, through cross-party working with the sector, patients and people involved, understanding the evidence on impact and considering the consequences—not through this half-arsed addition to an NHS reorganisation, which is essentially what the Government are doing.

If the Government are determined to leap into action, they should accept amendment 81 and get on with implementing the Care Act and the Dilnot proposals as originally agreed. I followed the implementation of the Act very carefully when I came to this place in 2015, and I think I have heard from the Government Dispatch Box today for the first time that it was never agreed, that it was undeliverable and not financeable. That is not what the people producing the Care Act or the Conservative Government of the time led us to believe. They moved the implementation to April 2020, expecting there to be a general election in that year, and never really came back to explain the rationale.

We will not get mired in details tonight because, as I said earlier, this is not really the place for it, but our constituents are being led up the garden path by this Government. This place should be considering the proposals properly. That is what the Lords have asked us to do, and the Opposition will support them in doing that. This question is too important to be left to a last-minute addition.

[Dame Caroline Dinenage]

I will speak briefly in favour of Government amendment (a) in lieu of Lords amendment 51. I draw hon. Members’ attention to my entry in the Register of Members’ Financial Interests and the fact that I am co-chair of the all-party parliamentary group on carers. My predominant interest is that this is a cause that I care very deeply for.

Ultimately, the aim of Lords amendment 51 is to focus on carers and the safe discharge of hospital patients. The Government’s amendment (a) in lieu will achieve most of what the noble Baroness Pitkeathley originally attempted to achieve in her amendment, ensuring that carers are involved at the point of hospital discharge.

Across the UK today there are about 6.5 million carers supporting a loved one who may be older, disabled or seriously ill. That is one in every eight adults providing unpaid care for their family or friends, whether around the clock or for a few hours a week. It is an enormous contribution and saves the health and social care system billions of pounds a year. It has an untold impact on carers’ own lives and livelihoods, but for the people they care for, it is literally a lifeline.

The amendment in lieu recognises the vital role that carers play and avoids any suggestion of their losing their rights, which could have been an unintended consequence with the wrong wording. It is important that carers are recognised in this legislation; it is clear that the Government have listened and reflected the strength of feeling about that, and I am grateful. We must do more to equip carers to care safely and well, and to juggle other aspects of their lives. That is why the requirement to consult carers prior to patient discharge is so important. The Lords amendment had cross-party support in the House of Lords, and I hope the amendment in lieu will achieve the same thing in the Commons.

According to Carers UK, there are still some worrying statistics on discharge: 56% of carers were not involved in decisions about discharge from hospital and what care and treatment the person they cared for needed, 82% of carers did not receive a carer’s assessment and 68% of carers were not asked about their willingness and ability to care at discharge. I am sure the House will agree that those are deeply distressing statistics, and that we have a lot of work to do to address them.

There are a few important points of clarification and assurances that I would like from the Minister. He mentioned earlier that young carers were covered, but the language is a little opaque, so can he confirm for me that he is talking about not only young carers who are looking after adults, but young carers who might be caring for brothers or sisters? Some young people perform that incredibly difficult task at enormous disadvantage to themselves, and I want reassurance from the Minister that this House and this Government have not forgotten them.

The second point of clarification is that the original amendment 51 included a test on whether a carer was willing and able to care, as in the Care Act 2014, and I want to ensure that this amendment in lieu will secure that. There are also important clarifications to be made around what “feasible” means; I hope the Minister can help me with that, so that carers are absolutely sure what he means by their rights.

Unpaid carers are so often invisible, their efforts unacknowledged, and I am pleased to see the Government taking steps to address that through their amendment in lieu. It is a start. There is much further to go to give unpaid carers the support and recognition they need—that is a discussion for another day, but it is a discussion I intend to have.

Adult Social Care

Caroline Dinenage Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

There is money to invest in the sustainability and professionalisation of the workforce. Local authorities have a local government settlement for this three-year period. We are exploring a number of options and we will set out further detail at the local government finance settlement later this year. That is when the hon. Gentleman will hear more about the costs that councils will have.

[Caroline Dinenage (Gosport) (Con)]

I congratulate my hon. Friend on bringing forward this milestone piece of work. It really is very long awaited. The devil, of course, is in the detail, and I look forward to reading that detail with great interest. I know she recognises that the care cap alone will not solve the adult social care crisis. We need imaginative and bold system reform. We need much better integration, and, above all, a plan to improve how we recruit, retain and value the care workforce and the army of unpaid carers out there. It is a massive task, but I know she is up to it. I am really keen to get her reassurance that once and for all, we have the Government’s commitment to fix this problem.

