Care (Older People)

Emily Thornberry Excerpts

Tuesday 6th September 2011 Westminster Hall

[Emily Thornberry (Islington South and Finsbury) (Lab)]

It is a great pleasure to serve under your chairmanship today, Mrs Main. I congratulate the hon. Member for Chatham and Aylesford (Tracey Crouch) on securing this hugely important debate.

The terrible consequences of the massive spending cuts are becoming clearer and clearer. They focus in particular on underfunding in the social care system, which is getting to breaking point. Earlier I shared with the Minister my research on the effect of the cuts on local authorities and on adult social care. I am sure he is pleased to hear that I am doing further research.

My preliminary research, which I put together with the House of Commons Library and which is a clarification or an interpretation of data published by the Department for Communities and Local Government, shows £1.3 billion in real-terms cuts in local authority spending on social care in both 2010-11 and 2011-12. For the oldest and most vulnerable, the picture is especially dire, with real-terms spending on social care for the over-65s lower than in 2009-10 by £60 million in 2010-11 and £1.3 billion in 2011-12. The Association of Directors of Adult Social Services has indicated that demographic pressures from an ageing population, physical disabilities and learning disabilities have placed a £425 million squeeze on social care funding in 2010-11, with fewer than half of local authorities allocating the funds to cover the bill. I believe that the Department of Health continues not to be able to provide a borough-by-borough analysis of adult social care funding, so when I have my full report available next week, I assure the Minister that I will let him have a copy.

As a consequence, care packages and care services are being renegotiated, with new and increased charges being imposed. Others are being denied state-funded care altogether, because of changing eligibility criteria. A recent report from Age UK warned that of 2 million older people in England with care-related needs, 800,000 receive no formal support from public or private sector agencies. With spending cuts, that number is likely to top more than 1 million between 2012 and 2014. The evidence is piling up.

The Minister may have heard yesterday’s “You and Yours” programme on the BBC, in which the UK Homecare Association gave an analysis of its recent research that showed a pattern of care in the home being taken away from people. In the cases that it looked at, 82% of councils were reducing the amount of time that people have with carers in their home, there was a widespread increase in very short visits—for example, the notorious 15-minute visits—75% of councils were reducing the number of visits per week, and 50% were trying to reduce the money spent on an hour of care. Fewer safety checks were being made on older people at home, there was a widespread reduction in the time allowed for bathing and washing, and social services were being cut completely. They include a range of services that are not personal care, but help people to stay in their home—vital services such as help with laundry and shopping and decisions about finances. With the cutbacks in all those services, we are heading for crisis.

In making the changes, councils are often failing to consult. My hon. Friend the Member for Birmingham, Erdington (Jack Dromey) referred to legal challenges resulting from lack of consultation. I believe that the number of judicial review cases has increased by 45%. The renegotiation of fees for residential care provision by councils is also putting great pressure on the care home market. That was not the only reason for the collapse of Southern Cross, but it was certainly one of the reasons.

I welcome the Minister’s statement today on Southern Cross, and I will take the opportunity to ask him three questions arising from it. First, has he established who all the landlords are? Secondly, he said that there is an expectation of a formal transfer of the care homes, with the second wave by the end of October. That expectation sounds similar to aspiration. How confident is he that that will happen? The third and most important question relates to the reference the hon. Member for Dartford (Gareth Johnson) made to residents’ rights, including their right to know what their future is and where they will live and not have their care home closed. Can the Minister help us by saying whether any Southern Cross homes are likely to be closed; if so, how many and at what stage will residents be told? My fear is that they will be the last to know.

Those are not the only continuing problems. There is a continuing and exacerbated postcode lottery for who gets what services. Tower Hamlets spends five times as much on each older resident as Cornwall, and such disparity leads to unfairness. Our social care system is definitely creaking at the seams.

The good news concerns the Dilnot commission. The Opposition have made it clear that we will work with the Government to find a solution to long-term funding of care based on the Dilnot recommendations, but funding is not the only matter dealt with in the recommendations of Dilnot and the Law Commission. They include less complex matters that may be less financially challenging, such as recommendations to improve available information, to support carers, and to enable portability of care. We want to ensure that that happens, and quickly. Will the Minister assure us that there will be legislation during the next session of Parliament to deal with the Dilnot recommendations? We all agree that we must get on with this.

We must also ensure that the present strains on the care system are dealt with. The concern is that even if we find a solution for the long-term funding of care, we may look at our care system in a few years, and wonder what is left. That is a genuine and continuing concern for all those involved in the sector. I understand that the business in the main Chamber includes an amendment to the Health and Social Care Bill which may help to regulate providers such as Southern Cross, but we have only 10 hours to discuss more than 1,000 amendments, so perhaps the Minister will take this opportunity to explain whether the Bill has been sufficiently changed to ensure that we will be able properly to regulate social care providers, particularly providers of residential care to elderly people, and whether the legislation will be able to help with that.

I welcome the partnership on dignity and care that has been established by the NHS Confederation, Age UK and the Local Government Group to look at standards of health and social care. I agree with many of the contributions that have been made today. There is concern not only about the funding of care, but about the standard of care. I listened to the passionate speeches by many hon. Members about the dreadful way in which some people have been treated. It is clearly hugely important to keep standards are high as possible. I look forward to the report of the Equality and Human Rights Commission, which I understand will be issued in the next few months.

That brings us back to the cuts. I do not want to sound like a broken record, but I take this opportunity again to warn the Minister that if the Government continue to cut local government funding as they are doing, the biggest area of discretionary spend, which is adult social care, will continue to be cut. The much vaunted additional £2 billion that the Minister says is available for adult social care is simply not sufficient. He must not continue to close his eyes to the situation. I know that he feels passionately about the issue, as do we all, but we must be realistic and more must be done to protect the elderly. We must put more money and more investment into social care and ensure that it is not cut to the bone.

[The Minister of State, Department of Health (Paul Burstow)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) on securing the debate. The speeches and interventions have demonstrated why we need Back Benchers such as my hon. Friend to raise such subjects, which Parliament has not debated enough over the past 10 or 15 years. That may be one reason why, as several hon. Members have said, social care has historically been the poor relation of the NHS and inadequately funded relative to the NHS.

We should not delude ourselves that many of the problems and pressures that have been amply and passionately described in our debate have emerged in the last 12 months. Indeed, if one takes a run through Hansard reports of the past 30 or 40 years, one sees that they have been raised previously. I do not say that to excuse the obligation that rests with the present Government to address the issues, but I ask hon. Members to bear in mind the fact that we should come to the debate with humility and recognition that past responsibilities were perhaps not fully met.

Attention was drawn to the fact that by 2033 almost a quarter of the population will be over 65. Indeed, some parts of the country have already reached that proportion—my hon. Friend the Member for Newton Abbot (Anne Marie Morris) referred to the situation in Devon. I agree entirely with the point made by my hon. Friend the Member for Dartford (Gareth Johnson) that all too often in these debates we use the language of time bombs and consternation instead of celebrating not just the successes of our health and social care system in supporting vulnerable and frail people, but the contribution that, in turn, older people make in our society, often to their fellow citizens. We should do more of that and I want to make sure that we do.

It is worth saying that if the NHS and social care are to cope, some systems and processes need to change; I will say more about that shortly, but it is also necessary for older people themselves and their families and carers to call the shots about the decisions that affect their lives, so that the system can provide the care that people want, need and feel comfortable with. The whole agenda of personalising services so that people have the resources to be able to make choices and to be in control of those services is important, and the Government are determined to turn that ambition into reality.

Let me say something about the coalition’s commitment to see health and social care provided in ways that achieve better outcomes and deliver more personalised services. A thread running through the comments from hon. Members during the debate is the role of integration, which is a key element in realising better outcomes and better quality in the system. Integration is about care services working together in the interests of people and the local populations they serve, and about learning from one another’s experience and ending up with care and support that is of higher quality, safer, and more comforting than ever before.

We also need a sea change in the nature of the working relationships at local level, so that closer working relationships between local authorities and the NHS become the norm rather than the exception. That is one reason why we have made extra funding available. We can debate and will continue to debate in the House whether that funding is adequate, and I have no illusions about the challenges facing local authorities, but the Government have done much to ensure that local authorities have the resources to address them.

