NHS: Independent Investigation

David Simmonds Excerpts

Thursday 12th September 2024 Commons Chamber

[Wes Streeting]

I am really grateful to my hon. Friend for her question. She has a huge amount of expertise in health and care, and she is absolutely right about the need for that shift. I have made it very clear to ICB leaders and to trusts across the country that I want more focus on secondary prevention, which means much more activity in the neighbourhood. I know that she will keep on championing these causes. She is a good critical friend, and I know that she will hold my feet to the fire to ensure that I deliver.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

I declare my interest as the husband of an NHS doctor; I also served as a non-executive director of my local NHS trust. The last time that Lord Darzi was brought into service was by a Labour Government, shortly before they appointed him to the House of Lords. Will the Secretary of State take steps to ensure the widest possible input from senior clinicians? It is clear that some, including Professor Sir John Bell, do not share Lord Darzi’s prescription for the improvement of the NHS. Will he also apologise to my constituents for the doubt that he has cast over the future of the new Hillingdon hospital, on which work had already started under the previous Government?

Oral Answers to Questions

David Simmonds Excerpts

Tuesday 19th April 2022 Commons Chamber

[Maria Caulfield]

I am sorry to hear about the case of the Bryan family, but I reassure the hon. Gentleman that, in Derby and Derbyshire, 92% of treatments start within 30 days, despite record numbers of patients coming forward. To tackle the issue of getting people diagnosed earlier, which is key to getting more successful treatment, we are rolling out rapid diagnostic centres across the country so that people can access screening and testing much more quickly and easily. We have 159 of those live right now, with more to follow.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

9. What steps he is taking to increase the delivery of personalised healthcare.

[The Secretary of State for Health and Social Care (Sajid Javid)]

Personalised healthcare is a key priority in my reform agenda. I recently set out a new ambition: that as many as 4 million people benefit from personalised care by 2024, covering everything from social prescribing to personalised support plans. We are also on track to deliver 200,000 personal health budgets and integrated personal budgets by 2023-24.

[David Simmonds]

I welcome the Secretary of State’s answer. My constituents are still telling me that they are experiencing some delays beyond the NHS guidelines on diagnosis for special treatment. What plans does my right hon. Friend have to address the lack of capacity and need for capacity in specialty-trained doctors and specialist diagnostic equipment, to make personalised care a reality?

Covid-19: Impact on Social Work

David Simmonds Excerpts

Wednesday 23rd March 2022 Westminster Hall

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I add my congratulations to the hon. Member for Lancaster and Fleetwood (Cat Smith) on securing the debate. Like her, I have had the opportunity over many years in the world of local government, to see the transformative benefits that social workers can bring to the lives of many of our most vulnerable people. Those are children in the care system, adults with learning disabilities and people facing difficulties in old age, where the professionalism, attention to detail and the care provided by local authorities across the country have enabled people to live the best life they possibly can in the circumstances they face.

The topic of today’s debate makes clear that the pandemic has tested not just the professionalism of our social workers, but our care system’s capacity to respond. We will all have seen amazing examples of how social workers and those connected to them have stepped up to the plate. The local authorities that serve my constituency—the London Borough of Hillingdon and the London Borough of Harrow—both played key roles in the community. Social workers identified the needs of individuals and harnessed support from volunteers, charitable and community organisations, to ensure that, where there were limits to what the state could do to provide for people in a time of acute need, others were able to step in.

I will give the example of H4All, a charitable organisation in Hillingdon that brought together the efforts of several organisations, supported by a local authority that recognised that social workers would be able to do their best work if they were effectively supported. For example, with libraries closed, library staff were redeployed to man call centres for people who needed to raise a concern about someone they knew, a family member, or who were supporting someone and needed to arrange delivery of medication.

They were able to use staff who were redeployed, so that social workers could concentrate on things that only they could do, such as assessments of need to enable people to progress in their care packages, the preparation of people to be discharged from hospital, and acute work in children’s services, such as child protection for those known to be at risk, who might otherwise have missed the opportunity of a regular visit from a professional to ensure they were safe and thriving in their placement. One of my neighbours, a foster carer, was supported through the process of fostering a baby who was placed with her. Social workers were able to continue ensuring that system for supporting the needs of the most vulnerable, despite all the pressures of covid.

In the context of the debate about the future of social work, covid has given us the opportunity, not just in social work but in many parts of our system, to learn lessons and identify what we can do better, based on how covid tested the operation of the system. As the co-chair of the all-party parliamentary group for social work, I am conscious that, along with other professional organisations, social workers are taking a key interest in how the profession will develop and sit in the context of the care system, of which it is a crucial part.

That is not a new debate. I commend the Department for Education for seeking, through the fast-track programme, to identify ways in which people who want to become social workers could develop their professional standards. They are able to pursue a programme, facilitated by placements in different types of organisations, with different aspects of the social work profession. Having sat in on some of those training sessions, I was fascinated to see how social workers saw things in a different light, through talking to people who managed cases other than the ones they might commonly come across in their day jobs. They were able to support each other to develop their professional judgment. The proposed re-tendering of that programme, although an important part of the system, needs to ensure that it continues to support social workers in developing the highest professional standards, and does not lose the focus it has brought to the system.

Some of those issues are consistent across all parts of the social work profession. We heard, for example, about caseloads, which remain a challenge for social workers whether they are dealing with adults with learning disabilities, very elderly people, or children who are in need for whatever reason. The context of regulation for children’s social workers is different from that of adult social workers, and that also remains a challenge. The work of the Care Quality Commission is perhaps beginning to diverge from the work of Ofsted, so the regulatory framework for the social work profession is becoming more and more diverse, reflecting the fact that the clients that social workers serve are different.

