(6 years ago)
Commons ChamberIt is a pleasure to follow my hon. Friend the Member for Sheffield Central (Paul Blomfield) in this important debate.
It is important that we pay attention to the fact that the Prime Minister announced the end of austerity, yet yesterday it was announced that austerity is “coming to an end”. Which is it and when will this be? Austerity was a political choice, not an economic necessity. How will the Government alleviate and redress the devastating impact of austerity? Austerity has not tackled the deficit; rather, the onus of who pays has been shifted to teachers, police and nurses. After eight years of this Government’s hard austerity, too many people are suffering and too many vital public services are in crisis.
Yesterday, we heard not a penny announced for the day-to-day costs of schools, even though school funding has been cut by 8%; not a penny for regular policing, even though 21,000 officers have been cut and violent crime is on the rise; and not a penny for local councils to close the funding gap of £7.8 billion by 2025—and they are facing cuts of £1.3 billion next year, too. The Government are not fixing the fundamentals. Must it always take a tragedy to effect meaningful change?
Take a look at our fire service: rather than fighting fires, it is having to fight for funding. It is beneath contempt not to pay those who work in our fire service properly. Indeed, real wages are lower today than they were in 2010, while CEOs are paid 143 times the wage of the average worker.
The late Audrey Hepburn once said: “As you grow older, you will discover that you have two hands: one for helping yourself, the other for helping others.” When will the Government stop and realise that? Rather than help, the Government have shown again through the Budget that they know the price of everything, yet the value of nothing. Once again, they are saying, “Your price is way too high; you need to cut it, cut it, cut it, cut it.” It is like the emperor’s new clothes: the emperor seeks to describe an elegant, flamboyant gown that he is wearing, but he is actually completely naked.
This Budget does not mark the end of austerity. The NHS has experienced the slowest spending growth in its history. When the Government created the Budget, clearly ignoring the issues caused by their austerity, it seems they had 99 problems but did not consider the state of the NHS to be one if they believed that £20.5 billion was sufficient to repair the damage caused by eight years of under-investment.
According to the Health Foundation, the £20.5 billion promised is simply not enough. The £2 billion that has been announced for mental health is welcome, but it is half what is needed, and let me be clear: this is not new money and these are not new resources. These financial gimmicks fool no one. The Health Secretary has said that it would take a generation to establish parity of esteem under this Government. However, people with severe mental health conditions cannot afford to wait five years for meaningful action from this Government. Too many people, including children, are already waiting months to access the treatment that they need, leading to a devastating mental health crisis.
In my constituency, there has been a real-terms cut of 10.6% in adult social care, almost double the national average, and the Government consider their announcement of £650 million for long-term adult social care services an accomplishment when it is less than half what the King’s Fund estimates is required to meet demand. Nearly 1.5 million elderly people are not getting the care that they need—an increase of 20% in just two years. The sum of £84 million over the next five years to expand children’s social care programmes is pitiful compared with the £3 billion needed by 2025. Services are over- stretched, and the recent trends in the level of funding are unsustainable and unacceptable. The needs of Peterborough —my constituency—have been attended to on the cheap for far too long. As a consequence, cracks are beginning to appear in our services. Our needs have not been properly or adequately assessed, or indeed addressed, and the current settlement is blatantly below par.
Does the hon. Lady agree that one of the biggest challenges facing Peterborough hospital, which serves her constituency and in which I work, is the financial burden of the PFI that was used to build the hospital? It is a beautiful hospital, but so much money was spent on it that we are burdened with this PFI. It was a Labour Government who did that and we are now having to pay for it.
I thank the hon. Lady for her intervention. Yes, I know that very well about the PFI, which is why Labour is seeking to end PFIs. [Interruption.] Before she says that we signed it, I would like to talk about now and the fact that PFIs actually came in under John Major. Talking about now, Government are pursuing efficiency to the point of ineffectiveness. I end on this poignant note: investment now is lower in relation to GDP and we are ranked 22nd in the world. The time for warm words is over. Austerity has dire consequences and a little extra just will not cut it.
(6 years, 4 months ago)
Commons ChamberThe first thing that I wish to highlight is my continuing concern about how wholly owned subsidiary companies are being established in the NHS largely to avoid the payment of VAT, which is not what Parliament intended. Although I recently spoke to people at the Treasury about this matter and they did not seem too concerned about the loss of VAT, it is not what Parliament intended in the estimates. It should be of concern to many Members that trusts are being forced down that route.
