Cancer Treatment and Prevention
Grahame Morris Excerpts(11 years, 4 months ago)
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Grahame M. Morris (Easington) (Lab)
It is a pleasure to serve under your chairmanship, Mr Gray. I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) and apologise for the discourtesy of my being late for the start of the debate.
It is an important subject and I am grateful for a few moments to raise with the Minister an anomaly that affects sufferers of brain cancer and to highlight the dislocation caused by the reorganisation of the commissioning of cancer services. The hon. Member for Basildon and Billericay (Mr Baron) highlighted the tension between organisation and outcomes. That is relevant to the issue I am raising, because of the hiatus that resulted from the reorganisation of the commissioning of cancer services, which came out of the Health and Social Care Act 2012; and it follows the theme of the importance of early diagnosis and treatment set out by the hon. Members for Strangford (Jim Shannon) and for Lancaster and Fleetwood (Eric Ollerenshaw).
University college London’s national hospital for neurology and neurosurgery, in Queen square, is the UK’s largest dedicated neurosurgical hospital. It is not only a UK centre of excellence, but a centre of excellence within Europe. For more than 150 years it has provided treatment and care for conditions including cancer affecting the brain. It is globally recognised. In October 2012, the hospital enhanced its services to cancer patients by the acquisition of one of the new advanced radiotherapy systems that we know as the Gamma Knife radiosurgery machine. I have been to see one of them at St Bartholomew’s hospital, and if the Minister—or any other hon. Member—has not seen one, I recommend making such a visit. It is an incredible piece of kit.
Before April 2013, when the new NHS England took over responsibility for commissioning radiosurgery, the national hospital was using its Gamma Knife to treat NHS patients with brain cancer. On 1 April, however, NHS England informed the hospital that it could no longer treat NHS patients with its Gamma Knife and that all patients waiting for treatment should be transferred to other hospitals. The other hospitals that were identified were run by private health care companies—BUPA and the Hospital Corporation of America. Not surprisingly, the patients concerned—about 60 in total—refused to transfer to other centres, because they would have to engage with new conditions and go through pre-operative checks and scrutiny, and rejoin the waiting list.
That situation makes a mockery of the Health and Social Care Act 2012. When the Government pressed the Act through Parliament, they relied principally on the argument that it would return control of patient care to clinicians and reinforce and enshrine patient choice in the NHS. NHS England has poured scorn on that idea and is exercising control over where patients can be treated. There is no choice for patients and certainly no choice for brain cancer patients who need immediate treatment.
Fortunately for the patients I have mentioned, there is good news. The national hospital is not as callous and cold hearted as NHS England, and it decided to treat them anyway. Some 60 patients have been treated since April. However, that has not dealt with the basic problem. They were treated there because it was their choice, and their clinicians’ choice, and despite NHS England’s refusal to pay for them. I should be interested in the Minister’s response. Will she give me a guarantee in good faith that she will look into that appalling situation as a matter of urgency?
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
It is a pleasure to serve under your chairmanship, Mr Gray. We have certainly had a wide-ranging debate. I think I would need another hour and a half to respond to all the points made, but I hope that hon. Members present know me well enough to realise that if I am not able to respond to their points in detail, I will get back to them after the debate. The shadow Minister and I have many opportunities to debate the wider public health issues, so I will devote most of my response to specific points, particularly those made by my hon. Friend the Member for Mid Derbyshire (Pauline Latham), who called for the debate. I will, however, try to touch on all points made in some way.
I congratulate my hon. Friend the Member for Mid Derbyshire on securing the debate. She always speaks movingly on this subject, not least as a result of her personal experience. She has been a tireless campaigner on behalf of her constituents and others, in particular with regard to melanoma. Before I respond to her specific points, I would like to restate the Government’s ambitions, as those apply across the debate. All Members have referred to this, but improving cancer outcomes is a major priority.
We aim to save an additional 5,000 lives a year by 2014-15 and halve the gap between cancer survival rates in England and the best in Europe. As my hon. Friend the Member for Basildon and Billericay (Mr Baron), who is the chair of the all-party group, said, we are not as good as we could be, so there is great effort and commitment to make us better. Our debate has been on how we do that, not why that is the right ambition. To achieve that, more than £750 million has been committed to deliver our cancer outcomes strategy, which includes £450 million to support earlier diagnosis of cancer by improving public awareness and GP access to key diagnostic tests.
Early diagnosis came up many times during the debate. It is worth making the point that most GPs will see relatively few cancers in a typical year. Because we all know someone affected, whether in our family or our group of friends, we imagine that GPs see cancer all the time, but they do not; certainly, they do not see many of the rare ones. The challenge of early diagnostic testing and training to get those tools into GPs’ hands is serious, because that is also a challenge for GPs, of whom we ask a great deal. That is why it is important that the Government are putting money and effort into those early diagnostic tests. That money also goes towards paying for extra testing and treatment in secondary care.
I want to touch on the architecture of the system. It has been mentioned a few times and hon. Members have expressed concerns about the changes to the system. The first general comment I would make is that the main thrust of the debate is that we can do a lot better on cancer, which would seem to lead to the conclusion that the old system was not necessarily delivering the outcomes we wanted. Although caution is understandable when major change has happened, Members are perhaps being unnecessarily gloomy about the changes that can be delivered under the new architecture for the NHS and the health system. Many of the criticisms that have been made this morning were made under the old structures as well.
Cancer is a priority for NHS England. Clinical expertise is at the heart of commissioning decisions and NHS England has established a range of clinical reference groups, and is leading on delivering clinical strategy. NHS Improving Quality is working with the strategic clinical networks and has played a key role in working with the NHS on early diagnosis, especially on awareness campaigns. NHS England has also created national service specifications for a wide range of cancers to ensure consistent, high-quality service across England.
Grahame M. Morris
I know that the Minister is trying systematically to get through all the points that were raised, but I challenge the point that there is no fundamental difference under the new arrangements. There really is a fundamental difference in the commissioning of specialist cancer services. Those were previously commissioned on a local basis, effectively, by primary care trusts coming together in London, but now it is done by NHS England. That has caused a huge hiatus for the patient cohort I identified. Will she agree to look at that and, if necessary, meet me and a group of clinicians to highlight the nature of the problem?
Jane Ellison
The point I was making was not that there has not been change—of course there has—but that it is far too early for hon. Members to be drawing the conclusions they have about the new system. The Government have put a great strategic priority on cancer and NHS England has been charged with delivering against a mandate and against that strategic priority. I take the hon. Gentleman’s point, but NHS England leads on this subject and is quite clear about the priority that the Government and Parliament put on it. I want to make that point. I understand why people have expressed concern.
Jane Ellison
No, I am going to press on, because I will have no chance of getting through all the specific points that were raised if I get into a debate with the hon. Gentleman.
I turn now to skin cancer. I should mention that NHS England has recently published a service specification—I mentioned that it has those across a number of cancers—on adult skin cancer services. That sets out what the NHS must have in place to offer high-quality skin cancer treatment, care and support. I am happy to send that to my hon. Friend the Member for Mid Derbyshire if it would be useful.
My hon. Friend and other hon. Members expressed great interest in what we are doing to ensure earlier diagnosis. It goes without saying that identifying cancers early has a huge benefit in terms of improving outcomes for individuals and for the whole health system. That is why we have committed over £450 million to improve diagnostic services. Later, I will consider in more detail prevention in the context of public health, but it is worth making the point that although diagnosis and treatment are vital, prevention is the biggest prize of all, because we can stop people even having to get to the point of being diagnosed. The more work on awareness and prevention that hon. Members and local councils—particularly given their new public health leadership role—can do, the more we will save the costs in money and in human misery.
Access to early diagnosis is most effective when people visit their GP early. That is why we are running a local Be Clear on Cancer campaign specifically on melanoma in the south-west in April and May, to raise awareness before the summer. We will evaluate the programme as part of our wider programme of Be Clear on Cancer campaigns, which, as the shadow Minister said, has done so much good work in so many areas.
We are also working with GPs to ensure they have the information they need. Cancer Research UK and the British Association of Dermatologists have developed a GP skin cancer toolkit. Evaluation shows that it has reached almost 10,000 GPs and helped to increase confidence in referring suspicious lesions.
My hon. Friend the Member for Mid Derbyshire spoke quite a bit about the NICE approval process, which was also mentioned by my hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw). I know that my hon. Friend the Member for Mid Derbyshire is concerned about access to NICE’s approval of drugs for late-stage melanoma. As she knows, our priority has to be to get the best possible results for all NHS patients with the resources we have. NICE’s methodology is the best guide we have to the clinical value and cost effectiveness of different treatments.
We have asked NICE to look at the way drugs are assessed so that patients can get the treatments they need at the best value for the NHS, and the price the NHS pays is more closely linked to the value a medicine brings. NICE will carry out a full public consultation before implementing any changes to its methodology. I understand that NICE plans to launch its consultation later this month, and I urge all Members to contribute. I am sure they will, as many Members present take a significant leadership role in Parliament on cancer.
I turn now to the particular concerns my hon. Friend the Member for Mid Derbyshire raised about yervoy or ipilimumab. Although NICE has recommended yervoy as an option for treating advanced melanoma in people who have received prior therapy, I understand her concern that it should be approved as a first-line treatment. I have been advised that NICE is currently considering yervoy as a treatment for previously untreated stage three or stage four malignant melanoma. Although it is not appropriate for me to intervene in an appraisal, I have been advised that NICE’s initial draft guidance, issued on 25 February, recommends yervoy only in the context of clinical trials, as I outlined to my hon. Friend at Health questions recently.
That is not a refusal, however. Instead, it reflects NICE’s view that the technology is promising but there is insufficient clinical evidence for the appraisal committee to recommend its use as a first-line treatment at this stage. However, I hope I can reassure my hon. Friend that the manufacturer is currently conducting a further trial, which, along with other research, is due to complete in 2016. Once that research is available, I am sure NICE will wish to reconsider its guidance. NICE is currently running a consultation on its interim guidance. Again, I would also recommend that hon. Members, and particularly my hon. Friend the Member for Mid Derbyshire, make their views known to NICE. I always make a point of referring Parliament’s views, as expressed through debates such as this, to the relevant people making the decisions. I did so the morning after the debate on pancreatic cancer last week, when I sent a personal letter with a copy of Hansard to the decision makers concerned to make them aware of Parliament’s views. I always undertake to do that where relevant.
In the interim, I understand that NHS England’s national Cancer Drugs Fund panel has considered including yervoy for first-line treatment of advanced melanoma. The panel has decided to refer yervoy to NHS England’s chemotherapy clinical reference group for consideration for inclusion under baseline commissioning. If that is agreed, clinicians would be able to prescribe the drug for use in first-line advanced melanoma according to the commissioning policy that would be developed by NHS England. NHS England will make its decision known in due course.
I also want to reassure my hon. Friend the Member for Mid Derbyshire that NICE is currently developing a clinical guideline on melanoma. It expects to issue final guidance in July 2015. I hope that gives her some sense that a lot is going on this area. We will endeavour to make sure that we keep her updated.
I will have to canter through some of the other points, Mr Gray, but as so many were raised I hope you will be generous and give me a little time to do so. I turn first to the points made about the Cancer Drugs Fund and the concern that no new medicines are being accepted, which my hon. Friend the Member for Lancaster and Fleetwood raised. Just for the record, so far in 2014 the panel has added a number of drugs to the national list—I will probably stumble over pronouncing some of them, but I hope the House will forgive me. They include kadcyla for breast cancer, tafinlar for melanoma and radium-223 dichloride for prostate cancer.