NHS funding that goes directly to local authorities for measures that support social care and benefit health will rise to £1 billion per year by 2014-2015. It is the first time that any Government have made such a significant transfer of resources. This year, £650 million has been allocated to PCTs and transferred to local authorities to invest in social care services. That will benefit health and have an overall impact on well-being. I am under no illusions about the interdependencies between health and social care services to which many hon. Members have alluded during the debate. One must look at both parts of the system to understand and mitigate the impact.

I look forward, as ever, to the next chapter of the report on social care by the hon. Member for Islington South and Finsbury (Emily Thornberry). From what I see, however, and from discussions I have had, I know that the picture is far from clear; it is mixed and different authorities are adopting different approaches to the challenges they face in meeting the Government’s deficit reduction targets. Some local authorities are being smart in the ways they confront those challenges and are looking at using telecare and telemedicine, investing in relevant services, and redirecting resources into earlier interventions that can make a big difference up stream. Other authorities—the ones we tend to hear about in debates such as this—are adopting more of a slash and burn approach and tightening eligibility without thinking through the consequences of such decisions and the impact on services. We need to challenge such actions not only in the Chamber but in our constituencies as constituency MPs. These pressures on the system are not new and we have seen such features for many years. Indeed, the vast majority of local authorities already used substantial need as a basis for eligibility and access to services before this Government came into office.

The £650 million that is being transferred to local authorities from the NHS is on top of the £530 million from the Department for Communities and Local Government that will go directly to social service departments.

[Emily Thornberry]

rose—

[Paul Burstow]

If the hon. Lady will forgive me, I want to ensure that I answer two or three of the key points raised by my hon. Friend the Member for Chatham and Aylesford. One key issue concerned the role of a Minister for older people. I certainly share my hon. Friend’s view that we must ensure cross-governmental dialogue and gain a much clearer understanding of the interdependencies between different policies and actions across the Government as they affect older people. The Government are not currently minded to appoint a Minister with specific responsibility for older people, but my hon. Friend has made a number of suggestions that could be a way to look at the issue. I undertake to take the point away and discuss with colleagues how we might join up services in a better way. A number of colleagues across Government have various responsibilities and we must find ways to ensure a clear articulation of the Government’s approach to ageing and an ageing society. We must ensure that that happens not only nationally but locally.

It would be remiss of me not to pick up on the comments about Southern Cross. I did not quite catch the second question, so the hon. Member for Islington South and Finsbury may wish to remind me of it so that I can answer. She asked about landlords, and the answer is that work to ensure that the transfers could take place required that measure to be concluded. As I understand, all landlords involved have now been identified, but if I am misinformed I will write to the hon. Lady and give her the details.

The hon. Lady also asked about home closures. In the past, I have said that when Southern Cross first made its proposals for restructuring the organisation, it suggested that the medium-term future—the next three or four years—would involve a limited closure programme. It did not specify a number and has not done so since. In some ways that programme is no longer the programme being followed; Southern Cross is effectively managing its own demise and passing homes on to new operators, which will have to make judgments about the economic efficiency of those businesses and the welfare of the people living in the homes, and decide whether they can carry on. We must have good advice and support to manage any closures that take place, which is why I have said on a number of occasions that I welcome the work done by the Association of Directors of Adult Social Services.

The hon. Member for Dartford raised an important point about tenure to which we must give serious consideration. I do not want to make a policy announcement about that today because the issue is complicated. We do, however, need to look at how we can give people a greater sense of confidence in the place they consider their home, and ensure that in the future they cannot be lightly tipped out to find a new care home. I will write to the hon. Member for Islington South and Finsbury about the second question to ensure that she gets an answer.

I appreciate the warm words of support—broadly speaking—that have come from all parties about the Dilnot inquiry and the appetite to get on with action. I will ensure that that appetite is well understood across Government. We are clear that the report submitted by Dilnot in July makes an excellent contribution to providing a framework or scaffold around which we can take forward a wider reform of social care for the future. We will soon set out a further process of consultation not only about the details of implementing the Dilnot inquiry—he sets out a number of parameters in his report that are up for further discussion, not least the one mentioned earlier in an intervention—but about the wider issues of quality in social care that were referred to by the hon. Members for Wirral South (Alison McGovern) and for Newton Abbot. We will approach all those issues in a combined way that will lead to a White Paper next April—that answers the question raised by the hon. Member for Chatham and Aylesford.

It is above my pay grade to announce what is in the Queen’s Speech; that has to be someone else’s job—probably Her Majesty, when she sets it out in detail, and the Prime Minister and the Cabinet who make those decisions. The Government remain committed to legislating at the earliest opportunity to bring in the Law Commission’s reforms and address the question of funding reform. I hope that answers the points of concern that have been raised.

The hon. Member for Chatham and Aylesford also mentioned housing, and she was right to talk about choice. That underscores the need for a cross-departmental approach to ageing and an ageing society, and I will raise her comments with my right hon. Friend the Minister for Housing and Local Government. Given his responsibilities for supporting people, it is important that I do that.

Prevention underlies many points that have been raised today and there is much we can do both to prevent admissions into hospital appropriately and to manage hospital discharges better. The increased roll-out and use of personal budgets will play a part in that, and will provide people with more control over the packages and nature of the care they receive.

The contribution made by the voluntary sector and charities has rightly been highlighted in this debate, in particular the role that such organisations can and do play in tackling social isolation. They also provide practical, low-level help—for example, helping to change a light bulb, which sometimes seems to take for ever. We must ensure that communities feel confident to give that help and are given support to provide mutual aid. Through our work on the big society we are determined to see that through. Local councils have an important role in improving health and well-being through commissioning those low-level services, and that has been well described in the debate.

The hon. Member for Newton Abbot expressed some concern about the role of the CQC. Like her, I met representatives from the care sector to discuss their views about what will soon be the first full year of operation for the CQC. The CQC was established in 2009 but has been fully operational only since October last year. Not all of what it does and will do has been explained to care providers as clearly as it should have been, but some of those defects are now being remedied. Just last week I had the opportunity to visit the CQC and see the work it is doing to establish a new, much simpler website. That website will provide a lot more information to providers about how issues of compliance with essential standards are being addressed.

Oral Answers to Questions

Emily Thornberry Excerpts

Tuesday 12th July 2011 Commons Chamber

[Paul Burstow]

I shall certainly elaborate on how we are doing that in greater detail later. For some months we have been working with the landlords, the lenders and Southern Cross, and making sure that local authorities are fully prepared for any likely contingency and the CQC is ready to deal with re-registrations, should that become necessary.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

The Minister of State has told us that one of the reasons why the publication of the White Paper has been delayed is to allow cross-party talks, so I wonder whether he can help us: when will the meeting between the Prime Minister, the Deputy Prime Minister and the Leader of the Opposition take place?

[Paul Burstow]

I am surprised that the hon. Lady does not know. As I understand it, there is a date in all three people’s diaries, but it is not for me to share that date. Although we do need to have cross-party talks between the leaders and the health spokespeople involved, we should also look back and draw some lessons from the royal commission on long-term care. What surprises me is that when that report was published by the right hon. Member for Holborn and St Pancras (Frank Dobson), all that was offered was a debate—not a debate that the Government would lead, but a debate that would take place across the country. We are still waiting for the end of that debate. This Government have a timetable and a commitment to engage.

Southern Cross Care Homes

Emily Thornberry Excerpts

Tuesday 12th July 2011 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

(Urgent Question): To ask the Secretary of State for Health if he will make a statement on the future of Southern Cross Care Homes.

[The Minister of State, Department of Health (Paul Burstow)]

As the House will be aware, Southern Cross has been working with its landlords and lenders to agree a restructuring process to secure a viable way forward for the future. As I set out to the House on 16 June, the Government have made it clear that our overriding concern is the welfare and safety of the 31,000 residents in Southern Cross’s care, and that we expect all parties to work together to secure a consensual, solvent restructuring of the business that meets their collective responsibility to secure the welfare and care of residents.

When I last updated the House on 16 June, Southern Cross, its landlords and lenders had the previous day announced an agreement to work through, over a period of four months, arrangements for a consensual, solvent restructuring. Yesterday’s announcement was one step in that ongoing process, and discussions to resolve the remaining steps continue.

