New Dementia Treatments

Damian Green Excerpts

Thursday 11th January 2024 Westminster Hall

[Damian Green (Ashford) (Con)]

I beg to move,

That this House has considered the matter of new dementia treatments.

It is a great pleasure to serve under your chairmanship, Mr Sharma. I thank the Backbench Business Committee for giving me the chance to introduce this debate.

It is timely to be having this debate at the beginning of this year because in 2024, almost for the first time since dementia became an increasingly widespread condition as people live longer, there are the first glimmers of hope. Alzheimer’s Research UK, which is one of the leading dementia charities, alongside various others such as Dementia UK, is openly talking about a tipping point. We must hope it is right, because the cold statistics and the human cost of dementia show that we desperately need progress on diagnosis and treatment for the set of diseases that cause the condition.

The figures are stark: nearly 1 million people in the UK live with dementia, and on current trends that number will have increased to 1.6 million by 2050. As I speak, in the UK there are no treatments that can slow, stop or cure dementia, and we have been living with that situation for a long time.

We all have constituents who are affected—there are 1,600 people living with dementia in my constituency of Ashford—but I first took a special interest in this issue for the worst possible reason: my father suffered from dementia in his last few years, so I saw close up and over a long time how cruel and debilitating a disease it is, not just for the victim but for the families and those closest to them. I am conscious that others in the Chamber will have had similar experiences. One in two of us will be directly affected, either by developing the disease ourselves, caring for someone with the condition or, in some particularly tragic cases, both.

The history of this disease could hardly be bleaker. It is the dark side of the historically wonderful fact that life expectancy has been rising very fast in recent decades in not just this country but many other countries too. One of the problems we face is that our health system has not been devised to cope with this disease.

Despite that bleak background, there is now a glimmer of hope—indeed, several glimmers of hope. The first is that new ways of diagnosing the diseases that cause dementia, such as blood tests for Alzheimer’s, are showing promise. The second, and the main cause of optimism among those who are involved in dealing with dementia day to day, is the development of treatments that slow the course of the disease. Since the treatments are the new things on the horizon, I will return to that subject in a moment.

The third glimmer of hope is that we are developing new insights that show how we can reduce the prevalence of dementia in the first place by addressing the factors that affect our brain health over the entire course of our life. I was fascinated to read that some experts think 40% of dementia cases worldwide could be preventable. That is clearly a long-term figure that we should bear in mind.

Although all three of those changes are important, for the purpose of today’s debate I want to concentrate on the treatments.

[John Spellar (Warley) (Lab)]

I congratulate the right hon. Member on securing this important debate. Is there not an enormously important fourth strand of this: effective management of the condition and the various aids, adaptations and regimes that enable people to continue to function longer, for the benefit of themselves, their families and wider society?

[Damian Green]

The right hon. Gentleman is completely right. There are new management techniques. I did not want to extend the debate too widely, but I am struck by the way that technology—not cutting-edge technology but technology available to all of us, such as smart speakers—can remind people that they need to take a red pill at 11 o’clock or remind relatives that the fridge has not been opened for five hours, meaning that someone has forgotten to take out their lunch. It can help with all those kinds of day-to-day issues and, if used properly, enable people to live in their own homes for longer, even if they are suffering this disease. I agree that that is a very important potential set of breakthroughs.

[Matt Hancock (West Suffolk) (Ind)]

I am grateful to my right hon. Friend for giving me the opportunity to add my voice in support of more research in this area. Is it not the case that, despite improvements, the amount of money spent on research and the structuring of proper research trials—which, by their nature, have to go on for many years—is a drop in the ocean compared with the savings we can make in the health system, improvements to people’s lives, and in the social care system? Is that not yet another motivation that makes this topic incredibly important?

[Damian Green]

My right hon. Friend has huge expertise over the entire health field and therefore in this area as well. He is completely right, and I will come on to savings, particularly potential savings in the social care budget as well as the health budget, in a couple of minutes. It is one of the points I want to emphasise to the Minister.

To return to the treatments, the Medicines and Healthcare products Regulatory Agency has already started consideration of lecanemab and donanemab—I wish treatments had more pronounceable names—two very important breakthrough drugs, and I believe a final decision is expected by the middle of this year. Inevitably, at this early stage of the development of drugs in any particular field, there are many more out there. Another 140 drugs are undergoing clinical trials around the world at the moment. They will not all work, but some of them will, so in scientific and research terms, this is genuinely an exciting period in this field.