It is worth reflecting on some of the pandemic lessons. We have seen, for example, a move away from significant numbers of family support workers in children’s services, as well as occupational therapists in supporting elderly people, and in the role of youth workers, which was referred to earlier. Perhaps we need to reflect on the structures that we expect from our local authorities and that our regulatory framework drives. Perhaps there should be a greater degree of local flexibility to bring together those different but allied professions so that they focus on the needs of the most vulnerable.

Local authorities will do that for a variety of reasons. I recall Hackney Council’s so-called pod model bringing together youth workers, therapists and social workers. By the time that other local authorities had adopted that model, Hackney had given up on it because it felt it was not working any more, so there is sometimes a risk that, when tested, new ideas prove to be not as effective as we would like. However, we should see the deployment particularly of folks such as family support workers in a way that can really help the social work profession to do what it does best and what only it can do, and the service that vulnerable people receive should be of the highest quality possible.

The greater divergence among the workforces around children, adults and the elderly can be positive, particularly in the context of extra funding, which we expect to see coming into the system through the decisions that the Chancellor and the Government make. Some will say that that is overdue and insufficient, but I can say that from my experience in a local authority it will be most welcome. It will ease a lot of the pressure that has been building up in the system and, because the local authority funding model is so diverse across the country, it can re-base social services departments so that they are more consistently funded through a national programme in a way that putting the burden on council tax payers cannot achieve because of the diversity of how much funding is raised.

The social work profession has an opportunity to consider parallels with what is going on in other professions, especially across the public sector where we see many similar roles. How is the nursing profession developing? How are the lessons from professional development being applied? In teaching and policing we see not just similar salary levels, but often common qualifications and of course a focus often at the most vulnerable end on the same families, so are there things that we can do to improve the way that the training and development across all those professions is aligned so that they can work more effectively together?

The pandemic period, the debate today and the celebration that has been referred to have demonstrated once again that social workers and those who support and work with them remain a key part, often a hidden part, of the social infrastructure of our country. The local authority with the most people coming into contact with any part of social care has less than one in five of its population receiving any form of support from social care during the whole of their lives. Most people will never be touched by social care, but for a critical group in society it is absolutely vital that they receive care to the highest possible standard, and I join the hon. Member for Lancaster and Fleetwood in paying tribute to the work that social workers have done in keeping society together during the pandemic.

--- Later in debate ---

[Jim Shannon]

The hon. Gentleman is absolutely right. Many social workers I deal with are probably of a certain generation. He makes the point that we need to be preparing, and that goes back to my question to the Minister about having a strategy and plan in place.

I understand that many young people do come into social work, because I have met some, but—I say this very gently, and it is not in any way meant to be critical—they need to have experienced social workers to work alongside and gain their knowledge. Young people will sometimes be confronted with cases that they might not have the life experiences to deal with. That is not a criticism; experience is gained over many years. I have been confronted by such cases on behalf of constituents, and I feel that decisions are not always made—in my opinion, as someone who is not a social worker—as they could or should have been.

[David Simmonds]

I entirely agree with the hon. Member’s point. Does he agree that programmes such as the fast-track ones bring the opportunity, in particular for young social workers who might be graduates straight out of university, to work with people who may have been in the profession for 20 or 30 years? Young social workers would have the chance to learn from experienced people and to see how they dealt with cases with which I, as a lead council member, was sadly familiar—for example, sometimes, the sexual abuse of children committed by professionals who were meant to be caring for them, or elderly people suffering complex financial abuse within a family. It is important that the Department of Health and Social Care and the Department for Education continue to support that type of professional development, so that we can grow our own highly professional social workers in the future.

[Jim Shannon]

As my friend, the hon. Member for Glasgow East (David Linden), said—and as I am trying to say, in my broken words—people have to start somewhere in life; they have to start their job somewhere and learn about their role.

Social care organisations have revealed that 75% of social workers feel more negative about their work life in 2021 compared with in the first year of the pandemic. People come to us all the time with problems, and I like that because it is my job. Many people say, “I don’t know how you do your job, listening to people’s complaints and always solving their problems, and so on”, but I reply, “That’s what life is about. Life is about making lives better.” We need to be aware that social workers sometimes deal with complex and difficult issues. My question to the Minister is, has any assessment been done of the impact of the pandemic on social workers? If the figures are right—I understand that they are—that 75% of social workers feel more negative about their work life in 2021, we have a potential problem. I hope we do not, but we must at least consider that and respond.

This situation is down to the increasing pressures and challenges that the social work sector has faced. Referrals of children to social services in Northern Ireland have increased every month since February 2020. The highest figure was in April 2021, with 3,616 children being referred. That clearly indicates that parents are struggling to cope, and is a clear sign of the increasing pressure on our social workers, which the hon. Member for Lancaster and Fleetwood illustrated very well in her contribution, and as other Members have reported.

We must not forget the impact that the covid outbreak has had on the social sector in relation not just to children, but to the elderly and the vulnerable. The hon. Member for Ruislip, Northwood and Pinner (David Simmonds) rightly referred to an issue that is on my mind as well: people who depend on family members to look after their financial affairs. I have dealt with a few of those cases, which are always difficult because there are often two sets of family members saying two different things—but there is a person in the middle who is losing out.