I also wish to highlight the tremendous work that has been done in the past few years by many of the Select Committees—some of the Chairs are present—including the Public Accounts Committee, on which I was proud to serve for two years. They have drawn attention to the dreadful state in which the NHS has been left over the past eight years, with the lowest growth in spending in any comparable period in its history. That has left a huge backlog of issues.
After several years of warning, tremendous hard work by Committees and scrutiny in this place, we have the welcome announcement on funding. It is just short of the average rise of 3.7%, but we are grateful for what we have got. The Secretary of State has set five tests to
“show how the NHS will do its part to put the service onto a more sustainable footing”.
He has tasked the NHS with improving productivity, eliminating deficits, reducing unwarranted variation, getting better at managing demand and making use of capital. As well as those five tests, he also said that the NHS needed to be back on track on agreed performance standards, on locking in and further building on safety and on transforming care. He went on to say that the Government will transform cancer care and move money into mental health to deliver parity of esteem. That is quite a list.
Does my hon. Friend agree that mental health has not been given parity of esteem, despite the 2012 legislation?
I do agree, as would most Members, I think. There is a strong willingness in the NHS and in the Department to make it happen, but it is very hard to see it happening on the ground.
The Secretary of State said two interesting things in the interviews that followed the NHS funding announcement. First, he said that the money is contingent on the NHS’s delivery of a plan based on the issues that I just outlined. Secondly, he said that the Government would tell us, the taxpayers, in the autumn how we were going to pay for it. I am not a great fan of the monumental paternalism that seems to have overtaken the Government.
This is a huge missed opportunity to talk to the public about the service that they wish to have in this country and how much it costs—and I mean in respect of the entire NHS budget, not just social care. This could be an opportunity to share with MPs the reality in our health economies. Which areas are doing well? Which area is an outlier in costs, in meeting targets, in safety or in other health outcomes? I do not want any more dashboards or league tables, but I do want a way to improve the debate. I want to be armed with information and for us scrutineers to be able to use this opportunity to take what we know from the estimates and the Select Committees and translate that back into our local health economies.
In this debate, we will be talking about billions of pounds. We are having a very amicable debate here this evening; normally, we trade points over who would do better and how we would spend different parts of the money. Even those of us who are MPs and who are experienced and understand the funding and service planning struggle through the local architecture and the decision-making to know what money we need, where it should be targeted and how on earth our constituents will pay for it.
I tried to look at the issues in my own health economy. Members will be pleased to know that I will not have time to go through all its accounts, which I looked at over the weekend. Bristol has been in balance over the past few years, but, unfortunately, our neighbours have not, and the solution has been to join us together, so now we are all suffering under a huge deficit. It was another £30 million last year. We have an £83 million historic deficit—not in Bristol, but in our neighbouring authorities for which we are now responsible. If we run forward with that deficit over the next five years, that is another £150 million, plus, possibly, the £83 million that we already have. We are then getting very close to the £300 million that the £20 billion equates to in our local health economy.
All hon. Members can take the £20 billion and equate it with their own health economies and start to see what that money will really buy. The £300 million that this may equate to is also roughly equivalent to what the sustainability and transformation partnership said two years ago that it would be short of. This is a long way round and I excuse hon. Members for not keeping up with the numbers, but what I am essentially saying is that the money will allow us to stand still and not much else.
The coalition Government wanted to liberate the NHS, but instead they put a torpedo in the middle of it, fragmented it and then threw it all up in the air. People have done a remarkable job in keeping it going over the past few years. Why not try a different approach? Why do we not liberate the frontline to talk to us about what this money means? Why do we not look at the real demand in our health economies, what that money is and try to make sense of it for local people? Then we should talk to them about how much it would cost to have the level of service and treatment that they think they want. That would be a really liberating thing to do for all those managers and clinicians on the frontline. Local transparency, local accountability, is the only way to go in starting to square the circle of demand, quality and cost. MPs should not be let off the hook and kept outside the production of this new NHS plan and the way that it will be funded by our constituents over the next five months.
