Housing Associations

Debate between Dan Poulter and Jim Fitzpatrick

Wednesday 12th June 2019 Westminster Hall

[Jim Fitzpatrick]

My hon. Friend makes a very good point, and I will come on to the role of housing associations and the change in their ethos. That will reinforce the concern that he expresses.

I hear all the time from constituents who are having trouble getting complaints about their housing associations dealt with. Issues such as above-inflation rent increases, unjustified service charges, unreasonable refurbishment costs and problems with repairs seem to be rife. The lack of information about tendering arrangements has also been a source of frustration. Residents often find it unclear who they can go to with their complaints, and do not have confidence that they will be given a fair hearing.

Accountability questions are all too common. In my constituency, there are many housing associations, many of which are very good. Some are average and some are poor. One of the best, if not the best, is Poplar Housing and Regeneration Community Association, commonly and locally known as HARCA. HARCA is a much-valued organisation in Tower Hamlets, going beyond its brief in housing to create community hubs and therefore maintaining a strong social ethos. It is also exemplary in its accountability. Its board has always had a majority of members from the local community, and it has created a tenant advisory panel with the aim of strengthening relationships with tenants and landlords. It was also an early adopter of the National Housing Federation’s “Together with Tenants” plan, again prioritising building good relationships with tenants.

In a recent consultation regarding plans for the Teviot estate in my constituency, there was a turnout of 81% of residents, 87% of whom voted in support of the plan. That demonstrates the high level of approval for HARCA’s work. HARCA also runs a resident-to-resident survey, where residents are trained to call other residents to get their comments on issues such as recent repairs, providing unbiased feedback for Poplar HARCA and involving the residents in shaping their local services.

Those initiatives have proved successful for Poplar HARCA not only in operating an efficient not-for-profit business, but in achieving high levels of resident approval. Its most recent survey, conducted in May, found that 83% of tenants and 75% of leaseholders were satisfied with the service. Clearly, involving residents in decision making at every possible level and seeking feedback regularly works in favour of both residents and housing associations.

However, that level of provision for, and investment in, tenants sometimes seems to be the exception rather than the rule. Housing associations are no longer obliged to have residents on their board. I urge the Minister to consider bringing back that requirement, as another means of making associations directly accountable to residents, and ensuring that executive boards have a local perspective.

At the opposite end of the spectrum to Poplar HARCA is A2Dominion, notorious in the housing world for its, at best, neglect of or, at worst, disdain for residents. The Daily Mirror recently reported that residents in Clyde House in south London are scared to sleep in their homes due to unsafe conditions. Thick mould covering pipes, water leaking into flats, vermin across the building and an assessment declaring it a

“moderate to high fire risk”

all appear in a new development.

A2Dominion is supposed to have the exact same social purpose as Poplar HARCA. However, residents are being ignored in their justified complaints. The lack of clear accountability means that it can get away with not taking responsibility for the necessary repairs and upkeep, while still charging tenants extortionate service charges. Associations such as A2Dominion need clear regulation, and residents need to know who they can turn to when they are not being taken seriously.

As the Minister knows, I have spoken several times in this place about fire safety in high-rise flats—not as often as him, of course—and the dangerous, highly flammable cladding that is still in place in too many blocks. If we want to show that we have learned the lessons from Grenfell, we have to bring in stringent legal oversight, so that no further lives are lost due to its absence, in addition to shoddy, cost-cutting workmanship, poor maintenance, wrong materials and weak fire regulations.

Another point of consideration is bringing local government into a more formal role in oversight. Local authorities are well placed to understand the performance, or underperformance, of housing associations through the relationships between councillors and residents, and through public realm services.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

The hon. Gentleman is making a good speech with many good points. On his earlier point about accountability in the context of having a more effective national ombudsman, given that we all, I hope, accept that social housing is a social good and, in many respects, a public service, the out-and-out free market approach that has been taken to its provision has not been effective and there is evidence of market failure. Does he believe that greater local oversight and giving local authorities a role in holding housing associations to account for how they treat their tenants are also important parts of improving the regulatory framework?

