Prevention of Ill Health: Government Vision
Debbie Abrahams Excerpts(6 years ago)
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Matt Hancock
I am working with the Department for Transport. Transport Ministers feel very strongly about this question. The document details some of the things that we are going to do, but I am sure that there are a lot more.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
May I suggest that the Secretary of State has a look at the report, “Fair Society, Health Lives”, by Professor Sir Michael Marmot, particularly at his recommendation about a minimum income for healthy living? With this in mind, what assessment has the Secretary of State made of the impact of universal credit and cuts to that scheme on poverty and healthy life expectancy?
Matt Hancock
I have of course looked at that report. It is important, and it is important that we get the answers to it right.
Budget Resolutions
Debbie Abrahams Excerpts(6 years ago)
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Matt Hancock
It is true that the Labour party in office has always left unemployment higher than it found it; it is true that, while Labour left the deficit higher, we are bringing it down; and it is true that inequality, too, is coming down. Page 8 of the distributional analysis shows that, contrary to what we heard in that paean of gloom from the shadow Chancellor, the biggest rises in full-time employee gross weekly real earnings over the last three years have been among the 10% least well paid in our country. That is what this Conservative Government are doing—delivering for everybody in our country.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
On inequalities, does the Secretary of State recognise that life expectancy is stalling under his Government? In some regions it is getting worse. For women, it is getting worse. Perhaps he can answer the question he could not answer last week—why, for the first time in 100 years, do four babies in 1,000 not reach their first birthday?
Matt Hancock
As the hon. Lady knows, life expectancy is increasing, and we are forecast to see an increasing number of people live to a good old age. Indeed, the number of people aged 75 and over is set to double in the next 30 years. That is a brilliant achievement, which is in part down to the hard work of our NHS. Cancer survival rates are at a record high, strokes are down by a third and deaths from heart failure are down by a quarter. Of course, those successes have brought new challenges. The biggest health challenge we face is that people are living longer, often with multiple chronic conditions. The money is only one part of the plan to safeguard the NHS and ensure it is fit for the 21st century. The Budget delivers the funding, and later this year we will deliver the plan for how we will set the NHS fair for the future.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I should like to highlight some of the facts and figures that the Chancellor missed yesterday before I move on to discuss some of the taxation and public spending measures. First, a record 8 million working people are now living in poverty. There are also 4 million children living in poverty, two thirds of whom are in working families. That number is going in the wrong direction. There are also 4 million sick and disabled people living in poverty—twice the number of non-disabled people. Our life expectancy is flatlining, and for women it is actually going backwards, but what do this Government do? They increase the state pension age. We also know that infant mortality has increased for the first time in 100 years, and that four in 1,000 babies will not reach their first birthday, compared with 2.8 per 1,000 in Europe.
Many epidemiologists have linked this reversal of the generations of health improvement with the austerity that this Government have wrought on the country as a whole and on people on the lowest incomes in particular. Resolution Foundation analysis published today and yesterday’s Budget book show that people on the lowest incomes will be hit disproportionately hard. The Government have not reduced inequalities. Have Ministers assessed the Budget’s impact on life expectancy? Will it continue to flatline, will it get worse or will it increase? I doubt they are able to say it is on the road to recovery.
On tax, I am pleased that small businesses, particularly those on the high street, will have their business rates reduced—that has been a particular issue for a number of my constituents—but what will that mean for councils’ revenue, and how will they be recompensed? My council has lost nearly half its budget from central Government. The digital services tax sounds great, but the OBR says it will affect around 30 tech giants, which will pay about £15 million each. How will that address the fundamental issue that, for example, in 2016, Google paid £36.4 million in corporation tax on declared UK sales of £1 billion, whereas according to its US accounts those sales were £6 billion?
On public spending, the Chancellor confirmed that the NHS would be given much-needed cash. That is welcome, but a range of think-tanks, from the King’s Fund to the Nuffield Trust, say it actually needs £30 billion by 2020. Again, the additional £2 billion for mental health crisis is welcome, but what about emphasising prevention? What about assessing the Government’s own policies on sanctions, work capability assessments and the personal independence payment process, which make the mental health of many claimants worse?
The £1 billion for social care is important, but it does not address the £2.5 billion funding gap since 2010 and does not help the 1.2 million people who need care but cannot get it. I worry that after the publication of the social care Green Paper, which is being consulted on, a new funding regime involving a social care insurance scheme will be announced. That would have disastrous implications for the NHS, as we see closer integration between the NHS and social care.
I could go on about the derisory figures for education and the fact that my local police force and our emergency services will receive nothing substantial, but I want to talk about homelessness, which is rising but was not mentioned in the Budget. We see rough sleepers on our streets in towns and cities up and down the country, but we hear nothing about the families who live in temporary accommodation or people who sofa-surf, as they are not deemed as having priority need for housing. That is the Government’s biggest shame. It epitomises their neglect of too many citizens and reflects not just their failure to ensure that enough houses are built for us all, with social and affordable homes as part of the mix, but their ill-thought-out social security policies, such as universal credit.
Universal credit has been a disaster from start to finish, and it has now been revealed to be driving homelessness. One shelter says UC is the reason why a third of its residents are in it. UC tenants of the housing association First Choice Homes in Oldham are in more than £2.5 million of rent arrears. Research suggests that nearly one in five people in Oldham struggles to pay a social rent. UC is part of that problem. Policy in Practice estimates that the changes to UC announced in the Budget will not have a significant effect. It says 345,000 more households will still be worse off and 29,000 will be no better off. Disabled people will still be worse off. People in employment will see some improvements, but self-employed people will see none at all.
Karin Smyth
My hon. Friend is a well-known expert in this area, which she has spoken up about many times. Does she agree that the Government’s inability to look at people in the round—particularly at their mental ill health, their disability, their poverty and their lack of access to work—drives some of the problems she highlights, including those with universal credit?
