Oral Answers to Questions

Derek Twigg Excerpts

Tuesday 6th February 2018 Commons Chamber

[Caroline Dinenage]

My right hon. Friend is absolutely right. The better care fund is already having a fantastic impact in the area. We are developing metrics for assessing progress on integration by local area, particularly at the interface of health and social care. We need to proceed with this as rapidly as possible, and I am sure that with his backing, that will happen in his local area.

[Derek Twigg (Halton) (Lab)]

It is of course very important that we see integration of the two services, but the fact remains that there is just not enough money. Over a year ago, one of the Minister’s predecessors praised my authority in Halton for the work it was doing in this area, but Halton is now on the brink in terms of the money it has and its ability to deliver its statutory duties. There is simply not enough money, and the Government keep trying to avoid that.

[Caroline Dinenage]

We have provided £2 billion of extra funding over the next three years to help councils commission high-quality services, in addition to giving councils access to up to £9.25 billion of dedicated social care funding by 2019-20.

Oral Answers to Questions

Derek Twigg Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

The hon. Lady happens to work in an NHS hospital in which there has been a big increase in the number of nurses. Across the country, there are actually 13,000 more nurses working on our wards than there were in 2010, but she is right: we need more nurses and nursing staff, and that is why we are expanding the number of nurse associates. This year we are, for the first time, opening up an apprenticeship route into nursing, which means that people from non-traditional backgrounds—particularly band 3 healthcare assistants—will find it much easier to get into nursing. That is how we will expand the workforce.

[Derek Twigg (Halton) (Lab)]

According to the latest NHS indicators published by the House of Commons Library last week, the number of GPs is estimated to have fallen over the past 12 months, and the figures for March 2017 are expected to show a further fall. Why is that?

[Mr Hunt]

We have had a big increase in the number of medical students choosing to go into general practice, but we have also had an increase in the number of GPs retiring early. That is a problem that we are urgently addressing.

Oral Answers to Questions

Derek Twigg Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

My hon. Friend’s ingenuity in bringing these issues up in question after question never ceases to amaze me. As he knows, we recognise that the pressure in primary care cannot just be borne by general practice, but we must always follow the science as to where we get our help from.

[Derek Twigg (Halton) (Lab)]

Only recently, a surgery has been closed down in the borough of Halton. There is a clear shortage of GPs. Despite the efforts of the clinical commissioning group to try to find replacements, that has not happened. How will merging CCGs help, and can the Secretary of State rule out any merger between Warrington and Halton?

[Mr Hunt]

This is something on which we take guidance from what local CCGs say. There are times when the CCGs feel that their scale is not big enough to have the impact they want.

[Derek Twigg]

You set them up.

[Mr Hunt]

The hon. Gentleman says from a sedentary position that we set up the CCGs. I remind him that CCGs came together without central prescription as to what their size should be, but we will always listen to the advice we get on the ground if people want to change their size.

NHS and Social Care Funding

Derek Twigg Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

I am going to move on a little.

If the Secretary of State is not abandoning the four-hour standard, as he insists he is not, we look forward to hearing him make that absolutely clear. He also said and has implied that we need to educate the public better, so that they do not turn up at A&E departments. That was the implication of his remarks on Monday. Will he tell us how he is going to do that? What will be the cost implications of explaining to the public that they must not turn up at A&E departments? Are we expecting to see a large advertising campaign? Will the cost fall on local authorities’ public health budgets, which have already been cut? Will local authorities be given more resources for this new public education campaign?

[Derek Twigg (Halton) (Lab)]

My hon. Friend is making an important point. The key similarity is that back in 1997, when Labour took over, the health service was in crisis, and it is again today. Is not part of the problem that people are having to go to A&E because they cannot get in to see their GP?

[Jonathan Ashworth]

Absolutely. It is so difficult to get to a GP, which is why there are all these pressures on our A&Es. Of course, it is only going to get worse, because this year we are going to see cuts to community pharmacies—3,000 will be lost from our towns and streets because of the cuts that are being pursued. Let us not forget that the figure of 3,000 community pharmacies being lost was what the previous Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), told MPs.

--- Later in debate ---

[The Secretary of State for Health (Mr Jeremy Hunt)]

I beg to move an amendment, to leave out from “House” in line 1 to the end and add:

“commends NHS staff for their hard work in ensuring record numbers of patients are being seen in A&E; supports and endorses the target for 95 per cent of patients using A&E to be seen and discharged or admitted within four hours; welcomes the Government's support for the Five Year Forward View, the NHS's own plan to reduce pressure on hospitals by expanding community provision; notes that improvements to 111 and ensuring evening and weekend access to GPs, already covering 17 million people, will further help to relieve that pressure; and believes that funding for the NHS and social care is underpinned by the maintenance of a strong economy, which under this administration is now the fastest growing in the G7.”

