Oral Answers to Questions

Debate between David Mowat and Baroness Keeley

Tuesday 21st March 2017 Commons Chamber

[David Mowat]

Much of the money will go through the better care fund and there is conditionality on that. We expect councils to spend this money, as they have requested it, on social care and we believe that that will be the case. We understand the pressures and have acted.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

But 1.2 million older people are living with unmet care needs. The £1 billion that was announced in the Budget for this year is not enough to prop up the failing care sector, when many councils are suffering contracts being handed back. Given that 1 million people over the age of 65 do not have adult children, will the Minister explain how all those people living with unmet care needs are meant to manage?

[David Mowat]

The figure on unmet care needs comes from an Age UK analysis. I am meeting Age UK to go through its recent report, but we do not accept that analysis because the Care Act 2014, which had cross-party support, set statutory consistent definitions for what care councils have to provide. It is illegal for that not to be met, and our follow-up work with the Local Government Association has indicated that it is being met. Furthermore, we have put in a 17% increase over the next three years.

Social Care (Liverpool)

Debate between David Mowat and Baroness Keeley

Tuesday 7th March 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

I thank all those who have spoken in the debate. This is a serious subject, and we have had a number of serious contributions. I will answer some of the points that have been made, before talking more generally about the Government’s approach to adult social care, both now and for the remainder of this Parliament.

I congratulate the hon. Member for Liverpool, Riverside (Mrs Ellman) on bringing this debate to the Chamber, because this subject matters. If there is one thing on which we can all agree, on both sides of the political divide, it is that the whole care agenda is very important to very large numbers of people. The care industry employs more people than the NHS: it employs 1.5 million people. As the hon. Member for Worsley and Eccles South (Barbara Keeley) said, many of them are not well paid. I think she said that some of them do not get the minimum wage. If she has evidence of that, she needs to come forward with it and we need to prosecute, because that is illegal.

However, it is right to say that 1.5 million people work in social care—more than in the NHS—and that number will grow over the next decade or two decades. Depending on how he gets on in the forthcoming election, the hon. Member for Liverpool, Walton (Steve Rotheram) may find that his responsibility in that regard is increased greatly. As well as those 1.5 million people, to whom we should all be grateful—I do not think I could do that work very well—6 million people across our country give informal care. Of those, some 300,000 are aged under 18. It is estimated that one in 30 people in schools are giving informal care to an adult or sibling. We should all reflect on that, because that number will also increase over the next decade or so.

A number of Members have made the point that the precept raises less in Liverpool than it does in Surrey. The hon. Gentleman said that many more houses are in council tax bands A or B, and the consequence is that the precept will raise less. That is self-evidently true, and the Government accept that. That is why the way in which the improved better care fund is and will be allocated to councils takes into account the moneys that are available from the precept, so that the total is in accordance with the relative needs formula.

There is one thing I want to get absolutely straight. I do not want to spend the next 18 minutes bandying numbers around, and I am happy to write to all the Members here about the numbers that I am about to give. The hon. Member for Liverpool, Riverside correctly said that the Liverpool spend on social care was £154 million in 2015, and she said that it is budgeted to be £130 million by 2020. I think those were the numbers she used. The number that we have in cash terms—I will write to Members with this—is £194 million by 2020. That is a real-terms increase of 18% between now and 2020. I have spent quite a long time with officials today to make sure that those numbers are correct. The amount that Liverpool City Council will receive from the improved better care fund in 2019-20 is £26 million. That dwarfs the amount that the precept will raise.

[Barbara Keeley]

The Minister said that he does not want to keep on bandying figures about, but as we all know, the difficulty is that the funding that he and the Government keep talking about is back-loaded. The problem is happening now—5,000 people have lost their care packages now, and the problem has been happening since 2010. It is not helpful, in this totally stressed situation, to talk about money in 2019-20.

[David Mowat]

I was just making the point that the figure the hon. Member for Liverpool, Riverside used was £130 million and the figure I have is £194 million. I accept that that number is not for today, and I also accept, as I have said many times in the Chamber, that the social care system is under pressure throughout the country, and Liverpool is part of that.