I know that there is concern about what yesterday’s statement might mean, and that residents, families and staff are anxious to know what will happen next. Let me repeat the assurance I have given to House before: whatever the outcome, no one will find themselves homeless or without care. We will not stand by and let that happen. We will continue to work with the Association of Directors of Adult Social Services, the Local Government Association, the Care Quality Commission and others to ensure that there is an effective response to any potential disruption to the continuity of care and to ensure that all residents are indeed protected. A consensual restructuring that assures a smooth transition to new arrangements will mean that those contingency arrangements will not be needed. We all want that to happen.

Let me reassure hon. Members about some of the questions that I know they will have. First, yesterday’s announcement stated that at the end of the restructuring process the Southern Cross corporate entity will cease to exist. That has no effect on the provision of care or the operation of care homes. Southern Cross remains in operation, and will continue to operate all its care homes until any transfer to new operators takes place.

Secondly, the transfer of care homes to alternative operators will be a managed process that ensures continuity of services. Yesterday’s statement makes it clear that care home staff will transfer on their current terms, and that the service that residents receive should be unaffected by the transfer. All parties involved in the negotiations have given a clear commitment that the continuity of care will be paramount in that process. Local authorities are already working to ensure that they can assist in the smooth transfer of arrangements in respect of homes in their areas. The Department has been working with ADASS and the LGA to support that.

Thirdly, no transfer will take place without new operators being approved and registered by the CQC. There has been speculation that companies with no experience in the care sector will take over the running of homes, but that will not happen. Alternative operators will need to be reputable and experienced companies that can satisfy the CQC that they are capable of delivering high-quality care and of meeting all regulatory standards. The CQC will not drop its standards in ensuring that requirements are met. I understand that each of Southern Cross’s landlords is settling its arrangements regarding which care home operators to work with, which is an essential part of the ongoing discussions. That will cover all landlords, so that there is a clear way forward for all homes.

Finally, I assure the House that the CQC has been working with Southern Cross landlords and other stakeholders for several months to ensure the smooth transition of services, and that it has processes to deal with re-registration, and to undertake the essential checks that are needed as a priority. It is having ongoing conversations with Southern Cross, landlords and other providers on the timing of applications.

The Government’s priority is to ensure that the current problems with Southern Cross are resolved and that a sustainable way forward can be secured, but, as the Prime Minister has previously stated to the House, we must all be clear on what future action is taken and draw lessons from what has happened.

I said earlier that yesterday’s statement from Southern Cross was one step in a process that will be ongoing in the coming weeks and months. Until all future arrangements are settled, Southern Cross will continue to operate and to provide care in all its homes. Only at the end of the process, when all transfer arrangements have been completed, will Southern Cross as an entity cease to exist. By then, all homes will have a clear plan for future operation, and the continuity of care will have been secured. That is the approach that the Department of Health has taken. Officials are in daily contact with all relevant parties. This Government are not sitting back; we are fully engaged.

[Mr Speaker]

Order. I thank the Minister for his statement, which was very informative, but he significantly exceeded his time. I will therefore allow the shadow Minister slightly more than her two minutes so that there is equity between the two sides. I emphasise for the future, however, that answers to urgent questions must be of the prescribed length, and the same goes for questions from now on.

[Emily Thornberry]

I thank the Minister for his response to my urgent question. Yesterday’s Southern Cross announcement that responsibility for managing 752 homes will pass back to the 80 landlords who own them has created a vacuum. I was interested to hear him say that that was part of a managed process, because it does not look like that—it has been a source of terrible uncertainty and great anxiety among residents and families. We have had so little information.

I am grateful for the information that the Minister has given today, but we need much more. Can the Government publish a list of all 80 landlords, or are the rumours correct that some of them have yet to be identified? Yesterday it was further announced that control of 250 of the homes would be handed back to the landlords immediately. We need to know which homes they are so that people living in them know who is running their home. Many of these landlords have little or no experience of running care homes. Does he have any information on the intentions of property companies such as London and Regional homes, which owns 90 former Southern Cross homes, or Prestbury, which owns 21?

I understand that the Association of Directors of Adult Social Services is doing its best to support its members, who will have a key role in ensuring that the operating companies can provide good quality care, and also that local authorities know how to perform financial stress tests to ensure that the new businesses have sound financial models, but what assistance is the Minister giving? Does he intend to provide additional resources to hard-pressed local authorities in order to help them? What advice can he give to local authorities if, for example, the new company is an offshore company? If the Department of Health does not have the expertise to assist ADASS, will he give that organisation access to officials from the Department for Business, Innovation and Skills, who might be able to provide that assistance?

Presumably, the new operators taking control of the homes will need to be registered with the Care Quality Commission—the Minister has assured us that that will happen—but given the staff shortages at the CQC will he assure us that the registrations will be completed quickly? The House has heard him guarantee that the new operators will honour the previous terms and conditions of the 44,000 employees, but how does that square with the announcement of 3,000 job losses? Does he know how many homes are likely to close and what the timetable is for such closures? What will happen to the 50 former Southern Cross homes owned by Lloyds properties, which is in administration? What about NHP, which owns 250 former Southern Cross homes and which is at a standstill with its bondholders? These problems must be addressed. We need a home-by-home plan from the landlords, and he must give us that plan. The buck stops with him. Will he now accept his responsibilities?

[Paul Burstow]

My slightly-longer-than-it-should-have-been answer to the hon. Lady’s question was an attempt to set out as much detail as was possible about the steps being taken to achieve a consensual, solvent restructuring of the business so that the homes can continue to operate. That is what my answer was all about. She asked about the role of the CQC, which, as I said to her, has been working for some months with the landlords to ensure a smooth process of re-registration as new operators are identified to take on the running of individual homes. I also said in response to her initial question that every home will be transferred. There is a plan in place that will lead to all homes being transferred over the next four months. She asked about engagement with BIS. Of course, as part of the ongoing work, the Department of Health is engaging with BIS to ensure that we have the very best advice in dealing with these issues. The Government have been—and remain—fully engaged with the process.

Health and Social Care Bill (Programme) (No. 2)

Emily Thornberry Excerpts

Tuesday 21st June 2011 Commons Chamber

[Mr Burns]

Thank you, Mr Deputy Speaker, and you can rest assured that I am doing my bit. If only Opposition Members would listen, they would get the plot.

As the changes we are making are substantial and significant, we have decided to recommit relevant parts of the Bill to Committee. I can tell the House that we expect to make around 160 amendments to the Bill, which we will table in good time. We will also go further and publish briefing notes to help explain the amendments to parliamentarians and those who follow our proceedings outside.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

When?

[Mr Burns]

The hon. Lady, from a sedentary position, rather like a Greek chorus that ill-befits her, asks when. The answer is that we expect to table the amendments by 23 June, which, if it helps her, is in two days’ time. That is despite the fact that many previous Bills—[Interruption.] The hon. Member for Islington South and Finsbury (Emily Thornberry) should listen to this because it has some direct relevance that she will not like. We are doing this despite the fact that many previous Bills were not recommitted under the previous Government despite their having undergone significant change. For example, the Local Government and Public Involvement in Health Bill in 2007 had 54 new clauses and three new schedules added by Government amendment, but rather than returning it to Committee the previous Government added them on Report. The Planning Bill of 2007-08 had 29 new clauses and three new schedules added by Government amendment; again, rather than return that Bill to Committee, the previous Government added the clauses on Report. Indeed, a Bill has not been recommitted for eight years since the Planning and Compulsory Purchase Bill in 2003.

No fair-minded person can claim that we are not subjecting the Bill to the closest possible scrutiny. Our recommitting the Bill will give hon. Members additional time to examine parts of the Bill that the Government propose to change. Of course, hon. Members will have further opportunity to scrutinise the entire Bill on Report in the Commons and the Bill will receive full scrutiny in another place. We do not believe that it is necessary for the entire Bill to be recommitted—[Hon. Members: “Why not?”] If hon. Members will listen they will find out why not. We do not believe that it is necessary for the entire Bill to be recommitted in order for proper scrutiny to take place. Indeed, we feel very strongly that that would unnecessarily delay the progress of the Bill to the ultimate detriment of patients. It is now time to give greater clarity and direction to staff and patients. As Professor Steve Field said in the Future Forum report:

“It is time for the pause to end.”

Professor Field is not alone in the opinion that now is the time to move forward and to enable proper and thorough scrutiny of those parts of the Bill that will change but without delaying the Bill’s passage beyond what is absolutely necessary. The Academy of Medical Royal Colleges said in its response to the Future Forum report:

“We hope the Government will now accept the Future Forum’s recommendations in full and move swiftly to make the changes to the Bill and the proposals that are required”.