Perhaps the most significant point I want to make to the Minister is to express the hope that the way in which the system decides whether to approve a drug is fit for purpose for this type of drug. That is genuinely in question and gives rise to the point my right hon. Friend the Member for West Suffolk (Matt Hancock) made about costs. There are inevitable gaps in our knowledge about the efficacy of new treatments in an area where, up to now, there have been no treatments. Much of the usual comparative work one would expect to be done in clinical trials cannot be done in these circumstances, so there is a task for Ministers to make sure that NHS bodies and the industry develop a joint plan to allow these new treatments to be available to the NHS at a reasonable price.

There is also an important specific point that could affect whether the National Institute for Health and Care Excellence gives financial approval to these treatments in the first place. The bulk of the current costs of dementia falls on the social care system, particularly on unpaid carers. Estimates suggest that around £22 billion a year of costs fall on informal or formal social care. The direct costs to the NHS are only £1.7 billion a year—a small fraction of the cost to the social care system. The current NICE assessment process will take into account only the NHS costs, and clearly that could adversely affect a decision about whether drugs are affordable.

Whether the current NICE system provides the proper result for this type of drug and disease would be questionable at any time, but it is particularly questionable when other arms of government are concentrating on getting more working-age people back to work. More than 1 million people between the ages of 25 and 49 are out of work because of caring responsibilities, and some of those will be caring responsibilities for people suffering from dementia, perhaps in its early stages, when we are not using technology well enough to allow people to lead more or less normal lives.

[Mr Philip Hollobone (Kettering) (Con)]

My right hon. Friend is making an excellent speech and a particularly pertinent point about NICE considering only the cost to the NHS. Is that not even more surprising given that NICE stands for “National Institute for Health and Care Excellence”? Clearly, the guidelines need urgent revision.

[Damian Green]

I am delighted to have my hon. Friend’s support. Since the old Department of Health was renamed the Department of Health and Social Care, it has been particularly important that, in all its manifestations, and indeed in all the manifestations of the bodies that report to it, the Department should reflect the treatment of health and social care as equals. That is a wider point that my hon. Friend should not tempt me to; I can go on at great length about it, and do not wish to in this debate.

As I said, caring responsibilities are a significant reason why so many people of working age are not working. I cited the figure for those between 25 and 49, but if we extend the age range up and down, less than a fifth of people who care for someone with dementia are in paid work. If someone is caring for someone with dementia, it is very likely that they will not be in paid work. I am grateful that others support my point that NICE should be instructed to consider the full cost of dementia to social care, as well as the NHS, to arrive at a proper evaluation of the economic case for the new treatments.

The prospect of these drugs becoming available also throws a spotlight on the need for better and, in particular, earlier diagnosis. At the moment, the drugs are effective only in the early stages of Alzheimer’s, and there is nothing like enough capacity for timely diagnosis. The latest NHS figures suggest that more than a third of the over-65s estimated to have dementia do not have a recorded diagnosis at all. There are significant regional variations within that figure. Some areas of the country are much worse: for example, diagnosis rates in Herefordshire and Worcestershire are as low as 53%. There is also evidence that minority groups, including black people and those of south Asian heritage, have higher rates of under-diagnosis. Without an increase in the effectiveness and timeliness of diagnosis, the beneficial effects of the new treatments will therefore be massively reduced.

For the new hopes I am discussing to be realised, we therefore need a revolution in our diagnostic capacity. At the moment, the most effective ways of diagnosing dementia—namely, PET scans or lumbar punctures—are accessible only to 2% of those seeking a diagnosis. The best short-term solution is to increase access to lumbar puncture, which is much cheaper and more scalable than expanding the expensive scanning equipment. Alzheimer’s Research UK suggests that the annual capacity for lumbar punctures should be increased from 2,000 to 20,000 a year. I am conscious that the Government are analysing the responses to the consultation on the major conditions strategy and that dementia is one of the six conditions covered by the strategy. My appeal to the Minister on that front is that, as we do in many cases in health and social care, we think at least as much about prevention as we do about cure.

Given the demographic pressures, it seems unarguable that, if we carry on as we have done since the NHS was created, concentrating almost entirely on treatments while relatively neglecting public health and preventive measures, we are heading for even more difficulties in the long run. But that is a much wider debate. In the specific area of preventing dementia, a number of factors, including hearing loss and high blood pressure, can and should be part of a preventive approach, which would reduce demand for expensive treatments in the long run and, even more importantly, allow people to continue to lead more or less normal lives.