In this 70th year, the best present that politicians could give to the NHS would be to stop piling on the priorities, knowing that the money is not enough to meet them all, and to front up the political choices that we have asked people to make and our constituents to pay for.
It is a pleasure to follow the hon. Member for Northampton South (Andrew Lewer).
One thing I think we can all agree on is that we take our health for granted. We all get bogged down with everyday worries and problems, and all too frequently we hear the phrase, often from those who are more experienced, “Your health is the most important thing. Don’t take it for granted.” Of course, everyday life—education, work, family, bills and so on—are very real challenges that we all face, and it is sometimes easier just to hope for the best and go for the line, “Fingers crossed, it won’t happen to me.” The reality, however, is that at some point every one of us will experience either poor health or the likelihood of having to care for a loved one who is suffering.
My real concern is that our health and social care system is built on shifting sands, and there seems to be no long-term strategy from the Government for dealing with the challenges we face as a nation. We have an ageing population, a growing population and a population with more complicated health needs, yet we lack forward thinking and planning.
At the time of my election last June, the Care Quality Commission had found that one in four social care services was failing on safety grounds, with at least one care home closing every week, while only 2% of providers were regarded as outstanding. Our Prime Minister acknowledged that our social care system was not working, and promised to fix it—it was even in the Conservatives’ manifesto—but that promise has been broken. Since then, the Chancellor failed even to mention social care in the autumn Budget, and he missed another opportunity in the spring statement. The single departmental plan of the Health Secretary’s Department of Health and Social Care has failed to acknowledge the social care workforce. The result is that care providers up and down the country, including in my constituency, have been placed in special measures and face closure.
It is devastating to see people at breaking point because of this undignified and broken system. It is not just those in need of care who suffer, but their families. I recently visited a very good care home in my constituency, and I spoke to a gentleman who told me how wonderful his care was at that home. He also stated that he had now spent his life savings on his care, and would more than likely have to sell his home, which his children live in, to be able to continue to fund his necessary care. He expressed his regret at an unfair system, in which dignity in old age is determined by the amount of money people can pay.
I wish to draw on one particular issue that has not had the publicity it deserves, even though it threatens the viability of the care sector and could jeopardise the care of the most vulnerable people in our society. It is the Government’s mismanagement of the sleep-in crisis. I first learned about this issue when a senior council worker at Cheshire East Council was sacked after raising concerns about dozens of careworkers who had been paid less than the national minimum wage by the Conservative-run council, which had pledged to pay all its workers a living wage. Since then, one of the Conservatives’ own councillors has said that the council knew it was underpaying careworkers as early as 2014, adding that he would resign if he was proven wrong.
Unison brought a successful claim to an employment tribunal, where it was ruled that careworkers who sleep overnight in care homes are entitled to the national minimum wage for each hour that they are at work in what are referred to as sleep-in shifts. In February 2015, the Department for Business, Energy and Industrial Strategy updated its guidance to reflect the court ruling, and this should have been the end of it. The Government, now knowing that their previous guidance was wrong, should have taken swift action to ensure that all careworkers received the back pay they were owed and were paid the national minimum wage.
Yet freedom of information requests have revealed that HMRC was instructed in February 2016 that staff were not entitled to the national minimum wage during sleep-in hours. In my opinion, this mistake is unforgivable. Over a year later, HMRC has finally started enforcing complaints made by workers, who are in addition seeking six years of back pay to make up for missing wages. However, the Conservatives stopped this by delaying in July 2017, and again in September 2017. Incredibly, local authorities were not instructed to pay the national minimum wage for these sleep-in shifts until October 2017. From 2015 to 2017, careworkers were ignored.
A careworker in the constituency got in touch with me because he did not know where else to turn. He described how staff morale was at rock bottom, with many careworkers suffering from poor mental health, worrying about their job security, relying on food banks and payday loans, and being too scared to take time off sick and unable to afford going on annual leave.
Does my hon. Friend agree that we must not allow the sleep-in crisis to be kicked into the long grass? We must draw attention to it, and the Government must do something about it.
I absolutely agree.
The careworker who contacted me described how careworkers feel that they have no voice and no respect. Is it any wonder that more than 900 careworkers leave their job every day? The way that this crisis is being handled is utterly disgraceful, and the Government have missed opportunity after opportunity to put things right. How can we expect the care sector to function, given all this uncertainty?
