Adult Social Care

Debate between Gillian Keegan and Philippa Whitford

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

Thank you, Madam Deputy Speaker. As was clear from their 13 years in Government, Labour Members are not interested in finding the answer, and they are certainly not interested in listening to my version of giving the answer.

Having 40% churn and such a high degree of insecurity in the workforce is not sustainable, so we need to fix that. We need to put the knowledge and skills frameworks in place. We need to invest in training and learning. We need to ensure it is captured and transferable. We need to have career routes that mean people can progress in the workforce. In my short time in the job, that has been immediately identifiable. The hon. Member for Sheffield, Heeley (Louise Haigh) and I worked on professionalising the social care workforce about four-and-a-half years ago, when we set up the all-party parliamentary group on social care. The issue has been recognised. It is not easy to fix. It is a large private sector. There is very large and increasing demand, but we are going to take the steps to fix it and the White Paper starts that process.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The challenges in social care of increasing need and demand are the same across the four nations, but until now the approach has been very different. The Scottish Government have always believed in seeing social care as an investment in allowing everyone to participate in society and live as independent and satisfying lives as possible. I therefore welcome the change in narrative and tone in the statement.

The Feeley review, which was carried out last autumn in Scotland, plans a human rights approach to social care, and sets out a path to developing a national care service to ensure high quality standards right across Scotland for its users, and also fair terms, conditions and career development for staff. As has been said, workforce is absolutely central to all services and social care is delivered by people for people. The Scottish Government pay the real living wage—not some pretendy living wage, but the real living wage. Will the Minister commit to raising pay for social care staff in England to £10 an hour, as the Scottish Government have planned from this month?

Brexit and the loss of freedom of movement have, unfortunately, exacerbated workforce shortages in both the NHS and care systems, with a shortage of well over 100,000 in care. Will the Minister urge the Home Secretary to widen the eligibility of the health and care worker visa to actually include care workers? It is quite bizarre that it does not include care workers.

Scotland is the only nation that provides free personal care, which is now being valued by the UK Government at £86,000 a head. Will the Minister consider, in this redevelopment, providing free personal care to people in England? While the Scottish Government are planning a 25% uplift in social care funding over this Parliament, the national insurance uplift will go largely on tackling the NHS backlog over the next three years. Does she not recognise that the care crisis is right now? The problems in A&E are not caused by people coming to A&E, but by the difficulty of getting patients into beds due to delayed discharges, which are due to the lack of social care provision. Will she state, as has been called for, what funding will go to social care right now to tackle the crisis as we go into this winter?

[Gillian Keegan]

Many countries across the world are grappling with this issue. We have an ageing demographic and we now live in different ways. We live much longer with more complex needs, and often we are not close to our families as we have increasingly globalised. Many countries are looking to address those challenges, including Scotland. It is important that we build the talent pipeline here. It is important that we not only invest in and train our own people, but that we build sustainability. We cannot always rely on taking workers from many other countries. We have a visa route for senior social care workers and we have reduced salary levels—I think £20,480 is the salary level—so in Scotland that probably fits the minimum hourly rate. Of course, we have had different approaches. We had a commission on adult social care which gave results in 2011. That is what we have used to build the basis of our reforms and I know Scotland has taken a different approach.

Privatisation of NHS Services

Debate between Gillian Keegan and Philippa Whitford

Monday 23rd April 2018 Westminster Hall

[Gillian Keegan (Chichester) (Con)]

It is a pleasure to serve under your chairmanship, Sir Graham. I thank the hon. Member for Hartlepool (Mike Hill) for introducing the debate. It is important to get the facts out in the open and to ensure that erroneous arguments about the use of third-party companies in the NHS are put in context and understood. It is also important that the 1.3 million people who work in our NHS are assured that they will continue to do so and that they are not about to work for a private company.

We have all turned to the NHS for help at one time or another, and I think it is safe to say that we are all proud of our doctors, nurses and community carers. However, our healthcare system, which is regularly rated the best in the world, will have to adapt as we all demand more from its services. This change may include the use of third-party companies—they are already used to build our hospitals and sometimes to transport patients, or in key services such as dentistry and GP practices—all of which are private.