I turn now to the topic of CCG accountability, which I have often discussed with my hon. Friend the Member for Basildon and Billericay, who chairs the all-party group on cancer with such vigour and passion. I entirely share his view that it is a critical point. He has articulated all the wins over the years in making sure that early outcome indicators are part of the CCG outcomes indicator set, and the importance that early outcome indicators have for early diagnosis and more information about survival rates, which we all want to see. It is important to remember that NHS England can intervene where a CCG is found to be failing in its duty to secure high-quality outcomes, although I accept that that is a high-level intervention. I think my hon. Friend is driving at what we will do with the information when we get it. NHS England is considering how it can better respond to the functions in the outcome indicator set and how all permissions and system structures work together to improve outcomes.
This is the first time we have had this indicator set and I know that my hon. Friend has talked to the national clinical director for cancer, Sean Duffy, about this, which is the right thing to do. I will also meet him to talk about it. It is helpful that Parliament returns to the issue regularly because it helps me to emphasise to NHS England how much store hon. Members set by local outcomes and how important it is for us to have a response throughout NHS England to indicators and outcomes that are not as good as they could be. I accept his challenge, which he knows that I am working on. I am having ongoing conversations about it, but it is always good that Parliament returns to the point and challenges the levers of change.
We have introduced GP inspection, and more and more data will be available to the inspectorate to ensure that it is asking questions not just about what GPs do, but about what they do not do and when we expect them to do more. There are all sorts of ways to challenge the system, and it is ongoing work.
I cannot respond to all the points made by the shadow Minister, but I will touch briefly on one. She referred to a report that highlighted the use of out-of-date equipment. To encourage NHS providers to update existing medical technology infrastructure, the Department established a £300 million fund in March 2012, which is operated by NHS Supply Chain to bulk purchase medical equipment to achieve better prices. In August 2013, NHS Supply Chain announced the signing of a deal with Varian Medical Systems to secure 20 new linear accelerators. More detail is available about that innovation fund and the radiotherapy innovation fund, but I do not have time to go into it now.
As ever, the hon. Member for Strangford (Jim Shannon) is present. He often attends debates and makes forceful points about the need for us to work together. The National Institute for Health Research is funded by my Department, so it is focused primarily on England, but I assure him, as I have tried to previously, that the published research is available to anyone. NICE guidance applies formally only to England, but it is available online to all who want to use it. It makes sense for all the Administrations to share that information and expertise, and to ensure that they make use of it when framing their own response.
We have previously discussed human papilloma virus in more detail in this Chamber and during an Adjournment debate on 13 January. My hon. Friend the Member for Mole Valley (Sir Paul Beresford) made many good points about the wider take-up of vaccination to reduce the incidence in females of that and other cancers, and in males. The HPV vaccine was introduced to tackle cervical cancer, which is why the strategy started with girls. He makes a good point about the potential benefits, which are well recognised, of extending that to protection against other cancers, particularly oral cancers.
Since 2008, more than 6 million doses of vaccine have been given in the UK with 87% of the routine cohort of girls completing the three-dose course in the 2011-12 academic year. I was concerned to hear the figure my hon. Friend mentioned from his own area. Hon. Members rightly come here to challenge Ministers about what we are doing, but when there is local information, I urge them also to challenge their local systems and to ask what it being done to bring them up to the national rate. We know that there are challenges about some of hard-to-reach groups, but I am surprised to hear the statistic my hon. Friend mentioned. I urge all hon. Members to recognise that we cannot drive the change solely from Whitehall, and that it is good if they also ask questions about accountability locally.
My hon. Friend referred to the fact that work is continuing through the Joint Committee on Vaccination and Immunisation to look at the matter in more detail. He said that the JCVI is also looking at adolescent boys and men who have sex with men, and highlighted the problem that they do not benefit from herd immunity as HPV vaccination is more widespread among girls. The JCVI is considering whether it is cost-effective to extend the programme to both those groups. The issue is complicated, especially concerning adolescent boys. The evidence base, mathematical modelling and deliberations will take time, but the work is ongoing and it helpful that the House continually expresses its interest.
I recognise that I have not responded specifically to some of the points made by my hon. Friend the Member for Lancaster and Fleetwood about pancreatic cancer, but I responded in the House only last week. I hope he will accept that it is not discourteous to say that my response has not changed substantially since then, but I took the actions I promised last week. He has put on the record his concern about the need to value the additional months of life in a disease that sadly takes people so quickly. Early diagnosis and GP training in that is critical in pancreatic cancer, which is so hard to diagnose. That is well recognised, and I thank my hon. Friend for making his point.
In the remaining few minutes, I cannot respond to all the public health issues raised, but smoking is a factor in so many of the cancers that have been discussed, as the shadow Minister said. Smoking in this country is at an historic low, and has dipped to below 20% of the population for the first time. There is a significant legislative programme and the shadow Minister said she hopes we will keep up the momentum. I assure her that I have no option given the programme that we must deliver in the coming year. I look forward to her co-operation. I also look forward to support from hon. Members in the Chamber when we introduce those measures in the House.
It is always good to remind people why leadership on smoking cessation and legislation is so important. It plays a role in prevention, which is important in many areas that hon. Members have highlighted this morning. There is a big role for leadership at local council level because the figures on smoking cessation are extremely patchy throughout the country. We must drive change at local level.
The hon. Member for Easington (Grahame M. Morris) referred to Gamma Knife, and I will respond to him in more detail after the debate if that is acceptable to him. I am sure he did not mean to say that NHS England is callous and cold. Clinicians must make difficult decisions every day on behalf of all of us in balancing competing health priorities. He used those words, but I know he did not mean them in connection with the people who must make the difficult decisions. Many of our clinicians and health leaders must perform difficult balancing acts. Just the challenges made to me as the Minister in this debate this morning would have an enormous cost. We must make difficult decisions all the time about where we can best spend resources to bring the best results for the population. I know that that is at the heart of hon. Members’ concerns.
I thank hon. Members who are present. Many are long-standing champions of particular issues in Parliament and I urge them to continue their awareness-raising work. NHS England will continue to respond to that, as will Ministers. I thank hon. Members for attending the debate this morning.
Care Bill [Lords]
Grahame Morris Excerpts(11 years, 4 months ago)
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Paul Burstow
My hon. Friend is absolutely right. That is the basis of the average fair rate, which I mentioned. New clause 15 would provide a mechanism for establishing a formula by which fee rates are set transparently for both domiciliary and residential care. The organisations representing the sector believe that that would lead to much greater transparency, and I think that it would deal with some of the rather toxic relationships that sometimes appear to exist, both nationally and locally.
New clause 2 is about older people, particularly the proposition that we should take a leaf out of the book of our colleagues in Wales and Northern Ireland in relation to having a commissioner for older people. Ageism and ageist attitudes are endemic in our society and, indeed, in public services. Our society is ageing, with life spans increasing, and that profound change will affect us all. It has implications for how the NHS and care services behave, but it goes far wider.
My new clause simply calls on the Government to work on the mechanics of establishing such a post so that there is someone to listen to and give a voice to older people; to champion their vital contribution to our economy—in work, as care givers and as volunteers, mentors and community leaders—rather than their being seen as burdens, which is how older people are all too often portrayed; to challenge the complacent and lazy stereotypes; and to hold public services to account.
Such a role already exists in Northern Ireland, Wales and other parts of the world. It would involve asking such questions as: why do the 360,000 cases of abuse suffered by older people every year lead to so few prosecutions, why are older people excluded from clinical trials and other research, and why do we stop reporting people’s cancer survival rates once they pass the age of 75? I hope that the Minister is open to the idea, and I look forward to his response.
New clause 26 deals with the issue of mental health, which came up very briefly in Committee. I know that the Minister is a passionate champion of mental health concerns. The new clause simply says that if a person has an accident—for example, breaks their arm—suffers a stroke or has a heart attack, the last place they would expect it to be sorted out is a cell in a police station, but that that is exactly where people who have a mental health crisis find themselves. The statistics are stunning: 36% of all people who are taken to a place of safety find themselves in a police station and stay there for more than 10 hours. Not only have adults been subject to that process, but 263 children, on the most recent figures. My new clause simply seeks to place a sunset provision on the definition of a place of safety, including a police station, which should create a way of concentrating minds to ensure that services are provided in the right place at the right time for children and adults.
I come to new clauses 7 and 9 last because they are about addressing what we might regard as the elephant in the room in any conversation about care services and the Bill’s noble intentions of improving the quality of care and of driving well-being into the heart of how care and support are delivered. The new clauses raise interconnected questions about the future funding of care and support, and about the independent nature of our health and care systems. Social care has for far too long—for decades—been the poor relation to health in decisions about public expenditure. Today’s funding challenges are chronic and are not simply the result of deficit reduction.
New clause 9 reflects the concern of a remarkable coalition of interests outside this place, including the Local Government Association, the Care and Support Alliance, hundreds of non-governmental organisations, directors of social services and chief executives, and many more besides. They all want to serve notice on the Government that they are concerned about the serious impact that the continuing pressure on local government spending will have on the ability of councils to deliver the care and support that everybody in this House wants to be delivered under the Bill. The picture is complex. Different councils are coping differently—some are overspending their care budgets and some are underspending them—but the trend is clear, despite the extra £7.2 billion that was allocated in the 2010 spending review and the transfer of money as part of the better care fund in the most recent spending review.
New clause 9 simply provides for an assessment to be made and signed off by the programme board that oversees the implementation of the Bill. It is not an unreasonable request that we check that the sums add up and that the money is sufficient to deliver what the Bill is about. I hope that the Minister will reassure us about how transparent that process will be. Impact assessments are one thing; this process would be another. I think that it would provide considerable reassurance to those who will have the job of implementing the legislation.
Grahame M. Morris (Easington) (Lab)
I apologise for breaking the right hon. Gentleman’s flow. I agree with virtually everything that he has said. On the need to ensure that the Bill does everything that it says on the tin, may I draw attention to the fact that when I met my constituent, Jason Roche, who is very active in the Royal National Institute of Blind People, he pointed out that 43% of blind and partially sighted people in England have lost access to adult social care services since 2005. Does the right hon. Gentleman agree that the Bill must address the needs of working-age adults who suffer from disabilities?
Paul Burstow
I am grateful to the hon. Gentleman for that intervention. He makes an important point. If one looks at the trends, one sees that there is no doubt that there are questions to be asked about why some people are not receiving the service that one would expect. Some of that—although I do not pretend that this covers anywhere near all of it—can be explained by the changes to the way in which services are organised. Some of it can be explained by the need to do more to re-able people and to enable them to maintain their independence. I do not say that to evade the question. That is why I have put new clauses 7 and 9 before the House. I genuinely think that whoever is in government in future will have to have a much more systematic approach to making decisions about how we meet demand.
That brings me on to new clause 7, which simply says that the Government should take a longer-term view. It states that every five years, the Government should look 20 years forward and take an independent assessment of the future demand for care and health services. That could be done by the Office for Budget Responsibility. It could provide modelling for the whole health and social care system that looks at the impact on demand, technology, demography and health status, and at the balance between all those factors. It could also look at the interactions between health and care, primary and secondary care, physical and mental health, and treatment and prevention. That would finally implement a recommendation that was made by Derek Wanless in his review for the Government in 2000. That is supported by the King’s Fund, which has suggested much the same thing.