One other point about the new era that we are hopefully entering with these treatments is that, as a country, we are well placed to contribute to the vital research that is needed. We have the scientists and the companies, but too few people are currently aware of the possibilities. Only 2% of people with a dementia diagnosis are currently registered to hear about clinical trials. The total UK share of the current clinical trials for dementia around the world is 7%. I hope that the Government will look at that aspect as part of the overall plan for dealing with dementia, which we are looking forward to.

Before I sit down, I should emphasise that I do not want to be ungenerous or over-critical about the Government’s action in this area. I am conscious that the Government have committed to doubling the funding for dementia research to £160 million by the next financial year, and I also very much welcomed the launch, last summer, of the Dame Barbara Windsor dementia mission; I am glad that the Government have put £95 million behind that. I know, of course, that the Minister and the Government widely recognise the horror of this disease, the fact that it is becoming more widespread and affecting more and more families and the fact that not just more money, but more creative thinking, will be needed to turn the tide.

I want to end on a hopeful note. This generation has the chance to see the end of the terrible situation whereby a diagnosis of dementia is a life sentence of an inevitably long degeneration. This absolutely needs to be a turning point for the millions of people who are touched by this dreadful disease. I hope that the Government and the medical authorities recognise the scale of the opportunity that scientific advance has given to them and all of us. This year could be key to setting the UK on a path to a more hopeful future. I am very confident that the Minister will be determined to lead us on that journey.

--- Later in debate ---

[Damian Green]

I will spare hon. Members the thought that I could go on for another half an hour, I think, under the rules—[Interruption.] I can hear shouts of “More!” from the Minister. I thank all those who have taken part, particularly my fellow APPG chair, the hon. Member for Oldham East and Saddleworth (Debbie Abrahams). There is clearly a Venn diagram with an overlap between the APPGs on adult social care and on dementia; we share an interest in this as chairs, as well as an interest driven by personal history.

I hear what the Minister says about the NICE funding decision-making algorithm. Through her, I urge NICE to be as open-minded as possible as to what costs it takes into account. I do take the Minister’s point that one can perhaps extend the boundary of what costs are caused by any particular medical condition beyond what is reasonable. However, I think the costs to the economy of those who are not working only because they are caring for someone with dementia are a genuinely legitimate cost that could be taken into account when assessing the economic viability or effect of introducing a particular treatment. I hope that the NICE guidelines can reflect that. Otherwise, I am very grateful to have had the chance to raise these subjects in this debate.

Question put and agreed to.

Resolved,

That this House has considered the matter of new dementia treatments.

NHS Long-term Workforce Plan

Damian Green Excerpts

Monday 3rd July 2023 Commons Chamber

[Steve Barclay]

It is simply not correct to say that this is simply about flexibility—for example, look at the very significant changes made on pension tax. That was the No.1 demand of the British Medical Association consultants committee, and the Government agreed to it. A significant amount of work is going on. The NHS people plan talked about not just flexibility but some of the cultural points that are important. Some roles that have been introduced need to expand, such as some of the advanced positions like advanced clinical nurse or physician associate, where there are opportunities for people to progress their careers. It is worth pointing out that, once again, not a single Welsh Labour MP has turned up to defend their party’s record in Wales. As we set out a long-term workforce plan, we are setting out that ambition for England, but we see very little from the Labour party in Wales.

[Damian Green (Ashford) (Con)]

I congratulate my right hon. Friend on this welcome announcement. I was happy to join his celebration of the 75th anniversary in the most practical way by visiting the new children’s emergency department at the William Harvey Hospital in my constituency. It is opening for patients this week and will be extremely welcome. He will be aware that some of the problems of the NHS can be solved only if we solve problems in the social care system as well. I urge him to follow up this extremely useful and welcome workforce plan for NHS workers with a similar idea for the social care system, because unless we fix one, we will not fix the other.

[Steve Barclay]

My right hon. Friend makes a valid point about the integration between health and social care, and that was a flagship part of the reforms in 2022, which brought the NHS and social care together through the integrated care system. I join him in welcoming the news about William Harvey Hospital, which is extremely important to the local area. On social care more widely, we must also be cognisant of the differences. The NHS and social care employ roughly similar numbers at around 1.5 million people, but one is one employer and the other is 15,000 employers, so the dynamics between the two are different. The prioritisation of that integration is exactly right. That is why my right hon. Friend the Chancellor announced up to £7.5 billion for social care in the autumn statement, recognising that what happens in social care has a big impact on discharge in hospitals and hospital flow, which in turn impacts on ambulance handovers.