[Gillian Keegan]

I thank my hon. Friend for all her work in this area. Obviously, I have just come in at the end of the journey and many, many people have been working on this issue for many, many years. They should all take credit for that work and for reaching this point. She has my firm commitment that the Government are absolutely committed to fixing social care. As I said, we cannot level up without fixing social care, and of course we all have a vested interest in having a very good social care system.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Gillian Keegan]

We will certainly be looking at all those points within guidance. Local authorities have a duty to assess the needs of young carers under the Children and Families Act 2014, and that duty has remained in place throughout the pandemic. Authorities must ensure that young carers are identified and referred to appropriate support if needed, and that the young carer is not taking on excessive or inappropriate care and support responsibilities. We have also announced an additional £1 billion of new recovery premium funding, which schools can use to support young carers’ mental health and wellbeing, alongside their academic recovery.

[Caroline Dinenage (Gosport) (Con)]

The carers action plan published in 2018 was a two-year cross-Government attempt to try to change the way we identify and support the millions of unpaid carers across our country. They save our health and care system a fortune, but for their loved ones they are literally the world. What plans are there to publish a progress report and set out the next steps for how the Government intend to keep focused on this really important issue?

[Gillian Keegan]

I pay tribute to my hon. Friend for her work in this role and also to all unpaid carers. There are 5.4 million unpaid carers in England and they do a fantastic job. In the forthcoming Bill that we are co-producing with unpaid carers, we will make sure that we continue to make progress in this area. I look forward to sharing that with her before the end of this year.

Health and Care Bill

Caroline Dinenage Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Caroline Dinenage (Gosport) (Con)]

I rise to speak on new clause 49. For 40 years, successive Governments have tried desperately to address this issue, and successive Governments have put it in the “too difficult” pile. It is incredibly expensive, it is hellishly complicated and, to put it simply, there is no silver bullet to address all the concerns surrounding it. That is why I am so proud that this Government have made an attempt to grip this issue.

The fact is that what happens to us in old age is entirely random, and whether we incur catastrophic care costs that wipe out everything we have worked for in our lives is often down to luck. The current system is complex, it is unfair, many people simply do not understand it, and that has been compounded by the fact that successive Governments—nobody is blameless—have used unhelpful language such as “death tax” and “dementia tax”, which have made people terrified of the issue and blown any Government’s attempts to try to solve it out of the water.

Such language strikes fear into people’s hearts about what will happen to us when we are elderly, when we are vulnerable, when we cannot look after ourselves any more. As humans, this is something we do not want to talk about. We do not want to consider it or think about it happening to us; not for us the slow decay, the hellishly expensive degeneration, which affects perhaps four in 10, with the catastrophic amounts of money involved affecting perhaps one in seven. That is why insurance models have never really worked.

The new clause looks to amend the cap on care, basically, where the local authority costs should contribute to the metering towards the cap. I have to be honest: I thought really hard about whether I could support this. Many people, including the brilliant Andrew Dilnot, have pointed out the financial inequalities and some of the geographical inequalities of removing the local authority contribution. As local authority contributions differ by area already—they are much higher in better-off areas—there is already a postcode lottery of care depending on where someone lives. We have to address that. The key thing here is not the cap, but the floor. Those with lower property values will be protected by the floor, not the cap. The reforms increase the threshold above which people must meet the full cost of their care from £23,000 to £100,000—more than four times the limit. The daily living costs limit of £200 per week means that more people will keep more of their income and assets and the package includes domiciliary care, which many others have not done. It is not perfect—it is far from perfect—but everyone who is contributing towards their social care today, and those of us who face the uncertainty of this possible spectre in our future, will be better off than they are now. That is why we have to move forward in a way that is deliverable and that we can finally, for once, get over the finishing line, after 40 years of trying.

There are details that need to be fleshed out. The White Paper just cannot come soon enough and I wish to mention two burning issues in particular. The first is how we support working-age adults, who make up more than half of those who need adult social care. Some people need that care throughout their lives; for others it happens to them unexpectedly. How do we support the people of working age for whom care costs are not paid out of a nest egg, which they might have been able to build up over decades of work? Finally, the biggest issue facing adult social care is the workforce. This job is significantly undervalued. It is too often described as “unskilled”. That drives me mad. These people have unbelievable skills. They have experience and passion, and we entrust our most valuable and precious family members into their care and their hands. Frequently, they just make more money in hospitality or retail. How do the Government create a society that values these heroes for what they are? I look forward to reading the White Paper and seeing how the Government will tackle some of these thorny issues, the most intransigent challenges facing our adult social care system, because for those money alone will not be enough.

[Daisy Cooper (St Albans) (LD)]

I would like to start by talking about social care. The Liberal Democrats have long called for reform to properly integrate health and social care services, but this Bill does not do that. As others have mentioned, it seeks to reorganise parts of the NHS, but it pays lip service only to social care. That is why the Lib Dems think that the Bill should be put on hold until the proper social care reforms are brought forward.