The King’s Fund has also emphasised the need to avoid unnecessary delay. It said:

“The ‘pause’ has served the NHS, its staff and patients well”—

Southern Cross Healthcare

Emily Thornberry Excerpts

Thursday 16th June 2011 Commons Chamber

[Paul Burstow]

The right hon. Gentleman is absolutely right. The Government’s paramount interest—it is the interest that all of us in this House should have—is to ensure the welfare of residents. That has been the message that I, as a Minister, and officials have been giving, and will continue to give, to Southern Cross and to the landlords, and the CQC will have the responsibility of ensuring that that is carried out. It is absolutely clear that we all have to ensure that the restructuring succeeds, because that is in the best long-term interests of the residents.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

I thank the Minister for his statement, limited though it is. I congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on being granted this urgent question on an issue of great importance to Members of the House.

This is not the first time that Members have tried to bring the Minister with responsibility for care services before them to respond to their concerns. The lack of leadership and information from him during this period of uncertainty and anxiety for Southern Cross residents and their families, as well as its employees, has been notable. As a result of the agreement reached yesterday, we now appear to have a period of relative stability. However, great uncertainty remains for residents and employees at Southern Cross homes. We have heard that Southern Cross will now begin a period of restructuring, with reports of around 300 homes changing management, but contracts have been ripped up and it seems that 3,000 jobs are being lost. What assurances can the Minister give on security of employment for those working in Southern Cross?

On safety, last week we heard that Southern Cross is making 3,000 people redundant. We have also heard from the Care Quality Commission that Southern Cross has breached standards at 164 care homes—the equivalent of 28% of its English estate. Can the Minister guarantee the safety of and standard of care for residents, and how will he do this? Will the CQC carry out more frequent inspections?

There has been widespread condemnation of the business practices that led to Southern Cross’s financial problems. It is all very well for the Minister to point fingers at what might have happened many years ago, but this problem exists now, and the Minister is in government now. When people are treated as commodities with no thought to the consequences for them of this risky business model it is important that Government step up to the plate and do something about it. Southern Cross is not the only company in this industry to have financial difficulties. We have heard from the Business Secretary that the business model of Southern Cross and others in the residential care industry will be looked at by his Department. Will the Minister provide more details on the timing of this review and how Members will be told about its findings?

On cuts, the Minister says that there will be robust local arrangements, and I am sure that local authorities will step up to the plate if asked to do so. He must recognise, however, that local authorities are already under enormous strain as a result of the cuts imposed on them by his Government, including the cuts that they are already having to make to adult social care. How can they be expected to pick up the pieces of this national problem without assistance nationally from Government? In other words, are they to be given more resources to deal with the problem of Southern Cross if they are expected to be involved in plan B?

[Paul Burstow]

The hon. Lady is long on critique but very shallow when it comes to how she would approach this differently. Last week, I set out in a written ministerial statement the approach that the Government were taking. We also dealt with this extensively at last week’s Health questions.

The hon. Lady asked about the 3,000 job losses that are being proposed as part of redundancy measures by Southern Cross. Let us be clear: it has a statutory obligation to declare a ceiling for the number of job losses that may—I repeat, may—take place in the business. I have asked the CQC to undertake additional inspections to address concerns arising from the proposed job losses, and that has already been put in place.

The hon. Lady talks about cuts in social care spending but glosses over the fact that this Government, through the spending review, agreed to an unprecedented transfer of resources from the national health service to support social care, with £2 billion extra going into social care by 2014.

We might agree that we need to learn lessons from what is happening to Southern Cross, in respect of regulation and how we ensure a stable and successful social care sector for the future. That is why the Government are committed to an overhaul of social care and to bringing forward a White Paper to set out the plans in due course.

Caring Responsibilities

Emily Thornberry Excerpts

Wednesday 15th June 2011 Westminster Hall

[Emily Thornberry (Islington South and Finsbury) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. The debate could clearly have gone on for twice or perhaps three times as long. A feature of it has been the number of people who wanted to speak and have not been able to. My hon. Friend the Member for Newport East (Jessica Morden) wanted to speak, as did my hon. Friend the Member for Birmingham, Erdington (Jack Dromey). My hon. Friend the Member for Glasgow Central (Anas Sarwar) had also prepared something, and my right hon. Friend the Member for Croydon North (Malcolm Wicks) had told me that he wanted to make a contribution. The fact that many people have shown an interest in the matter demonstrates its huge importance.

I congratulate my hon. Friend the Member for Edinburgh East (Sheila Gilmore) on securing the debate. It is very easy to come out with a number of platitudes about carers, but carers want to hear what we will do to help them. Carers probably save this country more in money than is spent on the national health service. By 2017, it is likely that the UK will reach a tipping point, as the number of older people needing care will exceed the number of people of working age with families. There will be a crisis and we need to ensure that we are up to dealing with it. We must be able to support those people on whom we rely entirely. As has been said, if anyone is demonstrating the Prime Minister’s big society, it is carers up and down the country, so we need to look after them.

Where is the good news? There is some good news, which has come from the Law Commission. It has published a report that has largely received broad support from social care groups. A number of proposals are well thought out and will be well received, for example, rather than the carer needing to request an assessment, the local authority will have a duty to provide one. In addition, those assessments should be made for people who provide some care, rather than being restricted to those providing substantial care. Both those proposals are sensible. The third proposal is to ensure that a national system of eligibility assessments will provide some consistency across the country and allow people to move from one local authority to another without there being a huge time lag, which causes great distress to families. That will allow some portability of care.

The Under-Secretary’s brother Minister who is responsible for care, the Minister of State, Department of Health, the hon. Member for Sutton and Cheam (Paul Burstow), has so far welcomed the Law Commission’s report. In his pre-coalition past, he expressed support for many of the ideas it recommends. However, many of the issues will not come within the Department of Health’s ambit, but within that of the Department for Communities and Local Government. Given that the Secretary of State for Communities and Local Government has indicated that he wants to conduct a review of local authority duties, there is some concern that he may be resistant to a new duty being put on local authorities to ensure that carers are assessed as well as the person needing care. I hope that that is not the case and that people are speaking strongly in his ear, so that the Law Commission’s recommendations can be implemented in full because they are to carers’ advantage.

The other piece of good news may be the Dilnot inquiry. I met Mr Dilnot again today. He is very generous with his time and is meeting a broad range of people. The meeting he had with me and my right hon. Friend the Member for Wentworth and Dearne (John Healey) was the first of eight meetings that he is holding today. Of course, we all agree that we need to make fundamental changes, that the status quo will not do and that we must have a fundamentally reformed care system. The Opposition believe that there should be high-quality care for those who need it and that care needs to be funded in a fair way, with proper accountability for those who deliver it.

We repeat the Leader of the Opposition’s invitation, which was made on Tuesday 7 June. We welcome cross-party talks and we would like them to happen as soon as possible. We will come with an open mind because we want to be able to work together for the best way forward. I understand that the Prime Minister has welcomed that approach, but we still have an empty diary and we want to be able to get on with it. If the failures of the past are repeated, we will not be forgiven by those who use the care system or their families. It is important to remember that, even with co-operation and a fair wind, we are unlikely to see any of Dilnot’s suggestions implemented until 2014-15. The current problem for carers is what is happening now to the social care system and their support .

I am afraid that that takes me to the end of the good news and into the bad news. As has been said very eloquently by my hon. Friends, social care cuts are clearly having a fundamental impact on the lives of carers. I was going to congratulate the Minister of State, Department of Health, the hon. Member for Sutton and Cheam on finally taking his fingers out of his ears, stopping singing, “La la la la la,” and accepting that the cuts to social care will affect front-line services. That is inevitable; there is no other option. Given that social care is top-tier councils’ biggest area of discretionary spending, we simply cannot have 27% cuts to local authorities without there being cuts to social care. It just does not work. Unfortunately, the Government have ignored the advice of the Association of Directors of Adult Social Services and the Local Government Group, who know what they are talking about.

Although no centralised assessment of the impact of the cuts to local government on social care was carried out, several people have done the Government’s job for them. A wealth of evidence has been provided by ADASS, the BBC and my own survey. As has been mentioned, my survey of the directors of social care received 61 replies from councils and shows some very worrying results. I am pleased that the Minister of State, has complimented my survey as being robust, accurate and, indeed, more reliable than that done by the BBC. However, he needs to look at the impact of it and what it means. We will do the survey again next year and the year after, and I am afraid that we will not get good news.