--- Later in debate ---

[David Mowat]

That is a fair challenge. We have a plan, and we are implementing it in that process. Winterbourne View was about seven years ago now. I have met a number of parents of the children affected and there has been a lot of pressure from them to go as far and as fast as we can. I make the point that every one of those facilities is a project of its own in terms of finding other accommodation and putting in place care—sometimes round-the-clock care. To answer the hon. Lady’s question directly, I would like us to go faster, but I think that we are doing as well as could be expected given the starting point. However, it is a fair challenge.

[Barbara Keeley]

I do not know whether the Minister watched last week’s Channel 4 “Dispatches”, “Under Lock and Key”, which showed some serious cases of young people who were not better off in their institution, a private hospital. It seemed very difficult to get them moved out into the community. I know that it was a different part of the country, but there were young people in that institution from across the country. It is great to have a plan, but we see programmes week in and week out showing failures, as I have highlighted.

[Mr Philip Hollobone (in the Chair)]

In responding to the intervention, the Minister needs to make his last point.

Health and Social Care

Debate between David Mowat and Baroness Keeley

Monday 27th February 2017 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The hon. Member for Central Ayrshire (Dr Whitford), who speaks for the Scottish National party, described this as a great debate. I agree that it has been a very good debate. Members on both sides of the House have spoken with a great deal of passion and, in general, with a great deal of knowledge. A number of clinicians, as well as three Select Committee Chairs, have spoken. I join the shadow Minister in thanking the Select Committees for the reports we are discussing today. An awful lot of comments have been made by Members and I will do my best to respond to the majority of them.

The Government accept that these are challenging times for both the NHS and social care. My hon. Friend the Member for Totnes (Dr Wollaston), the Health Committee Chair, talked about this at length. The demographics—both the number of people and their age—are uncompromising. I was at a Health Check conference recently and one of the speakers described the process we have been through. We have been very successful at elongating quantity of life. Until now, however, quality of life has not kept up. Increasingly, older people are living with multiple long-term conditions. Having one long-term condition is becoming unusual, whether it is diabetes, chronic obstructive pulmonary disease or heart disease. This is a fact we all have to face. One reason why we are so keen for the STPs to address this issue is that 70% of total expenditure on the NHS is spent on long-term conditions. Frankly, if we were starting with a blank piece of paper, we would not start with the NHS we have now. Instead, it would be organised around those long-term conditions, meaning more work in the community and all that goes with that. I will come on to talk about the STP process and how we are trying to achieve that.

We know, therefore, that there is an issue with demography. I think it was a Public Accounts Committee report that said that, in 1948, 50% of people lived to be over the age of 65. In 2017, only 14% die before they are 65. That is a massive demographic change and we all need to step up to the mark to meet it. We will try to do that. Drugs and treatment are becoming more expensive. They can do a lot more, but we have all heard the discussions around the cancer drugs fund. The third driver is that patients’ expectations are, rightly, higher than they were decades ago.

The Government response in the spending review was a front-loaded £10 billion injection into the NHS budget, representing an 8% or 9% increase, depending on how it is counted. I agree with the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, that we should not bicker about these amounts. We can argue about whether it is enough, but the facts are that this is a real increase over the course of this Parliament. There is a discussion to be had on whether that real increase is enough—I accept that. What I do not accept is what we have heard about cuts from some of those on the Opposition Benches. There is a valid discussion to be had about whether an 8% or 9% real-terms increase is enough—I gently remind the Opposition that at the last election they said they would not be in a position to fund more than that—but it is not right to talk about it in the context of cuts, as some Opposition Members have done.

[Barbara Keeley]

We get into this repeatedly. The Opposition have no plans to cut £5 billion from social care or to cut the budgets of local councils. That is the difference between us and the Government. Given that we have talked mainly about social care and cuts to social care, the Minister ought to take that into account.

[David Mowat]

I will come on to social care. We have covered the NHS, which this Parliament will get a real-terms increase of 8% or 9%. Let us accept that and move on. On social care, a 5% or 6% real-terms increase has already been made available—that is not the Budget; I do not know what is in the Budget. Again, we can argue about whether that is enough, given the demographics, but we cannot argue whether it is true.

I want to spend a little time on the international comparisons, about which we heard some discussion earlier. According to the OECD, in 2014 this country spent 9.9% of its GDP on health. The OECD average is 9%, so that is 1% more, but it is true that the OECD average includes countries such as Mexico with which we would not necessarily wish to compare ourselves. The average for the EU15, which by and large does not include the newer states in the east, is 9.8%. So in 2014 we spent more than the EU average. It is true that we spend less than some of our comparator countries—we spend less than France and Germany—but it is completely wrong to say that there is a massive gap between us and the EU.