Debbie Abrahams
My hon. Friend hits the nail on the head. The human misery caused by such an inhumane policy cannot be underestimated.
L contacted my office recently after her UC was suddenly stopped because her son, B, has severe learning difficulties and L, who is the main carer, did not realise that he would have to make a separate claim once he had reached his 19th birthday. When the money stopped, L had nothing—she did not know why it had stopped and nobody contacted her. It was an absolute disaster for her, and she said:
“At times I just want to end it all…it’s just so hard and I get no support or respite.”
L is a candidate for the new mental health crisis fund that the Government have set out—a product of their universal credit policy. On top of this, the investment in UC does not offset other cuts to social security, with welfare spending set to fall in the next couple of years.
Most worrying are the cuts affecting disabled people, which have not been addressed in the Budget. In fact, according to the OBR, disabled people will be worse off. As the United Nations said last year, this Government are presiding over a “human catastrophe”. The Equality and Human Rights Commission estimates that families with a disabled adult and a disabled child will have lost 13% of their income—£5,500 a year—by 2022. This is on top of colossal cuts across other Departments. What about their help from the Chancellor? What about their bright future?
We have done a lot—the former Labour Government did a huge amount to improve life expectancy, and to lift disabled people and children out of poverty—but we need to do more. The inequalities in our society are getting worse, not better. These inequalities are socially reproduced, so they can be changed, and that should give us all hope. But political will is needed to tackle them, and I am afraid that this Government just do not have it in them.
Oral Answers to Questions
Debbie Abrahams Excerpts(6 years, 1 month ago)
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Mr Speaker
As in the health service under successive Governments of both colours, demand exceeds supply and we cannot carry on indefinitely, but let us hear a few more questions.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Last week, the Royal College of Paediatrics and Child Health revealed that there has been an increase in infant mortality for the first time in 100 years. Four in every 1,000 babies will not reach their first birthday, compared with 2.8 in every 1,000 babies in Europe. This was warned against as an effect of austerity. What assessment has the Health Secretary done on the effects of next week’s Budget on child health and the longevity of our children?
Matt Hancock
I saw that report and we are analysing it. Last week was Baby Loss Awareness Week, and I am glad that there is more awareness of the issue now than there was previously. It is a very important issue that we are looking at right across the board.
Social Care Funding
Debbie Abrahams Excerpts(6 years, 1 month ago)
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Barbara Keeley (Worsley and Eccles South) (Lab)
I beg to move,
That this House notes that eight years of Government cuts to council budges have resulted in a social care funding crisis; further notes that 1.4 million older people have unmet social care needs; notes that Government grant funding for local services is set to be cut by a further £1.3 billion in 2019-20, further exacerbating the crisis; recognises with concern the increasing funding gap for social care; further recognises that proposals from the Government to invest £240 million will not close that gap; and calls on the Government to close the funding gap for social care this year and for the rest of the Parliament.
In October 2016, the Prime Minister told this House that her Government would provide a long-term sustainable system for social care that gives people reassurance. Then the Conservative manifesto said:
“Where others have failed to lead, we will act.”
But the Government have failed utterly to act and people in need of care have paid the price of that inaction. It is approaching a year since the Government promised they would deliver a Green Paper, yet it is still nowhere to be seen months after the planned publication date originally scheduled for summer. Since then, we have seen a further £1 billion cut from social care because of the cuts the Government have made to the budgets of the councils that deliver it, with disastrous consequences for the social care system.
The Prime Minister has not heeded her own warnings about failing to act. During last year’s election campaign, she said that
“the social care system will collapse unless we do something about it. We could try and pretend the problem isn’t there and hope it will go away, but it won’t. It will grow each year.”
That is exactly what has happened. The problem has not gone away and it has grown in the past year.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Does my hon. Friend agree that in addition to the immediate injection of £2.5 billion funding for social care, with 20% of the poorest local authority areas losing nearly £280 million in the past year compared with 20% of the most affluent local authorities gaining £55 million, we also need to address the issue in relation to the deprivation grant funding allocation?
Barbara Keeley
We do need to address that. Things have come to a pretty serious pass.
Matt Hancock
As I said, progress has been made. There has been a reduction of 17% in the number of in-patients—down from 2,875 in March 2015 to 2,375 on the latest figures—but I would fully acknowledge that there is more to do and I am determined to see that happen.
Our population is ageing. More people are living longer and, as a society, we must address the challenge that that creates for social care. To put that into context, over the next 25 years, the number of people aged 75 and over is set to double and the number of people aged 85 will rise by more still. Of course, this is good news. It is down in part to the hard work of our NHS. Cancer survival rates are at a record high and strokes are down by a third, but with such successes come new challenges. For instance, we are seeing a rise in dementia and in age-related conditions, with 70% of people in residential care homes now suffering with dementia.
Debbie Abrahams
Will the Secretary of State agree to support a dedicated dementia fund, as proposed by the Alzheimer’s Society, to recognise the inequity given the additional care costs that such people would be paying?
Matt Hancock
I have seen that proposal from the Alzheimer’s Society and we are looking at it now. At the same time, we are working on both the Green Paper for the future of social care, which will come before the end of the year, and the long-term plan for the future of the NHS. The interaction between the two is important.
NHS Long-Term Plan
Debbie Abrahams Excerpts(6 years, 5 months ago)
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Mr Hunt
My hon. Friend is right to raise that question, because under the Barnett consequentials, for every £1 per head additional for the NHS in England, there will be £1 per head available for the NHS in Scotland. The Scottish National party has chosen to invest only 84p of every £1, which is why people in Scotland are 30% more likely to wait too long for their elective care in Scotland. That is a choice made by the SNP in Scotland and I hope that it will do it differently this time.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I welcome any additional funding because, let us face it, it is not just the NHS that is in deep crisis, but social care, too. However, as others have said, it is still not enough—3.5% was the minimum that was needed to see actual improvements. What assessment has the Secretary of State done to gauge what the improvements will be in the next 12 months? What financial scenarios is the Chancellor considering, and will the Secretary of State commit to stop tendering health services to the private sector, which is a waste of money for the public?
