Homelessness
Debate between Dan Poulter and Heidi Alexander
Heidi Alexander
Anyone listening to the rhetoric during the last Parliament will be under no illusions about what certain members of the former Government have said.
I say this to the Government on behalf of my constituents: wake up! They should wake up and invest in social housing. They should wake up and build homes that people can afford to live in. They should wake up and stop pumping money into the bank accounts of private landlords and build social housing instead.
Heidi Alexander
I am afraid I will not give way, because I have already had my injury time.
I have previously spoken in the Chamber about the disparity that can exist between the housing benefit paid out on private rented property and that on social housing. If we take two families in receipt of full housing benefit in my constituency, with one in a two-bedroom private rented flat and one in a two-bedroom council flat, the annual benefit paid on the private rented property will be almost £9,000 more than that paid on the council flat. We cannot afford to go on like this. We all know—the Chancellor confirmed as much a few weeks back—that the public finances are likely to be shot to pieces as a result of Brexit. I fear for my constituents in these circumstances, and that makes it all the more important that the Government make the right choices. They should fund local authorities adequately, shift the public subsidy from benefits to bricks and mortar, and build social housing. Until we do that, any attempts to tackle homelessness will always be destined to fail.
Oral Answers to Questions
Debate between Dan Poulter and Heidi Alexander(10 years, 7 months ago)
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Heidi Alexander
One person’s definition of “essential” might not be the same as that of another person.
The Lords amendment tinkers at the edges of clause 119. Although it offers some marginal improvement on the Government’s original clause, it does not go far enough. I would vote for deletion again if I could, but parliamentary procedure does not afford me that opportunity. There is no doubt in my mind that this clause, even with the latest amendment, will allow more fast-track hospital closures in future. It removes the protection that existed in law, which allowed Lewisham council and the Save Lewisham Hospital campaign to take a case against the Government and win.
The latest amendment may guarantee another layer of consultation, but it contains no overall guarantee that services will not be closed at successful hospitals to balance the books elsewhere. Is the Minister or the right hon. Member for Sutton and Cheam able to say unequivocally that had this amended clause been on the statute book at the time of the TSA regime in south London, the future of Lewisham’s A and E and maternity service would have been secure? They cannot, because it is not the case.
In conclusion, I do not accept that their lordships’ amendment provides the protection that some believe it provides. The amended clause still extends and augments powers for TSAs and NHS bureaucrats. Even with the increased checks and balances contained within their lordships’ amendments, the TSA process is still a chaotic and rushed mechanism for closing hospital services. It plunges local health economies into desperate uncertainty and takes power away from the public and clinicians.
I do not believe this is the way to make the sorts of changes our health service requires to meet the challenges of the 21st century. I have maintained that position throughout the passage of the Bill and I make no apology for sticking to my convictions to the end. The public do not want more fast-tracked hospital closures, but this Bill legislates for them.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Before I turn to the amendments, I want to put on record my thanks to hon. Members for their contributions to today’s debate. I also want to express my thanks once again for all the contributions made by hon. and right hon. Members throughout the passage of the Care Bill and, indeed, for the contributions made by noble Members of the other place.
The hon. Member for Lewisham East (Heidi Alexander) made a characteristically robust contribution in standing up for her local health care services. I also pay tribute once again to the contribution made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), not only today, but at the Bill’s inception, during its scrutiny by the Joint Committee and throughout its passage through this House and the other place. He has done a tremendous amount of work to ensure that the Bill is much better than it used to be. He deserves considerable praise for what he has done and the help he has given the Government in securing a Bill that is not just fit for purpose, but which will make significant changes and improvements to our health care system.
It is worth bearing in mind that the Bill represents the most significant reform of care and support in more than 60 years, putting people and their carers in control of their care and support for the first time. The Bill will also put a limit on the amount that anyone will have to pay towards the costs of their care. It is a very big step forward and one that was long overdue. The Bill also delivers key elements of this Government’s response to the terrible events that took place in Mid Staffordshire and the recommendations of the Francis report by increasing transparency and openness and helping to drive up the quality of care across our NHS and social care system. I am pleased that the Government were able to table amendments that have been accepted in the other place, and I hope that those amendments will enjoy support in this House today.