In Committee, neither the Government nor the Opposition were able to make any funding commitments about part 1 of the Bill. I entirely understand why that is the case. However, we know that as the eligibility criteria are drawn more tightly, more people are excluded from help. In the long run, that does not save money, but shunts the costs. It pushes people away from living an independent life and towards a life of dependency. I hope that all parties will, in the end, sign up to something like new clause 7 as a good part of the future sound governance of our health and social care system. I hope that the Minister will support that.
I apologise to the House for speaking at such length, but I have put forward a number of issues that I hope will provide a framework for debating this important set of reforms. I look forward to the Minister’s response.
Grahame M. Morris
I echo the sentiments of other hon. Members about the lack of time we have been allocated. I appreciate that it is not your fault, Madam Deputy Speaker, but we have so much to get through and the shortage of time means that although I would like to speak in support of a raft of amendments and new clauses, I will limit my remarks to a discussion of new clause 9.
I am supportive of the Care Bill—changes that make care simpler and fairer are to be welcomed—but there are real concerns about the sustainability of the changes this Bill seeks to make. I do not doubt the integrity and good will of the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), but with all the good will in the world the proposals in the Bill can be implemented successfully only if they are properly funded.
Other hon. Members have raised concerns about the funding implications, and the original Dilnot report, one of the foundation stones of the Bill, made it clear that insufficient funding would hamper the effectiveness of any attempts to implement reforms, including the ones in this Bill, and that long-term social care funding will work only if the current crisis in social care is addressed first. So we must not forget that the success of the Bill will be jeopardised by laying reforms over a system that is underfunded. I do not have time to go into the figures, save to say that adult social care budgets alone have been reduced by £2.7 billion over the past three years—that amounts to 20% of average council budgets.
The impact of such cuts is compounded by rising demand resulting from demographic changes. It has been estimated that to meet the demographic pressures the nation needs to spend another £400 million a year. So local government has real concern that the implementation costs and ongoing running costs of the reforms being implemented through this excellent Bill have not been fully costed and will not be funded, other than as new burdens.
It is unacceptable—and it will damage public confidence and trust—to pretend that new standards will be able to be met if the resources are not in place to deliver them. That is why it is so important that an additional reporting mechanism is in place, such as new clause 9 would establish, to provide assurance that the social care system and reforms in the Bill are adequately funded. If the Government really intend the Bill to be their flagship piece of legislation on social care, we need to know that the numbers add up. Despite councils’ best efforts to protect front-line services, the reality of cuts on this scale has meant that adult social care has not been immune to their impact.
A number of hon. Members have indicated the scale of the impact in their own areas, but the eligibility criteria level for social care has risen dramatically across a range of authorities. It is unclear how the new eligibility threshold will work in practice, both in terms of the effectiveness of care that older and disabled people will receive and the impact that the threshold will have on local government finances. But it is a concern that an eligibility threshold set at “substantial” will, as the hon. Member for Totnes (Dr Wollaston) has said, fail to create a preventive care system—that is what we all want, along with well-being.
A failure to create a preventive care system could result in a false economy in the long term—my hon. Friend the Member for Leicester West (Liz Kendall) mentioned the figures from the Deloitte study. By not delivering the £1.2 billion of investment needed to lower the national eligibility threshold, central Government could be missing out on savings as great as £700 million. The well-being principle of the Bill will fail to become a reality as many old and disabled people will be ineligible to have their needs met, so it is important that the effectiveness and sustainability of the eligibility threshold is reviewed and changed when appropriate.
We have a unique opportunity to improve care, which is why I am in favour of establishing the joint care and support reform programme board set out in our new clause 9, which provides for a report on performance and implementation. A failure to do so could render the well-intentioned reforms in the Care Bill meaningless.
Bill Esterson (Sefton Central) (Lab)
Social services are under huge funding pressure, which has a knock-on effect on the NHS. New clause 9 highlights the crucial issue of funding and will contribute to addressing it. Just 10 days ago, I experienced at first hand those pressures on the NHS. I would have added my name to this new clause, but I was unable to be here because I spent three days in Southport and Formby district general hospital. I saw the pressures in the accident and emergency department resulting from beds not being available for the transfer of patients to the wards; the pressures arising from chronic staff shortages; the difficulty in helping patients to return home because of a lack of support in the community; and general practitioners sending older people to A and E with complex needs as there was a lack of other choice or care available. In large part, the cuts in social services funding meant that I saw all those things. Meanwhile, staff in the NHS are working incredibly hard, often doing double shifts to look after patients, for which I am extremely grateful, as are many others. I take this opportunity to thank them and everybody in the ambulance service for what they did for me and have done for many other people.
The evidence I collected during those three days shows just why we need to be confident that funding is in place. Unless the funding is adequate, both in social care and in the NHS, the challenges faced day by day, hour by hour in our NHS will grow worse. We need greater integration, provided through the all-party approach advocated by Sir John Oldham in the report by his Independent Commission on Whole Person Care. As the report says, practice needs to move on so that we can see more care provided at home, with professionals working closer together in the interests of the individual. The whole-person care approach would reduce the number of hospital admissions; it would keep more people at home for longer, reducing hospital admissions and avoiding the huge pressures that I witnessed. In the context of the Bill, we need to be confident that the funding is sufficient to deliver the new responsibilities, which is why we tabled new clause 9. I hope that Members will support it this evening.
New clause 19 calls for health bodies to promote the health and well-being of carers. As the independent commissions report states:
“Most care is delivered by people themselves and their families.”
That makes the health of carers vital. My dad cares for my mum, and his health is a major concern. Carers up and down the country face declining health as they care for loved ones. Caring for the people who care is also a vital aspect of care provision, and paid staff in the health and social care sectors are also carers. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) talked about priority treatment going to volunteer carers—family members, friends and other volunteers. We should also consider that approach for everyone who works in the NHS or in social care. If we read the new clause in its widest sense, we should consider paid carers too, be they in the NHS or in social care.
Some 1.3 million people work in the NHS, and 1.5 million in social care. We should promote the health of NHS and social care staff as well as that of unpaid carers who do a fantastic job up and down the country. I hope that new clauses 9 and 19 receive the support of the House.
Nick Smith
I assure my right hon. Friend that the new clause refers to all adults, so takes on board the people he mentions.
Subsection (4) of the new clause seeks to strengthen protection. It would ensure that, if abuse were found to have an element of corporate responsibility, and if systems or the approaches taken by the care provider are a contributory factor in the abuse or neglect, the new offence would allow the prosecution of a registered care provider. The Government have the opportunity to shape the culture of the care sector in the Bill tonight.
Grahame M. Morris
In Committee, the Minister said that he supported the sentiment of the proposal. Does my hon. Friend accept that, although the new fit and proper person test and the new fundamental standards are important, they do not make provision for a custodial sentence for proprietors, managers and directors of such establishments in such cases?
Nick Smith
My hon. Friend has got to the nub of the issue. Managers and directors of organisations such as care homes have to accept that they set the culture of those places, and that they are responsible for looking after the residents in their care, and for avoiding neglect and abuse. If they get it wrong, they should face the possibility of a jail sentence. That is what the new clause would do.
We must go that extra mile to ensure that our safeguards deliver for care home residents. New clause 27 would greatly help that cause. I intend to divide the House on the measure.
Mr Dorrell
I agree with the thought that my right hon. Friend identifies. I have been choosing my words with care—I hope—in inviting the Minister to chart a course towards a more joined-up concept of commissioning. Almost as I offer my critique of the commissioning structures, I can feel officials in the Box writing the next version of the legislation that will have another go at providing the perfect solution to deliver something that is better than we have ever dreamt up before. I emphasise that what I am looking for from the Minister is a route map or journey—a process, not an event—and preferably one that builds on existing institutions rather than committing what I regard as the mistake of starting again with a clean sheet of paper.
Grahame M. Morris
The idea that the right hon. Gentleman propagates, which he has long held—that fragmentation is a bad thing and integration and joined-up services are a good thing—is one that I subscribe to, but does he share my concerns at reports that the commissioning functions through the clinical commissioning groups are to be privatised? Is that likely to make for more joined-up services or greater fragmentation?
Mr Dorrell
The hon. Gentleman knows that I do not entirely share his concern about who holds the share certificate for a particular service. I am more concerned about the accountability of a public authority for the use of public money to deliver a public service. On that, the hon. Gentleman and I are probably as one. I am also concerned that the system, from the perspective of the patient and service user, does not rely on them finding their way under their own steam through an impenetrable morass, but is designed with their needs and instincts in mind. That is a test that our current system simply does not pass and has not passed for many years.
Dr Poulter
I have not said anything controversial yet, so if the hon. Gentleman will let me make some progress, I will happily give way later.
To realise the huge potential of health care data, patients and professionals must have absolute trust in the way that the data will be protected and used, together with an understanding of why collecting the data on such a scale is important. I absolutely understand that many people have concerns about how the process might work, but I am confident that the Government amendments will bring further reassurance to the House about the care.data programme.
The Government fully support NHS England’s decision to delay the start of the care.data programme so that more work can be done to build understanding and confidence. NHS England will be leading that work. In parallel, having listened to key stakeholders and to discussions in this place, the Government have brought forward a package of measures, including amendments to the Bill, to respond to concerns and to give the public greater clarity and reassurance that their data are safe.
The Health and Social Care Act 2012, which established the Health and Social Care Information Centre, introduced a raft of safeguards to balance the huge benefits that linking health and care data can bring. That offered people greater protection than was previously available. It is worth highlighting some sections of the 2012 Act as examples of that.
Under section 260, the Health and Social Care Information Centre must not publish the information that it obtains in a form that would enable an individual, other than a provider of care, to be identified. Similarly, under section 261, the HSCIC cannot disseminate share data that could be used to identify an individual, other than a provider of care, except when there is another legal basis for doing so, which could happen in the event of a civil emergency or public health emergency, such as a flu pandemic. Under section 263, the HSCIC must publish a code of practice that makes it clear how it and others should handle confidential data. Under section 264, the HSCIC must be open and transparent about the data it obtains by publishing a register with descriptions of the information. Indeed, the HSCIC is currently working to ensure that it is transparent about all the data it has released to others.
Moreover, the Government have made the commitment that if someone has concerns about data being used in this way, they can ask their general practice to note their objection and opt out of the system. Following that, no identifiable data about them will flow from their GP record to the HSCIC. Directions to the HSCIC under section 254 of the 2012 Act—separate from the amendments that the House is considering—will ensure that that commitment to patients has legal force.
We are going further than that. Having listened to key stakeholders and to discussions in Parliament, we have a further package of measures that, in parallel with NHS England’s further engagement activity, will respond to the concerns that we have heard and give the public additional reassurance that their data are safe. Of course, aggregated and anonymised data, which cannot be used to identify any individual person, should and will be made generally available. Indeed, a great deal of research relies on data of this type, where researchers do not need to see any data at the individual person level. Such aggregated and anonymous data are available now, and were available previously through the predecessor body to the HSCIC.
New clause 34 sets out a number of changes to the 2012 Act which, taken together, clarify when the HSCIC can and cannot release data. The new clause expressly prevents the HSCIC from using its general dissemination power where there is not a clear health care, adult social care or health promotion purpose—for example, for commercial insurance purposes. I am happy to confirm that the new clause enables anonymised information to be disseminated under the HSCIC’s general dissemination power for a wide range of health and care-related purposes, including for commissioning for a wide range of public health purposes and for research relating to health and care services such as the epidemiological research that is needed at the earliest stages of developing new treatments.