Covid Pandemic: Testing of Care Home Residents

Damian Green Excerpts

Wednesday 1st March 2023 Commons Chamber

[Helen Whately]

There has already been a legal investigation into some of the aspects that we are talking about today. Given the huge number of decisions that had to be made and the period of time that we are talking about, the right way to do this is to bring all the evidence together, in the form of a public inquiry, and have it fully examined. That is the best way to answer the sorts of questions that the hon. Lady suggests.

[Damian Green (Ashford) (Con)]

This is a profoundly serious question—literally a matter of life and death. As such, I am sure that my hon. Friend is right to say that the appropriate way to reach conclusions is through a proper public inquiry conducted by a very distinguished judge. Can she assure the House that the Government will be as transparent and as open as possible in giving evidence to that public inquiry, so that we can all be confident at the end of this that we have reached the appropriate conclusion?

[Helen Whately]

I can absolutely assure my right hon. Friend that the Government are sharing with the public inquiry a huge quantity of evidence so that it can reach the best possible, best informed conclusions.

Social Care

Damian Green Excerpts

Thursday 24th November 2022 Westminster Hall

[Damian Green (Ashford) (Con)]

I beg to move,

That this House has considered the matter of social care within local communities.

I thank the Backbench Business Committee for allowing me this debate, and it is a great pleasure to serve under your chairmanship for the first time, Ms Ali. I am particularly pleased to see the Minister back in her rightful place, although she will know that now she has taken on responsibility for care, she will have me on her back for as far ahead as the eye can see while she is doing this job.

Much of what I want to say will be unusually positive about what social care offers communities. I am conscious that the social care debate is often surrounded by crisis and difficultly—quite rightly—but there are so many positive aspects to it that I want to touch on. As co-chair of the all-party parliamentary group on adult social care, I am struck by how underrated the positive effects of good care can be, not least economically. Given the recent decision to delay the introduction of the payment cap, as recommended in the Dilnot report, I should also take the opportunity to urge the Government to take wider action. I hope they take the chance to conduct a full review of the whole system, not just funding. I welcome the extra money committed by the Chancellor, but it is clearly yet another temporary solution to try to tide local authorities over. I hope Ministers can be creative in finding a stable and sustainable way of increasing the money available to the care sector. I have my own ideas, but this is not the time for them.

Funding is one key issue, but I emphasise to the Minister that it is not the only one. I will identify four other areas where we need new thinking if we are going to “fix” social care, to go back to the phrase used by the last Prime Minister but one. The first is the workforce. It needs to be bigger, by more than 100,000, eventually. To achieve that, it needs to be better paid and have a higher status. I would like to see, for example, nurses in the care sector on the same “Agenda for Change” pay scales as nurses in the NHS. Otherwise, we will continue to lose nurses from the care sector to the NHS.

The second area is the voice of care within the new integrated care boards. This change is a chance to improve the integration of health and care systems without creating another massive bureaucracy, which is too often the effect of integration. At the moment, I fear that the new ICB system is settling down with the voice of care providers being relatively unheard. Local authorities are clearly key players in the system, but so are other providers.

The third issue I hope Ministers can concentrate on is the use of technology, both for sharing information between different parts of the system and for giving those in receipt of care more control over their daily lives. We are not exploiting widely available technology anything like enough, and the prize for getting it right is that more people will be able to stay in their own homes for longer. That is much better for them—it is what the vast majority of people want—and of course for the taxpayer. Given both those imperatives, I think it ought to be a high priority. It is particularly important for people living with dementia, which is a subject worthy of its own debate.

The fourth issue that I want to bring to the Minister’s attention, which expands on the idea of people being able to stay in their own homes for longer, is the provision of housing. I have written to the Minister and the Housing Minister about how we are failing to build anything like enough supported housing for older people, particularly in the form of retirement villages. Our provision is something like 10 times smaller than that of comparable countries. That is another issue that is worth a debate in itself, so I will refrain from going down that rabbit hole, but it could be a hugely important contributor to improving our care system.

The Minister will be aware that the current problems facing the NHS would be greatly reduced if there were a proper plan for social care. Each month, there are 400,000 delayed discharges from hospitals because of a lack of social care support. That has knock-on effects on NHS capacity and on ambulance delays. Something like 13,000 patients should be receiving care in the community but are blocked in hospital beds. At the end of April, some 540,000 patients were waiting for assessments, care packages, direct payments or reviews, so fixing social care will take some of the strain off the NHS and free up capacity for others. In that regard, I am delighted that the Minister is responsible both for care and for hospital discharges. Having those responsibilities in the same ministerial portfolio is an outbreak of sanity and common sense in Whitehall that we should all welcome.