Before I turn to the substantive amendments tabled by the hon. Member for Copeland (Mr Reed), I want briefly to address the points made about human rights legislation and the issue of direct payments. It is important to highlight that like clause 48 of the Bill, as originally drafted, and section 145 of the Health and Social Care Act 2008, which was the preceding provision, Lords amendment 11B relates to providers of social care registered with the Care Quality Commission, covering personal care provided at home and in residential care settings. The amendment covers physical assistance—for example, prompting someone to take their medication, dress, eat, drink and perform activities of daily living—but not non-personal care. To answer the question asked by my right hon. Friend the Member for Sutton and Cheam, I am happy to confirm that when self-funders start to receive support from the local authority, they will indeed be covered by the Human Rights Act 1998.
To turn to the amendments tabled by the hon. Member for Copeland, it is worth highlighting to the House that, contrary to what he asserted, the TSA regime—let us remember that the regime was laid down by the previous Labour Government—has been substantively improved by the amendments made to the Bill. In particular, clause 118, which has been debated as clause 119 at various points, will extend the requirements on the trust special administrator to consult not just the public, staff of the failing trust and its commissioners, but other provider trusts, their staff and their commissioners, local authorities and local healthwatch organisations. There is therefore a comprehensive duty of consultation and engagement in the TSA regime, and that will be further strengthened by the amendments we are now discussing.
Amendment (a) to Lords amendment 40B and amendment (c) to Lords 40C amount to wrecking amendments and, as I shall outline, amendment (b) to Lords amendment 40B is unnecessary and unworkable. Amendment (a) to Lords amendment 40B and amendment (c) to Lords 40C would mean that the recommendations of a trust special administrator could not restrict access to any services of another affected trust. Like previous ones, they are in effect wrecking amendments that would make it impossible for the administrator to do their job.
Both Houses recognise that the NHS is a network and that no hospital is an island, and have already agreed that clause 118 must allow the administrator to take a holistic view of the local health and care economy to find the very best solution for a failing trust. That is of course in the best interests of local patients. As my right hon. Friend the Member for Sutton and Cheam outlined in Committee, it is right that a trust and its patients in particular are not thrown to the wolves when the quality of care is unsustainable or letting patients down, but that a holistic and broader view of the local health care economy can be taken. That was the previous Government’s intention in setting up the TSA regime, and it is our intention now. The previous Government were not the first Government who did not necessarily make their legislation accord perfectly with the intentions they outlined in impact assessments for the TSA regime. That is why we are now in the position of having to correct and improve the regime through the Bill.
The amendments tabled by the hon. Member for Copeland would undo the effects in relation to the trust special administrator’s regard to the wider health economy, and they would reverse the effect of clause 118, such that the administration regime would not be able to create a complete and workable solution to intractable problems or failures of patient care in the NHS. I am sure hon. Members will agree that that would be entirely undesirable, and that it would not be in the best interests of NHS patients, who must be protected where a hospital cannot deliver safe or sustainable care.
Amendment (b) to Lords amendment 40B would give the trust special administrator significantly less time to finalise his or her draft recommendations about the future of a failing trust by requiring the publication of all correspondence between the administrator and commissioners at least 10 working days before publication of the draft report. Hon. Members will be aware that we have extended the time for the trust special administrator to draw up the report from 45 to 65 days and for the consultation from 30 to 40 days, because those processes need to be done properly.
I remind hon. Members that transparency is already built into such processes at every stage. The administrator is required to publish the draft report submitted to Monitor and is expected to include in it the commissioners’ statement in agreement or disagreement to the report. Following consultation, the administrator’s final report is submitted to Monitor for a decision. That report, which Monitor must publish and lay before Parliament, again needs to present to the regulator the views of all affected commissioners. The administrator is required to attach to the final report a summary of all responses to its draft report that were received during the statutory consultation. That would include the views of all affected commissioners as respondents and explain what consideration was given to those responses. There is full transparency at every stage of the process. Quite apart from being wrecking amendments, the Labour amendments are therefore completely unnecessary.
Care Bill [Lords]
Debate between Dan Poulter and Heidi Alexander(10 years, 9 months ago)
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Heidi Alexander
The experiences in Stafford and in Lewisham have probably been very similar. Multiple public meetings were run in a chaotic and haphazard fashion, and if I had not intervened in this particular meeting in Catford to try to calm the audience down and enable them to ask questions, I am not sure whether it would have been able to proceed.