Dr Poulter
I am not going to give way. I am still addressing the hon. Lady’s point, and I am not saying anything controversial. If we had had better, more joined-up data that could have been used in a more transparent way beforehand, we might have been able to head off the events that we saw at Mid Staffs much earlier. This is about protecting patients and the public, and about using population-level data in an open and transparent way. Under the safeguards that we are introducing in the new clause, data will not be used for commercial insurance purposes. Let me give that reassurance.
Dr Poulter
Hopefully, if I am allowed to make some progress and address the points that have been raised, I will give further reassurances a little later. It would be useful—[Interruption.] I will answer the question a little later, so there is no point in heckling or being abusive. If the right hon. Gentleman will wait, I will talk him through the Government’s amendments so that he can gain a better understanding —
Dr Poulter
No, I am not afraid to give way. The hon. Gentleman should sit down, because he often has quite enough to say, and it is not always a very valuable contribution. In this context, he may do well to listen to some of the purposes of the amendments. As I have already outlined, there are strong safeguards set out in the 2012 Act on how data can be used. Data can be used only for the benefit of the health and care system. In order to reassure the public, we have tabled amendments to clarify further how data may be used.
Speaking to a great many people in recent days, as well as considering amendments tabled by other Members, has prompted the Government to re-table the new clause in order to clarify that these kinds of data may also be disseminated for other wider public health purposes, such as research into environmental factors associated with asthma, or for healthy eating. We have ensured that those other kinds of research can benefit from the data by changing the wording in the new clause to make it clear that information may be disseminated for the purposes of
“the provision of health care or adult social care”
or “the promotion of health”. I am sure that the House will agree that it is essential that that valuable data resource is available to support a broad range of health research.
New clause 34 clarifies that in disseminating information, and indeed in carrying out any of its functions, the Health and Social Care Information Centre must have regard to the need to promote and respect the privacy of those receiving health services and adult social care in England. It also requires the HSCIC to take into account advice from the advisory committee that the Health Research Authority is required to appoint under paragraph 8 of schedule 7 to the Bill. The advice from that committee, known as the confidentiality advisory group, will provide a new level of independent scrutiny of the HSCIC’s decisions to publish or disseminate information.
Amendment 17 would also enable the confidentiality advisory group to advise the HSCIC on the exercise of functions conferred in regulations under section 251 of the National Health Service Act 2006, or more generally on decisions to disseminate information that could be used to identify individual patients. For example, when new regulations are made under section 251 of the 2006 Act that confer functions on the HSCIC, the confidentiality advisory group could advise the HSCIC on proposals to release data. New clause 34 requires the HSCIC to have regard to that external advice on its exercise of any function under the 2012 Act of publishing or otherwise disseminating information.
Amendment 18 gives the Secretary of State regulation-making powers to set out the specific criteria that the confidentiality advisory group will be required to take into account in giving advice to the Secretary of State, the Health Research Authority or the HSCIC in carrying out their duties. That provision is intended to enable regulations which would require that the confidentiality advisory group considers: that the purpose for which the data will be used should be in the public interest and for the provision of health and care services; that any approved processing must respect and promote the privacy of patients and care service users; that the purpose cannot be achieved using suitably anonymised data, rather than identifiable data; that it is not reasonably possible to gain explicit patient consent to achieve that purpose; and that the applicant requesting the data has not misused those kinds of data in the past.
That last criterion would effectively introduce a new “one strike and you’re out” deterrent. Potentially, for some organisations, the risk of no longer being able to access those kinds of data may prove a more effective sanction than the current maximum monetary penalty of £500,000 that can be imposed under the Data Protection Act 1998. Taken together, those measures provide an additional level of scrutiny and assurance to the processes of the HSCIC in publishing or disseminating information. The Government’s amendments—new clause 34 and amendments 17 and 18—provide robust assurance that those kinds of data cannot be disseminated for purposes such as commercial insurance or for assessing an individual’s mortgage application.
Dr Poulter
Indeed, Mr Speaker, and I hope that other Members will also be sensitive to that. The more interventions I take, the less opportunities there are for Members to speak. I have been very generous. I have taken interventions on a number of occasions from those on the shadow Front Bench, and from the hon. Member for Worsley and Eccles South (Barbara Keeley) and others. I have been generous with my time, but I want to preserve time for other Members to contribute to the debate, as I see you are keen for me to do, Mr Speaker.
Although the HRA amendments are important in ensuring that its remit is clearly and accurately defined, it will be able to work with those with an interest in children’s social care research when research crosses boundaries, to seek consistency in standards and to avoid unnecessary duplication.
Government amendments 15 and 16 are minor and technical. Amendment 15 is consequential to the addition of provisions on the better care fund—part 4—in Committee. It ensures that provisions on commencement cover the better care fund. Amendment 16 removes the privilege amendment inserted in the other place in accordance with the Commons’ sole privilege to deal with monetary matters.
The Government’s proposals ensure that we correct the difficulties we inherited from the previous Government in preserving confidential patient data. They ensure that we have in place a system in which NHS and care data must be used for the benefit of the health and care system and for public health purposes. They put us in a much better place to ensure that we enhance transparency and better use information to benefit patients. They ensure that we have a better basis on which to understand the basis of disease. If in the first place we had had the Health and Social Care Information Centre and the benefits we know will come from care.data, we would have been able to deal with and better combat many diseases while protecting patient confidentiality. We would have understood much more quickly the dangers of thalidomide and other drugs that were harmful to babies in utero. We would have been in a much better place to expose those examples of poor care, such as Mid Staffs; to develop national frameworks for treating diseases such as chronic obstructive pulmonary disease and heart disease; and to understand what good care looks like in the treatment of those conditions by collecting data in a fundamentally better and joined-up way.
The Health and Social Care Information Centre will, for the first time, provide us with a repository for joined-up, integrated data across health and care. Hon. Members often rightly talk of integrated care, and of the benefits of joining up health and care. Unless we have the data collected to understand what good integrated care looks like, and unless we understand what measures of integration are right, we will not be able properly to inform the debate on delivering integrated care or break down the silos that have sometimes existed to the detriment of patients across the health and care system. I hope hon. Members on both sides of the House can support that. I hope they decently recognise that this Government have put in place not just a patient opt-out if they do not want their data to be shared, but strong safeguards—much stronger safeguards than the previous Government —to protect patient confidentiality.
Grahame M. Morris
In principle, I support the utilisation of truly anonymised patient data sharing for the purposes of improving public health, but I take issue with a number of the Minister’s points, not least in relation to new clause 25, tabled by my hon. Friend the Member for Copeland (Mr Reed). Accountability is important. If the Minister and the Government are serious about addressing the public’s concern, they would ensure that the Secretary of State and Ministers are responsible rather than an unelected quango. Frankly, the Minister’s assurances at the Dispatch Box this evening, and those given to the Health Committee just a week or two ago, need to be in the Bill, so that there is a level of accountability and some comeback.
When we debated patient data sharing in Committee and, more recently, in Westminster Hall, my impression was that Ministers have tended to conflate legitimate patient privacy concerns, which are shared by hon. Members and members of the public, with the general lack of support for the utilisation of patient data for further research. They are mistaken, because right hon. and hon. Members are more or less unanimous in supporting any move that can lead to better research, improved care and increased safety.
Barbara Keeley
I am grateful to my hon. Friend for giving way, because the Minister was clearly frightened of answering questions from me and from my right hon. Friend the shadow Health Secretary. The Minister refused even to listen to the question, so I shall ask my hon. Friend: does he think that there is scope for confusion because some companies are in the market of insurance products and health and social care? The Minister would not take the question, so we do not have any answers on how a firm such as BUPA, which is already involved in research and already using the data, could be dealt with.
Grahame M. Morris
That is a perfect example and an important question that the Minister and the Government should answer. If we are to ensure that we have public trust in the data and who will use them, such questions must be answered and people be given the opportunity to consider what the Government propose.
It has become clear in recent months that the public lack confidence that the implementation of the care.data scheme as currently proposed would protect the data from inappropriate use, not least because of the point that my hon. Friend has just made. I am sure she would recall that we recently had a Health Committee session on this issue—in fact, the Minister was present—and certain assurances were given, not by the Minister but by one of his officials, that companies outside the United Kingdom would not have access to such data. The thought ran through my mind that many private health companies are global in their operations.
Andy Burnham
To add to the theme that my hon. Friend is developing, is not one of the problems with care.data that we have had so many statements from Ministers and officials that have not in the end come to be true? At the last Health questions, the Secretary of State said that a leaflet would be sent to every home in the land to explain what was happening. That also was not true. Does my hon. Friend agree that this is bringing the whole scheme into disrepute?
Grahame M. Morris
My right hon. Friend has hit the nail on the head, because there has been a catalogue of mismanagement. What we need to do if we believe in the importance of such a database is to ensure that we rebuild public trust. The Government have an opportunity to do that, but it will not be a simple matter. We have to look carefully at the implications of what the Government propose and give the necessary assurances.
The assurance that the official gave to the Health Committee had a gap that a coach and horses could be driven through. Several multinational companies could get round it by establishing a subsidiary based in the UK that would have access to the data, if that were the only safeguard.
Mr Dorrell
I want to return to a theme that we were discussing in an earlier debate this evening. The true nature of the hon. Gentleman’s concern is unclear. If his concern is that sensitive patient information should be made available only on the basis that the identity of the individual can never be traced and the data remain properly anonymised and confidential, I think that concern would be shared on both sides of the House. But is that his real concern, or is it that the information might be used by a private sector body for the purpose of improving the delivery of health care? I am not clear, provided that the information is anonymised and patient identity is properly secured, what his objection could be.
Grahame M. Morris
I thought I was being fairly clear. In the debate on the earlier group of amendments, we discussed the privatisation of the clinical commissioning function. My concern is that that would lead to greater fragmentation, not greater co-operation. On data sharing, I think it was my hon. Friend the Member for Leicester West (Liz Kendall) who gave the example of a questionnaire she was asked to fill in by her GP, which contained questions relating to alcohol consumption, smoking and so on. If that information was made available to a private health care company and, as a consequence, premiums were increased, people would have concerns. The Minister said that that has been ruled out and that it would not happen, but it is an example of why such concerns have been raised.
Oliver Colvile (Plymouth, Sutton and Devonport) (Con)
It is very important for there to be as much protection for the individual and the patient as possible. I assure the hon. Gentleman that my medical records are particularly uninteresting, but I would not want them to be leaked to an insurance company seeking to make money out of them or trying to change my premium. I am sure that that is very important in people’s minds.
Grahame M. Morris
The hon. Gentleman makes an interesting point which echoes a point made on the Labour Benches a few moments ago. The problem is that a number of private health care companies are also insurance companies, so it would be quite a task to ensure that data are not shared with companies that might have a commercial interest in them. To restrict access in the way we would all want is not as simple as the Government would have us believe.
Andrew George
The hon. Gentleman and I often agree on these issues, but I am slightly concerned. Of course we want reassurances, and while we have the pause we should seek further reassurances on the anonymisation of data and that they will not be misused. How far is he prepared to push this point? Is he prepared to push it to the extent that the initiative falls, with all the consequences for the lack of progress in advances in medical care? In 10 years’ time we could be talking about hundreds of thousands of lives that could have been saved as a result of pressing on with this very important development.
Grahame M. Morris
The hon. Gentleman makes an excellent point. It is not my intention to do that, but we have to recognise that the public awareness campaign—the Government’s early assurances about leaflets and letters—has been wholly inadequate. At a time when it is important for the Government to instil public confidence in the scheme, they keep doing things that undermine public confidence, for example by giving the hated company Atos—if you do not mind me using the term, Mr Speaker, because of the debacle in the Department for Work and Pensions—the contract to extract the data. There seems to have been a catalogue of errors.