[Jim Fitzpatrick]

The hon. Gentleman makes a good point, which I am also trying to make. The Government’s proposals for a national regulator and beefed-up regulations are sound and welcomed across the sector—the House reinforced that last week during the Grenfell debate—but there is a gap that local authorities could easily fill. There could be local oversight through local authorities engaging with the housing associations that operate in their local authority area, as well as national scrutiny through the national regulator, so there would be a local and national partnership to hold housing associations to account. Some housing associations are getting so big that they are becoming far too remote from their residents.

On that point, local authorities have no official role in formal regulation. If councils were given a role locally, alongside a national social housing regulator that focused on customer service, associations could be held to account and complaints dealt with more directly. I would be grateful if the Minister commented on that possibility.

Another concern is the practice of under-the-table mergers between housing associations. Although the Government do not officially play a role in that, they have created an environment that has led to more mergers and takeovers of housing associations. Those have to happen sometimes, but as housing associations get bigger, whether through mergers or national expansion, their ability to be financially transparent and locally accountable reduces. That is a serious problem for residents who pay service charges, as it becomes less clear to them where their money goes. Bigger and more remote associations can also avoid being answerable to residents on other questions about repairs not being done, or not done to a high enough standard, or about costs going up or questionable rent increases.

My worry is that the bigger housing associations become, the more they become like money-driven businesses, rather than locally focused organisations with a social purpose, as my hon. Friend the Member for Dagenham and Rainham (Jon Cruddas) said. I am grateful for the commitments in the Government’s Green Paper, which was published last year, and for the matters raised by the Secretary of State in last week’s written ministerial statement, but we need progress to be made through regulation and legislation.

On a separate matter, I agree with Grenfell United, and the recent Labour party paper, that it is high time that the Freedom of Information Act 2000 covered housing associations, rather than just council properties, as mentioned by the hon. Member for Westmorland and Lonsdale (Tim Farron). Residents and the public should have the right to information about safety standards and the like, to ensure that conditions and costs are monitored.

The Green Paper and the written ministerial statement offer better protection, more transparency and real accountability for residents in social housing, and I would be grateful for any assurance from the Minister that those commitments will be met as soon as possible after the close of the consultation that was announced last week. We want to ensure that our social housing lives up to its purpose of providing comfortable homes that are considerately managed, and that residents feel empowered in decisions made about their homes.

As I said at the start of my speech, I do not believe this issue is controversial or rocket science. There is support across parties and across the housing sector for what the Government are proposing—more transparency in respect of housing regulation, policing and enforcement—through a more powerful regulator. We need a strong commitment from the Government that they will move with speed and efficiency. As we approach the two-year memorial to Grenfell, some recommendations in Dame Judith Hackitt’s report have been enacted, but the Grenfell public inquiry will likely not conclude or produce a report until 2021 or 2022.

As I think the Government recognise, they need to take action where and when they can to reassure the public that their safety and wellbeing are paramount. A new regulator would be an easy way to demonstrate that determination, as would the other ideas I have suggested. I look forward to the Minister’s response, and I would be grateful if he considered this speech my contribution to the Department’s consultation on the matter.

General Practices (Coventry)

Debate between Dan Poulter and Jim Fitzpatrick

Thursday 30th October 2014 Commons Chamber

[Dr Poulter]

I am pleased to have brought some good news about future planning to the debate. As I will be writing to the hon. Member for Coventry North West in detail about some of the initiatives with medical students, I am happy to outline further the future plans for that practice in the letter.