--- Later in debate ---

[David Mowat]

There are assumptions in that—to do with our GDP growth, their GDP growth and everything else—so it is a difficult question to answer. I would just refer again to the latest OECD figures, for 2014. Those figures are accurate. There is a valid debate to be had about whether they are enough, given the demographics and all the rest of it—that is fair—but it is not fair to imply that there is a massive disparity between us and our EU neighbours.

[Barbara Keeley]

rose—

[David Mowat]

I have given way to the hon. Lady once already, and I need to make some progress.

--- Later in debate ---

[David Mowat]

He is right about that. NHS England is evaluating the STPs at the moment and during March and April, and it will decide which STPs are high priority, which will be invested in and which will be taken forward at speed. We heard the phrase “accountable care organisations” used earlier, and it is the Government’s intention to ensure that those high-performing STPs that we proceed with—it will not be all of them; frankly, the standards are variable and locally driven—will in time become accountable care organisations.

The shadow Minister asked me to talk about social care, and I will do so. During the present Parliament, accessible funding for social care has risen by 6% in real terms; it fell during the last Parliament. Last year 42% of councils increased their social care budgets in real terms, and in December £900 million was provided in new homes bonus payments.

[Barbara Keeley]

Will the Minister give way?

[David Mowat]

No, I will not.

[Barbara Keeley]

rose—

[Mr Speaker]

Order. The Minister is not giving way at the moment.

Oral Answers to Questions

Debate between David Mowat and Baroness Keeley

Tuesday 7th February 2017 Commons Chamber

[David Mowat]

My hon. Friend is correct in so far as two thirds of all delayed transfers of care are a consequence of internal NHS issues, not issues between the NHS and councils. The issue regarding Blackburn and Burnley is part of that.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Recent figures on delayed transfers of care ranked Salford 105th out of 154, with 533 delayed days in November 2016. Sir David Dalton has said that overcrowding at Salford Royal hospital is due to its

“inability to transfer patients safely to an alternative care setting”,

and that changes to social care funding are “urgently required”. Salford Council’s budget has been cut by 40% since 2010, leading to the loss of £18 million from social care budgets. Salford royal hospital, rather than the council, is now providing social care. I know that the Health Secretary respects Sir David. Does Minister accept Sir David’s view about the need for funding changes, or will he continue to find people to blame for cuts inflicted by his Government?

[David Mowat]

Conservative Members very much respect Sir David Dalton. I remind the hon. Lady that she stood for election on a slogan of not a penny more for local government, so it is entirely inappropriate for her to say different things now. There is now an opportunity in Manchester, through the devolution deal, to integrate care and the NHS more effectively, and I expect that to happen.

Social Care Funding

Debate between David Mowat and Baroness Keeley

Monday 12th December 2016 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the crisis in funding in social care, and the effect it is having on the NHS and on the care of vulnerable older people.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

I thank the hon. Lady for raising today’s question. All Members of this House will agree that there are few areas of domestic policy that touch on so many lives and that are so important to so many of our constituents.

I wish to start by acknowledging the work of more than 1.4 million professional carers, the vast majority of whom provide excellent, compassionate care. I also wish to acknowledge the 6 million informal carers who also do so much.

Spending on long-term care in our country is more than the OECD average—in particular, it is more than comparable economies such as France and Germany. Nevertheless, I accept that our system is under strain, and that pressure has been building for some years now.

The Government response has been to ensure that councils have access to funding to increase social care spend by the end of this Parliament. We estimate that the increase could be around 5% in real terms. Additional funding comes from the better care fund, the additional better care fund and changes to the precept.

Another response has been to put into place and enforce a robust regulatory system. Between 2014 and early next year, all homes and domiciliary providers will have been re-inspected. Seventy-two per cent are classified by the Care Quality Commission as good or outstanding. Where homes are inadequate, powers now exist to ensure improvement or force closure. Those powers are being used.

Another Government response has been to work with local authorities to ensure that a continuing market exists. In the past six years, the total number of beds has remained constant, and there are 40% more domiciliary care agencies now than in 2010. Finally, the Government have responded by driving further and faster the integration of the care and health systems. We have seen that those councils that do that best demonstrate far fewer delayed transfers than those who adopt best practice more slowly.