I accept that this proposal has the potential to be a huge step forward. The Minister said it was not revolutionary, but I am quite often in favour of things that are revolutionary. It is revolutionary, because previous data collections from a hospital-based setting, from secondary care, have been largely episodic. This scheme will harvest data from GPs and primary care to follow the whole of the patient journey, and to identify trends and follow-ups. That is a revolutionary step forward, provided we have the necessary safeguards and assurances, and that we rebuild public trust. I am not suggesting that the scheme is unworkable and cannot be reformed, but there is a huge job to do to ensure that we restore public confidence.
Grahame M. Morris
I wanted to mention an example that has been presented to me in relation to rare illnesses. It is suggested that a patient could never be identified from the data, but identification might be possible in the case of very rare conditions, particularly if pharmaceutical companies had their own databases. We need some form of protection to cover those circumstances as well.
Barbara Keeley
I thank my hon. Friend: he is being very generous in giving way. Does he agree that scope is an issue? The Hospital Episode Statistics database was an administrative database, and that is what our data were being used for. My hon. Friend has made an important point about the loss of trust. When did any of us sign up to having our data used to recalculate the cost of insurance cover for long-term illness? When did we sign up to have it sold on a chargeable basis by BT and by MedRed, on its cloud system in the United States? Once control has gone, it is possible for the scope to vary all over the place.
Grahame M. Morris
That is a good point. It is very important for the Government to lay down parameters for the scope.
The sharing of medical data has a fantastic potential to do good, as long as the necessary safeguards are there, but if it is mishandled, it also has the potential to do great harm. Patient data consist of very confidential information, which could prove damaging to the public if it were to end up in the wrong hands. We have already seen examples of that. I share the public’s fear that the Government are not seeking appropriate safeguards in respect of highly personal and sensitive information. Despite the Minister’s assurances about new clause 34, I do not think that it goes far enough.
Let me return to the issue of accountability. The benefits for companies that seek to misuse or leak patient data, for example, are considerable. The Minister has ruled out insurance companies, but I am worried about private health care firms. The pharmaceutical industry could profit from the re-identification of patient records, and I believe that the absence of parliamentary accountability to which I referred earlier, and a lack of clear and harsh penalties for those who misuse data, are undermining trust in what could be a highly beneficial scheme. Subsection (2) of new clause 25 defines misuse, and subsection (3) gives an indication of the penalties that would be applied. I think that they might act as a deterrent.
Mr Jamie Reed
My hon. Friend is making an excellent, intelligent and informed speech. The charge has been made that pushing our proposals too far risks scuppering the project, but is it not the case that the more safeguards we can introduce to reassure the public, the better the prospects of its success will be—and, moreover, the greater the data sample will be, and the better the system will be as a result?
Grahame M. Morris
I entirely agree. I think that that is vital, because, as we have seen in the case of politicians following the expenses scandal, once public trust has been lost, it is a huge task to win that trust back. There is a mountain to be climbed. I therefore think it important that we get this right.
The Government have an opportunity to pause the implementation of the Bill in order to consult properly, and, in the Bill itself, to address issues that have been raised by Members in all parts of the House and by other interested parties. I believe that if there is to be public confidence in the scheme, the Government should make a gesture by supporting Labour’s new clauses, particularly new clause 25. Given that the misuse and identification of data are the prime concerns of the public, I think that it would be eminently sensible to make them an offence. That is not rocket science, is it? If that is the problem, why do we not address it directly by creating an offence? Similarly, if an organisation makes applications for data from the Health and Social Care Information Centre, it should have to disclose any previous convictions under that offence. I am a big supporter of transparency and the extension of freedom of information. Private health care companies should disclose information that is relevant in those circumstances.
It seems bizarre to insist that the public should allow their private information to be shared with organisations that are allowed to hide their chequered pasts in some cases behind the cloak of commercial confidentiality. Parliamentary accountability, too, should be introduced to the decision-making process. The Secretary of State should retain the duty to approve any applications. The buck should stop with the Secretary of State. If there is a serious commitment to win back the public’s trust on care.data, the buck should stop with the Secretary of State, rather than with a big and unaccountable quango.
It would be of great benefit to the public if data sharing were exercised in an accountable and secure manner. I have always been an advocate of investment in public health. For that to be effective, we need an evidence base on which to plan interventions. The scheme is set to be disrupted unless the Government can demonstrate that they are serious about protecting patients’ privacy.
Oliver Colvile
Does the hon. Gentleman think that there will be a problem with patients sharing that information with their pharmacists if that meant that they were going to get better more quickly?
Grahame M. Morris
On an individual basis, I do not see a problem with that. The problem arises when dealing with large volumes of harvested data that include not just primary care records of patients in the community but hospital records, where pharmaceutical companies are perhaps able to benefit. Whether that is in patients’ best interests needs further consideration. I do not think that there is any such concern about individual conversations with GPs or pharmacists, but there are still major holes in the Government’s proposals. They need to be tightened further. A good starting point would be Labour’s new clause 25.
Paul Burstow
The hon. Gentleman has been incredibly gracious in giving way on several occasions. He has said that new clause 25 should be commended. I wonder whether he has considered amendment (b), which suggests that one of the other issues about safeguarding data is people being satisfied of the competence of the organisations that will receive that data and that they comply fully with the data protection obligations.
Grahame M. Morris
I have considered that, and that is an important point. Compliance is important. Those issues should be addressed in the Bill. If we are to ensure that there is public trust, those points must be addressed.
Mr Jamie Reed
Does my hon. Friend share my concern and that of many GPs that the lack of necessary safeguards in the Bill may have an unintended consequence, particularly among the hardest to reach groups in society? Fear about the lack of safeguards in the Bill may stop them from accessing GPs and sharing their details and problems with them.
Grahame M. Morris
That is a huge danger. We have an opportunity to address that in this House this evening and when we consider the Bill further tomorrow. I personally am not advocating that people sign up to the opt-out clauses. That is important, but we need assurances to be able with confidence to support the Bill and the data collection proposals.
Francis Report
Grahame Morris Excerpts(11 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Andy Burnham
It is no good coming all holier than thou and claiming a counsel of perfection from the Government and that all the problems arose under Labour. There was no independent regulation in the NHS under the previous Conservative Government. There were no data of the kind that the hon. Member for Mid Norfolk (George Freeman) mentioned, so that comparisons could be made. Those things were introduced by the previous Labour Government, learning the mistakes of previous failings. This has been a continuous journey in the NHS—when things go wrong, the Government of the time act to make things better. The Secretary of State would do well to remember that before he makes the kind of statements he has made today.
We welcome some of the steps that have been taken, and I want to focus on two in particular on which we have seen an important change of emphasis. First, severe cuts to front-line staffing numbers were a primary cause of what went wrong in Stafford. In the last year, there has been a temporary halt to the cuts to nursing numbers that we saw in the early years of the coalition Government. However, Monitor has warned that this is just short term, and points to further large planned job cuts of close to 7,000 nursing posts in 2014-15 and 2015-16, made worse by severe cuts to nurse training places since 2010, which have forced many trusts in England to recruit from overseas. While we welcome the change of emphasis, we will watch carefully to ensure that recent progress on staffing is not lost.
Secondly, the Secretary of State has been right to focus on the care of older people. Moves to appoint named consultants and GPs for over-75s will clearly help to improve continuity of care. Those are the first steps in the right direction, but we would argue that something much more radical is needed. I believe that the time has come for a fundamental rethink, from first principles, of the way we care for older people, and that is what our commission on whole person care, published yesterday, has begun to set out.
Today, there are quite simply too many older people in our hospitals. Many do not need to be there, but hospital is fast becoming the last resort for people who have lost support in the home—be it support by social care or by the NHS. If we continue as a country on the current path—with further severe planned cuts to social care throughout the rest of this decade—it is a plan for the ever-increasing hospitalisation of frail older people. It is no answer to the ageing society and indeed will make it much harder to address the issues that Robert Francis identifies in his report. Instead, we need a completely new approach, where we start in the home and build a truly personalised service around each individual, their family and their carers. We need an NHS for the whole person, able to see all of an individual’s needs. We need a service where the home not the hospital becomes the default setting for care and, as I will come on to explain, that is what our policy of full integration of health and care is designed to deliver.
To listen to the Secretary of State today, people would be forgiven for thinking that everything in the NHS right now is just fine, everything is being put right and there are no problems. I have to say to him that the complacency he showed in his speech is simply not justified and, in fact, very worrying. May I remind him that hospital A and Es in England have now missed his Government’s target for 32 weeks running? The last 12 months since the Francis Report was published have—taken together—been the worst year in A and E for at least a decade, with almost 1 million people waiting more than four hours. That shows that NHS services have got worse, not better, since the publication of the Francis report.
Grahame M. Morris (Easington) (Lab)
Does my hon. Friend also recognise the growing problems in the mental health sector, as illustrated by evidence given to the Health Committee only earlier this week? We have seen the loss of 1,700 mental health beds over the last two years.
Andy Burnham
My hon. Friend anticipates me, as I will come on to that subject. My point that the NHS has gone downhill is no better illustrated than by the crisis that is developing in mental health provision.
Grahame M. Morris (Easington) (Lab)
I am honoured to be able to participate in this debate, and it is champion to follow my hon. Friend the Member for Rotherham (Sarah Champion) in the debate—
Grahame M. Morris
Thank you very much, Bob.
I want to make three points. First, I want to consider the context of the Francis report. I have the honour of serving on the Health Committee; we have held several inquiries and had the opportunity to meet and question Robert Francis on several occasions, so I am pleased to participate in this debate to consider where we are, one year on.
I also want to touch on mental health. As often happens when one speaks at the tail end of the debate, that has been raised by other hon. Members, but the issue is close to my heart. The third issue I want to discuss is the impact on social care. Although the Secretary of State kept implying that Francis is about acute hospitals, in fact his recommendations extend across the spectrum. The ideas and proposals in the 290 recommendations are just as valid for mental health and social care as they are for acute hospitals.
Clearly, the failings at Mid Staffs were absolutely shocking. I am sure that Members on both sides of the House who believe in the values of the NHS will, like me, have been appalled by those terrible events, but it is important not to conflate those terrible events with a wider diagnosis of the state of the NHS. We should think of the tremendous dedication and effort put in by the hundreds of thousands of NHS staff—I think the NHS is the biggest employer in Europe outside of the red army; it is a substantial employer—who make it such a national treasure that is ingrained in our psyche. I want to place on record the thanks of Labour Members, and, I think, the whole House, for their efforts.
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. The hon. Member for Beckenham has only just come in. He perhaps ought to hear a little bit more of the debate to get the flavour of it before he intervenes. That would help his good self.
Grahame M. Morris
We should remember that most hospitals provide very high standards of care, and have dedicated and compassionate staff. I am not just talking about doctors and nurses, but ancillary workers, cleaners and support staff. I worked in a pathology department as a medical scientific officer for a number of years. We should remember that the NHS is an integrated service that relies on all of its elements to perform at a high level and deliver a high-quality service.
Clearly, what happened in Mid Staffs was alarming. There were unacceptable practices, including, as other Members have said, professional failings. The hon. Member for Stafford (Jeremy Lefroy), in a terrific speech that was considered, thoughtful and non-partisan, alluded to those professional failings. My right hon. Friend the Member for Rother Valley (Kevin Barron), a former Chair of the Health Committee, made the point strongly that many Labour Members feel there should be a duty of candour on individuals. That is one of the recommendations of the Francis report that was rejected by the Government but could well make a difference. There were clear signs that changes needed to be made and we need to ensure that failures are never repeated elsewhere.