The BBC revealed in mid-2021 that almost 2,000 people in Northern Ireland are waiting for care packages, so that they can be supported to live in their own homes. Just this week, a very lovely man who I have known all my life—he is well into his 80s now—has been ill and had to go to hospital. Although he wants to come home, and would be able to, he needs a care package in place before he can come home because, due to the nature of his disability, his wife would be unable to provide the physical care that he needs. That is not the Minister’s responsibility; I am just illustrating the issue.

The wait for care packages could mean an increase of patients to residential care. My constituency of Strangford takes in the South Eastern Health and Social Care Trust, which has reported that 282 people were waiting from the end of August 2021. Social workers are a key part of making that a success story. The provision of home care is crucial in taking the additional pressure off of hospitals and care homes. We must ensure that our social workers have the capacity to deal with the increasing amount of care packages needed. I have never seen anything quite like it. I know that we are getting older—we are living longer and our bodies are breaking down, meaning that more people need care packages—but there has to be a strategy and a vision for how we deal with that, as has been pointed out in other contributions.

There is an increased risk of covid infection for those who work in the social work industry, as we have seen happen over and over. That is nobody’s fault; it is the nature of life. It cannot be helped when tests are positive and people must take time off work. However, that is where we can step in to ensure that there is a sustainable number of social workers to cope with the level of care needed by children, the elderly, the vulnerable and the disabled.

We must also take into consideration the impact of the pandemic on our social workers’ mental health. Some 55% of respondents to a survey said that they felt increased anxiety—in an already difficult job—given the risk that they posed to the vulnerable by potentially carrying covid. I am keen to hear the Minister’s thoughts on how we can better deal with that. One way would be to have extra staffing, as the hon. Member for Lancaster and Fleetwood mentioned earlier. Social workers are as prepared as they can be in terms of personal protective equipment, as the Government and the Minister have done extremely well in responding to that need, but the Government must step in when it comes to staffing and workload. Many social workers have stated that their casework load has increased by as much as 40% over the pandemic. They are working longer hours—I know that, because they tell me that and I see it—and those longer hours are probably for the same money. Overtime rates will never compensate for the loss of physical wellbeing and mental health.

The Department of Health and Social Care must have provisions in place to ensure that our social workers are not under the most extreme pressure. I very much look forward to the Minister’s response and the encouragement that she will give us. I urge her and her Department to consider the impact of that pressure not only in England, where her responsibility lies, but across the United Kingdom. I know that the Minister, like those in other Departments, regularly contacts her equivalent Minister in the devolved Administrations, be that in Scotland, Wales or, in my case, Northern Ireland, so I know that there is continuity between those Administrations. I say very gently to my two friends, the hon. Member for Glasgow East and the hon. Member for Linlithgow and East Falkirk, that I very much think that within this great United Kingdom of Great Britain and Northern Ireland, we are always better together; we can work together and exchange ideas, and we can all benefit from that. I say that gently to my friends in the SNP, because I know that they really do agree with me that we are better together.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank the hon. Member for Lancaster and Fleetwood (Cat Smith) for securing the debate so close to World Social Work Day, and for using her excellent speech to highlight the excellent and varied work that social workers do day in, day out. I had the pleasure of attending the world social worker of the year award ceremony, which was held here in Parliament on World Social Work Day. I know that many Members from both sides of the House enjoyed going along, meeting their local nominees and celebrating the fantastic work of social workers, as well as congratulating the winners of the awards.

Social work is a highly valued vocational profession and we thank all social workers for their important work to support those who are hardest hit, especially during the pandemic when we really relied on their support. Social workers provide a critical model of practice for the health and social care sector. They undertake relationship-based engagement with individuals, their families and communities, and combine emotional support with practical help at a time of great need. Their strengths-based personalised approach in understanding what matters enables them to shape people’s care and support so that they can have the best possible lives. I pay tribute to them all, including the hon. Lady’s father, who obviously contributed to changing many lives during his career.

Importantly, social workers work across agencies and connect people to the resources and the services that they need. They span the boundaries of our health and care workforce, ensuring that people’s human rights are protected and that the individual’s choice and control of their care and support is respected at all times. The pandemic has taught us that co-operation and collaboration across the health and care sectors are absolutely critical, and social workers are central to embedding that way of working. They co-ordinate health and care planning and make vital links to ensure that people with care and support needs do not slip through the gaps in provision.

We have never needed the expertise and insights of social workers more than we do now. As we emerge from the pandemic—into fresh anxieties and tragedies born from the war of Ukraine, the cost of living crisis and other things that we will have to deal with—we will turn to the social work profession for advice, guidance, leadership and support. Covid-19 had a significant impact on health and social care services, including social work, and the response of our workforce was one of dedication and commitment to the people whom they support. Those were unprecedented and challenging circumstances and we stand by the entire workforce and thank them for their vital work to make a difference to people’s lives.

Our focus has always been on ensuring that the adult social care sector has the resources that it needs to respond to covid-19. Throughout the pandemic, we have made available more than £2.9 billion in specific covid support funding for adult social care, including £1.81 billion for infection prevention and control, £523 million for testing, and £583 million for workforce capacity—recruitment and retention—as we know that there are shortages across the sector.

The infection control and testing fund and the workforce recruitment and retention fund supported the care sector to prevent the transmission of covid and to support local authorities in working with providers to boost staffing and support existing care workers until 31 March of this year. Some of that funding helped to enable local authorities to provide continuous support to those in need of social care, including by delivering social work appointments virtually, as well as in person where it was appropriate and safe to do so.