ADASS has shown this year that the shortfall to adult social care spending is £1 billion. The Government have done their best not to affect adult social care, but next year they have to cut again and the year after they have to cut yet again. If things are bad now, as has been so eloquently reported by my hon. Friends, where are we going? Do the Government have any idea of the impact of these cuts on carers? This has already been asked, but I repeat: how many of those who no longer meet councils’ very narrow eligibility criteria will need to rely on the informal care provided by their families? Do the Government know how many carers will have to go without support from their local authorities and will, as a result, be forced to give up work to meet their new obligations?

I was particularly pleased to hear what the hon. Member for Banbury (Tony Baldry) said about respite care—I support him in that. The Government are right—our Government was right—to ensure that money is put aside for respite care. The difficulty is that the mechanics do not work. Primary care trusts have been given that money. It is not ring-fenced. It is not clearly labelled. There is no accountability. The Department of Health is very unclear about which PCTs have spent it, in what way, how much they have worked with local authorities, or how much they have worked with carers—there is no overall picture. Frankly, is that not the sort of thing that the Government should do? It is not just a question of handing out the money. Surely there needs to be some form of accountability.

The Princess Royal Trust for Carers has been doing its best to conduct an audit of that, just as I am doing an audit of local authorities and the impact of the cuts on social care, but surely that should be a job for Government. Surely the Princess Royal Trust for Carers has things to do other than conduct an audit of whether the money given by the Department of Health to PCTs for respite care for carers is actually being spent on carers. That is part of the knock-on effect of the chaos that has been created through the proposed partial abolition of PCTs in the Health and Social Care Bill. What action will the Government take if PCTs do not work with local authorities and carers of organisations to publish plans and budgets?

The other piece of bad news, which has been mentioned, is welfare reform. We welcome the Government’s announcement that carer’s allowance will be outside universal credit. We also welcome the news that disability living allowance will be excluded from the overall benefit cap. However, the bad news is that, when the Government talked about introducing personal independence payments, they said that there would be a 20% cut to DLA. It is not just a 20% cut to DLA. Those people will not be springing from their beds, suddenly well. People with dependants will still be there. Not only will they, but their carers will lose their money, because carer’s allowance will be attached to DLA. There will, therefore, be a huge impact on the families of those people who are losing their DLA. Do the Government have any idea of how many carers will lose out as a result of moving DLA to the personal independence payment and the 20% cut? Are the Government aware that carer’s allowance is not excluded from the proposed benefit cap, while DLA is? I am sure that the Minister would agree that that is, at the very least, not consistent, let alone fair.

[Mr Gary Streeter (in the Chair)]

Order. It may help the hon. Lady to know that the debate ends at 4.10 pm, and I want to give the Minister some time to respond.

[Emily Thornberry]

May I just come back to this last point? It is shocking that, at a time like this, carers suffer in the way that they do. It is a question of priorities and hard choices. As my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) so eloquently put it, it is not right that a woman has to put her husband to bed at 4 o’clock in order to do a part-time cleaning job to pull things together. It makes “We are all in it together” hollow rhetoric.

Oral Answers to Questions

Emily Thornberry Excerpts

Tuesday 7th June 2011 Commons Chamber

[Paul Burstow]

The hon. Gentleman makes a fair point that relates to the earlier question where I indicated that we are in constant contact with the devolved Administrations and will continue to have that dialogue—if necessary, at ministerial level.

[Emily Thornberry (Islington South and Finsbury) (Lab)]

Although we welcome the Government’s statement today that whatever the outcome of the restructuring of Southern Cross, they will not allow anyone to find themselves homeless, may I cast the Minister’s mind back to a week ago? Where was he? Why was he not visiting Southern Cross homes and speaking to residents, families and carers, as I was? Does he not now regret hiding in his bunker and allowing No. 10 to attempt to answer the questions that were put to the Government on behalf of these very vulnerable people?

[Paul Burstow]

I was about to say that I was grateful to the hon. Lady for the question, but clearly I am not. I have been following this as a Minister throughout, and I continue to follow it closely and to give the necessary instructions to officials to secure the future and the fate of the residents in these care homes. We have to be cautious and careful about the language we use on this particular endeavour. That is what I am doing, and I would urge the hon. Lady to do the same.

[Emily Thornberry]

The Minister can be assured that I am careful in the language that I use, and the words that I wish to use are these: does he agree that it is simply wrong that financiers and some of Southern Cross’s previous directors have creamed off millions of pounds while putting at risk the care of 31,000 elderly people who seem to have been used merely as commodities? Now that this has come to light, will the Government look urgently at whether regulation should be extended to ensure the financial stability of organisations that we entrust with the care of our most vulnerable?

[Paul Burstow]

That question has already been asked, and I have already indicated the approach that we intend to take with regard to the White Paper. I also point out that the establishment of the business model that Southern Cross operates of separating out provision from the ownership of the homes took place not under this Government’s watch but under her Government’s watch.

Winterbourne View Care Home

Emily Thornberry Excerpts

Tuesday 7th June 2011 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

(Urgent Question): To ask the Secretary of State for Health to make a statement on the Government’s decision not to hold an external independent inquiry into the abuse of vulnerable adults at Winterbourne View.

[The Minister of State, Department of Health (Paul Burstow)]

Nobody watching the BBC’s “Panorama” programme last week could have been anything but shocked and appalled by the systematic abuse of residents at Winterbourne View. May I, first, extend my deepest sympathies, and those of all of my colleagues in the Government, to those so horribly mistreated and abused, and to their families and loved ones? For the avoidance of doubt, I should say that we have not ruled out an independent inquiry. A criminal investigation is under way and it is important that we do nothing that could prejudice it.

In the coming weeks, the Care Quality Commission will inspect the other 22 hospitals run by Castlebeck and the reports will then be publicly available on CQC’s website. The CQC is also starting a three-month inspection of the 150 hospitals that care for people with learning disabilities, and this will include unannounced inspections. Where it identifies inadequate care, the CQC will require the necessary improvements to be made immediately. South Gloucestershire council will also lead an independently chaired serious case review. I have asked the Department of Health to draw together the findings of these various investigations and ensure that they are completed in a thorough and timely manner. I can also report that Mark Goldring, the chief executive of Mencap, will bring an independent voice and a depth and breadth of knowledge of the needs of people with learning disabilities to the task of drawing conclusions and learning lessons. Once in possession of the full facts, and once the police investigation has concluded, we will be in a position to decide what further action is required.

Since being made aware of the abuse, our priority has been ensuring the safety of patients at Winterbourne View. Fifteen staff have been suspended by Castlebeck and no further patients will be accepted at Winterbourne View. All residents now have a personal advocate and the CQC is working with all the agencies involved to find suitable alternative placements for them, taking into account their specialist needs and the wishes of their families. I issued a full written ministerial statement on these matters at 9.30 this morning.

It is the right of every individual being cared for by others to be treated with dignity and respect and it is the responsibility of those trusted with their care to provide it: a responsibility that weighs most heavily on those who care for the most vulnerable, including those with learning disabilities. This responsibility rests in four places: with the providers themselves, in this case Castlebeck; with commissioners, both primary care trusts and local authorities; with the regulators, including both the Care Quality Commission and the professional regulators, and the CQC has acknowledged it should have acted sooner and issued an unreserved apology; and, of course, with individuals. No training, guidance or management should be needed to tell people that the behaviour experienced by the residents of Winterbourne View was nothing other than obscene and unacceptable.

In future, our proposed HealthWatch organisations will provide a valuable early warning and will be able to ask the CQC to investigate where concerns exist. We intend to put safeguarding adults boards on a statutory footing, helping local authorities, the NHS and the police to work together to safeguard vulnerable adults. We will do everything in our power to prevent incidents such as those at Winterbourne View from happening again and to ensure that, if they do, the system responds quickly and decisively to protect those at risk.

[Emily Thornberry]

The Opposition agree entirely with the sentiments expressed by the hon. Gentleman. It was with great shock and sadness that we saw the terrible events happening, before our eyes, on the television screens. To see the abuse of the most vulnerable by those entrusted with their care was truly shocking and sickening. In the wake of this tragedy, however, vital questions must, in our view, be answered fully and impartially.