Mr Hunt
It is really extraordinary that on a day that we have announced a £20 billion annual rise in the NHS budget—you could not get a bigger commitment from a Government to state-funded healthcare—Labour is still running off down the rabbit hole of privatisation. If it is any reassurance to the hon. Lady, last year the proportion of NHS services contracted to the private sector went up by the enormous amount of zero.
NHS Outsourcing and Privatisation
Debbie Abrahams Excerpts(6 years, 6 months ago)
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Debbie Abrahams (Oldham East and Saddleworth) (Lab)
I rise to speak as a former public health consultant and the chair of a primary care trust.
I want to start by recalling a conversation I had with Brenda Rustidge, a constituent of mine. She was born in the 1930s, and she described to me what it was like living in a pre-NHS world. Her father, who had just been demobbed after the war, was unemployed. She had a number of brothers and sisters, and they used to have to hide under the window when the doctor’s secretary called round on a Friday night to collect the money. She described the real fear and shame that she felt as a result. Of course, all that changed nearly 70 years ago when the NHS was created. Brenda and her family have thrived because of that.
This debate is not about scaremongering. It is about raising awareness of the real concerns not just of political parties but of clinicians, academics and experts across the country and across the world about what privatisation means. Okay, it is on a small scale, but in terms of spending it has increased from about 2.8% in 2006 to over 7.5%—over 10% if we include not just private providers but all non-NHS providers.
I want to reflect on a point made by my hon. Friend the Member for Stockton South (Dr Williams): we have within the NHS a system that provides universal, comprehensive and free healthcare. That is something we should be very, very proud of. We are seeing that being eroded. For example, private providers of knee and hip replacements exclude certain people. They do not want the complex cases because they are too time-consuming and costly. I take issue with the point that the right hon. Member for Mid Sussex (Sir Nicholas Soames) made, because it does entirely matter who provides the care that we get. There is a slow and steady erosion of the NHS as the sole provider.
In 2014, I conducted an inquiry into the international evidence on the effect of privatisation, marketisation and competition across different health systems. We commissioned a review of reviews, which is the strongest type of evidence, on the impact on health services, particularly looking at equity and quality. It was submitted to peer reviews and accepted in peer-reviewed journals subsequently, and it showed clearly and conclusively that health equity worsens in terms of not only access to healthcare but health outcomes.
It also revealed that there is no compelling evidence that competition, privatisation or marketisation improves healthcare quality. In fact, there is some evidence that it actually impedes quality, increasing hospitalisation rates and mortality rates. Of course, that was the key argument and the sole reason that the Government put forward for the Health and Social Care Act 2012.
The report found a whole host of other issues. I am sure that Members will go to my website to read about that. The transactional cost was one example—
Social Care
Debbie Abrahams Excerpts(6 years, 7 months ago)
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Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Let us get back to the present day, because that is what we are debating. Disabled people of working age make up more than half of adult social care users. Given that the UN condemned the Government’s breaches of the convention on the rights of persons with disabilities, particularly article 19 on independent living, what does the Minister estimate to be the impact on independent living for disabled people of the cuts to social care?
Caroline Dinenage
If the hon. Lady will bear with me, I will come on to discuss that, but there will be a separate, parallel workstream on working-age adults, who account for over half of the spending—
The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I should open with a thank you to those Members who have made some very thoughtful contributions to today’s debate. We recognise the challenge we face, and the hon. Member for Central Ayrshire (Dr Whitford) put it most strongly when she said that it is the result of something very positive: that we are all living longer. That requires some serious strategic thought about how we fund social care. It is in that spirit that we are rising to the challenge.
Both Opposition Front Benchers, the hon. Members for Worsley and Eccles South (Barbara Keeley) and for Denton and Reddish (Andrew Gwynne), expressed their dissatisfaction with the speed with which we are pursuing these reforms, but it is important that we get it right and that we take people with us. With that in mind, we have put together an advisory group to work with on the reforms. The whole sector is co-operating with us and actively contributing to the debate, because it more than anyone recognises the need to fix this and get the solutions right. I make no apologies for the fact that we are where we are now, but we are well down the track with the process. In the spirit of cross-party consensus that I have heard a lot about this afternoon, I will not get into some of the partisan points that have been made, but I want to set the context of where we are with the debate. When we introduce the Green Paper, I hope it will be received in the spirit of the comments that we have heard from most hon. Members today.
Debbie Abrahams
The Minister who opened the debate was unable to respond to my question, so I will repeat it to this Minister. What assessment have the Government made of the impact of social care cuts on the ability of disabled people to live independently, and will she apologise to those disabled people for what the UN has described as this Government’s “grave and systematic violations” against disabled people?
Jackie Doyle-Price
To be frank with the hon. Lady, one of our priorities is to make sure that disabled people can live independently for longer. That is very much a central part of our approach and we are making more money available for it. [Interruption.] She can sit and smile, but that informs our approach.
I should also like to associate myself with the comments made by a large number of colleagues in paying tribute to the hard-working, committed people who make up our social care workforce and to the informal carers who play such a vital part in our health and social care system. Central to the points made by the hon. Members for Stretford and Urmston (Kate Green) and for Keighley (John Grogan) is that we all collectively need to send a clear message that the work that those people do is valued. We are working with Skills for Care to put more value on this as a profession. People who work in the care sector do so because they are personally motivated and money actually matters less to them. We ought to give them a clear message that we really appreciate all the efforts that they make.