I thank the shadow Health Secretary for bringing this afternoon’s debate to the House. He is right to draw attention to the pressures in the NHS, but, regrettably, I will have to spend much of my time correcting some totally inaccurate assertions that he has made, and that is a shame. This is an important debate for our constituents—for his and for mine—and for the NHS. The country deserves a proper debate, but that is difficult when we are given misinformation at a time when the NHS is under sustained pressure.

I am also very pleased to see the Leader of the Opposition in his place. I think that he has become rather a fan of my parliamentary appearances—[Interruption.] It is a Jeremy thing, he says—if only. I wish to address one part of my speech to him, because it is an area of policy for which he is perhaps more personally responsible.

Winter is always challenging period, and I want to repeat the thanks of the shadow Health Secretary and the thanks that I gave on Monday to NHS staff. According to NHS Improvement, on the Tuesday after Christmas the NHS had its busiest day ever. Earlier in December, it treated a record number of patients within four hours. Overall, as the Prime Minister said this morning, we are seeing 2,500 more patients within the four-hour standard every single day compared with what happened in 2010. As we discussed on Monday, the NHS made record numbers of preparations for this winter, because it is always a difficult time, including having 3,000 more nurses and 1,600 more doctors in full-time employment.

Let me address what the shadow Health Secretary said with regard to Worcestershire. I met colleagues from Worcestershire on Monday. A huge number of actions are now being taken, but we must say right up front that it is totally unacceptable for anyone to wait 35 hours on a trolley and that we expect the hospital to ensure that that does not happen again. There are plans in place to open additional bed capacity this week. We have already had capacity made available by Worcester Community Trust to support the flow. The trust has deployed its chief operating officer on the task of facilitating discharges. The trust is in special measures, so we have a big management change, and a new chief executive will be starting later on in the spring.

What is wrong with what the shadow Health Secretary has just said is the suggestion that winter problems are entirely unusual. As my right hon. and learned Friend the Member for Rushcliffe (Mr Clarke) said, the NHS had difficult winters in 1999, 2008, and 2009. He remembers difficult winters from his time as Health Secretary, but there are things that are different today. One of them is that, compared with six years ago, we have 340,000 more over-80s, many of whom are highly vulnerable or have dementia. We know that when people of that age go to an A&E at this time of year, there is an 80% chance that they will be admitted to hospital.

[Derek Twigg]

The Secretary of State talks about correcting the points that have been made so that the House has the right information. May I repeat the question that I asked him on Monday? What are the latest figures—he should have them up to this week—for the number of people who could be discharged but have to remain in hospital because there is no community support available for them? Can he give us that figure now? He said that he would write to me, but he must know that figure now.

[Mr Hunt]

Last year, on average, it involved around 7,000 beds, which is far too many. That is why the Secretary of State for Communities and Local Government announced in December a new package of support worth around £400 million—

[Derek Twigg]

rose—

[Mr Hunt]

Let me answer the hon. Gentleman’s question. I said that I would write to him, and I will do so. He may have noticed that there are other issues that we are dealing with, which is why I may not have had time to sign the letter. The £400 million extra for local authorities over the next two years will make a significant difference and he should recognise that.

--- Later in debate ---

[Mr Hunt]

I will give way, but first I want to make some progress.

I want to talk about something else that is different in our A&E departments today compared with six years ago. Although we are sticking to the four-hour target, we also insist on much higher standards of safety and quality.

On Monday, I congratulated Labour on the introduction of the four-hour target—I support it—but we should also remember that four years after that standard was introduced, we started to see some horrific problems at Mid Staffs, many of which were in the A&E department. Some were caused because people thought they would be fired if they missed the target. Robert Francis said that the failures at Mid Staffs were

“in part the consequence of allowing a focus on reaching national access targets.”

Therefore, although we retain targets, we will not allow them to be followed slavishly in a way that damages patient care.

[Derek Twigg]

Will the Secretary of State give way?

[Mr Hunt]

I have already given way to the hon. Gentleman. There are many other Members who want to intervene.

That is why we have a new inspection regime that makes it harder to cut corners in the way that used to happen when beds were not being washed, there was poor infection control and ambulances were being used as waiting rooms.

Mental Health and NHS Performance

Derek Twigg Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

While I do not agree with moving to a social insurance model, I have some sympathy with what my hon. Friend has said about the broader issue of resourcing healthcare. If there are to be a million more over-65s in the next five years, we shall have to find a way to continue to invest more in our health and social care systems over the decades ahead. We are doing that this year in providing an extra £3.8 billion, and Governments will need to continue to do it in the coming decades.