Although internal investigations conducted by the CQC and South Gloucestershire council, both of which are directly connected with this failure, will be of some value, they are nevertheless insufficient. We are asking for an independent inquiry similar in nature to the well-respected “Healthcare for all” inquiry, which Sir Jonathan Michael carried out in May 2007. The Government could include in that inquiry experts to work alongside Mark Goldring, such as Professor Jim Mansell, who has already conducted two reviews for the Department of Health into the structure of homes for those with learning disabilities, because the issues raised in his reports are still to be resolved, as this tragic case suggests.

We need full and frank answers. Was the CQC’s failure to monitor the treatment of residents due to the lack of resources? Was it due to the shortage of 300 staff, as reported in the Financial Times last week? Does the CQC have adequate powers to act in cases such as that of Winterbourne View and, if so, is it using its powers appropriately? If not, how must the CQC be strengthened to prevent a repeat of this failure and what actions will the Government take to ensure that staff working in social care are better trained and regulated so that events such as those at Winterbourne View can never be repeated?

Last week, the Minister created confusion with his response. On Tuesday, he seemed to imply that there would be an independent review of the case but by Wednesday he seemed to have changed his mind. Does he now think that internal reviews will be sufficient to answer the questions? I hear what he says about sub judice and the police inquiry, but we are not asking for an inquiry into individual culpability. We are asking for an independent inquiry into the failure of the system, for that inquiry to begin immediately and for there to be no delays. We need assurances that there will be a wide-ranging review, held in public, that will shine a light on the terrible events at Winterbourne View. Only an independent inquiry will do.

[Paul Burstow]

Of course, we need to ensure a full and thorough inquiry into all these matters, which is being undertaken in the serious case review, which will be chaired independently, and in the work of the CQC. That will go on as the Department brings together all the different reviews and that is why we are very pleased that Mark Goldring will take part in the process.

The hon. Lady suggests that there was confusion last week, but the confusion was only that which she sought to spread. We were very clear from the outset that we wanted to examine all the results from all the different inquiries, and that is what we are doing. We are not ruling out any further inquiries, but we want to ensure that the processes that are in hand are concluded and that we make judgments with the full facts available.

Social Care Services

Emily Thornberry Excerpts

Tuesday 17th May 2011 Westminster Hall

[Emily Thornberry (Islington South and Finsbury) (Lab)]

I do not believe I have served under your chairmanship before, Mr Brady, and it is a pleasure to do so.

I congratulate my hon. Friend the Member for Stockton North (Alex Cunningham) on securing the debate, and on his excellent contribution and the moving examples that he put before us. The truth is that not enough time is spent in the House on this fundamental issue, which is vitally important to many of our constituents; but we have had a very good debate today.

There seem to be two issues here: the structural problems and the cuts. My hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) touched on standards of care and on ensuring proper status for social care workers. My hon. Friend the Member for Blaydon (Mr Anderson) made a very important political analysis of the ongoing problems, and my hon. Friend the Member for Nottingham South (Lilian Greenwood) demonstrated her great expertise in this area.

My hon. Friend the Member for Wolverhampton North East (Emma Reynolds) yet again raised the importance of ensuring a long-term solution and expressed our continued regret that this issue was essentially bombed before the last election by the Conservative party, which decided that it was better to make cheap political points than for us all to work together. I assure the Minister that when the Dilnot commission reports we will not be emulating the behaviour of the Opposition at that time and that we will approach the matter with an open mind. We need a fair and sustainable solution, and we want to be able to work together on that. In the end, the issue is more important than party politics, and we must work together not just to find a solution but to implement it.

During the comprehensive spending review, the Government flourished the fact that they were giving an additional £2 billion for social care, but a few months later, local authority budgets were slashed by 8%. Given that social care is top-tier councils’ biggest area of discretionary spending, it was simply inconceivable that it would not be hit.

The Local Government Group and the Association of Directors of Adult Social Services both raised concerns about the implications for social care of the CSR local government settlement, warning that the extra £2 billion was simply not enough to meet demand. They argued that the spending gap during the period was likely to be between £3.5 billion and £4 billion due to increasing demand from our ageing population, which will add another 4% a year to social care costs in upcoming years.

Of course, some efficiency savings can be made, but they will never be enough to meet the shortfall. Personalised budgets and various reforms might be able to save some money, but the Minister should listen to those who know, such as ADASS and the Local Government Group, when they say that they will be billions of pounds short when it comes to social care. In those circumstances, they will not be able to protect the most vulnerable in our society. The much-vaunted £2 billion is simply not enough, especially as it is not ring-fenced. Will the Minister tell us whether the whole £2 billion, half of it or a quarter will be spent on social care? Can he do anything if not all of it is? Furthermore, can he confirm that he does not know whether it will be spent or not?

Not only are the Government cutting back on social care through local authorities under the cloak of localism, they are no longer doing centralised assessment of adult social care provision. In other words, they simply do not know what is going on. It is extraordinary that unprecedented cuts are being made at a time when local authority provision of social care is no longer being monitored, yet the Government steadfastly maintain that there need be no cuts to front-line services.

The Secretary of State for Communities and Local Government said that

“cutting front line jobs and hitting front line services isn’t inevitable—it doesn’t have to be an option at all”,

and the Minister said:

“It is wrong to scare people about cuts. The coalition Government has prioritised social care—the spending review announced significant extra funding for social care for each of the next four years, increasing to an extra £2 billion investment in 2014-15…This extra money means no councils need to reduce access to social care”.

It is simply not good enough for the Minister to put his fingers in his ears and sing “La la la.” The truth is that cuts in social care are being made now. Although he might not know about them, I can tell him, because ADASS, the BBC and I have done surveys. Last month, I surveyed directors of adult social care in England and got 61 replies, representing a 40% response. I appreciate the detailed responses by 27 Conservative councils, 29 Labour councils and four Liberal Democrat councils; that was, obviously, before the last local elections. The responses showed that 88% were increasing their charges, 16% were increasing eligibility criteria and 7% were considering charging more in the longer term. Many were closing day centres and care homes, 54% were cutting the voluntary sector and a further 24% were considering it for the future.

As predicted by everyone who knows, cuts are happening. Councils have not been able to meet increasing demographic pressure, which ADASS believes amounts to £425 million in 2011-12 alone due to the rising number of older people and people with learning disabilities needing substantial support. The ADASS survey shows that, far from increasing spending to meet rising needs, local authorities in England have cut adult social care spending by £1 billion.

We have heard in this debate about the terrible consequences of cuts to front-line services for the most vulnerable in our community. The fact of the matter is that as a result, an elderly woman might no longer get up at breakfast time but at lunch. She might not have an advocate, but we have a duty to ensure that such people are protected. It is not good enough for the Minister to remain in Whitehall saying that there need be no cuts to front-line services. He must listen to the reality of what is going on. Not to address the funding shortages in local authority social care is reckless and wrong.

Funding cuts also mean that local authorities cannot invest in preventive services, so the cuts being made now will have knock-on effects in the long term. If someone does not have a regular visit—if their shopping is not done for them, or if they are not got up in the morning on time—they are more likely to go downhill faster and to end up in hospital. Some 52% of respondents to my survey said that the cuts adversely affected the development of new preventive services. Services that could reduce the need for long-term care and promote independence are among the first to go, but that only increases the strain on health and social care services in the long run.

It is irresponsible of the Minister to continue to say that no cuts need be made to front-line services. Will he admit that he was wrong not to listen to the warnings and to say that front-line services would not be cut? Will he also admit that efficiency savings alone cannot deliver the huge cuts being forced on local authorities? What is he doing to increase the provision of social care now that he has heard the truth about what is going on?

The holy grail, as we all agree, is integration of social care and health, but the difficulty is that the Government are, on one hand, cutting local authorities extensively and, on the other, taking the health service by the ankles, turning it upside down and shaking it hard. Those are not ideal circumstances for the two bodies to integrate properly. The Bill calls itself the Health and Social Care Bill, but it contains precious little social care. There is a great deal of talk about integration, but words are not enough.

When it released the results of its survey recently, ADASS recommended that, as the Government are pausing to reconsider the Health and Social Care Bill, perhaps they might pause long enough to hear the results of the Dilnot inquiry and radically reconsider their plans for long-term care. If they want to be radical on health and social care, that is the area of need. We do not need the fundamentally misguided Health and Social Care Bill as it is drafted. We do not need competition driven into the heart of the NHS. What we need is co-operation and collaboration. We need health and social care to work more closely together.