GP patient survey results from 2014 indicate that 85% of people who responded in the Coventry and Rugby clinical commissioning group area rated their GP surgery as “very good” or “fairly good”. Although this is a high proportion, it could of course be improved further. The figure is, however, testament to the work of local GPs and the quality of care they provide, alongside everybody who works in those practices. I am also aware that Coventry local medical committee had concerns that Coventry and Rugby CCG was not following NHS England planning guidance and investing more in general practice to support it in transforming the care of patients aged 75 and older. I understand the LMC has now reached agreement with the CCG on that, which is good progress. Our plans for personalised care for the most vulnerable patients included NHS England asking CCGs to set aside £250 million from existing funds. However, as has always been the case, CCGs are not restricted to using this funding on general practice only. For example, in some areas, CCGs have used the funding to employ extra district nurses for local practices.

On the important point about the wider community work force, it is increasingly the case that although a nurse may be counted as a member of hospital staff, their role goes across not just the hospital, but the community. That is particularly the case for nurses who support patients with long-term conditions such as multiple sclerosis and diabetes. Although that nurse is officially counted as a hospital employee, they play an increasingly important role in supporting the patient in the community. Having visited the local hospital in Coventry, I know that there is a great emphasis on the hospital working much more collaboratively with the community. The role of the hospital is about not just picking up the pieces when things go wrong but proactively supporting patients, especially those with long-term conditions, when they are at home.

[Jim Fitzpatrick]

I apologise to the Minister for intervening on him while he is replying to a debate on Coventry. He just mentioned collaborative service. The Barkantine practice in my constituency combines a 10-handed GP practice with a walk-in centre. It is able to offer appointments from 8 o’clock in the morning to 8 o’clock at night seven days a week, which is what the Prime Minister made a big point about in his conference speech. However, because of restructuring, the practice is having to hand over its walk-in centre finances to the local CCG, which means that the critical mass for providing the 8 am to 8 pm service seven days a week is no longer appropriate. Will the Minister look at that with regard to collaborative working, as we are talking about breaking down a system that the Prime Minister wants to see replicated across the country?

[Dr Poulter]

I hope the hon. Gentleman will excuse me if I do not detain the House in addressing that specific point today, but I will look into it and write to him separately about it. We have discussed local issues in his constituency before. I will take away what he says and get back to him, hopefully with some reassurance on the points that he has raised.

The CCG is developing a pre-hospital model to help manage urgent care and reduce attendance and admission to hospital. The development includes operational and clinical staff from a number of organisations including patient champions, primary care, local trusts and authorities, and unscheduled care providers.

The model being considered at the moment describes a community urgent care system designed around the patient, ensuring easy and timely access at a convenient location without blocks or diversions. The CCG and its partners at the Coventry urgent care board have developed and agreed a winter capacity and resilience plan. NHS England has made £2.8 million available to support the plan, and a number of specific winter schemes are already being put in place. They include: additional home care capacity for both planned and unplanned support; additional social worker capacity to support A and E and ward board rounds; GP responders; and hospital at home.

The plan sets out a clear mechanism for engaging and developing leaders and staff to enable the cultural changes required to support clinical commissioning activities, performance improvements and services changes necessary in the changing NHS environment at a local level. As we have said, this is about ensuring that the emphasis is moved away from a reactive care model in the hospital—having met the staff in Coventry I know that it is a very good reactive care model—and giving people better support and care at home. That is what investment in local GP practices and increasing GP numbers is about. It is also about ensuring that the right relationships are engaged at a local level to support the right type of care being delivered to patients in Coventry. Its focus is on developing internal capacity and capability to ensure that the emphasis is on upstream interventions, preventing people from becoming so unwell that they need to go into hospital, and making sure that people with long-term conditions and disabilities get the proper community-based support that they need.

I hope that I have brought some reassurance to the hon. Members for Coventry North West and for Coventry South, and I have a couple of points on which I will write to both of them. Once again, I convey my gratitude to the front-line staff working in Coventry. I have seen the local hospital for myself and know how hard local staff work. It is clear that investment is going into GP premises locally and that there is a commitment to continuing to support general practice in Coventry and the development of improved community services to ensure that the big challenge that faces the NHS, which is to support people with long-term conditions, is met, not just nationally, but in particular for those patients who need services from the NHS in Coventry.