Social workers went above and beyond during the pandemic and they deserve huge thanks for their tireless work. That is why continuing to help social workers manage their mental health and wellbeing remains a priority for the Government. We are determined that everyone working in social care should feel they have someone to talk to or somewhere to turn when they find things difficult. As many hon. Members have said, they deal with the most complex and difficult cases. We are committed to supporting social workers to recover from their extraordinary role in helping our country through the pandemic. We will deliver a listening service to help relieve immediate pressures, as well as talking therapies and coaching sessions for those with more intensive needs.

The chief social worker for adults, Lyn Romeo, has implemented a range of measures during the pandemic, including partnering with Tavistock and Portman NHS Foundation Trust to issue guidance to support the wellbeing of adult social workers and social care professionals. She meets regularly with the principal social workers in each local authority and NHS trust, advising and supporting them on practice and workforce support for their staff during the pandemic.

We have invested in increasing the number of social workers completing their approved mental health professional qualification for local authorities to increase their capacity in responding to the needs of people with mental ill health. An additional 228 social workers will be supported to complete their training. Social workers have been supported to improve their knowledge and skills in working with people with learning disabilities and autism.

My hon. Friend the Member for Ruislip, Northwood and Pinner (David Simmonds) mentioned the vital work that social workers do to support people with learning disabilities. The chief social worker for adults commissioned the British Association of Social Workers to develop a capability statement for social workers working with adults with a learning disability in 2019. That supports best practice in this important area, especially considering the impact of the pandemic on those with learning disabilities and/or autism.

As well as our focus on wellbeing, we know the importance of building and strengthening our social care workforce. A number of hon. Members mentioned that it is vital to strengthen the social care workforce so that we can meet demand now and in the future. It is encouraging to note that the number of child and family social workers in the workforce is increasing every year, up from 28,500 in 2017 to 32,500 in 2021. That is 2% more than in 2020 and 14% more than in 2017.

The hon. Member for Strangford (Jim Shannon) rightly focused on recruitment and strengthening the workforce. The Government invest over £130 million a year on recruiting, training and developing social workers to ensure the social care workforce has the values, capacity, skills and knowledge to perform its roles. This includes investments in bursaries for undergraduate and postgraduate social work degrees. A new and very popular addition, which I am very proud of, because I worked on it in my last role, is degree apprenticeships.

We have education support grants to support practice placements in organisations delivering social work services. That is vital to build that experience that was mentioned by the hon. Member for Strangford and the hon. Member for Glasgow East (David Linden). We also have a range of postgraduate fast-track training programmes for those wanting to work in children and family social work or mental health social work. Our attention is not just on training our social workers of the future; we also invest a significant amount in leadership and development programmes for qualified social workers. That includes leadership programmes for social workers and the assessed and supported year in employment for newly qualified social workers. That provides high-quality support for every newly qualified social worker by sharing best practice and quality-assuring provision.

We have announced record investment in developing the social care workforce. In our recent White Paper, “People at the Heart of Care”, we set out our workforce development strategy and plans for the investment of £500 million over the next three years. I am sure we will be discussing that many times as we develop those plans. The investment will help us to realise our vision for a workforce of people experiencing rewarding careers with opportunities to develop and progress in the future. That includes a focus on how we can develop new training routes for people who want to become social workers.

We will also work with the adult social care sector, including providers and the workforce, to co-develop a universal knowledge and skills framework and careers structure. As well as supporting the development of our care workforce, we will help those wanting to progress into regulated professions such as social work. I am also delighted that the number of people taking part in the new social worker degree apprenticeship programme continues to increase, with 660 starts in 2019-20 alone. That is only the second year for which it has been available, so that is phenomenal growth.

Looking forward, we have commissioned Health Education England to work with partners to develop a robust long-term strategic framework for workforce planning. For the first time ever, the framework will include regulated professions working in social care, such as nurses, social workers and occupational therapists. That work will look at the key drivers of workforce supply and demand as well as careers, as has been mentioned, and will inform the direction of the health and care system over the next 15 years.

The framework will help identify the main strategic choices facing us, develop a shared and explicit set of planning assumptions and identify the actions required at all levels of using all our system levers. That will ensure that we can plan for a workforce that is skilled, confident and equipped with the right support to deliver the highest quality health and social care in the future. It will also form the basis of our next phase of work to develop a long-term workforce strategy, led by NHS England and NHS Improvement in partnership with Health Education England and the Department of Health and Social Care.

[David Simmonds]

I very much welcome what the Minister is sharing with us today. Does she agree that it would be worth considering how to develop the finance function of health and social care? The recent Competition and Markets Authority report highlighted that a lot of the provision the private sector has brought into the care market, both in children’s homes and adult social care, is, frankly, quite an astonishing rip-off for the taxpayer. Profit margins of 30% and more are not unusual and these are complex structures that are extracting resources that could be spent on care. Does she agree that there is an opportunity both strategically and in developing the skills of social workers and others involved in those decisions locally to bring more focus to the issue so that we can ensure we procure the best possible care with an eye to value for money for the taxpayer?

[Gillian Keegan]

My hon. Friend raises an important point that we will address as part of the White Paper, “People at the Heart of Care”. It is important that we equip local authorities with the skills and tools they need to commission well in the market and to get the balance right between paying a fair cost for care while making sure that they get value for money for taxpayers.

Oral Answers to Questions

David Simmonds Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Mr Speaker]

Order. Questions and answers are meant to be short and punchy. We cannot get into a full-blown debate.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

T5. My constituents benefit from the excellent healthcare provided at Hillingdon Hospital, but it is long overdue a rebuild. Can my right hon. Friend give me an update on when we might expect to see progress on those plans?

[Sajid Javid]

It is a vital project, and the trust project team are working well with NHS England and with my Department. The scheme, as I understand it, remains on track; like my hon. Friend, I look forward to its completion.