My hon. Friend has rightly highlighted a specific problem. I do not have a solution to it now, but I want him to know that I understand that, in rural areas, people can wait too long for ambulances. Our system of targets gives ambulance services an incentive to prioritise the calls to which they can respond quickly in nearby towns, but I shall look into the issue.

[Derek Twigg (Halton) (Lab)]

The Secretary of State tells us that he has a plan and a strategy, so I assume that he is on top of all the facts, but will he assure us that he understands the scale of the problem by answering this question? As of the latest count this week, how many hospital beds were being blocked by people who could not be discharged because no facilities for their care were available in the community?

Oral Answers to Questions

Derek Twigg Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

No one fights harder and more eloquently than my hon. Friend for the needs of the people of Stafford. I always look with concern at proposals to change emergency services given the huge pressures that exist, so I shall happily look at the plan as he suggests.

[Derek Twigg (Halton) (Lab)]

21. The problem is not just winter pressures but pressures all year round. The Secretary of State will no doubt tell me that the Government have now allowed councils to increase the precept to allow councils to fund it better, but the fact is that that is not enough money. There is no strategy. Does anyone outside the Department—those in the Department might not either—believe that the Government has a strategy for social care?

[Mr Hunt]

All I would do is urge the hon. Gentleman to listen to what the Prime Minister said at this Dispatch Box last week. She said that we recognise the short-term pressures—indeed, the Communities Secretary came up with a package of £900 million extra over the next couple of years—but that we also need a long-term sustainable solution, on which the Government are working hard.

CQC: NHS Deaths Review

Derek Twigg Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

I am happy to do so. We will lay down in regulations in the House that the information must be published for all trusts on a quarterly basis. I draw my hon. Friend’s attention to what I said in the statement, which is that it is not legitimate to compare the numbers in different trusts, because trusts will have different levels of reporting. In fact, our better trusts may actually have higher levels of reported avoidable deaths because they are better at picking up these things.

[Derek Twigg (Halton) (Lab)]

One of the recommendations says:

“Greater clarity is needed to support agencies working together to investigate deaths and to identify improvements needed across services and commissioning.”

How is that going to happen?

[Mr Hunt]

This is a very complex issue, but it is a very important one, particularly for people with learning disabilities who are users of the services of multiple organisations. The National Quality Board will put together guidance before the end of March, so that we can roll this out across the whole NHS during next year.

Social Care Funding

Derek Twigg Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

There is an issue with that, and that issue exists in various parts of the country. We acknowledge it and we need to manage it. We also need to manage the total number of beds in the system and the total number of domiciliary providers in the system. The total number of beds, as I said earlier, is the same now as it was six years ago. The total number of domiciliary providers is around 40% higher.

[Derek Twigg (Halton) (Lab)]

The Minister, in a debate on 16 November, congratulated

“both Halton and Warrington Councils on being two of the best performing councils in the country on delayed transfers of care and on increasing their budget.”—[Official Report, 16 November 2016; Vol. 617, c. 350.]

Halton still has a massive shortfall, because the precept goes nowhere near meeting the demand on the services in the area. The simple fact is this: there is no coherent national strategy or funding package in place to solve this crisis we now face. The Government are abrogating their responsibility, and the system will tip over.

[David Mowat]

The hon. Gentleman is quite right. I congratulated Halton and Warrington Councils on being two councils that have particularly low rates of delayed transfers of care. The fact that they are achieving that in spite of the budget constraints that he mentions demonstrates that this is not just about money; it is about quality, it is about leadership and it is about best practice.

Social Care

Derek Twigg Excerpts

Wednesday 16th November 2016 Commons Chamber

[Derek Twigg (Halton) (Lab)]

I am afraid it was the same old story from the Secretary of State: no response to the funding crisis. It is a national crisis and a national disgrace that social care is not being funded properly.

The social care system should of course become more efficient, but much work by local authorities and local health providers to make it more efficient and bring about improvements has already taken place. The simple fact, however, is that there is just not enough money. My local authority, Halton Borough Council, works closely with local NHS providers, but it has suffered a 50% cut in its budget, so how can it be expected to sustain and grow support for adult social care?

In the time I have, I want to quote parts the Care Quality Commission “State of Care” report of 13 October. It states that demands are increasing on health and social care, but that

“despite increasingly challenging circumstances, much good care is being delivered”.