If the Government are to pause, let them pause and think about that. Let them pause and ensure that, for example, we can keep the elderly out of hospital for as long as possible by allowing social services to provide proper social care, and that once someone is in hospital, they can get out quickly. That is the only fair way to treat people. Frankly, it also saves a great deal of money. If the Government spent more time, energy and resources on solving such issues and a little less on introducing competition into the national health service, we would all be a lot better off. I know that in his heart, the Minister agrees, but he has unfortunately found himself in the difficult position of having to defend this extraordinarily awful Bill.

I may have argued those points when the Bill was discussed in Committee, and I am glad to hear that ADASS now agrees with me in general. I am also glad to hear that the right hon. Member for Charnwood (Mr Dorrell), never one to allow a bandwagon to pass him by, said that the legislation should be rethought:

“A clear commitment should be written into the Bill to achieve full institutional and managerial integration of the NHS and adult social care in England.”

The Select Committee Chair agrees with us as well.

I ask the Minister to reconsider funding and the reality and to give us an undertaking that he will no longer make false claims that there need be no cuts to front-line services and that he will do something about the matter. I also ask that the Health and Social Care Bill be worthy of its name, if it is not killed off completely. It needs major change so that social care can be integrated properly into health care. Worthy words are simply not enough to achieve that.

--- Later in debate ---

[Paul Burstow]

Yes; we can build on that point. The Government recognise the importance of social care and the fact that it lets people live independently, which is what it should be about. It should be about enabling people to live well, to be safe, to continue to do things that we take for granted and to be active participants in civic life.

As has been rehearsed in this debate, there are big challenges. There are demographic challenges and the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) has outlined some of those facts. The hon. Member for Wolverhampton North East (Emma Reynolds) has rightly said that, while we should be concerned about the challenge, we should not be so concerned as to forget to celebrate the fact that we have an ageing population—a population that is living for longer and, in many cases, living healthily for longer as well. We also have changing societal expectations and a greater expectation of being able to make choices for oneself, to be in control of one’s own life and to be able to have high standards of support to facilitate that. We have financial challenges. We have a structural deficit. For every £4 that this Government spend today, £1 is borrowed, and we are spending £120 million every day on interest charges.

Reference has been made to the survey by the Chartered Institute of Public Finance and Accountancy for the BBC. I have to say that, of the many surveys that have been produced, including that of the hon. Member for Islington South and Finsbury, it is probably the least robust of the lot. There we go—I give the hon. Lady credit that her survey must be more robust than that of CIPFA, which did not provide a great deal of detail and did not ask the right questions. Indeed, those who answered the questions were not all social services authorities, and they included things in their figures that are not part of social care. Even the Association of Directors of Adult Social Services has criticised that piece of work.

On attempting to address and mitigate the impact of the reductions that the Government have had to make in formula grant over the past year, we have strived to mitigate it in those areas with the greatest needs to make sure that we have increased the support in those areas, relative to others.

The hon. Member for Stockton North talked about high mortality figures in constituencies such as his own. Again, we have to dwell on why that is still the case after so many years, why we still have that legacy, why we have to continue to address those challenges, and why this Government, through their commitments in public health and elsewhere, are determined to make progress.

Despite the deficit legacy, we have taken some decisions. Members have forecast that I would refer to them, and I make no apology for that. We set out in the spending review in October how we would ensure sufficient resource in the system to allow decision makers at a local authority level to protect social care, if they decide that that is their priority. We have a good settlement in that context. An additional £2 billion will come to social care by 2014-15, and that money is getting through. In January, £162 million was put into social care via the national health service, which is something that we were asked to do and which we have done to ensure that social care gets additional support. Moreover, there is £648 million of additional funding from April this year. That money is going to social services departments and is being transferred by the NHS for that very purpose. A further £1.3 billion is supporting the transfer of funding for the commissioning of learning disabilities.

Those sums constitute the biggest transfer of hard cash from the NHS to social care ever. It is not only about supporting social care, but about breaking out of silos. It is about using cash to get people to start having those dialogues that are so important to achieve the collaborative behaviour and integration that are essential to delivering better services for our citizens.

On top of that is the £530 million that will come through the formula grant. I will not micro-manage, from this Chamber or my desk in Whitehall, every single social services authority and tell them how to use that money. It must be their decision, based on need, and they are accountable for such decisions.

[Emily Thornberry]

The Minister has anticipated what I am about to say. First, if money is being transferred from the health service to social care, I presume that it is being done by primary care trusts, which are at the same time being abolished. Is he confident, therefore, that that money is properly accounted for by the Department of Health, given the current chaos reigning within the health service? Secondly, will he tell us how much of the money given to local authorities is actually being spent on social care in the way in which it is supposed to be?

[Paul Burstow]

The answer to the first question is yes. The answer to the second question is that I will write to the hon. Lady with further detail. However, it is certainly the case that money is being agreed between the NHS and social services for the provision of social care services that support health and underpin prevention.

I would also like to refer to the work of the King’s Fund, which is reputable body that is often cited by Opposition Members. It has confirmed that, if we take into account efficiency savings, there is no funding gap for social care during the spending review period. Of course, the grounds on which some councils have made their budget judgments mean that some have acted to protect social care through innovation and the redesign of services. Other councils have decided to change their eligibility or charging policies.

Reference has been made to the ADASS survey, which shows that social care spending as a share of council spending has increased. The hon. Member for Islington South and Finsbury has referred to savings that local authorities are making. For every pound of savings that will be made from social care this year, 70p is a result of efficiency and doing things differently and only 20p—this is still something that I regret—is a result of actual reductions in service.

Yes, eligibility has been tightened, but that is not new. As I have mentioned, a survey carried out by the Learning Disability Coalition shows that those tightenings in eligibility criteria have been part and parcel of local government decisions for many years. Indeed, the ADASS survey shows that, when this Government came into office last year, 101 local authorities were already limiting eligibility to services to those with “substantial” need. Twelve months later, 116 local authorities are using “substantial” need and just six are using “critical” need. It is worth looking behind those headlines, because some councils are changing the eligibility criteria, but they are reinvesting the savings they make from that decision into preventive services, such as telecare and giving people personal budgets. For example, Southwark council has reviewed the needs of people with learning disabilities and is changing its services through the introduction of personal budgets, supported living and providing more control and dignity. It is saving resources, but it is also giving people a better quality of life.

The hon. Member for Newcastle upon Tyne North described the unacceptable quality of care in some care homes and the inquiry that was carried out by a local broadcaster. She is right to describe some of the shocking stories that she has heard and to decry how older people all too often get relegated in the headlines compared with scandals over the care of children. She talked about the Care Quality Commission and the fact that it has changed its inspection model. I respectfully suggest that the basis for the legislation that introduced essential standards and has led to a more risk-based model for inspection was debated in the House not under this Administration, but under the previous one. We have not abandoned the changes the previous Government started or thrown the whole regulatory framework up in the air yet again and caused chaos, as often happened in the past 13 years. We are trying to ensure that that model delivers.

The hon. Member for Newcastle upon Tyne North asked about skills and training. Those issues were also touched on by the hon. Member for Blaydon (Mr Anderson). The Government are working with Skills for Care, which will produce work force, retention and personal assistance strategies to address the sorts of concerns that the hon. Lady and others have mentioned. I will publish those shortly.

--- Later in debate ---

[Emily Thornberry]

On the issue of confusion, the Minister spoke earlier about the King’s Fund and said that its view is that cuts will not be made to social care. I have just checked that, and I believe that the King’s Fund has said that there will be a shortfall of £1.2 billion by 2014-15.

[Paul Burstow]

The King’s Fund has stated that but, if one reads on, the document concerned states that if efficiencies of 3.5% are made, there is no need for a funding gap to open up.

On social care law reform, our current legislation is the product of 60 years of piecemeal legislation that looks back to 19th-century poor law principles. A Law Commission report makes 76 recommendations and provides a firm foundation on which we can build. The Government intend to publish a White Paper later this year and to introduce a Bill in the second parliamentary Session.

Our intentions are clear. During the life of this Parliament, we want both the law on social care and its funding to be reformed. We want that reform to be based on a vision in which there is a greater personalisation of social services, a more preventive focus on how those services are provided and a real attempt to deliver around outcomes. We want services that are more innovative and that are based around growth, telecare and involving other providers. There also needs to be a partnership between the individual, the state and health and social care providers. That is how we can secure the future of social care and make a real difference for every one of our constituents. I thank the hon. Member for Stockton North for initiating the debate, and I hope that we will have more debates about social care than have taken place during the past 13 years.