After years of continued mismanagement, the careworkers’ back pay bill is due in November. The reality is that the Government have never paid local authorities enough money to allow them to provide sleep-in shifts at the national minimum wage. We know from sector surveys that care providers cannot afford to pick up the Government’s tab. If they are made to do so, some will close and some will hand back contracts, leaving the vulnerable people they support to find new carers and local authorities to struggle further. Some will be forced to cut the additional services they provide, such as those that help disabled people live more independent lives. Blackpool has already seen one care provider close. We do not have long until we start seeing the effects across the UK. It is vulnerable people and low-paid carers who will suffer.
The Government have had three years to get to this point, so where are their proposals for safeguarding the viability of the care sector? I ask the Government please not to wait any longer. The careworkers deserve better, the providers deserve better, and the citizens of this country deserve better.
(6 years, 6 months ago)
Commons ChamberI thank my hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this debate, which is of paramount importance. I have listened to the contributions from Members on both sides of the House. I was struck by the comments made by the hon. Member for Congleton (Fiona Bruce), who said she felt that we could not say now that the use of surgical mesh should be suspended. I have been brought up to think that if it has four legs, eats grass, produces milk and moos, it is not a fish. If we are hearing from the women who have had the mesh implants that they are not working, that they have destroyed their lives and that they have debilitating painful consequences, why on earth would we try to justify not suspending the use of this mesh? It is horrendous.
On 21 March, I asked the Prime Minister about surgical mesh. She advised in her letter of 28 March that the Medicines and Healthcare Products Regulatory Agency review concludes that the benefits of vaginal mesh implants outweigh the risks. How can this be? How can it be that people who have gone in for a day’s surgery and come out thinking, “My life’s going to be better—I can rock climb, mountain bike and run with my kids,” find that they cannot move and are in constant pain? Some constituents who have contacted me are reduced to being in wheelchairs. How can we possibly say that the benefits outweigh the risks? It is horrendous.
Furthermore, according to both the NHS and the MHRA, the risk of vaginal mesh complications after an implant is stated as being between 1% and 3%. However, as other Members have mentioned, a recent study for Nature Research found that 9.8% of people suffered complications within five years of surgery. The Sling the Mesh Facebook page has over 6,000 members. The numbers do not add up: more people are suffering from the mesh complication than are credited in the statistics.
Even former surgeons such as Dr Peter Jones have declared that they would not take the risk of using mesh. A survey by Sling the Mesh found that over 60% of patients are suffering from anxiety and depression. I therefore urge the Minister not to risk more women having their lives blighted. We have heard that mesh can shrink, degrade and twist in a woman’s body—I put that to the Prime Minister in my question—and we now know that women have been left in permanent pain, unable to walk and unable to work because of the procedure.
I would argue that, due to the limited remit of the audit in the Government’s “Retrospective Review of Surgery for Vaginal Prolapse and Stress Urinary Incontinence using Tape or Mesh”, many women have been missed, which is why the stats do not stack up. Women who for years have gone back and forth to their GP for pain relief or antibiotics and have then become resistant to the antibiotics, women who have been treated in the last 12 months, and women who have not yet been referred have been overlooked. An urgent public inquiry must be undertaken into the number of women adversely affected and why the safety of so many has been disregarded.
We have heard about Kath Sansom, the founder of the Sling the Mesh UK campaign, who is in the Public Gallery. She said that she
“lost hope for the future”
when she underwent the surgery. She ran a poll of 500 women, and 83% said that they had not been fully informed of the risks. People have the right to make an informed choice and the right to receive the information and understand the implications of undertaking the procedure.
Furthermore, 70% reported having lost their sex lives and that they are still facing adverse events as late as 18 years after the procedure. These events include debilitating pain in the groin, pelvis and legs, as well as infection and inflammation. People are basically not able to conduct their usual business, such as playing with their children or going mountain biking, as I mentioned, and it is not fair. Most women in Kath’s support group added that they do not feel there is any aftercare following the implant procedure. That ties into the availability of information and the ability to make an informed choice.
Despite the recommendations from the NHS England report, less than 27% of clinicians have reported on these adverse events. Private hospitals are not audited for adverse events. Worse still, doctors who have been struck off by the General Medical Council are still able to work in these institutions. That is unacceptable.