When care failures are uncovered, the priority above all else is to make a candid assessment of what went wrong and what needs to be done to fix it. Francis was clear on the need for cultural change. That is exactly what happened in the wake of the Mid Staffs scandal. Despite attempts by some Government Members to undermine Labour’s commitment to the NHS, for the record we should be aware that it was the then Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), who is now in his place, who called in Robert Francis to lead the initial review into what had happened so that we could find out what went wrong and learn lessons for the future.
I accept the point made by the hon. Member for Stafford that we should not hark back to previous Administrations, but my recollection, as a relatively new Member from 2010, is that that was not something we engaged in. It was a huge issue for Labour, and for me personally, that people were dying due not to lack of care in a hospital setting, but to the length of waiting lists—people were dying on waiting lists. After 1997, the NHS was transformed. Spending had tripled to £104 billion when Labour left office. Under Labour, 100 new hospitals were constructed, and the Labour Government employed 89,000 more nurses and 44,000 more doctors than had been employed in 1997. The transformation of the NHS under the last Government was reflected in public satisfaction with the service, which rose from record lows before 1997 to record highs.
There was a bit of contention during Prime Minister’s Question Time, and subsequently during the opening speeches in the debate. The Secretary of State suggested that the number of nurses had risen, but my information from the Royal College of Nursing and FactCheck indicates that that is not the case. I hope that the record can be corrected, because staff numbers are a key issue. A number of Members have referred to it today, and Robert Francis cited staffing as a causative factor.
It would, I think, be irresponsible to assume that a combination of implementing the Francis recommendations—even all of them—and talking down the last Government will be sufficient to ensure the provision of high-quality care throughout the NHS. The truth is that the combination of cuts in alternative services—I am not just talking about the replacement of NHS Direct with the 111 service, the reduction in the number of walk-in treatment centres, the difficulties in gaining access to GP services and, indeed, the cost and disruption caused by the top-down reorganisation—is more likely to contribute to failures in care. It will certainly increase the pressure on accident and emergency departments.
The Francis report made it clear that the “overwhelmingly prevalent factors” in the failures at Mid Staffordshire
“were a lack of staff, both in terms of absolute numbers and appropriate skills”.
It was made clear that ensuring that our hospitals are adequately staffed is key to ensuring that standards of care are high. That point was made by the hon. Member for St Ives (Andrew George), who I know has been campaigning on the issue for some time. A year on from the Francis report, a survey found that 39% of nurses believed that the staffing position had become worse rather than better, and 57% said that their wards remained dangerously understaffed. I hope that the Minister has noted that, because it must be cause for concern.
The hon. Member for Stafford told us that when he was first elected the NHS trust was running a deficit of £10 million, and the focus of the hospital management was on reducing the deficit in order to secure foundation trust status. What went through my mind then were figures given to the Select Committee, according to which nearly a third of NHS trusts are predicting deficits towards the end of the current financial year, and the possibility that similar pressures will be applied as a result. We are now seeing the spectre of clause 119 of the Care Bill, which we are to debate next week on Report and Third Reading. If it paves the way for rapid hospital closures—Labour Members fear that predatory private health care interests may seize the opportunity—that will be very dangerous. We must examine that issue very seriously.
According to evidence from the survey conducted, I think, by the RCN, not only are hospital wards increasingly understaffed, but nurses are being burdened with work that is preventing them from doing their jobs. I am sorry to fire statistics at the House, but, according to that evidence, 86% agreed that the amount of non-essential paperwork had increased in the last two years. There has thus been an historic recent increase in administrative duties. That has been keeping nurses in their offices or at their nurse stations, standing in front of computers or photocopying machines, instead of being available on the wards providing the TLC—that direct health care—that patients require.
Just this week the president of the Royal College of Psychiatrists warned the Government that the mental health sector is heading towards its own Mid Staffs-type scandal. I am very concerned about that. The figures for that field were given earlier, but the fact that the budget for mental health services is reducing in real terms should be a cause for concern. This Government gave a commitment to parity of esteem as between physical and mental health. That was promised and loudly trumpeted as a significant step forward, but in truth it has failed to materialise. There is a clear funding imbalance between acute providers and non-acute trusts, which will disproportionately impact on mental health services in the wake of the Francis report.
I also want to touch on the tariff reduction. In 2014-15 there will be an overall reduction in the tariff price—essentially, the price that hospitals are paid for procedures and operations they perform—of 1.5% for acute providers and 1.8% for non-acute trusts. A third of NHS trusts are predicting they will be in deficit at the end of the financial year, and this tariff reduction will only compound that problem. This means the efficiency target for mental health and community trusts is in practice a fifth higher than for acute trusts, so perhaps it is no wonder that we have a chronic bed shortage, highlighted by various newspapers and the BBC, with children and adolescents travelling long distances to access appropriate care and sometimes temporarily being put in police cells. This is not acceptable, and there are real concerns that programmes introduced by the last Labour Government to make talking therapies available to people with mental health conditions are not getting the priority they deserve. Last year half of all patients referred for counselling did not see a specialist, with a third giving up entirely because the waits were so long.
As I mentioned in an earlier intervention, 1,700 mental health beds have been lost over the last two years, and services are under such pressure that people with mental illnesses are ending up either in police cells or presenting at accident and emergency departments, as the right hon. Member for Sutton and Cheam (Paul Burstow) said. Those are completely inappropriate locations.
I want to mention the cuts to social care since 2009 and the impact they are having on the ability of the service to deliver quality care in the light of our review of the Francis recommendations. We should not forget that since 2009-10 some £1.8 billion has been cut from local authority budgets for adult social care. The cumulative spending power of my own local authority, Durham county council, is being reduced by 17.3% under this Government.
Areas such as mine with a legacy of coal mining or industry have higher care needs. These are the areas that are being hardest hit by cuts to local government. It is simply not possible to make cuts of this significance to local government without it having an impact on standards of care. Some 76% of community nurses agree that social care cuts have resulted in increased work pressures, with just 15% thinking that patients are receiving adequate support from social care services. Cuts mean that an increasing number of those with care needs are going without any support—the figure I have seen is about 800,000—and those receiving support are not even having basic needs met. We know about the 15-minute visits, and councils are now having to introduce or increase charges for services that may well have been free before or might be free in other parts of the country.
Care in the home and in the community is declining, and people are turning to their local hospitals—this is the point I am trying to make—as the default option. That means that those who should be taken care of at home are staying unnecessarily in hospital beds. Accident and emergency is the coal face—the pressure point—and any failures in the system show up there, putting even more pressure on an already burdened system. In “The Francis Report: one year on”, Robert Francis said that there needs to be
“a frank discussion about what needs to be provided within the available resources…It is unacceptable to pretend that all can be provided to an acceptable standard when that is not true.”
I agree with him. It is no good telling people that care standards will be improved or maintained while removing the support that is required to provide high standards of care, particularly social care. In conclusion, I agree with the Health Committee that legislation and regulatory bodies can only do so much to ensure that care standards are met if the necessary staff and resources are not available.
Mr Deputy Speaker (Mr Lindsay Hoyle)
I now have to announce the result of Divisions deferred from a previous day.
On the motion relating to the draft Marriage (Same Sex Couples) (Jurisdiction and Recognition of Judgments) Regulations 2014, the Ayes were 360 and the Noes were 104, so the Question was agreed to.
On the motion relating to the draft Marriage of Same Sex Couples (Registration of Shared Buildings) Regulations 2014, the Ayes were 363 and the Noes were 100, so the Question was agreed to.
On the motion relating to the draft Marriage of Same Sex Couples (Use of Armed Forces’ Chapels) Regulations 2014, the Ayes were 366 and the Noes were 103, so the Question was agreed to.
On the motion relating to the draft Consular Marriages and Marriages under Foreign Law Order 2014, the Ayes were 367 and the Noes were 100, so the Question was agreed to.
On the motion relating to the draft Marriage (Same Sex Couples) Act 2013 (Consequential and Contrary Provisions and Scotland) Order 2014, the Ayes were 365 and the Noes were 103, so the Question was agreed to.
On the motion relating to the draft Overseas Marriage (Armed Forces) Order 2014, the Ayes were 368 and the Noes were 98, so the Question was agreed to.
I now call Alex Cunningham.
Liz Kendall
Wherever there is evidence of poor care, it must be looked into. The hon. Gentleman did not mention that the Welsh Assembly has ordered a specific independent inquiry by experts outside Wales into aspects of care at the Princess of Wales and Neath Port Talbot hospitals, which I welcome.
Of all the lessons to be learned from Mid Staffordshire, the most important one is that the primary cause of the failures was the hospital and the trust board not listening to patients and their families, and not putting their needs and concerns first. Sir Robert Francis rightly says that there must be fundamental changes to ensure the real involvement of patients and the public in all that is done and to secure a common patient-centred culture throughout the NHS.
National Voices, a coalition of more than 130 patient, user and carer organisations, says that a concerted drive to listen to patients and carers must be a top priority for all trust boards and care organisations. It emphasises that over and above regulation, which it says has
“an important but limited role in ensuring quality and safety.”
Ministers have rightly spoken about the need for effective regulation and have taken some welcome steps, but the Care Quality Commission and the new chief inspectors will not be the main way of preventing the sort of failings we saw at Mid Staffordshire. Regulation identifies problems when they have begun, rather than preventing them from happening in the first place. Regulators cannot be everywhere all the time, but patients and their families are, which is why their views must be heard from the bedside to the boardroom, and at the heart of Whitehall.
The Labour Government made important progress. They published, for the first time, data on stroke and cardiac care. That helped to improve standards for patients and was a powerful incentive for staff to make changes. The next step is to provide systematic and comprehensive patient feedback. That must move from being the exception to being the norm.
The Government’s friend and families test is welcome as far as it goes but, as National Voices says,
“it is a crude measure on which the NHS would be unwise to place too much reliance.”
It asks only whether patients would recommend an NHS service to others, but not why, and it does not provide the detailed, real-time feedback that patients want and staff need to improve the quality of care. Developments such as the patient opinion and care opinion websites offer a powerful way forward. They enable people to tell the story of their NHS or care experience online, in writing or on the phone. That gives patients a voice, allows other people to see what is being said about a service, and in a simple and cost-effective way provides staff with a direct incentive to improve.
The Secretary of State said we must all be champions for change, and hon. Members may remember that I wrote to everyone saying that as a Member of Parliament they should sign up because it is a great way for us to understand what is really going on. I have asked my hospital trust and other services to do the same. That will be a powerful way of making change happen.
We must also look at how staff are trained to ensure that they always put patients first. Places such as Worcester university are leading the way: patients and families help to interview people who are applying to be nurses and health care assistants; they help to develop the content of courses so that they include what really matters to patients; and they take part in teaching students. Ministers should have spent the last three years championing such initiatives instead of reorganising the training structures as a result of the Health and Social Care Act 2012.
Individual patient voices are not the only ones that must be heard. We need a strong collective voice for users. The Francis report recommended investing in patient leaders to speak out on behalf of the public, to help to design services locally, and to hold them properly to account. Ministers claimed that that is what Healthwatch would do, but their rhetoric is simply not matched by the reality: national Healthwatch has nowhere near the same power, authority or levers to change services as NHS England, the Care Quality Commission or Monitor.
Local Healthwatch bodies are also weak. They were late out of the starting blocks and are woefully understaffed. Last week, we heard that £10 million of the £40 million budget that was promised for local Healthwatch has gone missing, despite the explicit recommendation in the Francis report that
“Local authorities should be required to pass over the centrally provided funds allocated to its Local Healthwatch”.