Many Members have raised the issue of funding cuts to council budgets. That subject obviously informed the comments from the hon. Member for Denton and Reddish just now. I will not run away from the fact that there have been challenges for councils in recent times— [Interruption.] Opposition Members mention cuts, but the bottom line is that we can only spend what we collect from taxpayers. That is the reality of the situation. I will be first in the queue to pay tribute to those councils that have stepped up to the challenge, coped well with the reductions and worked hard to become efficient. They have shown real innovation in rising to the challenge.
Pennine Acute Hospitals NHS Trust
Debbie Abrahams Excerpts(7 years, 10 months ago)
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Graham Stringer
As I just said to my hon. Friend, I will not go into the details, but I probably know more than she does about the situation from the patients’ side, because a relative was affected. I have no doubt that those patients were treated appallingly. I cannot comment on the details of personnel issues, but I can comment on the fact that patients have been badly treated. Given the technicalities of the situation and having watched the programme, I find it worrying that although one or two cases were found after six months, the nurses were re-employed.
After “Dispatches”, the CQC report found scandalous failings within the trust. It found that the safety and wellbeing of patients were inadequate, and that the trust’s responsiveness and effectiveness needed improving, but that the care of patients was good. That report was very worrying; the trust would have been put in special measures, if a new team had not already been put in place to deal with the situation.
As I say, the CQC report found that the care of patients was good, but within a very short time—and after excellent investigative work by Jennifer Williams of the Manchester Evening News and other journalists—an internal report on maternity care was made public, showing that the care provided by some individuals was very poor indeed.
It is worth reading out for the record an extract from that internal report, because we have now had a 13-year period of failure. It is also worth remarking that both that internal report and the CQC report relied on nothing but internal statements by the trust’s staff. A paragraph from the internal report really contradicts the CQC report, as it states:
“Staff attitude has been a feature of a significant number of incidents, from the most basic reports of staff relationship breakdowns, resulting in women and their families exposed to unacceptable situations, to an embedded culture of not responding to the needs of vulnerable women”.
The report went on to say of one woman that
“in one incident it is clear that the failure of the team to identify her increasing deterioration and hypoxia attributed her behaviour to mental health issues. Failure to respond to deterioration over a period of days resulted in her death from catastrophic haemorrhage.”
That means that, according to internal sources, the situation was actually worse than had been thought.
The report continued:
“A further example of staff attitude and culture has been experienced recently when a woman gave birth to her baby just before the legal age of viability (22 weeks and 6 days)…whilst no resuscitation would be offered to an infant of this gestation, compassionate care is essential. However, when the baby was born alive and went on to live for almost two hours, the staff members involved in the care did not find a quiet place to sit with her to nurse her as she died but instead placed her in a Moses basket and left her in the sluice room to die alone.”
That is inhuman treatment.
These failings are the failings of individuals, of management, who failed to sort things out, and of the structure of the Pennine trust itself. I could list a whole series of other cases. In fact, late last night I was contacted by constituents I know about another case. I do not know the details of that case, but my constituents wanted me to take it up, as they strongly believed that a misdiagnosis meant that proper therapeutic care had not been provided. So problems in the Pennine trust continue.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
My hon. Friend is making a very powerful speech and I share his absolute horror at some of the reports of the standard of care that some patients have received. Like me, he was at a meeting with staff last month, who also expressed their concerns about the quality of care being provided.
I am trying to understand something. Is my hon. Friend saying that this poor care, as set out in the CQC report and other reports, is endemic and is found right across the Pennine Acute Hospitals NHS Trust? Also, does he recognise that the new leadership is playing an important role and that the site leadership teams will have an important role in turning this situation around?
Graham Stringer
What I am saying is that there have been failures from the very beginning of this trust, in that it has four hospitals that were jealous of each other. That caused administrative problems, which means the trust has never worked well, and there is also a structural problem. Secondly, there have been failures of management to deal with those issues of individual failure to care.
I have enormous confidence in Sir David Dalton and the team who are taking over the Pennine trust. Sir David’s record of developing Salford Royal hospital is exemplary, and I hope that he can do the same with North Manchester general hospital and the other hospitals within Pennine.
As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, along with my hon. Friend the Member for Heywood and Middleton (Liz McInnes) we met the trade unions in Pennine just before Christmas and, like the vast majority of the staff, they were committed to improving healthcare in the trust. Like my hon. Friend the Member for Oldham East and Saddleworth, I made the point that one has to acknowledge failures to ensure that there is improvement. One cannot just say that, just because so many staff are committed, that is good enough for the future. One also has to recognise the failure of the local clinical commissioning groups to deal with the problems, the fact that the board of the trust seems to have been paralysed and the fact that NHS Improvement has not dealt with the trust’s problems.
I have listed some of the cases that have caused public concern. One cannot put a financial cost on those cases, but if one reads the internal report on maternity care, one sees that the amount of money spent on compensation in the year 2014-15 was £58 million. I repeat— £58 million. Nearly £20 million went on three cases, which means that just over £6 million was spent on each one. In those cases, the people involved took legal action and at the end of the process were awarded that sum to look after severely handicapped patients.
There is no question but that, as I just said to my hon. Friend the Member for Oldham East and Saddleworth, Sir David Dalton has put in place a team who are committed to taking North Manchester general hospital out of Pennine and putting right what was a structural mistake.
It is worth reflecting on another point that was made in the Westminster Hall debate about 10 years ago, which is about why the Pennine trust was created. It was not created for good medical reasons. There was a public reason, which was given at the time by Billy Egerton, the then chair of the North Manchester health trust—I think that was what it was called. He said that he thought that if North Manchester general hospital had remained separate from the trust, it would have been prey to the predatory instincts of Manchester Royal infirmary and the major central hospitals in Manchester. First, I do not think that was a good idea—there could have been co-operation—and secondly, there were a number of chief executives in the trust who were retiring, which meant that three chief executives could be paid off and one chief executive found. Those three chief executives who were paid off came back and did consultancy work for the NHS. Unfortunately, that is the way that the NHS has dealt with problems. It has spent money, and wasted money.