Health and Care Bill

David Simmonds Excerpts

Report stage
Tuesday 23rd November 2021 Commons Chamber

[Peter Dowd]

I am afraid that I do not have time. Let the Secretary of State report on access to NHS dentistry and give it a seat at the table on integrated care boards and partnerships, along with other health professionals. In conclusion, these proposals are about a comprehensive national care strategy that will help both patients and the NHS, and giving dentistry the attention that it deserves. Those are the areas we need to focus our attention on. They need a bit of tender loving care.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

I will be exceptionally brief, Madam Deputy Speaker. I wish to speak on amendments 103 to 105. It seems clear to me that when a House has made a decision to impose statutory obligations on local authorities and other local bodies, we need to ensure that they are effectively consulted, in order to bring their expertise and local insight to bear in improving the quality of services that are offered to our patients. I hope that Ministers will be taking that on board in their response tonight.

[Carla Lockhart (Upper Bann) (DUP)]

I wish to speak to new clauses 51 and 52, both of which stand in my name. New clause 51 relates to the practice of abortion based on sex selection, and it seeks to clarify that abortion on the grounds of the sex of the foetus alone is illegal. Hon. Members from across the House would doubtless agree that aborting a baby on the basis of their sex is immoral, yet the status of this in law remains unclear.

Unfortunately, there is growing evidence that this horrible practice is taking place in Great Britain today. A 2018 BBC investigation found that non-invasive prenatal tests were being used on a widespread basis to determine babies’ sex early in pregnancy. We know that women are being coerced into having abortions based on sex selection. This was confirmed by a 2015 report from the Department of Health that detailed the awful testimonies of women who had been forced into a sex-selective abortion. The problem has been made much worse by the use of abortions pills to be taken at home. Abusive partners who do not want a particular sex of child—usually a girl—can more easily force their partner into having an abortion via telemedicine. The new clause seeks clarification that this practice is illegal, so provides an opportunity for the Government to do more to help women who are pressured into having an abortion on the basis of sex.

I wish briefly to touch on new clause 52—also tabled in my name—which would introduce an upper gestational limit on abortion on the grounds of disability that is equal to the upper limit on most other abortions. It would correct the current deeply discriminatory situation that permits abortion up to birth if

“there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.”

That has been interpreted as permitting abortions up to birth following the diagnosis of either a cleft lip, a cleft palate or a club foot. This is inconsistent with disability discrimination legislation, because it allows for abortion on the grounds of disability more widely than most abortions are allowed.

Health and Care Bill

David Simmonds Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Karin Smyth]

I came to this place largely on the back of the disastrous Lansley Act, and I am pleased to see it banished to the dustbin of history, which is what this Bill essentially does. It also banishes to the academic shelves that example of how not to make policy. Lansley took a sledgehammer to our work in primary care trusts, to partnerships, to morale, and to our capacity to forward-plan. Along with the austerity funding that came with it, the Act directly led to the poor state in which we entered the pandemic, and that must be front and centre of any review of the pandemic.

This Bill is a seminal point in the history of the NHS, because it banishes again to the history books experimental competition as an organising principle and a driver of efficiency. The key issue is what replaces it. Now we have in its place local cartels dominated by hospital trusts, and the supreme power of the Secretary of State to interfere in all local decisions. There is no power here for local elected representatives, no power for primary care or community care or mental health, no voice for patients, no voice for the public, and no voice for the taxpayer, who is asked to pay ever more. As we move to an ever more costly health service, accountability and transparency of our NHS in this role has to be at front and centre in order to bring people with us on that journey of paying more.

I have tabled two amendments to this part of the Bill. One is on the need for the local boards to be cognisant of palliative and end-of-life care. The other is on local improvement finance trusts, the local public private sector bodies introduced under the last Labour Government that are instrumental in providing good primary and community care estate—something that this Government are allowing to wither on the vine. My own South Bristol Community Hospital needs more support through these trusts in order to thrive, so that people have decent, good-quality estate from which to receive their care.

I also draw hon. Members’ attention to my new clause 23 on a good governance commission, which will be discussed tomorrow. I genuinely offer it as a helpful way forward. If it were enacted by the Government, it would avoid the cronyism that we have become used to, and would ensure that local bodies are more democratically accountable to their populations and more cognisant of the needs of their local populations. It would ensure that the people leading the local bodies are fit and proper, meet basic criteria regarding what is expected of them and have crucial accountability to local populations. It is akin to the Appointments Commission, which was abolished in the abolition of the quangos; that was a huge mistake. If the Government took notice of it, the new clause would really help us to get around some of the real concerns about how our local health services are governed.

Let me finally address new clause 49 on social care. It is a disappointment and unexpected. We had six weeks in Committee. In that time, we could have looked carefully at the proposal and shone a bit of light on it. The right hon. Member for West Suffolk (Matt Hancock), who is no longer in his place, clearly tried to say what this provision is really about, in that one part of the state should not be subsidising another part of the state. He started to say that that was a true Conservative principle and he was absolutely right. This provision will remind people who are in receipt of benefits that they are in receipt of those benefits, and that anything they may have built up should not be counted towards their future. It is a punitive property tax. I am old enough to remember what happened to the last Conservative Government who introduced a regressive property tax; this Government really ought to think again.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

I draw the attention of the House to my entry in the Register of Members’ Financial Interests in that I am married to an NHS doctor, who is employed by a hospital trust that serves my constituency.