The NHS faces significant challenges. In tackling them, we must adopt a collaborative approach among all sectors to ensure that patient outcomes remain the driving force and that the health service remains a patient-first system. My right hon. Friend the Health Secretary recognises that better integration of health, social care and community care services is a big part of improving our health system. If we achieve more integration, we will improve services, save money and reduce some of the fragmentation that was referred to, which is a function not of who runs the service but of how the system is designed.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Does the hon. Lady not recognise that if parts of the service are in competition with one another for their financial survival, it is very difficult to integrate them and that that causes fragmentation?

[Gillian Keegan]

I recognise that as a challenge. It is not just competition but organisational ownership—organisations sometimes want to control things themselves. We certainly saw that in West Sussex when we tried to put together two public sector pieces under an accountable care organisation. At the moment, we are going to have to find a different model to do that. That is not to do with finances or competition, although that can occur; it is to do with the will of the leadership to work in a more collaborative way. I accept that we face many challenges in the future that we must go towards.

Integration has a worthwhile prize: improved services that are delivered more effectively. When I served as a governor at my local hospital, St Richard’s, I saw at first hand acute beds being occupied by patients who, in medical terms, were perfectly fit for discharge but who still needed care. There were not sufficient community care services for patients to be discharged to. That situation would be exacerbated if private community bed options were removed as a result of petitions such as the one we are debating.

It has been the ambition of all major political parties to implement a modern health model that is fit for purpose and fully integrates community and acute care, but I think we can all agree that, despite our best intentions, that is easier said than done, for some of the reasons we have discussed. It is like someone trying to change the tyres on a car while they are driving—it is difficult because the system is operating.

In my constituency, we have capitalised on the support offered by this Government, such as the public health grant and the better care fund. West Sussex County Council is working on preventive action. Chichester is home to one of seven wellbeing hubs across the county. That hub, which is run by the district council, supports people one to one to reduce their risk of developing diseases such as heart disease, cancer and type 2 diabetes through sustained lifestyle changes. It helps people to lose weight, to be more active and to develop techniques to reduce their risk of falling, to name but a few things. Those services are provided in conjunction with local community and voluntary organisations, and with third-party companies, which provide a wealth of different expertise.

More than one quarter of my constituents are over 65, so adequate social care integration is vital. West Sussex County Council, in partnership with Coastal West Sussex CCG, has connected local authorities, GPs, voluntary and community sector partners, third-party companies, primary care services and our community foundation trust to form two local community networks. That list spells out some of the complexity there is even today, with many services delivered through the public sector. Those networks divide the more populated south, where there is a city, and the more rural areas in the north, recognising that needs are different in each locality. A social prescribing project has been formed as part of that work: a team of community referrers will be co-located in GP practices across the district to find community-based solutions to non-clinical issues.

The charitable sector is heavily involved in the delivery of many of our healthcare services. I recently visited the Sussex Snowdrop Trust, which works with children who have life-threatening illnesses and is funded in part by the NHS and in part by charitable donations. Its nurses give specialised care at home and teach parents how to care for their seriously ill children. The impact of its work is clear, and we should not underestimate the importance of working with such specialist community partners. The corporate structure of those partners is less relevant than the importance of the work they do. The Government have set out not only to better integrate the entire healthcare system but to allow local commissioners to dictate health provision to suit their populations. In cases such as the Sussex Snowdrop Trust, which provides specialist local services to a very small and specific portion of the population, the outsourcing funding model is effective and provides an invaluable service to families.

I fully support the work that is being done by local authorities in Chichester. They have already put plans in place to tailor services to different parts of the population—rural and urban—with different needs, and to focus on prevention and adult social care, in line with the Government’s five year forward view. Those changes are long overdue and will take time to bear fruit, but they are key to achieving a truly integrated health service. Being overly prescriptive about who can be involved in delivering services would limit options as we move towards integrating health and social care, using technology more widely and placing a bigger emphasis on preventive treatment, much of which will be new. It is important that the right level of patient care is delivered quickly and efficiently, and that it is free to all citizens who need to rely on our wonderful health service.