[Jim Fitzpatrick]

On a point of order, Madam Deputy Speaker. On 16 October, during the Backbench Business Committee debate on cycling, I said that

“the proportion of cars on that stretch of road is already less than 9%”.—[Official Report, 16 October 2014; Vol. 586, c. 502.]

Further research has clarified that the 9% figure refers to an assessment of the percentage of private cars using the A3211 route at certain times of the day. This is based on counts carried out by transport consultants Steer Davies Gleave for Canary Wharf Group. It would have been more accurate for me to have said, “the proportion of private cars on that stretch of road is already less than 9% at some times of the day.”

I am grateful to be able to set the record straight. I apologise for not accurately reflecting the position. I am not sure whether this qualifies technically as misleading the House as it was an incomplete picture, but I apologise unreservedly for doing so, as that was clearly not my intention.

GP Services (Tower Hamlets)

Debate between Dan Poulter and Jim Fitzpatrick

Tuesday 13th May 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship, Mr Streeter, for what I believe is now the third time, and to respond to this debate. I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) not only on securing the debate but on his advocacy on behalf of local patients. We have discussed that before during meetings in my office in the Department on other issues. I am sure that my noble Friend Earl Howe will be happy to meet him, and I extend that invitation on my noble Friend’s behalf.

[Jim Fitzpatrick]

I apologise for intervening so early, but I do not remember having any meetings with the Minister in his office on any subject. I would not want to mislead the House, or for people to think that we had held meetings in which I had not raised this issue.

[Dr Poulter]

A congregation of MPs from London came to see me and I believed that the hon. Gentleman had been there, but I am obviously mistaken. I apologise for that mistake, but I can recall similar conversations in the past during meetings with other MPs from other parts of the country, in which we talked about not just GP services but other local health care services of a similar nature. During those meetings there was advocacy of similar strength to that which we have heard today.

Indeed, a previous debate in Westminster Hall, led by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron), focused on the impact of the minimum practice income guarantee changes on more rural practices in his constituency. The topic has come to the fore for many hon. Members, who I know will wish to discuss it further with the relevant Minister. I therefore want to put on record a formal invitation to come and see my noble Friend Earl Howe to discuss the subject further at some point after this debate.

It may be helpful if I outline why the minimum practice income guarantee was set up in the first place and why it is important to change the payment structure for general practice. The minimum practice income guarantee is a top-up payment to some general medical services—GMS—practices. It was introduced as part of the 2004 GP contract to smooth transition to what were then new funding arrangements, so it is now 10 years out of date. Last year, we announced that the minimum practice income guarantee will start to be phased out from April 2014. We consider minimum practice income guarantee payments to be inequitable because under the system, two surgeries in the same area serving similar populations may be paid different amounts of money per registered patient.

The MPIG will be phased out over a seven-year period, as the hon. Member for Poplar and Limehouse will know. We are phasing it out to make sure that there is more equity between what different practices in comparable areas receive per patient, and that funding follows the patient more accurately, rather than the practice. I am sure we can all sign up to that in principle. The payments will be phased out gradually with the overall intention that the funding for GP practices will be properly matched to the number of patients they serve and the health needs of the local population.

The money released by phasing out the MPIG will be reinvested in the basic payments made to all general medical services practices. Those payments are based on numbers of patients and key determinants of practice work load such as patients’ ages and health needs—deprivation is of course a driver of patients’ health needs. We are committed to making sure that patients have access to high-quality GP services wherever they live and ensuring that in the same geographical area similar practices receive effectively the same amount of funding for each patient they look after.

It is also worth highlighting the overall impact for practices, both in the country more generally and in London in particular. NHS England has undertaken analysis regarding the withdrawal of the MPIG. Inevitably, a small number of practices will lose funding, and NHS England has considered the very small number of significant outlier practices for which alternative arrangements may need to be made to ensure appropriate services are maintained for local people.