Future of the NHS

Emily Thornberry Excerpts

Monday 9th May 2011 Commons Chamber

[Emily Thornberry (Islington South and Finsbury) (Lab)]

This has been an interesting and important debate at an important time for our health service.

[Tony Baldry]

Where are they?

[Emily Thornberry]

I am being heckled already. I do not intend to make a habit of this—the hon. Member for Banbury (Tony Baldry) can heckle as much as he likes—but I will answer on this occasion. There is another draw this afternoon. My right hon. Friend the Member for Doncaster North (Edward Miliband) is speaking, but I understand that my hon. Friends will be coming in a moment.

We have heard a number of interesting and important speeches from Members who have shown great expertise and have been serving the community and the public through their work on Select Committees, including the Health Committee. We heard from my hon. Friends the Members for Easington (Grahame M. Morris), for Walsall South (Valerie Vaz), for Oldham East and Saddleworth (Debbie Abrahams) and for Pontypridd (Owen Smith), and from the hon. Members for Central Suffolk and North Ipswich (Dr Poulter) and for Stafford (Jeremy Lefroy). Listening to their contributions, we have had a taste of the quality of debate that took place in the Health and Social Care Public Bill Committee. It is a shame that the Government did not give an inch as a result of those debates.

We have heard from the Liberal Democrat representatives, including the hon. Member for Southport (John Pugh), who talked about the Jekyll and Hyde drafting of the Bill, and the hon. Member for St Ives (Andrew George), who said that he is likely to vote against it on Third Reading. We heard a characteristically passionate, robust and articulate speech from my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson). My hon. Friend the Member for Eltham (Clive Efford) asked a very simple question that I will repeat in the hope of getting an answer: what changes will be made as a result of the pause?

I hope that the Secretary of State was listening to my hon. Friend the Member for Stockton North (Alex Cunningham) because he brought a dose of reality to the debate by explaining the effect the reorganisation will have on his poor constituency and the redundancies it is suffering.

[Andrew Bridgen]

Will the hon. Lady not concede, perhaps even reluctantly, that the real reason her party is acting as a roadblock to essential NHS reform is that it pays far more attention to its union backers and paymasters than to NHS patients and taxpayers?

[Emily Thornberry]

The great strength of being in opposition, in many ways, is the opportunity it gives us to listen to interested groups of every type, including representatives of the work force, experts and the public, and to hear their concerns about the Bill. Those concerns translated into more than 300 amendments that we tabled in Committee and more than 100 votes. As I have said, the Government considered it wise not to give an inch. However, on the day after the Committee finished its considerations, the Government decided that there ought to be a pause so that they could think again. The very fact that they decided to think again tends to encourage us to think that we might have been right in the first place. What a shame it was that they did not listen to us earlier.

For the Health Secretary, it must seem a lifetime since the Prime Minister said about him:

“He is probably the Health Secretary in the last 20 years who has the greatest understanding and greatest passion for the NHS.”

His Deputy Prime Minister stated in the foreword to the NHS White Paper that the reforms were

“rooted in the coalition’s core beliefs”.

Patient groups, professional bodies and health experts gave the underlying principles of the White Paper a cautious welcome, but I ought to explain to the Secretary of State that there is a difference between giving a cautious welcome to the underlying principles of a White Paper or Bill and reading the Bill and realising that it will not deliver on those underlying core principles. That is why there has been an increasing chorus of opposition. Our difficulty is that, although there were more than 6,000 responses to the White Paper, those concerns were largely ignored. When the Bill was published, those concerns increased to alarm and the criticism became less diplomatic, less polite and more forthright, and yet the Secretary of State continues not to listen. More people began to join the Opposition’s side of the argument. Although at the beginning the Secretary of State might have felt encouraged that he had many people in his “liberate the NHS” team, as more people realised just what the Bill was about, more and more of them decided that they had been on the wrong side of the argument and that the Bill was wrong and so crossed the room.

I pray in aid the comments made by the hon. Member for Totnes (Dr Wollaston), who talked about throwing a hand grenade into the NHS, and those of the Royal College of Nursing, which passed a vote of no confidence in the Secretary of State, with 98% of the vote. Its general secretary said that the Bill

“could well turn out to be the biggest disaster in the history of our public services”.

The British Medical Association called for

“a halt to the proposed top-down reorganisation of the NHS”.

When I listened recently to the hon. Member for North Norfolk (Norman Lamb), I was reminded of Luke 15.7 —there shall be more joy in heaven over one sinner who repenteth than over 99 just persons who do not need to repent. The number of people who are moving over to our side of the argument are becoming a flock. They say they realise that the Bill is not what they had first thought it was, that it needs to be fundamentally changed, and that if it is not fundamentally changed it needs to be scrapped.

Lord Owen has said:

“The coalition unexpectedly and inexplicably forged ahead with legislation for NHS reforms of staggering ineptitude.”

Lord Tebbit, who I believe is the Secretary of State’s former boss, has said:

“What worries me about the reforms, however, is the difficulty of organising fair competition between the state-owned hospitals and those in the private sector.”

I could go on. Michael Portillo has said of the Tories:

“They didn’t believe they could win an election if they told you what they were going to do because people are so wedded to the National Health Service.”

The whole of the Liberal Democrats have also crossed the room. Evan Harris has talked about the Bill being “disastrous”. Although I heard the right hon. Member for Charnwood (Mr Dorrell) say encouragingly that the Bill would give

“a holistic basis—a structure for the health service, going forward”,

the Health Committee’s report has not been so enthusiastic, if indeed what he said today could be characterised as enthusiastic. Lady Williams has said that the Bill is “completely misconceived”, and the right hon. Member for Bermondsey and Old Southwark (Simon Hughes) has said that it needs “fundamental change”.

The Health Secretary must be feeling increasingly lonely. Perhaps the most deadly time was when the Chancellor of the Exchequer stated:

“I want changes too, and so does David Cameron”.

I appreciate that the Health Secretary has the Minister of State, the right hon. Member for Chelmsford (Mr Burns) and the Under-Secretary of State, the hon. Member for Guildford (Anne Milton) on his side, along with the hon. Member for Banbury (Tony Baldry). I respectfully suggest to the Health Secretary that he holds very tightly to the hand of the Minister of State, the hon. Member for Sutton and Cheam (Paul Burstow). It must seem a very long time ago that the Prime Minister said:

“I have been involved in designing these changes way back into opposition with Andrew Lansley. I take absolute responsibility with him for all the changes we are making.”

We will see just how long it is that the Prime Minister stands shoulder to shoulder with his Secretary of State.

There has been great excitement in SW1 bubble land on what effects the NHS reforms will have on the coalition and what the Lib Dems will do next, but the fundamental point is that it really does not matter what happens in SW1; what matters is what happens to our national health service. The Bill is a threat to our national health service. Leaving aside the political shenanigans and the saving of the Deputy Prime Minister or the Liberal Democrats’ soul, what is important is what happens to our national health service. We should be looking at the fundamental principles in relation to that. Everything else is just words, words, words. We are told that we must not rush GPs into consortia, but the majority of them have already been rushed into consortia and their PCTs are being abolished. If that is the extent of the fundamental reforms that the Liberal Democrats want, that would be very disappointing.

We in the Opposition have five tests: delete part 3 of the Bill; keep waiting time guarantees; ensure that consortia are not too small, involve wider expertise and require openness and accountability; ban GP bonuses, stop conflicts of interest and do not allow commissioning jobs to be done by the private sector; and keep a cap on the number of private beds. Let us do that, which would be a fundamental change to the Bill. Most importantly, let us delete part 3.

Instead of wasting time, energy and money on unnecessary top-down reorganisation, the Conservative party should have been building on Labour’s achievements. When we handed over the NHS to the Conservatives, we did so in trust. They should have built on our achievements. I am not saying that the NHS was perfect, but it was much better than it was when it was handed to us. These reckless, costly and ideologically driven reforms are not doing well for the health service. As the hon. Member for Totnes has said, while competition has a role, it is not an end in itself. If we allow competition to run rife within the NHS, it will fundamentally undermine its essence, which is that it is built on a culture of collaboration and co-operation. It is an expression of our fundamental commitment to equality.