Let me turn first to new clause 49. Those of us who have been in the world of local government for a long time will have seen the attempts by Governments of various parties to address the financial settlement around social care. I chaired a social services committee that pushed through the charging policies introduced by the last Labour Government in an attempt to address these costs. I also chaired a social services committee that had to balance the demands of the fair access criteria, and saw the last Labour Government drive a coach and horses through a lot of local provision.

I recognise that we should all seek to ask questions of Governments about how we address in particular the impact on working-age adults. In response to the people asking whether we are proud of what we are here to do tonight, I would say that we should be proud of the fact that we are willing to take what are sometimes difficult decisions to ensure that we balance the books and have a sustainable financial settlement that supports social care for our constituents. It is too late for my two grandparents, who went through the process and saw very modest assets consumed by the cost of long-term care, but I welcome the fact that my constituents, and people up and down the country, will benefit from what this Government are seeking to achieve.

I will move on, briefly, to new clause 55, which addresses the responsibilities for ICSs regarding the provision of services and planning for services for our youngest children. My right hon. Friend the Member for South West Surrey (Jeremy Hunt) made a helpful intervention, in which he pointed out the effectiveness of Ofsted-style regulation in ensuring the quality of provision at a local level.

We had an excellent debate in the Chamber just a few weeks ago, discussing the work done by my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), which was reflected in the budgetary decisions that were brought forward previously. Having had that debate, it seems clear to me that in tabling an amendment supported by more than 70 organisations in the field of children’s care, we have an opportunity—one which was debated and touched on through various assurances from Ministers in Committee. It is an opportunity to ensure the right level of rigour and accountability in what we ask of ICSs, so that we can make sure that our youngest children, babies, neonatal care, and indeed young people up to the age of 25 who are already covered by statutory provisions in respect of special educational needs and care leaving, are appropriately covered.

[Several hon. Members rose—]

Giving Every Baby the Best Start in Life

David Simmonds Excerpts

Tuesday 9th November 2021 Commons Chamber

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

All of us in this House who are parents or have young children among our family and friends will know that there is an abundance of advice available on the topic of today’s debate and many of us take that advice: we talk to our babies in the womb; we play games with them before they are born; we study baby-led weaning; and we invest in stain-proof covers that never seem to extend quite far enough. But wherever on the nurturing scale we sit as mums and dads, babies thrive when they are surrounded by adults taking an active interest.

The focus of my contribution is the babies and young children who need extra help to thrive—those whose interests are at the heart of the decision by the Government to invest in family hubs in the recent Budget, as championed by my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). As many Members have said, it is welcome that this agenda is taking a higher profile in the context of levelling up, because we all recognise the need to build on sound foundations.

Twenty years’ experience in children’s services has taught me a lot about the strengths and weaknesses of the child support system in our country. Like our NHS, we are very good at emergency services, and studies by academics at the University of Bristol and the University of Warwick show that the UK has a world-leading child protection system. But today’s debate goes beyond protection from harm, and into how we help children to thrive and flourish—something that is a matter not just of social responsibility but, as my right hon. Friend the Member for South Northamptonshire highlighted, of long-term economic benefit to our country.

Thriving children live lives that cost the taxpayer less and contribute more to everyone’s benefit. To that end, I am going to offer three points, which are focused on how we turn the widely-shared aspiration that we hear in the Chamber—I grew up in the village of the hon. Member for Pontypridd (Alex Davies-Jones) and am glad to hear of the progress it is making—into a change that children and their families can see and feel in their lives.

First, we need to follow the flow of money. The funding for early years, which is a key statutory responsibility for all local authorities, remains mired in bureaucratic processes that are dominated by those whose focus, for good reasons, is elsewhere. Schools forums, which determine the distribution of the dedicated schools grant, in which much of this funding sits, are dominated by the interests of our secondary schools. A fragmented early years sector of small private, voluntary, charitable providers often struggles to be heard. There is a structure around the money that inhibits innovation and flexibility, and stands in the way of creating the joined-up local offer that my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) highlighted. Although I can see that there is a perceived political benefit to lumping that early years funding in with schools, in reality the needs of the sectors are different.

[Mr Kevan Jones (North Durham) (Lab)]

I have listened carefully to what the hon. Gentleman says about ringfencing and I do not disagree, but that is why Sure Start funding was directed through local authorities and ringfenced at a local level for local authorities to draw up their local strategies. He talks about levelling up, but this process did not start in 2019. We have seen the devastation of Sure Start centres, certainly in County Durham, as a result of cuts to that funding by his Government—although I know that he perhaps was not in the House then.

[David Simmonds]

It is good to hear the right hon. Member’s contribution. I was in a local authority throughout Sure Start’s implementation period, and although it was welcome to see a Government giving a high degree of priority to children in the earliest years of their lives, there were a number of failings with that programme. One was that the pace at which Government sought to deliver it—for understandable reasons, it was a political priority—meant that poor decisions were often made about the location of services and exactly what was delivered. At a time when many activities outside Sure Start were a high priority for local areas, Sure Start was generously funded to meet the Government’s aspiration while other activities, such as child protection, were starved of cash. Although all Governments want to deliver their priorities, we need to achieve a longer-term consensus about what is in the interests of children in the earliest years of their lives.

I call on Ministers to consider how we free the early years sector from the shackles imposed by the dedicated schools grant and bring it together with other local authority and NHS budgets, so that investment can be aligned with the needs of local families and built on the strengths of the early years sector. We must not forget that the sector is not just about nurseries; it provides an opportunity to join up with a range of local statutory and non-statutory services, which include health visiting, child minding, family hubs, child protection, public health, vaccination services, libraries, play and informal learning. When I was a new parent, the services provided by the libraries of the London borough of Hillingdon, including story time for young children, were an outstanding example of that early support. They were a chance to meet other parents whose children were at the same stage, to get informal advice and tips. That may sit outside what Government mandate, but it is exactly the sort of thing that parents of young children treasure.