We appreciate that this is a matter of concern for some practices, including some in the hon. Gentleman’s constituency that he has mentioned today. That is why we have decided to use the next seven years to implement the changes to the MPIG, introducing them gradually through a phased transition to a new funding arrangement, rather than taking a big bang approach. Phasing the changes in over that seven-year period will allow the minority of practices that lose funding to adjust more gradually to the reduction in payments.

As the hon. Gentleman highlighted in his remarks, the changes cannot be seen in isolation but should be looked at together with the changes to the quality and outcomes framework payments for GP practices; those changes need to be set alongside the global sum paid to GMS practices. When all those factors are put together, I understand that practices in London with a GMS contract, of which there are 721, will see an overall funding increase of £731,000 resulting from the net effect of all the changes. I will write to the hon. Gentleman to outline that in detail ahead of his meeting with my noble Friend Earl Howe.

[Jim Fitzpatrick]

When we have that meeting with Lord Howe, it would be useful if NHS England could provide the Minister and his officials with an accurate breakdown of figures for the practices in Tower Hamlets. Given the order of deprivation, the chronic ailments and conditions, the age profiles of very elderly and very young people, and the language problems, even NHS England, as I quoted, is saying that the combination of changes to the minimum practice income guarantee and the quality and outcomes framework reductions is creating specific difficulties in Tower Hamlets that are not generally replicated across the rest of London.

[Dr Poulter]

I am happy to write to the hon. Gentleman after the debate to outline the more general points, and I am sure that we can ensure that more specific details are available for him to discuss in his meeting with my noble Friend Earl Howe. NHS England has made it clear that it has been looking carefully at how it can support the practices that are most affected, through its area teams, and I am sure that it will be happy to continue a dialogue with local practices and with the hon. Gentleman to work out how further local support could be given if some practices are struggling as a result of the changes. That offer has been made to those practices that have already been identified as most affected, but NHS England is continually reviewing the matter as a pathway process for phasing in the changes.

NHS England has also suggested that those practices with very small lists, which may be particularly affected, could collaborate through federating, networking or merging with other practices nearby to provide more cost-effective services. It also suggested that it would be possible to identify other ways in which practices might improve cost efficiency, such as reviewing staffing structures and other commissioning or contracting options—for example, how some patient care services are offered in the area by collaboration. Sometimes, back office costs and inefficiencies can be reduced to free up more money for patient care. We must remember that, on the whole, GP practices are small businesses in their own right. We expect NHS England to work with GPs to support best practice and technology, and to encourage general practices to collaborate and work together, and it is happy to do so. It is expected that general practices will do what they can to help themselves, and that NHS England will work with them to facilitate that for them as small business owners.

[Jim Fitzpatrick]

I recognise that there is some logic in the Minister’s suggestion about smaller practices. The Jubilee Street practice has 13,000 patients. It is a big practice and is multi-handed with clinicians and staffing, and is considered to be extremely efficiently run.

[Dr Poulter]

Indeed. I will talk in more detail about Tower Hamlets, but the hon. Gentleman is right to say that it has a long history of collaboration, efficiently run practices and good working between GPs and other community health services to support some of the most vulnerable people in our society and to address specific issues of health care and equality. The hon. Gentleman outlined that in his speech and local GPs should be proud of what they have done and their work and efforts in many cases to help deliver greater efficiencies. Nevertheless, the offer is there from NHS England to engage with area teams to see what more support can be provided. It is keen to ensure that if particular practices believe they are disadvantaged, the teams will do what they can to work with the practices to mitigate that.

It is worth talking briefly about the changes in the quality and outcomes framework. In addition to the minimum practice income guarantee from April this year, we have also made changes to QOF and reduced it by more than a third to free up space and time for GPs to provide more proactive and personalised care for their patients, particularly the frail elderly. One of the great frustrations that we are all aware of—medical staff, health care staff and particularly GPs—has been the amount of bureaucracy that GPs are sometimes required to undertake, which has got in the way of their being able to deliver front-line patient care and spend time with patients. The changes to QOF were welcomed by the British Medical Association and GPs because they will help reduce the bureaucratic burden and allow GPs to spend more time with patients and focus more on personalised care and more vulnerable patient groups. I think we all believe that to be a good thing and a great achievement from those GP contract negotiations.