We have heard about the quality of the consultation in Lewisham. The fact that the online consultation did not include a direct question about the closure of accident and emergency services and maternity services at Lewisham hospital beggars belief. My constituents were asked whether they agreed that acute services should be consolidated on four instead of five sites in south-east London. It is no wonder they came to me asking, “Where is the question about Lewisham A and E?” As my right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) said, the consultation contained no direct question about the sale of two thirds of the land. There was a question about the sale of land at the hospitals that were placed in administration, but there was no such question about Lewisham hospital. We must be under no illusion that if clause 119 had been on the statute book at the time the administrator made recommendations about Lewisham hospital, its full A and E, its full maternity service and its excellent paediatric unit would now be closing.
Many people have said to me that I am somehow against change in the NHS, but nothing could be further from the truth. We have already heard about the successful changes to stroke care in the capital. They did not come about overnight, or over 45 nights or 75 nights; they came about as a result of clear and calm consultation and communication with residents. They came about as a result of clinicians, not accountants, being in the driving seat. The public rightly care about their NHS and the local health services to which they have access. As I said on Second Reading, that is because people experience the best and the worst moment of their lives in our hospitals. It is right that they have their say in a process that is fit for purpose, but an extended and augmented TSA process, which the Government propose through clause 119, is not the right way to take decisions of such significance and which excite such public interest.
The Government have tried to spin clause 119 as some sort of clarification of existing policy. That is nonsense. It is a direct result of the Lewisham hospital case that was heard in the courts. We know that the previous Government produced guidance that said that the TSA regime should not be used as a back-door approach to reconfiguration. This is a fundamental change in policy. It removes the legal protection that currently exists for successful hospitals located adjacent to failing hospitals that have been placed into administration.
The Government also claim that such a process would be used only in exceptional circumstances, but how do we know how often it will be used in future? I press the Minister to respond to the point made by the shadow Health Secretary about whether he has had any discussions with his officials about other hospital trusts being placed into administration and about applying the unsustainable provider regime elsewhere.
Dr Poulter
Let me place it on the record that, as far as I am aware, there have been no discussions involving either me or my ministerial colleagues about applying the TSA regime elsewhere.
Heidi Alexander
That is useful. I am sure that Members are grateful to hear that from the Minister, but we know that there are many trusts in serious financial difficulties. Given the huge pressures on the NHS at the moment, this regime could be applied in many more places in the future. The truth of the matter is that the TSA regime will be used as a steamroller to force through the closure and downgrading of hospital services with limited public consultation, using a process that is set up in a way that creates public scepticism and mistrust from the word go.
The Government want to change the law to allow them to do elsewhere what the courts told them they could not do in Lewisham. As I have said already, I would not want to inflict that chaos on anyone else. It damages trust not only in NHS leaders who are meant to be leading change but in our democracy.
I wish to say a few words about new clause 16. As I have already said, I will vote for the new clause if the right hon. Member for Sutton and Cheam pushes it to a vote this evening, because it offers a limited improvement on clause 119. None the less, it raises its own set of questions. The new clause leaves clause 119 in the Bill, so it still allows an administrator appointed to a failing hospital trust to make recommendations about services provided at successful neighbouring hospitals, which are not part of the trust to which the administrator has been appointed.
As I understand it, the right hon. Gentleman’s new clause would give power to the commissioners of such services at the affected hospital outside the failing trust to have some sort of veto over whether the recommendations go any further. It suggests that if the commissioners of services at the affected hospital, such as Lewisham, agree with the changes being proposed, full public and patient consultation would kick in, consistent with the normal levels of communication and engagement that are required in full-service reconfigurations. If the local commissioners disagree with the recommendations, they can, if I understand his new clause correctly, call the process to a complete halt. I can see why that has some attractions, because it seems to provide some kind of brake on the all-encompassing powers of an administrator, and for that reason I am content to support it. However, it does not provide an entirely coherent solution to the problem that lies at the heart of clause 119.
Oral Answers to Questions
Debate between Dan Poulter and Heidi Alexander(11 years, 11 months ago)
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Dr Poulter
I thank my hon. Friend for that question and he is right to highlight the fact that any decisions about service reconfigurations must be clinically led, as was outlined in the Government’s tests for any service reconfiguration.
Heidi Alexander (Lewisham East) (Lab)
T8. Last week, the Secretary of State refused my request to meet a small group of local GPs, hospital doctors and residents who are opposed to the closure of accident and emergency and maternity at Lewisham hospital, yet in his former role he seemed very happy to trade hundreds of texts with Rupert Murdoch’s lobbyists about the purchase of BSkyB by News Corp. Why is it one rule for Rupert Murdoch’s lobbyists and another for doctors in Lewisham?