If Ministers are serious about giving patients a strong voice locally, they must look again at the support that Healthwatch is getting on the ground.
A strong patient voice is more essential than ever before because of the huge pressures on local services. Across the country, the NHS is struggling to cope with the increasing number of frail elderly people ending up in hospitals that were designed for a different age. Twenty per cent. of hospital beds have older people in them who need not be there if they had the right support in the community or at home. Half a million fewer people are receiving basic help to get up, washed, dressed and fed as council care budgets are cut to the bone. Mental health services, especially for children, are under intolerable strain as money for vital community services is being diverted to cope with pressures elsewhere in the system. This is not good for patients and families, it puts staff under pressure, and it ends up costing the taxpayer far more as people end up in more expensive hospital care or, in the case of mental health patients, being transported hundreds of miles around the country.
The NHS needs radical change, not to its back-room structures but to its front-line services and support. Improving safety and quality means that some services must be concentrated in specialist centres and others must be shifted out of hospitals into the community and towards prevention, fully integrated with social care. Under the previous Government, plans had been drawn up to reorganise services in every English region through Lord Darzi’s next stage review, but rather than pushing forward with those plans and making the changes that patients want and need, Ministers scrapped them simply because they were developed under the previous Labour Government. Instead, they embarked on a huge back-room NHS reorganisation, wasting precious time, effort and resources.
As several hon. Members have said, the new NHS structures are utterly confusing, with no clear lines of accountability or responsibility. There are now 211 clinical commissioning groups, 152 health and wellbeing boards, 27 NHS England local area teams, four NHS England regional teams—I am not sure what they are doing—23 commissioning support units, and 10 specialist commissioning units, alongside Monitor, the Care Quality Commission and NHS England. Can you make sense of that, Mr Deputy Speaker? Who is providing the leadership? Who is to be held to account? Across the country, people are doing their contract negotiations for next year, trying to make changes to services, and they say to me that there is no clear leadership in the system. That must change.
We have heard a lot about changing the culture in the NHS. That culture is about behaviour and the millions of personal interactions that happen every single day in the NHS. Getting those right will not happen through regulation alone but by giving patients and the public a powerful voice in every part of the system. This issue has had too little attention since the Francis report was published. Crucially, the culture is about leadership, and leadership comes from the top.
I warn Ministers not to be complacent about saying that the bullying culture has gone. On Friday, I met the chief executive of a trust who showed me an e-mail from the NHS Trust Development Authority, which is quite close to Ministers’ doors. I will not be able to say exactly what it said because it contained swear words, but it said, in effect: “Open the beep beds; just beep do it.” That was in an e-mail to a chief executive. The bullying culture is still going on. Ministers need to get a grip, particularly on what is happening at the NHS Trust Development Authority, which is causing real problems in the system.
Grahame M. Morris
This is more pervasive than something that happens at the highest level. When members of my trade union, Unite, from the Yorkshire ambulance service raised legitimate concerns about the impact on the service of privatisation and de-skilling, the reaction of management was to de-recognise the trade union. That is outrageous.
Liz Kendall
This is not leadership; this is not what we want in our health service.
Real leadership is about setting a vision and working with staff and patients to make it happen. Yesterday Sir John Oldham published the report of his independent commission on whole-person care, which was drawn up with people who have worked in the system and sets out the reforms that we need to ensure that our NHS and care services are fit for the future. Across the NHS, patients and staff are crying out for clear leadership. Until we get this right, we will not really have learned the lessons from the failings of Mid-Staffs.
Patient Medical Records
Grahame Morris Excerpts(11 years, 4 months ago)
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Grahame M. Morris (Easington) (Lab)
I congratulate my hon. Friend on securing a timely debate on a very important subject. Does he agree with me that a scheme that is already lacking in public confidence is not helped when Atos has been awarded the contract to extract the data from GP records? Does he agree that that should never have happened?
Mr Godsiff
I entirely agree with my hon. Friend and indeed, I will come to that point later. As I said, we have an opportunity in the next six months to try to get the scheme right. If the Government now address the many concerns raised about privacy, consent and the creeping commercialisation of our health service, they have the opportunity to create a scheme that offers enormous benefit to health care and research. However, if they fail to do that and continue to steamroll ahead, ignoring public concern, in six months’ time they will find themselves in precisely the same place as they are now, faced by massive public opposition to a scheme that has the potential to do so much good and to save lives.
Mr Godsiff
Thank you very much, Mr Weir.
The Pulse survey found that as many as one in 12 GPs are considering opting out all of their patients from the scheme, and 33% said that they were undecided. Unless public awareness and GP confidence improves massively in the next six months, we will see huge opt-outs. What would the consequences of that be for the health service? I asked the Minister what would happen if a GP refused to upload patient data. His rather disconcerting reply was that
“NHS England would need to consider whether to take remedial action for breach of contract.”—[Official Report, 25 February 2014; Vol. 576, c. 275W.]
Will the Minister tell us whether such remedial action would make it impossible for GPs to continue to practise? Can he guarantee that doctors will not lose their jobs for doing what they believe to be best for their patients by protecting the confidentiality of personal data?
NHS England has said that it is delaying the scheme for six months because it wants to ensure that the public better understands the proposals. That is a hugely arrogant argument. NHS England is basically saying, “Look, we know best. We tried to get this through by stealth but we got found out. We will therefore delay it by six months while we try to explain it better to you, the public. We know best—we understand and you do not.” As I just said in response to the hon. Member for Worthing West (Sir Peter Bottomley), 87% of the population have considerable concerns about the scheme and do not want their data to be taken outside of the confidentiality agreement that exists between a patient and their doctor.
Mr Godsiff
No, I have given way on many occasions.
NHS England must start listening. GPs in Birmingham, where my constituency is, have said that they simply do not have time to have a proper conversation with patients about data sharing. GP surgeries are already stretched, and patients struggle to get an appointment within a reasonable time frame. Are we really suggesting that GPs should be talking to patients about the minutiae of a data-sharing scheme when ill people already cannot get an appointment? Would that really be the best use of doctors’ time?
My hon. Friend the Member for Easington (Grahame M. Morris) raised the issue of who is going to extract the information, and pointed out that Atos appears to have won the contract. At first, I thought that that was a joke, and I looked at the calendar to check that it was not 1 April. If it is seriously being suggested that Atos, probably the most loathed and inept company operating in the UK, is to be left to extract the data, all I can say is God help the patients of this country. The Department for Work and Pensions has found that 60% of Atos disability assessments have been overturned on appeal. The company is absolutely hopeless. How on earth can the Government award it a contract to extract patient data? I ask the Minister: will it be done in this country, or on the other side of the world? I have no confidence whatever that Atos will be able to retain the confidentiality that patients want.
In conclusion, some people say that the choice is between protecting patient confidentiality and saving lives, but that is a false choice. As I said right at the start of my speech, people such as me who are concerned about the scheme are not against medical research or the provision of information to allow research to go ahead. I am opposed, along with the vast majority of people in this country, to private information about patients being sold off to private companies for private gain. That cannot be right. I urge the Government to look at the issue again and listen to what doctors and patients are saying.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to serve under your chairmanship, Mr Weir, I believe for the first time. It is also a pleasure to respond to the debate and the points raised by the hon. Member for Birmingham, Hall Green (Mr Godsiff). I congratulate him on securing the debate, as well as on the keen interest he has shown in the correspondence we have conducted via written questions. We have talked through some of the issues and he has expressed concerns about the importance of patient confidentiality.
I hope today to be able to reassure Members that strong safeguards were put in place by the Health and Social Care Act 2012, and that the creation of the Health & Social Care Information Centre was not a sudden event. The process is evolutionary and was debated fully and thoroughly during scrutiny of the Health and Social Care Bill a few years ago. I was a member of the Health and Social Care Bill Committee, as was the hon. Member for Easington (Grahame M. Morris), and it sat for longer than almost any other Committee in the House for more than a decade. It is therefore not correct to say that the issues have not been debated and properly scrutinised in the past, because they absolutely have.
Dr Poulter
I am not going to give way because of the time. I have not said anything controversial; I am just reiterating the fact that a lot of the issues that have arisen today were discussed at great length during scrutiny of that Bill. The hon. Gentleman will recall that as he made many interventions and speeches in Committee.
We need to highlight the importance of this issue. We must ensure that we have the right data and the right processes in the NHS to inform good care. It is about ensuring that we have the data to improve research, to drive better integration and, in the wake of the Mid Staffs scandal and the Francis inquiry, to ensure transparency in protecting patient confidentiality and in the quality of care provided by health care providers so that we can ensure that high quality care is provided throughout the NHS and that its quality is properly scrutinised. We must learn from examples of good care, and where, by comparison and other standards, care is not good it should be transparently exposed.
There are important research benefits, too. We know that if we want to combat disease, address some of the challenges that we face in the health system and improve our knowledge of diseases from cancer to heart disease, we need to have the right information. We have to ensure that we collect data and information to improve patient care, which is the heart of everything we are talking about today. As long as we do that—I believe that we have the right safeguards in place through the 2012 Act and through the further clarifications and reassurances provided by the amendments to the Care Bill that have been tabled for next week—we are in the right place to deliver improved transparency and care quality while ensuring that we protect patient confidentiality, in which we all believe.
NHS
Grahame Morris Excerpts(11 years, 5 months ago)
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Andy Burnham
No, it was your law, your Government’s law, the Health and Social Care Act 2012—the same law against which his own care Minister, the hon. Member for North Norfolk (Norman Lamb), has recently been speaking out. He recently told the King’s Fund:
“I have a problem with the OFT being involved in all of these procurement issues… I think that’s got to change… In my view I think it should be scrapped in the future… That might happen at some future date… we’ve got to look at the barriers and address them and sort them out.”
Is that just his view, or the view of the whole Government? [Interruption.] He voted to let the OFT into the NHS. Why is he now changing his tune?
The former care Minister, the right hon. Member for Sutton and Cheam (Paul Burstow), said the same:
“The one area I have my concerns about is the way”—
the 2012 Act—
“opened up the role of the OFT.”
Yes, but did we not tell him that two years ago when he voted for the Act and when his hon. Friend the Member for St Ives (Andrew George), who is sitting next to him, joined us in the Lobby to oppose it? This is exactly what we warned them about. We warned them that it would let the market run riot through the NHS, but they would not listen, and that is why we are where we are today.
It is not just Ministers who are saying it; the comments by the chair of the Care Quality Commission at the weekend show the utter confusion in Government policy on competition in the NHS:
“We need more competition…more entrants into the market from private-sector companies”.
Will the Secretary of State clarify? Is that a statement of official Government policy? Is it his policy to get more private sector companies and more competition into the NHS? Is that what he wants? If that happens, it will mean more enforced competition leading to the fragmentation of care, and it will load extra costs on to the NHS at the worst possible time.
Grahame M. Morris (Easington) (Lab)
My right hon. Friend is making some positive points about the privatisation of the NHS, but does he share my concern that Monitor’s board is packed with executives who have come from private health sector companies?
Grahame M. Morris (Easington) (Lab)
Given the heated exchanges we have just had, I want to make it clear that I am speaking in support of the Opposition motion.