We know that, but it goes on to say:

“However, the sustainability of this position is in doubt…The financial challenges in the NHS have been extensively documented…there has been evidence of a deterioration in quality…and some providers…are struggling to improve their rating beyond ‘requires improvement’.”

By the end of 2015-16, NHS providers had overspent their budgets by £2.4 billion. Local authorities were reported to have overspent by £168 million. Delivering high-quality care while achieving good financial management is therefore more important and more challenging than ever before.

The fragility of the adult social care market and the pressure on primary care services are now beginning to impact both on the people who rely on these services and on the performance of secondary care. The evidence suggests we may be approaching a tipping point. Profit margins are reducing because of pressures on fees and cost pressures that include the national living wage. Some providers are already starting to hand back home care contracts as undeliverable. Local authorities predict more of that to come.

The Treasury allowed local authorities to raise an additional 2% above the existing threshold, but this amounts to only £790,000 in 2016 for Halton Borough Council. That is well short of meeting the increased cost of adult social care. In addition to the costs, the council is facing its sixth year of austerity measures and has to find a further £30.3 million by 2020. Adult social care has delivered £17.4 million in savings from 2011 to 2017, but this level of savings is no longer sustainable given the pressures on the service. That pressure is compounded by increasing demand and financial constraints from health services, which can have a direct impact on social care services. Halton has to find an additional £2.9 million, while the additional precept it has received amounts to only £790,000. The council tells me that the adult social care and funding reform allocations in the Care Act 2014, which moved into the settlement funding assessment, are insufficient to meet the requirements of part 1 of the Act.

The national living wage is the greatest financial pressure at present facing adult social care, and the Government are not funding it. The ageing population of Halton is increasing, and that is part of a general change in demographics. The number of residents aged 65-plus will increase by 43% by 2037. Care providers, on the other hand, are exerting pressure on the council for increases in rates over and above inflation. The expectation appears to be that local authorities should fully fund the additional costs. I pay tribute to our care workers, who work under great pressure with a greater workload and fewer staff. Things do go wrong from time to time and they have to be addressed, but the care workers do a fine job. I was struck by the findings in the Unison “Care in Crisis” report. In answer to the question, “Have budget cuts affected your work or workplace?”, 70% said there was a greater workload and over 60% said there were fewer staff.

I have been in touch with my local hospitals, too. Warrington and Halton Hospitals NHS Foundation Trust says it is currently engaged in the challenge of trying to achieve the four-hour A&E target, as well as an improvement programme. As part of that, an independent audit was recently carried out under the emergency care improvement programme. On the Warrington site, it reviewed 241 patients across 15 in-patient wards where the length of stay was longer than six days.

The feedback received was that 58%, or 140, of the 241 patients reviewed were deemed medically fit—in other words, did not require a bed in an acute hospital. Of these, 91 required the intervention of an agency external to the hospital, such as local authority, social care or community care providers. The top three delays identified were: waiting for external agency assessments; waiting for a community hospital placement or other bedded intermediate care; and waiting for the start of social domiciliary care packages. The hospital of course acknowledges the difficulties that local authorities and commissioning bodies face around social care.

On the subject of Warrington hospital, the Minister will be interested to know that I asked the chief executive of Halton CCG whether, as part of the STP programme, consideration had been given to reducing the opening hours of Warrington A&E, but he refused to answer the question and gives no reason for that. I hope that the Minister will look into the matter and ensure that I get the information I should be entitled to.

The Government cannot go on ignoring the fact that there is not enough money. We heard the Secretary of State again today ignore this fact. He spent most of his speech not talking about the crucial point, which is funding, and that is clearly the feedback from all parts of the service. The CQC says that the system is fragile and at a tipping point. This is not Labour MPs or Labour councils; this is the CQC. I ask the Minister to tell the Secretary of State that he and the Chancellor need to come forward with a proper plan for funding social care. If they do not, the crisis will continue and deepen, and the Government will be responsible.

[Several hon. Members rose—]

NHS Funding

Derek Twigg Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Speaker]

I would like to conclude these exchanges by 4.30 pm because there is other pressing business. If people take a long time, they are preventing their colleagues from contributing. I am sorry, but it is as simple as that.

[Derek Twigg (Halton) (Lab)]

Does the Secretary of State believe that there is a need for additional funding for adult social care over and above that which has been already allocated?

[Mr Hunt]

We are putting extra money into adult social care, and local authorities have the ability to increase their funding to adult social care through the new precept. In an ideal world, everyone would like more money to go into the NHS and social care system, but Government Members know that those systems are powered by a strong economy and that we can increase our budget only at a rate that the economy can afford. The past six years show that if we take care of the economy, we can increase the NHS and social care budget, and that is what we are doing.