I promised to be more positive than is usual in social care debates, so I want to spend a few minutes highlighting the value of social care to local communities. First, it has a big economic value to local communities. Skills for Care found that it contributes £51.5 billion in added value to the economy of England every year. Although half comes from the wages of social care staff, a large proportion of the economic value comes through harnessing local business to support the provision of social care through access to transport, maintenance, activities and equipment. That creates a cycle of local spending, benefiting local industries and communities.

I am not just talking about professional care. Carers UK estimates that unpaid care provision saves the economy £132 billion a year, which would otherwise be a cost to the state. In other words, it saves an amount approaching what we spend on the NHS every year. The thought of that money being added to taxpayer-funded provision is unthinkable.

Care provides economic value by supporting people to live independent lives. It gives people the ability to control their own finances and in many cases gets them back into employment. Of course, it contributes to overall economic provision. That in turn reduces the number of people relying on benefits, which reduces the welfare budget.

Interestingly, Skills for Care’s figure of £51.5 billion contrasts with the amount that local authorities spend on care, which was £21.4 billion in 2021-22—less than half the economic value. That is instructive, because the wider public perception is always that social care is a drain on public finances, but it is not. It actually has a net economic benefit.

As I said, the care workforce is one of the key areas where we need investment—not just in the recruitment of staff, which is often the focus of these debates, but in the retention of staff. Social care is about much more than having to fix a broken system or act as a bed-clearing service for the NHS. It is about ensuring that there is support to enable older and disabled people to lead the best lives they can, and with as much control over their own lives as possible. The social care workforce is key to enabling that.

Some 1.79 million people work in social care in England, in something like 39,000 different establishments. The problem of recruitment and retention is evident, because we have 165,000 vacant posts in social care, which is the highest number on record and has increased by more than 50% in recent years. The word “crisis” is overused, but it can be legitimately applied in this case, not least because the number of posts filled has dropped by 50,000—the first drop ever in the number of social care workers.

Average vacancy rates across the sector are nearly 11%, which is twice the national average, at a time when we are finding it difficult to fill posts in many areas of the economy. The reasons are not hard to find. A care worker with five years’ experience is paid 7p per hour more than a care worker with less than one year’s experience, and the average care worker pay is £1 less per hour than that of healthcare assistants in the NHS who are new to their roles. It is not surprising that people in the social care workforce are turning to employers who offer more attractive pay rates.

Because of the issue with pay, the providers of social care increasingly have to rely on short-term agency staff. That has an impact on the standard and continuity of care, but it also has a high cost. A market report by Cordis Bright estimates that there will be a 157% rise in agency costs, which will increase from £56 million in 2021-22 to £144 million in 2022-23. If the trend continues, agency staff costs are likely to increase by between £175 million and £220 million by 2023-24. I suspect that the huge cost will result in services being handed back to local councils by providers, which simply cannot cope with such staffing prices.

A report by Public Policy Projects, which I chaired, recommends a number of things that would help the situation, including raising the minimum wage for social care workers, mirroring the NHS “Agenda for Change” pay scales, and positively promoting social care as a technically skilled and fulfilling career. I would support something similar to the Teach First scheme in order to get some of our brightest and best young people into social care and to raise its status, so that people can see that it is fulfilling work and will provide not just a job, but a career. In the coming months, I hope I can persuade Ministers to commit to bringing forward a full workforce plan for social care, with pay progression in line with the NHS, better terms and conditions, training and other structures.

Apart from that, the sector needs support through long-term funding. The Prime Minister and the Chancellor have understood the importance of a long-term strategy and funding base for the sustainability of social care.

It is always a pleasure when Ministers move straight out of Select Committees into ministerial jobs, because there is a public record of everything they think about individual issues. That is particularly helpful with the Chancellor: while he was Chair of the Health and Social Care Committee, it produced numerous reports setting out the need for an additional £7 billion a year for social care. That is why I have high hopes in this policy area.

I welcome the fact that the Government have outlined their intention to provide £500 million in discharge funding from the NHS to social care. I hope we receive more detail on that and about when, where and how that funding will be made available.