The proposals for devolution will help to deal with the problem. The national structures have not worked. Having the combined authority, encompassing the 10 local authorities, taking decisions and examining these issues, with North Manchester general hospital being within the Manchester hospital schemes, is not a guarantee of success, but I generally believe that when decisions are taken closer to what is happening on the ground, they are more likely to be correct decisions than if they are left to a national body, which has clearly failed in this situation.
Mr Nuttall
I am grateful to the hon. Gentleman for raising walk-in centres. I was going to mention them later, but I will deal with the issue now. I met with representatives from the Bury CCG some months ago, before all this was announced, and they took me through what they were planning. They convinced me that it was in the best interests of my constituents. It would be easy for me to say the popular thing, which is, “I think we should oppose it.” I entirely appreciate why the good folk of Prestwich do not want their walk-in centre to be closed. I can see that there is a likelihood that it would increase pressure on the A&E. That highlights the point I was making, which is that there are good arguments to be made on both sides of the debate as to whether to have walk-in centres or a more community-based approach to delivering services. That is where Bury CCG was coming from.
Following the devolution of healthcare in Greater Manchester, since last April, we have been in an entirely new situation. We have an opportunity to make a reality of the joining up of health and social care, which has long been argued for.
I want to make three points this morning. First, I do not accept that the problems that have been identified at Pennine acute are all down to a lack of funding. To be fair, I think the hon. Member for Blackley and Broughton accepted that the questions went much wider than funding. It is an easy get-out to simply blame a lack of funding.
Debbie Abrahams
Does the hon. Gentleman accept that the NHS estimates a shortfall of £1 billion for the Greater Manchester health economy by 2020 under the devolution deal? Does he also accept the differences between the consolidation of different sites into specialist units and the huge shortfall that has meant that Pennine acute has not been able to recruit staff?
Mr Nuttall
There are two separate points there. On the first, I have been involved in politics for getting on for the best part of 40 years, and I have never come across a time when it has been claimed that the NHS is not short of money. I cannot remember a time when the parties have all agreed that the NHS was getting all the money it needed. In every general election that I have ever been involved in, there has always been this claim that the Conservative party is about to privatise the NHS and the NHS is short of money. We are not very good at it—if we had been, we would have privatised it years ago, were that the Conservative party’s intention. The fact of the matter is that Pennine acute alone is a huge organisation, with a budget of more than half a billion pounds. Even with our small part of the NHS, such sums of money are difficult to comprehend, never mind the totality of it.
We can all argue that our particular part of the NHS should be given more funding, but in reality the NHS will always be competing with all the other calls on the public purse. If we are to stick with the current funding model, we will only ever be able to increase spending on the NHS significantly if we have a strong and growing economy. I do not want to get bogged down in the broader questions about our NHS, however, because the specific issue this morning is the future of Pennine Acute Hospitals NHS Trust.
The CQC report identified major problems with the leadership of the organisation. Like the hon. Member for Blackley and Broughton, I have every confidence that Sir David Dalton and his new team will bring a fresh approach and outlook to the trust. The one worry I have is that we are perhaps expecting too much of that gentleman. He is clearly a very talented man, but we are all limited by the fact, no matter what our particular talents may be, that there are only 24 hours in the day. I have heard anecdotal stories that he is pulled from pillar to post because he has so many demands on his time. That is understandable; it is not in any way a criticism. It is just a fact of life that he is being asked to do an awful lot. I wish him every success in the world. I hope he can deliver, and I am confident that he will but, if I have one concern, it is that he is perhaps being asked to do too much. I understand that he is focusing on trying to have a more decentralised approach to management to bring management closer to those the trust seeks to manage, and I hope that that will improve matters.
My second point is the issue of maternity services. The removal of children’s services and the closure of the maternity department and the special care baby unit at Fairfield occupied much of my time for years when I first moved to the Bury North constituency. Almost everyone thought that the services at Fairfield were excellent. At the time, my constituents and I were told that things would be even better—even safer—if services were closed at Fairfield and moved to North Manchester and Bolton hospitals. I made it clear that I had doubts about that, as did my constituents. I do not want to quote again from the CQC report, but I want to put on the record this particular quote from it:
“We found poor leadership and oversight in a number of services, notably maternity services, urgent care (particularly at North Manchester Hospital) the HDU at Royal Oldham hospital and in services for children and young people.
In all of these services leaders had not led and managed required service improvements robustly or effectively.”
My constituents could be forgiven for saying, “We told you so.” They can understandably feel vindicated on the stance they took. Incidentally, I understand from a councillor who serves on the Pennine acute scrutiny committee that it was told that the trust was liaising with Newcastle hospitals to learn best practice for maternity services. However, some little time later, when the scrutiny committee asked how that was going and followed up on that idea, it was told, “Sorry, it never went ahead. We are not proceeding with that now.” That little anecdote perhaps gives some idea as to why the CQC discovered problems.
In conclusion, I will make a quick third point. I believe that what Pennine acute would benefit from most in the months and years ahead is a period of stability. It seems to me that part of the problem at Pennine is the constant chopping and changing of leadership. No sooner does one team settle in than they move on and someone else takes over. The difficulty is the resultant lack of accountability. When things go wrong, it can always be blamed on someone else, whether that is to do with a lack of funding or decisions made by a previous management. My constituents and I need to see an end to the changes; we need to see some continuity. My constituents want Pennine acute to be a success. Other NHS trusts are successful, so there is no reason why, with the right leadership in place, Pennine acute cannot be as successful.