As part of the QOF changes, we have retired indicators when they were either duplicating other incentives in the health care system, or were of low clinical value and use—for example, if they were just process measures rather than measures linked directly to patient care. We are ensuring that the payment system is strongly linked to delivering better care and improving care for patients rather than to process measures. That has sometimes been a criticism of QOF payments in the past, not least by GPs. Removal of these indicators will help to reduce bureaucracy, unnecessary patient testing and unnecessary frequency of patient recall and recording.

The money released from the changes to QOF will be reinvested in the basic payments made to all general medical services practices, to which I alluded earlier. The global sum will be reinvested through the GP contract and I understand that practices in London with a general medical services contract will overall be net beneficiaries to the tune of roughly £700,000. We welcome that, and I will give the exact figures in my letter to the hon. Gentleman, but I believe that what I have said in this debate is an accurate reflection of the situation.

I turn to Tower Hamlets and will address some of the concerns that have been raised in the debate today. We understand that some practices have particular concerns about the changes to the minimum practice income guarantee and to QOF funding. I assure the hon. Gentleman and his constituents that the Government and NHS England are committed to ensuring that good, high quality primary care for local people, such as his constituents, is a priority. I understand that despite being one of the most deprived boroughs in London, Tower Hamlets has developed some outstanding general practices often as a result of the hard work and dedication of the GPs who want to address health care needs, to look after vulnerable people in society, and to ensure that the health care inequalities that we have discussed are properly addressed. His local GPs and all health care staff delivering care on the ground should be proud of that.

As the hon. Gentleman outlined, Tower Hamlets is top in the country for blood pressure and cholesterol control for patients with diabetes, resulting in reduced complications of diabetes and reduced admissions for heart attacks. It is also top in London for MMR vaccination and for flu vaccination for the over 65s. That is an example of how, even in one of the most deprived areas with some of the greatest health care needs, local GPs, local primary care and local community care are delivering very good results for patients. It is also one of the 14 national pioneers for integrated care, a programme in which primary care will play an increasingly important role. We want to keep people out of hospital and it is vital that they are supported in their own homes and communities. Integrating primary care with community care and effective adult social services care from the local authority will be key in delivering that.

I understand that NHS England’s area team has set up a task and finish group to look at the support that might be offered to practices with membership drawn from local medical committees and the London office of the clinical commissioning group’s chief officers and the local area primary care commissioning team. I understand that NHS England’s area team in London has been in regular contact with individual practices in Tower Hamlets to offer them ongoing support regarding these changes. I am sure that after this debate, that important input and dialogue will intensify to recognise some of the issues that the hon. Gentleman raised.

We also recognise some of the challenges facing small practices in delivering the increasingly wide range of primary care services as more services move from hospital settings into the community. All health services, hospital trusts, community and mental health care providers, as well as GPs, are facing the challenge of meeting increasing demand with small increases in funding. That demand is coming from an ageing population with increasing levels of long-term conditions as well as the costs of new drugs, and patients’ expectations. Those issues are faced throughout the health service, but they are acute in Tower Hamlets. Local GPs recognise the need for flexibility in the way in which future services are provided and we need to support practices to work together to demonstrate how best to use their resources for the benefit of all their patients.

We have announced that NHS England is supporting practices as they phase in the changes to the minimum practice income guarantee and to QOF payments. There is an offer to meet my noble Friend Lord Howe and I know that NHS England will continue to do what it can to support local practices in Tower Hamlets.

Again, I put on the record my congratulations to the hon. Gentleman on securing this debate and to the local GPs who deliver some of the best health care outcomes in England for the patients they look after.

Question put and agreed to.