Under the US Physician Payments Sunshine Act 2010, manufacturers must submit annual data on payment and transfers of value made to covered recipients. Several studies have been carried out by organisations with shares in mesh manufacturers. Similar legislation designed to increase the transparency of financial relationships between physicians, teaching hospitals and manufacturers of drugs, medical devices and biologics is required in this country. We need to understand what the kickback is. If someone is being asked the question, “Do you think mesh is good?” and have investments in mesh, why would they say no? We need to be more transparent and understand what these women are going through.
These sequential calamities must each be understood and corrected so that they are not repeated. Those who have suffered and faced complications must be referred via their GP to a specialist unit with multidisciplinary teams of professionals who can listen—not just hear what they are saying, but listen and understand what they are going through—advise and support them, and ensure that no more patients are harmed. I urge the Government to suspend the use of surgical mesh and tape for all procedures.
(6 years, 8 months ago)
Commons ChamberI thank the hon. Gentleman for his intervention, and I agree with him: the longer people are supported to stay at home, the longer they are not an even greater financial burden on the state. I will develop that theme later.
Such is the crisis in health and social care in our country that our NHS commissioners face difficult choices, and families are very worried that they could be facing a substantial cut in the provision offered to them as the local clinical commissioning groups seek to stretch the limited resources they have to meet an increase in demand for support. The CCG for north Tees and Hartlepool and the South Tees CCG are reorganising the way they provide residential respite care. When I met the north Tees chief executive on Friday, she told me of the need to have needs-based services and the plan to review exactly what each individual needs. I know, and so does the Minister, that we must have equity in the system and meet the needs of each individual, and I do not have a problem with that, but, sadly, the review is being interpreted by the families as a cut in provision, with some believing they could lose up to half their respite nights, which they are very anxious about.
I definitely agree that provision should be right to meet the needs of the individual, but this issue is much greater than that: it is also about the needs of the whole family, and perhaps the CCG should have conducted a needs assessment before deciding on the review. In fact, I have always thought that the respite care was very much for the family— an opportunity to take a break from their caring responsibilities, to recharge the batteries and to prepare to resume what they see as their duties.
The CCG has been at pains to stress to me that its proposals do not necessarily mean that there will be a huge reduction in the number of respite nights, but it recognises things will change for some people and is working with families and piloting different ideas to try and improve provision and reassure them. While I think the CCG could have handled this whole business better and understood more comprehensively the issues from the perspective of the families and the various local authority and joint health scrutiny groups who oppose the plans, I cannot say it is its fault.
In my constituency, a home providing respite care for very disabled and unwell children called the Manor is being closed, and I very much agree with my hon. Friend that this issue should be about the whole child, including the family, and the respite having that night provision gives to the family. In my constituency, that night provision is being entirely cancelled; does my hon. Friend agree that the impact of that must be assessed?
I certainly do agree. I opened my speech by talking specifically about this being not just a Teesside issue, but an issue across the country, and it is a tremendous challenge to Government to plan for the future; I will also be developing that later in my speech.
I know that the team members at the CCG dealing with respite and wider provision are dedicated to their jobs and that they too have been distressed as we have gone through this process, and I for one appreciate the strains of dealing with such sensitive issues. They are trying to do their best within what they say are the ring-fenced resources available, although I personally could have hoped that they would have kicked the Government for failing to provide the resources needed.
Currently, respite is provided in two NHS centres of excellence, Aysgarth and Bankfields, but what are they planning to do now? The best of the options available to carers is this perceived reduction in residential care provided by the expert and nursing staff for their family members, and then the provision of a menu of alternative choices, largely without nurses. The choices include beds in care homes, hotel rooms, adapted caravans and even in carers’ own homes. Could we really see a vulnerable adult accommodated in a caravan somewhere and looked after by people in whom their parents may struggle to have confidence? What about the risk assessments for that menu of provision? Who is going to check that all the new people caring for these vulnerable people are both trained and suitable for this role and that the premises are suitable? What respite is it for a carer if they have the respite worker under their own roof? That is not much of a break for the carer or the family member.