Just like every other sector, social care is suffering from inflation. According to a cost of living survey by Methodist Homes, 94% of its community schemes had heard members or residents express concerns about the rising costs of living, while some 49% of respondents said that increased transport costs were a significant issue among their members.

Social care providers expect their energy costs to increase up to sixfold next year. There is a real danger that rising energy costs could significantly reduce the number of services available and will have an immediate impact on discharges from hospitals into the community.

The Association of Directors of Adult Social Services has reported that nearly half of all directors of social care services are not sure that unpaid carers will be able to cope financially with the inflation problem. That could lead to more demand for professional social care services. I urge the Government to guarantee that adult social care providers are defined as a vulnerable sector in respect of the energy bill relief scheme after April 2023.

An analysis by the County Councils Network found that inflation could cost councils £3.7 billion in extra costs if they keep social care services running. I fear that is not sustainable and the quality of care will decrease. That is just one example of why it is unfair to rely on local council tax payers to fund so much of social care. The pressure should be taken off local budgets and social care should be funded through national taxation. That would be both fairer among different areas of the country with different tax bases and, in the long run, much more sustainable.

The Government made a number of welcome commitments in their “People at the Heart of Care” White Paper, but that was published nearly a year ago. Many of us are eagerly waiting for those commitments to be put into practice. As I have said, the care sector is not only a completely essential service in a civilised society but a positive economic and social force in local communities throughout the country. We need a coherent plan to address the many problems of the sector, but we should never forget that those who need care are often the most vulnerable among us, and those who provide the care are often the best of us. They deserve the best we can offer them.

--- Later in debate ---

[Damian Green]

I will cheer everyone up by not taking the opportunity, which I think would be available to me, of winding up for the next 45 minutes; I will simply make two brief points that have come out of the debate. I am very grateful for the commitment made by the Minister.

The first is the degree of consensus that underlies this difficult subject. Frankly, the hon. Member for Leicester West (Liz Kendall) said almost nothing I disagreed with, and I suspect that I said almost nothing that she disagreed with—and, of course, I agreed, definitionally, with everything that the Minister said. We all know what the problems are and what we need to do to solve them. It is a matter of political will and drive.

That is the other, less cheerful, point. I have personal reasons for my interest in the issue. My father died of dementia, and therefore spent the last few years of his life in the care system, which inspired a deep personal interest, as it does in many other people. However, I was responsible for this matter when I was First Secretary of State. That was five years ago now, and five years later we are still going round the same course again.

Having arrived for the end of the previous debate, on the contaminated blood scandal, I was struck that colleagues across the House were complaining that things were moving very slowly. I set up that inquiry in Government. That problem obviously goes back a long way, but the solution started five years ago, and it clearly has not got there yet. When we have such intractable problems, too often the whole machinery of government—this is not remotely an attack on Ministers—moves incredibly slowly, even when there is large-scale political consensus on what we need to do.

Finally, Godspeed and good luck to the Minister and her ministerial colleagues, because this issue needs to be driven by Ministers. Across the House and within the political parties, we do not particularly disagree about the solutions, but the issue needs the active pursuit of energetic Ministers if the necessary changes are to be made. Those changes are desperately deserved, both by those who provide care and by those who receive it. I wish all the best to the Minister in dealing with this.

Question put and agreed to.

Resolved,

That this House has considered the matter of social care within local communities.

Oral Answers to Questions

Damian Green Excerpts

Tuesday 1st November 2022 Commons Chamber

[Steve Barclay]

Pensions are an important issue, and I shall be meeting the Chancellor later today.

[Damian Green (Ashford) (Con)]

T4. More than 13,000 people who are in hospital today would be out of hospital if the care system had the necessary capacity, and most of them could go back to their own homes if we had enough domiciliary care workers. Can the Secretary of State assure me, and the House, that he will produce a proper workforce plan for the care sector as a matter of urgency?

[Steve Barclay]

Very much so. The hon. Member for Ilford North (Wes Streeting) asked about a taskforce. With our colleagues in NHS England, we launched a “delayed discharge” taskforce with a “100-day challenge” over the summer; we have also set up an international recruitment taskforce within the Department to prioritise the establishment of a “clearing house for care”. I will not add further to my answer, other than to say that this is a key area of focus.

East Kent Maternity Services: Independent Investigation

Damian Green Excerpts

Thursday 20th October 2022 Commons Chamber

[Dr Johnson]

I know that this is a matter on which the hon. Lady has been campaigning furiously on behalf of her constituents. I share her anger, and her shock when I read the report, at some of the cases and some of the ways in which patients have been spoken to during their time at their hospital. It is truly unforgivable.