The Minister of State, Department of Health (Mr Philip Dunne)
It is a pleasure, Mr Streeter, to serve under your chairmanship in such a well-attended debate. I congratulate the hon. Member for Blackley and Broughton (Graham Stringer) on securing the debate and on encouraging so many of his neighbours, who clearly have an interest in healthcare in the area served by the Pennine trust, to attend and to make such powerful contributions. Everyone has spoken from the heart and with true sensitivity.
As the hon. Gentleman said at the start of the debate, it is difficult to strike the right balance between drawing attention to trusts’ obvious failings, which need to be brought into the public domain and dealt with, and not seeking to lay blame on individuals. We all recognise that the individuals who work in the trust, as we heard so powerfully from the hon. Member for Heywood and Middleton (Liz McInnes), who worked at the trust for many years, give of their best and wish to provide the best possible care for their patients. Often the systems and structures around the individuals can inhibit that good intent.
I applaud the hon. Member for Blackley and Broughton for highlighting some dreadful examples of very poor care in the trust over many years, but especially those that came to light last year. As he well knows, the problems at Pennine go back many years. The trust is 16 years old, as other Members have said. Within three years of its creation, consultants at the trust had passed a vote of no confidence in its then management, as the hon. Member for Heywood and Middleton reminded us.
The hon. Member for Ellesmere Port and Neston (Justin Madders) pointed out that, in the days before the CQC, Sir George Alberti was asked to report on what was happening. Much of last year’s CQC report, however, echoes the findings of the 2005 Alberti report, as the hon. Gentleman said in his constructive contribution. We must try therefore not only to learn the lessons, but to implement them; they clearly have not been in the past few years. I will touch on some key findings of the CQC report before I develop my remarks on what we are doing to respond to the findings and shortcomings.
The CQC report was based on an inspection in February and March last year, which rated the Pennine Acute Hospitals NHS Trust overall as inadequate. In particular, the trust was rated inadequate for safety and leadership. As the hon. Gentleman pointed out, however, it was rated good for care, which is a visible tribute to the quality of care provided by the dedicated staff in the main.
The report found other problems: shortages in nursing, midwifery and medical staff, which have been touched on by other hon. Members; a lack of understanding of key risks at departmental, divisional or board level; problems in services, including in A&E, maternity, and children’s and critical care; key risks were not recognised, escalated or mitigated effectively; and there was inconsistent performance reporting and concern about the quality of data to support performance reporting.
In addition, the CQC identified low morale in a number of services, in particular maternity, and described a poor culture with deeply entrenched attitudes. Regrettably, some staff accepted suboptimal care as the norm, and patients’ individual and specific needs were neither appropriately considered nor met.
Those were the CQC findings. In contrast to what has happened following previous problems and subsequent actions, the new CQC regime is introducing beneficial change—which I hope is recognised by the hon. Member for Heywood and Middleton—and improvement. An inadequate rating by the CQC would normally result in the trust being put into special measures, but in this case a different remedy is being used to turn the trust around and, in particular, to address the obvious challenge of leadership, which almost every contributor to the debate has identified as an historical failing at the trust.
In April last year, the management team of the neighbouring Salford Royal, led by Sir David Dalton and Jim Potter, took over the chief executive and chair roles at Pennine acute on an interim basis. That team is in the process of guiding a management contract for the long term to continue providing the strong leadership needed to drive the improvements that we all recognise. The new management team at the Pennine trust got to work immediately. In July last year, the Salford team completed a diagnostic assessment of the issues facing Pennine and developed a short and long-term improvement programme based on patient safety, governance, workforce, leadership and operational performance.
Debbie Abrahams
Given the Pennine trust’s current position and the staff shortfalls that the Minister has also mentioned, what additional funding support can he offer Pennine acute?
Mr Dunne
I will not be drawn too far down that route at this point, because I would like to develop my overall response. This is not all about funding, as many hon. Members have said. Staff shortages are not necessarily driven by funding either; they are often driven by a trust’s difficulties making it an unattractive place to work. I do not have in my head the number of applicants for vacancies, or the number of vacancies, but I will tell the hon. Lady in a moment how many staff have joined the trust—what increase there has been—under its new leadership.
Debbie Abrahams
Maintained vacancies have caused significant pressure on, for example, middle-grade clinicians in the A&E department. Vacancies have been maintained to try to save money, and that has been a real issue.
Mr Dunne
I am grateful to the hon. Lady for her intervention. I will come on to staff issues in a few moments.
As several hon. Members have said, local political leaders have broadly welcomed Sir David Dalton’s appointment as the chief executive of the Salford Royal trust, which is one of the finest trusts in the country and was one of the first to be rated outstanding by the CQC. He is listening to staff and, where appropriate, deploying Salford’s systems and experience to help to support staff in Bury, Rochdale, Oldham and North Manchester to deliver the high standards of service that we all want. I welcome the support that has been expressed for Sir David’s efforts by everyone who has spoken in this debate, in particular the hon. Member for Blackley and Broughton.
Sir David believes that all the evidence shows that staff are best placed to know what needs to be improved in their ward or department. He has introduced a system—tried and tested in Salford—that involves staff and supports them to test their ideas for improvement. Ideas that are shown to work will be replicated across the whole hospital. That approach turns on its head the idea that people in senior management positions always know what is best for patients on a ward, and instead recognises that frontline staff have expertise in spades and supports them. It will help to develop the culture change that was called for in particular by the hon. Member for Oldham West and Royton (Jim McMahon), who rightly identified that as a fundamental problem in the Pennine acute trust.