Any system would benefit from higher budgets, and social care is no exception—but quality matters too. Today is not a budget statement or a local government settlement. I wish to end by commending again the many hundreds of thousands of carers who work hard to make the current system work for so many.

[Barbara Keeley]

That was a disappointment. Before the autumn statement, we debated the funding crisis in social care—it is not a strain but a crisis—and the serious concerns expressed by local government health and clinical leaders. We on the Labour Benches called on the Government urgently to bring forward promised funding to address that crisis. The Chancellor did not listen and did not bring forward any funding for social care—he did not even mention it. Will the Minister tell us in his response why Health Ministers do not stand up for vulnerable and older people in this country and fight harder to get extra vital funding for social care?

Over 1 million older people in this country have unmet care needs, 400,000 fewer people have publicly funded care than did so in 2010 and, as he recognises, a heavier burden now falls on unpaid family carers. The crisis in social care has been made by this Government as a result of £5 billion being cut from adult social care budgets. Can the Minister confirm what is reported by The Times—that the Government intend to dump this funding crisis on local councils and council tax payers by increasing the social care precept?

The King’s Fund has called that proposal “deeply flawed” because local councils in the least deprived areas would be able to raise more than twice as much as those in the most deprived areas. This year that means that the precept raises £15 per head of the adult population in Richmond, but only £5 per head in Newham and Manchester. That would widen inequality of access to social care across the country. Is it the care Minister’s intention to support a solution that widens inequality of access and denies social care to hundreds and thousands of vulnerable older people?

[David Mowat]

The hon. Lady fought the last election on a manifesto that said not one penny more for local government spending. She is against the change to the precept that we brought in in the spending review. She talked this morning about being against taxpayers and council tax payers having to meet the cost of increased social care. That raises the question who she thinks should be paying for it. Is it borrowing, or is it the magic money tree? She said that the precept increases inequalities because some councils are able to raise more than others from it. That would be true, if it were not for the fact that the additional better care fund is distributed in a way that balances that. That is precisely what we do.

Oral Answers to Questions

Debate between David Mowat and Baroness Keeley

Tuesday 15th November 2016 Commons Chamber

[David Mowat]

My hon. Friend is right that there was an inadequate CQC rating for that care home. It is therefore right that the care home must either improve or go out of business. That is what the CQC regulatory environment will ensure. She makes a point about the issue with the hospital in Paignton; that is out for consultation at the moment, and I would expect the local care situation to be part of that consultation.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The National Audit Office report “Discharging older patients from hospital” said that

“there are…far too many older people in hospitals who do not need to be there”.

Delayed discharges reached a record level in September. The Minister says that this is complex, but I can tell him that the main drivers for that increase were patients waiting for home care or for a nursing home place; those issues are both related to the underfunding of social care. Does he agree with NHS England chief executive Simon Stevens that any extra funding from Government should go into social care?

[David Mowat]

As I said earlier, we accept that the system is under pressure, but we also make the point that there is a massive disparity between different councils. Some 13% of local authorities cause 50% of the delayed transfers of care—DTOCs. The real point is that those local authorities that go furthest and fastest in integration, with trusted assessors, early discharge planning and discharge to assess, have the most success.

Community Pharmacy in 2016-17 and Beyond

Debate between David Mowat and Baroness Keeley

1st reading: House of Commons
Thursday 20th October 2016 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Minister for allowing me advance sight of his statement.

Community pharmacies play a crucial role in our health and social care system: indeed, 80% of patient contact in the NHS is in community pharmacies. The Government’s decision to press ahead with damaging cuts which represent a 12% cut for the rest of the year, on current levels, and a 7% cut in the following year will therefore cause widespread concern and dismay. The public petition that was launched when the funding cuts were first proposed became the largest petition ever on a healthcare issue. It now bears 2.2 million signatures. The message is clear: people want their community pharmacies to be protected.

In the face of unprecedented demands on health and social care services, the importance of local pharmacies is greater than ever. They help to safeguard vulnerable people and signpost them to other services; they are very important to carers; and, crucially, they reduce demand on GPs and out-of-hours services. Do Ministers not recognise the extent of the support that those pharmacies offer, and the impact that their loss will have on communities?