Having touched on the funding challenge, we need to ensure that every area has the scope to develop a strategy for thriving that suits local circumstances. Many of our councils—the 152 top-tier authorities—are in partnership arrangements of one kind or another. Some are council to council, and others reflect outsourced services. That all reflects issues of local need and capacity. Along with the statutory lead member for children’s services and the director of children’s services, the health and wellbeing board has the most scope to join up the offer to get babies the best start in life. Those boards—statutory committees of the local authority—still struggle to assert their role, especially with the NHS, which in my experience is strategically disengaged, despite their role as key partners.

The rearguard action fought by the NHS against making public health a local and accountable service has also inhibited innovation and tied up resources in rolled-over NHS contracts rather than stimulating the reshaping of local services around children. I have seen some outstanding examples of such reshaping, however. I pay tribute to my constituent Dr Jide Menakaya, a leading paediatrician who has led work across the sector in his field of neonatal care in the London borough of Hillingdon to join up children’s services and Sure Start so mums and dads have a seamless experience. However, the system still tends to stand in the way of creativity rather than promoting it.

My suggestion to the Front-Bench team is that, in line with previous asks of our health and wellbeing boards—for example, to produce joint strategies on child mental health—we look at setting a clear expectation for them on a strategy for helping children to thrive in line with the first 1,001 days ambitions. Much of this already exists in different forms at a local level, but for a new parent or an expectant family, it can feel hard to access and fragmented, because it is driven by the disparate duties and funding regimes imposed by Government. In line with the local offer for children with special educational needs and disabilities, a strategic approach to the local offer for the earliest years will deliver greater value for money and, vitally, greater coherence for parents who access it.

The final area that I would like to put forward for consideration is accountability. Successive Governments have adjusted the regulatory environment for the early years, but broadly speaking the two priorities today are school readiness—seen in the regulation of settings such as child minding and nurseries—and the avoidance of harm to children, which is seen in the regulation of child protection and the NHS. We are in a context where resources are extremely stretched—not just money, but, as we have heard from a number of Members, the workforce too—which tends to drive a risk-averse approach in the early years, prioritising the absence of failure, rather than the promotion of innovation. We need to consider how we line up the accountability that we have all talked about with what we are seeking to achieve for our children. My suggestion to Ministers is that we need to look beyond the current inspection regimes and datasets used for performance management, many strengths though they have, and think about how we measure the things involved in a child thriving—the positive health and social outcomes that we want for babies in our country and how we incentivise the behaviour that will deliver them. Time is tight, so I will simply say that we have so many statutory duties in place that will help us deliver that, but so often the holders of those duties lack the autonomy needed to fulfil the aspirations we have. We need a permissive approach from Government.

In conclusion, we need to recognise that much of what we do is world class and of the highest quality, as many parents of young children, including me, can attest, but the regulatory regime still too often expects low standards. Rather than contributing to success, we have a complex funding system that stands in the way of local communities and their leaders delivering value for money and good outcomes for every child. We all want to give our babies the very best start in life. By enabling local leadership, setting high standards and setting people free to innovate, we give ourselves the best chance of levelling up life chances for all our children.

Menopause (Support and Services) Bill

David Simmonds Excerpts

2nd reading
Friday 29th October 2021 Commons Chamber

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

Time is very much against us, but I particularly welcome this debate and especially the decision by the International Menopause Society to adopt bone health as its theme for this year. I pay particular tribute to Councillor Janet Gardner of the London Borough of Hillingdon, who has been very public in talking about the impact of osteoporosis. Having people in public life who are willing to talk about that, to demonstrate how they can continue to serve the public, is incredibly important when we discuss these issues.

The Bill’s scope is extensive and, in the short time open to me, I will focus particularly on the lessons that we can learn from public health campaigns, as well as on the points raised by the hon. Member for Swansea East (Carolyn Harris) about how we turn the aspirations that we all share into transformational change in the way in which women are supported with the symptoms that they may experience and other members of society can engage in providing the help that is needed to access that range of support.

There is an opportunity through the devolution of public health responsibilities to local authorities, which took place in 2013, to ask our local health and wellbeing boards, which play a key role in educating the public about a huge range of different health issues, to take on some of the issues that the hon. Lady raised. In particular, I was struck by the point about a menopause check. Public health bodies are very active in encouraging, for example, parents to take two-year-old children for their health check and adults to access the health check for 40-year-olds. That would be an excellent way of building into public health work an opportunity to raise this discussion and highlight the issues, because it has been striking that so many voices today have said that the key challenge, as with so many different aspects of public health, is ignorance. Not knowing what is happening or how to access treatment and ask good questions remain the biggest barriers to success.

Finally, I encourage the hon. Member for Swansea East and Ministers in responding to think about how we can devise a process that is useful in addressing all the issues that she highlighted, including mental and physical health aspects and the relationship with GPs. We must ensure that local authorities who lead on the work can share best practice so that all women in our society can access excellent services such as those highlighted by my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer) and no one is forced to suffer in silence.

Covid-19 Update

David Simmonds Excerpts

Monday 5th July 2021 Commons Chamber

[Sajid Javid]

The hon. Gentleman will have heard in my statement that no course of action that we take now is without risk, and I think he understands that. There is still a pandemic—as I said, it is not over—so we will of course continue first to monitor for new variants, and to have border restrictions and some test, trace and isolate procedures in place. Those measures, taken together with the success of the vaccine programme, are the best answer to his question.