As my hon. Friend the Member for Bury North (Mr Nuttall) called for, Sir David Dalton at the beginning of this month introduced new site-based leadership teams in each of the four hospitals. For the first time since the creation of the trust 15 years ago, each hospital site and place-based team will consist of a medical director, a nursing director and a managing director, each dedicated to the daily oversight of that hospital. Together, they will manage the services of a care organisation. That site-based arrangement will give leadership teams a clearer focus and enable them to offer staff better support and engagement and take operational decisions for each site. Those leaders will also have the benefit of being in post on site to strengthen local relationships and promote joint working with other partners in the health economy, including local authorities and commissioners.
The hon. Member for Blackley and Broughton and my hon. Friend the Member for Bury North highlighted poor maternity care. The newly appointed director for women’s and children’s services led an internal review of maternity services under the new management arrangements. That review dug deeper and revealed even more than the CQC was able to. Some of the instances of poor care that were revealed are truly shocking, and I express my sincere regret to everyone affected by those tragic incidents, some of which the hon. Member for Blackley and Broughton highlighted. As an immediate result of those reviews, an improvement plan and a new management team for maternity services have been put in place at North Manchester general hospital. Central Manchester University Hospitals NHS Foundation Trust maternity staff are working alongside Pennine staff to develop a clinical leadership and staffing support programme.
The hon. Member for Oldham East and Saddleworth (Debbie Abrahams) asked about staffing. I am advised that between March 2016, when the new management team came into place, and December 2016, the number of people employed on a full-time or part-time basis by the trust increased by more than 300. I think that is 300 more full-time equivalents. That includes seven doctors, 133 registered nurses and 58 midwives and is a net addition to the trust.
The A&E departments remain under pressure, not least given the winter pressures that have been common across the NHS in the past couple of weeks. That is particularly true at North Manchester, but that department has been stabilised and measures have been put in place to support staff, including direct GP and primary care input into the A&E department from Manchester GPs. Those GPs are supporting the department seven days a week and seeing around 30 patients a day, taking pressure off the service and ensuring that patients see the right professionals and receive the right care. Similarly, the local NHS in Oldham is piloting embedding enhanced primary care support in the A&E and urgent care system. Two GPs a day work between 11 am and 11 pm to support that system.
Measures have also been taken to stabilise children’s services; there has been a temporary reduction in beds at the Royal Oldham and North Manchester hospitals to reflect the workload that staff, given their current numbers, can deal with safely. Those measures are having an impact on turning around the performance of the hospitals in the trust. Additionally—the hon. Member for Ellesmere Port and Neston asked about funding—extra financial support of £9.2 million was secured in year to enable the trust to put in place immediate and short-term measures to stabilise services.
The hon. Members for Blackley and Broughton and for Oldham West and Royton asked about avoidable deaths and the culture of silence when problems arose. The new management have been determined to change that culture. Since April 2016, the trust has investigated and closed down 489 serious incident cases, and the average investigation time has been reduced from 156 days to 90 days. Considerable progress has been made on changing the culture of how problems and complaints are dealt with.
Hon. Members talked about the future and expressed concern, particularly from a staff perspective, about yet another change happening. As all Members are aware, NHS England is in the midst of implementing sustainability and transformation proposals and turning those into plans for 44 areas across the country. Greater Manchester’s five-year plan, “Taking charge of our Health and Social Care”, predates the request for STPs, but NHS England has agreed that that plan meets the STP requirements and they are now effectively one and the same thing. There is, therefore, a real opportunity for healthcare in Manchester, with devolution of control to the council and opportunities for the local authority to work with the NHS to improve services for all the people of Manchester, to become a model for the rest of the country.
The NHS in Manchester has been looking at how acute services can best be organised to deliver benefits, including operational financial efficiency, for quality of care, patient experience and the workforce. As has been said, the proposal is to create a single acute provider for Manchester, with the Wythenshawe hospital and the North Manchester general hospital joining the Central Manchester foundation trust. That is an ambitious proposal, and the organisational change it requires is complex, but we believe that the potential benefits are considerable and offer a real chance for care to be standardised across the city. I know that hon. Members will be concerned about what that means for the Pennine trust. If that proposal proceeds, services at North Manchester general hospital will be combined with those at the other hospitals in Manchester, but the intention is for the remaining hospitals in the Pennine acute trust to continue to work with Salford Royal in a new relationship, which is under active consideration.
Hon. Members mentioned resources for estates. Like any trust, the Pennine acute trust needs better-quality, flexible and fit-for-purpose buildings. I have little time in which to outline what is happening but, as some hon. Members will be aware, construction has begun of a brand new, purpose-built 24-bed community intermediate care unit on the grounds of North Manchester hospital. That unit will cost £5 billion and will take 12 months to build. The Royal Oldham hospital, which includes the old workhouse, is being developed into a high acuity centre to serve the population of north-east Manchester.
Motion lapsed (Standing Order No. 10(6)).
NHS Commissioning (Pre-Exposure Prophylaxis)
Debbie Abrahams Excerpts(8 years, 5 months ago)
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Mr Speaker
I think his Whips are pleased to see the arrival of the right hon. Member for South Holland and The Deepings (Mr Hayes). He has never knowingly been keen to be hurried on anything.
Debbie Abrahams (Oldham East and Saddleworth) (Lab)
Will the Minister clarify the timescale for the decisions? Evidence reviews and trials can take months and years, but clearly, as other Members have said, people do not have months and years. Will she tell us what the process and the timescales will be, so that we can be reassured—or not?
Jane Ellison
We would expect to get the evidence review that we have called for in the autumn. NHS England is already working on plans for the pilot programme, which will happen over a two-year period. We hope to get that under way towards the end of this year. Both those pieces of work are under way. We expect the pilots to be informed by the review, hence we want to get it back in a relatively short time.