On the question of safety, that was my first question when I read the report: are we sure that patients going in today to have their babies are safe to do so? So I met Anne Eden, the regional director of NHSE, yesterday to talk to her about safety, and I have been reassured about both quality and outcomes. On outcomes, I have been reassured that, looking at crude data, which I appreciate has not been published yet, the numbers of stillbirths and neonatal deaths over the last year or so have fallen substantially. On quality, it is doing a review, so each woman is contacted six weeks after her delivery to ask about her experiences, and where experiences have not been as they should be—although they are in almost all cases—that has been further investigated in each case.

[Damian Green (Ashford) (Con)]

This report is a terrible read, particularly, obviously, for bereaved parents, who have gone through untold anguish, including some at the William Harvey Hospital in my constituency. What makes me particularly angry is that this was going on for more than a decade under several different management regimes at the trust. Can the Minister give some reassurance to women in Ashford who are about to have a baby at the William Harvey that they will be treated safely and respectfully, and can she assure the House, looking further afield, that the terrible repeated examples of similar tragedies and scandals around the NHS are now at an end?

[Dr Johnson]

I know that my right hon. Friend shares the House’s desire to ensure that such events do not reoccur, and that his constituents are safe. He asked about failures over time. In fact, there were signs as early as 2010 that problems were being raised with the trust. The failure was not so much to find those problems, but that they were not properly dealt with when they were found. Yesterday, I received assurances from the regional director of NHS England, as I described a few moments ago, and I will meet her regularly to receive updates to ensure that the process is not just put in place but followed through.

NHS Dentistry in England

Damian Green Excerpts

Wednesday 22nd June 2022 Westminster Hall

[Derek Thomas]

I completely agree. My right hon. Friend will know that in Cornwall we are very competitive; we always want to win, but I do not want to win this competition. This tragedy for both Cornish residents and his constituents highlights the fact that something needs to be done urgently. I thank him for his intervention.

[Damian Green (Ashford) (Con)]

I am very grateful to my hon. Friend for giving way again and allowing me to continue this tour of woe around the country. I can tell him that the situation is equally bad in Kent; it is almost impossible in Ashford to find an NHS dentist. My frustration and that of my constituents about this is compounded by the lack of response of the health service generally. The clinical commissioning group refers me to NHS England, and NHS England—the Minister may take note—just does not reply. I have before me an email I sent seven weeks ago regarding someone who could not find a dentist, but there has not even been a reply from NHS England. From top to bottom, this system needs complete reform.

[Derek Thomas]

I appreciate that intervention. In my case, NHS England, and commissioners for the south-west have been fairly good and engaged with the challenge. However, it is a tale of woe, as my right hon. Friend says. Perhaps we can all commit to coming back to this place in a year or two to commend the Minister and celebrate the fact we have a new contract that addresses exactly the challenges that we are all quite rightly highlighting today.

Adult Social Care

Damian Green Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

Many countries across the world are grappling with this issue. We have an ageing demographic and we now live in different ways. We live much longer with more complex needs, and often we are not close to our families as we have increasingly globalised. Many countries are looking to address those challenges, including Scotland. It is important that we build the talent pipeline here. It is important that we not only invest in and train our own people, but that we build sustainability. We cannot always rely on taking workers from many other countries. We have a visa route for senior social care workers and we have reduced salary levels—I think £20,480 is the salary level—so in Scotland that probably fits the minimum hourly rate. Of course, we have had different approaches. We had a commission on adult social care which gave results in 2011. That is what we have used to build the basis of our reforms and I know Scotland has taken a different approach.

[Damian Green (Ashford) (Con)]

I congratulate my hon. Friend on reaching this point, which we all agree is just the first step, but it is long awaited. I welcome the principles she set out, but I hope she can expand in particular on the changes that will allow more people to live in their own homes for longer through technology and home adaptations. That would not just reduce the need for residential care and therefore save money, but cut pressure on the NHS and, above all, improve the quality of life of many, many frail older people. What can we expect to see on that front?

[Gillian Keegan]

I thank my right hon. Friend for recognising that reaching this point is actually a milestone. It is the first time that any Government have reached this point.

Housing is key. We will increase the capacity of local areas to deliver supported housing. We will increase local expenditure on support services for those living in supported housing. We will adapt more supported housing units to make them suitable for use, as well as incentivising longer-term investment in new supported housing by local areas and housing providers. In the coming months, we will be working in partnership with local authorities, housing providers and others to design and establish our new investment in housing.