As others have mentioned, it has been months since the Prime Minister announced his plan to fix social care. It is unforgivable that this new clause was sneaked out during the sleaze row last week, in a move that changed the goalposts. The Minister would do well to listen to the unease among his Back Benchers as well as among Opposition Members.

Struggling families now face being hammered by a double whammy of unfair tax rises and the prospect of losing their homes to fund care costs. The right hon. Member for West Suffolk (Matt Hancock) is no longer in his place, but I noted that he selectively quoted Andrew Dilnot. He did not quote Andrew Dilnot’s comments on new clause 49. Andrew Dilnot said that that proposal was not welcome. He said that he was very disappointed and that this represented “a big change” that

“finds savings exclusively from the less well-off”.

That is two promises from this Tory Government now broken.

There is also no mention in this Bill of the millions of people who are unpaid carers in the UK, even though we know that carers are twice as likely to experience ill health as a result of caring. That is why I have tabled new clause 63 for debate tomorrow. It is supported by Carers UK and it calls for the NHS to ensure that the health and wellbeing of unpaid carers is taken into account when decisions are made concerning the health and care of the person for whom they care. I hope the Government will support it. I know it is grouped for debate tomorrow, but I reference it now to highlight again the fact that the Bill does not present a comprehensive plan to reform social care.

The Bill also represents a massive and unnecessary power grab by the Secretary of State. It is simply wrong for the Government to have the power to abolish arm’s length bodies and approve or reject the chairs of integrated care systems. The public have been rightly outraged at political meddling in covid contracts, and the Government should learn their lesson. We should all be seeking to protect the independence of the NHS.

Vacancies in the NHS and social care are utterly staggering. We know the numbers: 100,000 vacancies in the NHS and more than 120,000 in social care; and 1.5 million people missing out on the care they need. We simply cannot go on like this, with the Government setting their own sporadic targets and constantly missing them. NHS waiting lists are at a record high. Ambulance services received a record number of calls in October. Major A&Es treated more than 1.4 million people in October—the third highest monthly figure on record.

The Bill will do nothing to get those waiting lists down, nothing to recruit the workforce we need, nothing to help people get seen faster and nothing for the millions of unpaid carers. The Government should delay the Bill for a few months and look properly at reforming social care, rather than doing a half-baked job now. But I do not think they will, and that is why the Lib Dems will vote against it.

Oral Answers to Questions

Caroline Dinenage Excerpts

Tuesday 19th October 2021 Commons Chamber

[Sajid Javid]

The hon. Gentleman may have heard me say a moment ago that, of course, cancer remains a huge priority for the NHS. Very sadly, there have been people who have waited longer than 62 days after urgent referral. The number has come down considerably in the past year, to 19,000 as of May 2021, but that is still 19,000 too many, which is why the NHS is rightly committed to clearing that completely by March 2022. That requires a lot more investment. There is the additional £34 billion this year, but it requires long-term, sustainable investment, which is why the plan we have announced for long-term funding over the next three years, with additional funding of at least £12 billion a year for health and care, will make a real difference.

[Caroline Dinenage (Gosport) (Con)]

3. What steps the Government is taking to improve health outcomes for people with learning disabilities and autism.

[The Minister for Care and Mental Health (Gillian Keegan)]

I thank my hon. Friend for her work as the Minister for Care and particularly for starting the work on the Oliver McGowan mandatory training. We are currently trialling the training to improve awareness and understanding of learning disability and autism for all health and care staff. The improvement of health outcomes for people with learning disability was also championed by our dear friend Sir David Amess; I shall think of him every day in this role and try my very best to live up to his expectations.

[Caroline Dinenage]

I warmly welcome the Minister to her role, which I know she will do with great care. Will she expand a little on the roll-out of the mandatory training for all health and care professionals working in learning disability and autism, which is, as she knows, named in honour of Oliver McGowan? Will she say when it is likely to be rolled out nationwide and what sort of funding will be attached to it? Will she also say when the annual GP health checks for people with learning disability or autism are likely to be rolled out throughout the country on a face-to-face basis post covid?

[Gillian Keegan]

We have started the trials and they are well under way. We are using three trial providers. Our final evaluation report is due in spring 2022 and I would be very happy to share that with my hon. Friend. The outcomes of this trial and the evaluation will inform the plans for the roll-out across the country. I am working closely with Paula and Tom, Oliver McGowan’s parents, who, incidentally, grew up in the same place that I did—in fact, two streets away. They are key stakeholders and, obviously, we will make sure that we set out the detailed plans for roll-out as soon as possible. I thank my hon. Friend and Paula and Tom for all the work that they have done in this area; it really is remarkable and will make a massive difference. On the annual health checks for people with learning disabilities, the NHS has already met its target two years ahead of time for 75% of people on the GP learning disability register to receive an annual health check. I would urge anybody to come forward to make sure that they take advantage of that very important step.