As the Minister said, the Government’s latest funding offer was rejected by the Pharmaceutical Services Negotiating Committee, because it was clear that there was little substantive difference between that settlement and their original proposal in December 2015, and that the outcome would be the same. Earlier this year the Minister’s predecessor, the right hon. Member for North East Bedfordshire (Alistair Burt), said that up to 3,000, or 25%, of community pharmacies could close, and clearly the thousands of remaining pharmacies could be forced to scale down their services. If the Minister does not agree with his predecessor, will he now tell us how many community pharmacies he expects to close as a result of the Government’s cuts? Pharmacies that do survive the cuts will be under significant pressure, which will result in job losses and service reduction. That is putting patient safety and welfare at risk.

The Government’s plans are not only deeply unpopular; they are short-sighted, and will hit the areas with the greatest health inequalities hardest. A study by Durham University has shown that pharmacy clusters occur most in areas of greater deprivation and need. Will the Minister reassure us that the areas of greatest deprivation will not lose pharmacies on which they rely, and will not be disproportionately hit by the cuts? I was not reassured by what he said in his statement.

The cuts will have a significant impact on older people, people with disabilities or long-term illnesses, and, I reiterate, carers, who do not have time to look after their own health and often do not even seek GP appointments. The Minister has said nothing today about releasing an impact assessment. Given that the effect of the cuts is likely to be substantial, with rural, remote and deprived areas most affected, when will we see an impact assessment to justify them?

Community pharmacies help to relieve pressure on our already overstretched health and social care services, and in recent years they have delivered more than 4% of savings for the NHS in cost reduction and quality improvement year on year.

It seems to me that Ministers are ignoring the conclusion of a recent PricewaterhouseCoopers report showing that community pharmacies contribute a net value of £3 billion through just 12 of their services—not all of them; just 12. Therefore, if one in four community pharmacies were to close, that value would be lost and the cost to the NHS would be significantly increased. Has the Minister considered the long-term impact that that will have on other NHS services?

We know that there is concern in many parts of the healthcare sector about these proposals. Can the Minister reassure us that all parts of the health service, including NHS England, support the proposals? Earlier in the week, he said that no community would be left without a pharmacy, but he was then unable to say which pharmacies would close and where. Will he repeat the pledge that no community will be left without a pharmacy?

We recognise the need, as does the Minister, to integrate pharmacy services better with the rest of primary care, but introducing cuts on this scale to community pharmacy services will not improve health services—it will damage them.

[David Mowat]

Frankly, a lot of that was scaremongering, which does not help what we are doing here and does not help with some of the difficult decisions we have had to make. Those difficult decisions are directed at modernising the service, bringing it up to date, making it much more dynamic in terms of added value and less static in terms of dispensing and all that goes with that.

I will answer some of the specific points that were made. There is a full impact assessment and it will be released immediately after the statement.

The hon. Lady asked about the PwC report. I have said on the record on a number of occasions that the report is an excellent piece of work. It does drive home yet again the value of community pharmacies, which we on the Conservatives Benches and in the Government accept. What it does not address is the extent to which those services could be delivered for less cost to the NHS. That is what I have to address and that is what we have done.

The hon. Lady asked whether NHS England supports the changes we are making. She might have heard the comments made by Simon Stevens, but I will read out, in answer to her question, a quote from the chief pharmaceutical officer of NHS England:

“NHS England, as the national commissioner of community pharmacy services in England, can reassure the public that the efficiencies which are being asked of community pharmacy will be manageable and there is sufficient funding to ensure there are accessible and convenient NHS pharmacy services in every community in England.”

[Barbara Keeley]

How many are closing?

[David Mowat]

The answer to that question is, I do not know. It is possible that none will close. I do not believe that 3,000 will close. However, I would say this. The average operating margin that the pharmacy makes on the numbers that I quoted earlier is 15%. That is after salaries and rent. The cuts that we are making, or the efficiencies that we are asking for, are significantly lower than that. Of course there is no such thing as an average pharmacy, which is why I cannot guarantee that there will be no changes. What I can say is that, if there are mergers and if there is some consolidation, that demand does not go away—it goes to the other pharmacies in the cluster. To say that those pharmacies will be put under more pressure is plain wrong.

I say again that what we are doing is building an industry that is fit for the future, that is modern and that is adding value in a way it has not been able to do in the past.