To be fair to the CCG, it has promised that there will always be appropriately trained staff to offer the care and support required. Sadly, however, it is yet to provide the families with the reassurance they need, and the uncertainty is torture for them. So much more needs to be done to drive understanding. We also have to ask whether changes that cause such disruption are really appropriate in 21st-century Britain when carers do not know what the future holds. Our provision should be improving, not deteriorating in practical terms nor in the eyes of the carers.
(6 years, 9 months ago)
Commons ChamberI want to start by making it clear that I recognise absolutely that there is intolerable pressure generally across the emergency care system, and there are serious issues that have to be addressed particularly around handover delays, and I include within that the sense that there is quite a variation from one hospital to another and we need to understand why it appears as though some hospitals are more successful than others in addressing this.
I also want to make it clear that it is not my intention to focus on the adequacy of funding of the NHS in this debate; that is for another occasion. The question I want to address here is whether the East of England Ambulance Service NHS Trust is doing all it can with the resources it has.
I also want to place on record my understanding that we have incredibly committed clinical staff in this trust, and I want to express my gratitude to them; they are often working under intense strain, frequently dealing with extraordinarily distressing and sensitive personal situations, and they do so admirably. I should also express my gratitude to the Minister for meeting me this morning to hear more about my concerns, and for the seriousness with which he listened to them.
My reason for calling this debate is that I met a senior employee of the trust, who is a whistleblower in effect, and who came to me with deep concerns about what is going on in his service. I found the testimony to be very credible and I took the concerns extremely seriously. I have seen a list of 40 cases of potential patient harm associated with delays in response times, including 19 cases where patients lost their lives.
Simon and Michelle came to see me about this very issue. Their 999 call was downgraded, and as an unintended consequence, they lost their baby girl, Darcey, in what appears to be one of a catalogue of failures in the interaction between the ambulance trust in the hospital.
I am grateful for that intervention, and the hon. Lady is doing exactly the right thing in pursuing that matter on behalf of her constituents. They deserve answers to the concerns that they have expressed over that tragic case.
Beyond the list of 40 cases, I understand that a further 120 incidents of potential patient harm and a potential 81 patient deaths have been associated with delays over this period of time. One case, which is not on the list of 40 that I have seen, concerns a constituent who does not want her family’s name to be mentioned. She has written to me as follows:
“My Mum had been ill from Boxing Day and finally on New Year’s Day she deteriorated to such a level that I had to call an ambulance. When I first logged the call they advised me that as she was still breathing we would have to wait an hour before a team could get to us. Mum’s health deteriorated further to a point that I had to place another call to the ambulance call centre as she had suffered a stroke and then a heart attack and had stopped breathing. My sister and I had to perform CPR whilst waiting for the crew. When they finally arrived, although they tried, they said that there was nothing they could do and she was pronounced dead.”
I should say that my constituent commends the crews that attended for the work that they did.
(7 years, 1 month ago)
Commons ChamberI thank the right hon. Lady for her intervention, but I have to say that a future Labour Government will not just talk the talk; we will walk the walk. A Labour Government will be on the side of ordinary people—those serving on Britain’s frontline. It is not right that in 2017 Britain, those at the top of our civil service can receive golden handshakes, taking home more than a quarter of a million pounds a year, while those on the frontline are stuck on the breadline.
In response to the comments from the right hon. Member for Broxtowe (Anna Soubry), does my hon. Friend agree that instead of just saying that we respect our public sector workers, we want to show them that respect? The cap has affected morale and retention. To say otherwise, when we can see that what is being done is harming people, is to be much like the people in the story of the emperor’s new clothes who said to the emperor, “You are not naked.”
I agree 100% with my hon. Friend’s argument, which was most eloquently put. While those on the frontline work so hard, they are on the breadline. Our firefighters, teaching assistants, council officers, nurses, policemen and women, prison guards and hospital porters—the list is endless—are the glue that binds our country together. The services in which they work are vital, because they allow people in every part of the country to live their lives, feel safe and have opportunity. Those workers—I have the pleasure of working alongside many of them at St George’s hospital in Tooting—do not seek recognition; they serve our country selflessly on a daily basis. They are simply seeking a decent day’s pay for a decent, hard day’s work. That is why the Labour party would scrap the NHS pay cap and give our hard-working NHS staff pay that recognises the skill and dedication that they bring to their working lives.