Defending Public Services
Debbie Abrahams Excerpts(8 years, 6 months ago)
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Debbie Abrahams (Oldham East and Saddleworth) (Lab)
In that vein, I will try to be constructive, but I need to point out the current situation. I want to challenge the Government on their assertion that they will “deliver opportunity for all”, as the Prime Minister put it last Wednesday, or extend life chances for all. All the evidence indicates the contrary.
We are one of the most unequal countries in the world and under this Government that is set to get worse. In the UK 40 years ago, 5% of income went to the highest 1% of earners. Today that income figure is 15%. The Institute for Fiscal Studies forecasts indicate that between 2015 and 2020 the 90:10 ratio—that is, the ratio of income at the 90th percentile of the household income distribution to income at the 10th percentile—will increase from 3.8 to 4.2, largely as a result of tax and social security changes. In other words, the richer people are, the more quickly they will accumulate even more income, and the poorer they are, the less income they will accumulate.
We know that that is bad for society. If we are looking for constructive criticism, there is so much evidence to show that as the gap between rich and poor widens, everybody suffers in terms of social mobility, life expectancy, mental health and crime. Everything gets worse when we become more unequal, and that is what is happening. It is not just a matter of income; it is also about wealth, as we know from the Panama papers, which revealed that the richest are keeping their assets in offshore tax havens where tax is avoided and evaded.
According to the Equality Trust, in the past year alone the wealth of the richest 1,000 households in the UK increased by more than £28.5 billion. Their combined wealth is now more than that of 40% of the population—that is 10.3 million families. While the wealth of the richest 1% has increased by 21%, the poorest half of households saw their wealth increase by less than a third of that figure. I could go on. This is constructive criticism. This is the effect of the Government’s policies.
The Government, like the coalition, have a regressive approach to their budgets, and it looks as though this will continue. Regressive economic policies where the total tax burden falls predominantly on the poorest, combined with lower levels of public spending, are key to establishing and perpetuating inequalities, with all the damage that I have just described. As has been pointed out, when Labour was in government NHS spending increased by 3.2% in real terms, whereas between 2010 and the present, we have seen a decrease from 6.2% to 5.9%. That has caused a financial crisis for many trusts. In my own area in Greater Manchester, where we have had the opportunity of devo Manc, we are expecting a deficit of £2.2 billion by 2020. That is the projected outcome of the unfavourable devolution of that budget.
The same is happening in education and, in my area, in social security and support for disabled people. We have seen a general decline in support for disabled people since the 1960s. I am looking critically at Labour’s record too. In 2012 1.3% of GDP was spent on support for disabled people. Now that figure is 1.1% and it will decline to 1% by 2020. It is particularly the people on low income, including the working poor, and the sick and the disabled who have been hammered and continue to be hammered by this Government. As a result of the Welfare Reform Act 2012, 3.7 million people will have had £28 billion of cuts in support.
We have just passed the Welfare Reform and Work Act 2016, which will compound the cuts. We are all aware of one of those—the cut of £1,500 a year to approximately 500,000 people who have been found not fit for work in the employment and support allowance work-related activity group. That is anathema, particularly as the evidence shows that on average disabled people have extra costs of £500 a month.
That and further cuts will plunge disabled people into poverty and affect their condition. Ultimately it will affect the demand on the NHS and social care. The Government’s own data released last August show that people on ESA and incapacity benefit in 2013 were 4.3 times more likely to die, compared to the general population, which shows just how vulnerable they are. These figures were released during the August bank holiday after the Government were compelled by the Information Commissioner to release them.
Research published last November in a peer review journal estimated that the work capability assessment alone was associated with 590 additional suicides, 280,000 additional cases of self-reported mental ill health and 725,000 additional anti-depressant prescriptions. Just a week ago, when Parliament was not sitting, the Government published the peer review reports on 49 social security claimants who had died between 2012 and 2014. At the time the former Secretary of State denied that the Government held any records on people whose deaths may have been linked to the social security system. We now know from those reports that 10 of the 49 claimants had died following a sanction, and 40 of the 49 deaths were the result of a suicide or suspected suicide. That has occurred throughout the country. The heavily redacted reports highlight widespread flaws in the handling by Department for Work and Pensions officials of claims by vulnerable claimants.
Last week I called for a statement to be made on those reports, but the Leader of the House refused, so I am putting on record the questions to which I want answers. What action has been taken to address the recommendations from those reports? Will the Government review the recommendation from the Select Committee’s sanctions report last year to establish an independent body to review the deaths of social security claimants? Will they agree to an independent review of sanctions and stop the rollout of the current pilot on in-work sanctions? Finally, given the links of those deaths to the work capability assessment, will the Minister recognise that that process has lost credibility, and will he make the fresh start that we want to see?
In 2009 we became signatories to the UN convention on the rights of persons with disabilities. The Government promised a White Paper on employment to set out how they intend to halve the disability employment gap by 2020. Where is that dealt with in this Queen’s Speech? The Prime Minister said last week that the Government were reducing the disability employment gap. No, they are not. The evidence shows the contrary—that it is up from the previous year to 33%. Only 124 employers have signed up to the Disability Confident campaign. Last year 37,000 disabled people benefited from Access to Work, out of 1.3 million. That clearly will not cut it.
On education and training, why is there is such a delay in children being assessed for education, health and care plans? Why are we not increasing the number of apprenticeships available to disabled people? What will the shifting of the disabled students allowance on to higher education mean for disabled people? What about the 42% reduction in access to transport funding, which is making disabled people prisoners in their own home, and the cuts in home adaptations for disabled people? I have not even mentioned the £4.6 billion of cuts to social care, also impacting on disabled people. The cuts to local government funding will also have a direct impact on them.
This Government must look at the cumulative effect of all these cuts on disabled people, and they must value claimants in our social security system. Like our NHS, it is based on principles of inclusion, support and security for all, and it is there for any one of us, should we become sick or disabled.