Health and Care Bill

Damian Green Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

New clause 49 has attracted a slightly fuller House than my previous speech did. This additional clause relates to the cap on care costs for charging purposes.

On 7 September, my right hon. Friend the Prime Minister took the bold step of publishing “Build Back Better: Our Plan for Health and Adult Social Care”. Successive Governments over decades have failed to tackle the reform of social care. This Government are delivering a package—package is the key—of reforms that will not only tackle the wider challenges faced by the adult social care system but reform how social care is funded to ensure that everyone, regardless of where they live or their level of assets, is protected from catastrophic costs. Let me remove all doubt on this issue: no one will lose from these reforms, compared with the system we have now, and the overwhelming majority will win.

Underpinning the reforms set out in the plan is an additional £5.4 billion over the next three years. That funding will end wholly unpredictable care costs and include at least £500 million to support the adult social care workforce. The reforms will make a real difference to the frontline of adult social care, including care users and the dedicated care workforce who have performed heroics throughout the pandemic. A crucial element of the reforms in the plan are the proposals to reform the existing social care charging rules.

[Damian Green (Ashford) (Con)]

I am grateful to the Minister for giving way so early in his speech. I am glad to hear him assert that no one will lose out and most people will win. Will he publish an impact assessment that will allow us to look at the detailed figures? As he will be aware, there is much commentary about the distribution of the possible losses, which seems to me to be an extremely important and sensitive issue for the Government to address.

[Edward Argar]

My right hon. Friend has long taken a close interest in this issue. In a moment, I will come to some of the figures and changes; I hear what he says about giving the House and the other place the information that they need and the aim is to do exactly that.

Oral Answers to Questions

Damian Green Excerpts

Tuesday 19th October 2021 Commons Chamber

[Maria Caulfield]

I thank my hon. Friend for raising his constituent’s granddaughter Mia’s case. With over 7,000 rare conditions, awareness among healthcare professionals can be difficult. That is why in January this year the Government set up the UK Rare Diseases Framework whereby officials are working with partners including Health Education England to raise awareness of rare conditions such as Dandy-Walker so that we provide training for staff and target education for healthcare professionals. I would be happy to meet him and his constituent to talk about this and listen to some of their concerns and experiences.

[Damian Green (Ashford) (Con)]

7. What steps he is taking to provide a long-term solution to social care.

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

Last month the Prime Minister announced an unprecedented investment in social care to support our own futures and those of our loved ones and our growing ageing population. This investment of £5.4 billion will support the wellbeing of the 1.5 million-strong workforce, offer professionalisation and provide hundreds of thousands of training places. It will also fund supported housing, better advice and capped care costs at £86,000, removing the fear of spiralling care bills.

[Damian Green]

I am grateful for my hon. Friend’s answer, but she will acknowledge that even the promised better integration of health and social care, although very welcome, will not be enough. We need a long-term plan covering workforce issues, the use of technology, and provision whereby people can live in their own home for longer if we are to achieve ultimate success. If we do not solve all those issues, then I am afraid we will not have fixed social care.

[Gillian Keegan]

I agree with my right hon. Friend. The forthcoming White Paper on adult social care reform, which we will publish before the end of the year, will set out our vision for the sector. It will cover issues that affect care users, including housing and innovation within our housing models, access to information and advice, and funding for the workforce. I am very happy to be meeting him on 4 November in his role as chair of the all-party parliamentary group on adult social care to ensure that his insight and all the work that he and the APPG have done in this area are carefully considered.

--- Later in debate ---

[Sajid Javid]

We have a plan for both the pandemic and other challenges over the winter, which we set out in detail. I remind the hon. Lady that we do not charge for lateral flow tests.

[Damian Green (Ashford) (Con)]

T8. My right hon. Friend will have seen last week’s Care Quality Commission report expressing continuing concern about maternity services in East Kent Hospitals University NHS Foundation Trust hospitals, including the William Harvey Hospital in my constituency. Can Ministers offer some reassurance to mothers-to-be in east Kent that giving birth in those hospitals will be safe?

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

I thank my right hon. Friend and I share his concerns completely. Just to reassure him, NHS England provided £1.6 million to East Kent Hospitals University NHS Foundation Trust to fund an additional 38 midwives, with 26 already in post. I would be happy to keep updated with him to see what the clinical experience is on the ground.