[David Simmonds (Ruislip, Northwood and Pinner) (Con) [V]]

One headteacher in my constituency tells a tale of losing more than 2,700 days of education, having 390 children sent home and zero transmission among pupils in school. So will my right hon. Friend assure me that swift action will be taken to ensure that children can get back to school and headteachers can get back to teaching as soon as possible, without the damage the current situation is creating?

[Sajid Javid]

Yes, I can give my hon. Friend that assurance. The Education Secretary will be saying more later this week, but I can confirm to my hon. Friend that on 19 July it is our plan to remove bubbles and end the requirement for early years settings, schools and colleges to carry out contact tracing routinely. I will have more to say on how we intend to exempt under-18s who are close contacts from the requirement to self-isolate.

Covid-19: Social Care

David Simmonds Excerpts

Thursday 22nd April 2021 Westminster Hall

[David Simmonds (Ruislip, Northwood and Pinner) (Con) [V]]

It is a pleasure to serve under your chairmanship, Mr Twigg.

I commend the hon. Member for Dulwich and West Norwood (Helen Hayes) and my right hon. Friend the Member for Ashford (Damian Green) for securing this debate, and I particularly commend my right hon. Friend for his work to develop long-term policy solutions for many of the challenges that we see, which are not new but which have been brought into sharp focus by the experience of covid and its impact across the social care sector. We have all seen large numbers of constituents, for example, who have been enormously distressed by the restrictions on care home visits, which has had a hugely significant impact, and it is welcome that we are able to see a lifting of restrictions, so that families can get together at long last.

However, when we look across the whole of the UK, we recognise that even in places where there is a relatively high level of demand being placed on the care sector, less than one in five of the population will make use of it during their lifetimes, including children’s social care, adult social care and social care for older people. It is a sector that is often not well understood. In fact, because most people do not engage with it during their lifetime, unlike the NHS, the police and other emergency services, people often do not appreciate how it works or indeed recognise that for most top-tier local authorities—those with social care responsibilities—social care will consume around 70% of their budget. It is far and away the biggest area of local authority expenditure in England.

I would like to draw the Minister’s attention to the work of Sir Paul Carter, formerly the chairman of the County Councils Network and the leader of Kent County Council, who has been looking internationally at models of care, particularly for older people, and ways of funding care that represent a move towards sustainable and long-term funding. This is a topic that I will come back to my closing remarks, but when 70% of the typical local authority budget is being spent on care, there is clearly a serious risk that unless we find a long-term solution, it will consume the rest of the budget.

Many of those other services, such as libraries, parks and leisure services, which support the wellbeing of the wider community and in many cases represent the infrastructure that our communities need, will genuinely be in financial peril unless we find a long-term financial solution. Indeed, the only area of local authority expenditure to have increased in the last decade is expenditure on children’s social care, which has been achieved largely at the expense of other areas of local authority expenditure, rather than through tax rises.

A number of ideas have been put forward. I know that many in the local government sector—I speak as a vice-president of the Local Government Association—have welcomed the opportunity to raise a council tax precept specifically for social care. However, even when I consider my own two local authorities, which are London boroughs, there is enormous variation within the same type of council and within the same type of city in what that precept can contribute to boosting social care budgets. It ranges from the maximum precept being implemented —in the City of London, an additional 0.02% on the budget—to the other end of the scale, in the London Borough of Richmond, where much more expenditure is raised directly through council tax and where there is an additional 1.8% net. When we take into account the variations across the country, it is clear that precepts are not a long-term solution to social care funding. We need to find a different way of looking at this issue.

The second issue, which seems to me absolutely critical, is that we need to consider the success or otherwise of the joint working arrangements put in place under schemes such as the better care fund, whereby the NHS and local authorities come together to manage local services. When we look at those ventures, it is very clear that it is the local authority-led elements of them that have consistently delivered against the targets that they have been set and the outcomes that we are all seeking to achieve. The NHS has found it considerably more challenging.

That demonstrates that we need to look at a local authority-led model for social care, because it is already clear and established that it is more efficient, more focused on delivery for our residents, and more likely to achieve the outcomes that we want to see. Because the vast majority of social care for children and adults of working age is well outside both the remit and the capacity of the NHS—indeed, it is not something that would normally be a priority for the NHS—it is clear that that bigger picture needs to remain firmly in view as we look at a long-term solution. A key element of likely success in social care reform will be in ensuring that it is managed and controlled by local authorities, who are in the best position to deliver against that.

Moving to conclusions, it is clear that in order to be effective and to address the issue around the discharge of patients from hospital, which causes such concern, a new model of care needs to have a very direct form of input, particularly from acute NHS services when it comes to the discharge of patients from hospital and rehabilitation services, which are a big part of this. We also need to ensure that general practitioners are able to work closely with the system so that the needs that they see emerging among patients in their surgeries can be taken into account. What we need most is a stable and consistent funding model, and there have been different attempts at developing that.

In his recent work, Sir Paul Carter looked at how the German operation is funded and structured through a form of social insurance. To an extent, what matters is not that we try to find a perfect solution. We need a solution that providers of social care and local authorities can rely on to ensure stability in the system and to avoid either the large-scale collapse of parts of the social care system, as we have seen with some providers, or a continued shortfall between what people need and expect, and what local authorities and their partners in the NHS can provide.

It seems clear from everyone who has spoken today—I am sure the Minister has grasped this message—that stability and consistency of funding are critical to provide a long-term solution for social care in England and the wider United Kingdom.