Given the extent of the crisis that is being faced by accident and emergency departments around the country, one would be forgiven for thinking that this Government must have inherited an NHS on the brink of collapse. In fact, the opposite is true. I know we have stopped doing the patient satisfaction surveys, but at the time that was discontinued, patient satisfaction was at an all-time high and we must not forget that the national health service had been transformed by the Labour party. I worked in the health service and I remember what it was like in the 18 years when the Tories were running it. The NHS that the Labour party inherited in 1997 was transformed. The budget for the NHS was £30 billion then, but when we left the NHS in good health in 2010, the budget was over £100 billion. The 18 years of Tory neglect had been thoroughly addressed with new hospital buildings. Every single A and E department was replaced.
What have we seen since? We have seen an unwanted top-down reorganisation, which nobody wanted and nobody voted for, coupled with under-investment, and the slashing of alternative services has placed a huge burden on our A and E services. By referring to alternative services I am talking, for instance, about walk-in treatment centres, including my own excellent Healthworks in Paradise lane, Easington Colliery. It is under enormous pressure yet offers a fantastic service with out-of-hours and weekend opening, but we are not sure whether that will continue because of pressures that the clinical commissioning group is facing. By almost any standard, it is clear that the performances of accident and emergency departments are struggling under the current Government. It is clear that patients are waiting longer to be seen and that the numbers of delayed discharges and emergency admissions are up—I think the Secretary of State admitted that. The number of cancelled operations is certainly up.
Nicholas Soames (Mid Sussex) (Con)
I am following carefully what the hon. Gentleman is saying; he is making some very good points. Does he acknowledge that 45% of the health service budget is spent on 5% of the population—namely, those vulnerable people with multiple chronic illnesses? Getting that right must be the key to the future. What does he think the solution is?
Grahame M. Morris
I am grateful to the right hon. Gentleman for that intervention, because his point is germane to my argument. I shall develop that subject in the few minutes I have left when I talk about the consequences of what is happening in social care. I certainly feel that some of the policies that his Government have supported have contributed to the crisis. For example, the top-down reorganisation has had a damaging effect on A and E performance. I will address that point in a moment.
Other hon. Members have spoken today, in interventions on my right hon. Friend the Member for Leigh (Andy Burnham), about patients being ferried to hospitals in police cars. That has certainly happened in County Durham, and it must be a cause for concern. The A and E crisis can largely be placed at the Government’s door, because they have not faced up to some of the problems. It has rightly been pointed out that the number of admissions had risen by 633,000, not least because of demographic changes involving more older people and people with core morbidities and multiple conditions. That is placing a huge amount of extra pressure on A and E departments, but that pressure is being compounded by damaging cuts to local authority budgets.
My own local authority, Durham county council, is experiencing cuts of £222 million between 2011 and 2017. I know that Ministers will say that social care is ring-fenced and that £3.8 billion is being transferred to the home care fund, to be made available to clinical commissioning groups and local authorities, but what that means in real terms for the people living in Easington is that EDPIP—the East Durham Positive Inclusion Partnership—which supports frail elderly people and young people in vulnerable families, is closing down because of a lack of funding from the local authority. Similarly, East Durham Community Transport, which provides transport to take the frail elderly—including my mother, incidentally—to day centres and elsewhere, has been severely curtailed.
The Government have been warned by experts that cutting the staggering £1.8 billion from council social care budgets in the first three years of this Government would have a knock-on effect for the NHS, particularly in accident and emergency departments. That point has been made in expert witnesses’ evidence to the Health Select Committee, on which I have the honour to serve. Because of the cuts to social care, fewer older people are getting adequate support in the community, and are therefore visiting A and E departments instead. The impact of that is twofold. First, it means that those with care needs are not getting the treatment they need. Secondly, it means that our A and E departments are being put under great strain. Directly and indirectly, the Government have ignored warnings that by slashing social care they would make it difficult to discharge patients with care needs because it would be unsafe to send them home.
Barbara Keeley
Perhaps it would be pertinent at this point to mention the comments of Sir Bruce Keogh to the Health Committee’s inquiry into urgent and emergency medicine. When I asked him if the cuts in social care bothered him, he said:
“Yes, it does bother us and I think it bothers everybody. We are trying to maintain a stable and improving service in the NHS at a time that our colleagues in social care are taking a massive hit to their baseline.”
Grahame M. Morris
I am grateful to my hon. Friend for that intervention, and I hope that her point will not be lost on Ministers. That is a significant factor.
The lack of adequate support in the community and in the home has stored up problems in the NHS, and I am convinced that they will be exacerbated by what is now happening. I know that we have done some good work on the Care Bill—there is good intent there—but I have real concerns about whether the resources necessary to make social care really work will be provided. We have seen attendances at hospital A and Es continuing to rise.
Norman Lamb
We have had this discussion on the Care Bill. The hon. Gentleman talks about the need for additional resource, but in Committee there was no indication from the Opposition that they would make a commitment to provide extra resources. Is he now saying that they would do so?
Grahame M. Morris
I cannot thank the Minister for that intervention. We have had many exchanges during the passage of the Care Bill, but that decision is above my pay grade. It would be for those on our Front Bench to determine the level of such resources. The purpose of this debate is to consider the A and E crisis. I would like to think that that commitment could be made, however, and if the Minister is asking me personally whether I support it, the answer is that I do. I believe we should also support free end-of-life care, which I know the Minister and many others on the Government Front Bench support. However, I must make some progress with my speech.
The lack of adequate support in the community has had an impact. It has contributed to increased attendances at A and E departments. I hope that Members will not have forgotten that, two years ago, the Prime Minister said:
“I refuse to go back to the days when people had to wait for hours on end to be seen in A&E”.
Well, I am afraid that we have gone back to those days. Sadly, by removing the social care needed for many elderly people to avoid unnecessary trips to hospital and to return home when their stay should be over, the Prime Minister is bringing back those days. I urge hon. Members to support the Opposition motion today.
Oral Answers to Questions
Grahame Morris Excerpts(11 years, 6 months ago)
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Dr Poulter
As I am sure the hon. Gentleman is aware, the reason there have been increased referrals to therapists is that this Government are investing in early intervention and ensuring we invest in improving access to the psychological therapies programme so we can get to people with mental health problems much earlier and give them better support before they reach the point of crisis.
If I may beg your indulgence for one second, Mr Speaker, on the hon. Gentleman’s specific point about gay to straight conversion therapy, I also find that absolutely abhorrent in principle, but the issue is—it is an important issue and he should listen to this—that if we were to ban or put in place regulations on that it may have unintended consequences. That may stop counsellors practising who are supporting people coming to terms with their sexuality. That is an important service, and I hope we can support it on both sides of this House.
Grahame M. Morris (Easington) (Lab)
11. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances.
Robert Flello (Stoke-on-Trent South) (Lab)
13. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances.
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
Although councils have reduced social care budgets, the evidence suggests that this is not having an impact on the NHS. In fact, the data published by NHS England show that councils are getting better at getting people out of hospital at the appropriate time.
Grahame M. Morris
The National Audit Office reports that cuts to social care led to nearly 500,000 delayed bed days in accident and emergency in 2012-13, so will the Government see sense and commit to investing in lowering the eligibility threshold to moderate, ensuring that older and disabled people’s needs in Easington and throughout the country can be met in their community so they do not need to present to A and E causing further pressures on it?
Dr Poulter
Taking the hon. Gentleman’s question in the spirit he intends, I think there is a misunderstanding of the statistics. We need to reduce the pressure on A and E, and evidence from NHS England already shows that improvements in how social care works with the NHS over this Parliament are delivering improvements to care. In 2011-12 there were about 523,000 bed days lost because of delays attributable to social care, but in 2012-13 the number had fallen to 476,000, a drop of nearly 50,000. That shows that social care is working well to reduce pressure on A and E.
Accident and Emergency
Grahame Morris Excerpts(11 years, 6 months ago)
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Andy Burnham
That is a question for the Secretary of State. How can it make sense to close so many A and E departments in the middle of an A and E crisis? This year, the facts on the ground have changed. As I have said, it has been the worst year for a decade. Any proposal to change A and E in areas such as that of my hon. Friend needs to be considered in the light of that new evidence. We need to consider whether it is safe to proceed. As the A and E sister said, it is crisis management. That is the view from the real world. In here, it is a different story. It is, “Crisis, what crisis?”
My purpose in holding this debate is to cut through the spin. I want to bring into our debate today the voices of those A and E nurses, occupational therapists, paramedics, community nurses, and NHS 111 staff and mental health professionals who came to our summit. For instance, there is the paramedic who told us of his worries about ambulance response times getting longer because ambulances are trapped at A and E; and of the time when a patient who was held a long time at the door of a busy A and E suffered a heart attack and had to be rushed back to the ambulance. Another paramedic told us about being at the scene of a serious incident in a city centre. After calling for back-up, he was joined by a private ambulance which did not appear to have adequately trained staff to take patients to hospital. A community nurse spoke of her frustration at spending an hour and a half on the phone trying to get a GP appointment for a frail patient. An A and E-based occupational therapist said that she was now regularly diagnosing dementia for the first time in older patients who had ended up in A and E. Surely we can do better than that.
Grahame M. Morris (Easington) (Lab)
My right hon. Friend is giving an excellent argument as to why we are in this crisis. Is it not completely predictable given the response that we have just had on the local government grant settlement? Increased pressures on the system will be felt by old people and in deprived areas.
Andy Burnham
I agree. The Government have made grave mistakes. I warned them—they misquote me every week—that it would be irresponsible to give increases to the NHS, which is what they were promising, if they had to ransack local government, particularly social care budgets, to pay for them. That is a false economy. It means that older people have support withdrawn from the home, and they drift towards A and E in ever greater numbers. That is what is happening today on this Secretary of State’s watch.
Grahame M. Morris
If the Government are doing so well in relation to targets, why have they downgraded the four-hour waiting target from 98% to 95%?
Mr Hunt
I will tell the hon. Gentleman why. It was done on clinical advice, for the good reason that there are some patients whom it is better to see, even if it takes longer than four hours, so that they can be discharged and sent home, rather than admitting them to the hospital, which is what was happening under the 98% target. Labour agrees with that, because it is following the same procedure in Wales.
Lisa Nandy
I will not give way to the Minister because I presume he will be winding up the debate and I hope he will spend the rest of his time listening to Members rather than trying to explain away such an appalling record.
I cannot understand why, despite all the pressures already being put on my A and E by this Government and despite its still being consistently one of the highest performing A and Es across the north-west, we are being disrupted by the Healthier Together programme, which has caused so much anxiety in Wigan.
Grahame M. Morris
I want to reinforce that point in relation to Durham county council. I have just been advised that Library figures show that it is facing cuts of £222 million between 2011 and 2017. That must have a huge impact on social care and a consequential impact of increased demand in A and E.
Lisa Nandy
My hon. Friend is absolutely right, as always.
The Healthier Together programme has, at this time, caused huge anxiety across Wigan. In June, documents leaked to my local paper the Wigan Evening Post revealed plans to reclassify hospitals as red and green, with several hospitals downgraded, as my hon. Friend the Member for Stretford and Urmston knows only too well. That prompted real fears across Wigan that it would lose its well-regarded 24-hour A and E. The decision appeared to be based on population, not on the performance of hospitals. In September when I visited the Healthier Together offices in Manchester to explain my concerns with my hon. Friend the Member for Bolton West (Julie Hilling), I was surprised to see, at a time of funding pressures that are causing real pain, how expensive those offices were, situated in the middle of Manchester. Imagine my surprise, Madam Deputy Speaker, when Healthwatch Wigan found through a series of Freedom of Information Act requests that the total cost of the Healthier Together programme in Greater Manchester to date has been £3 million, with £1.3 million of that spent on third-party organisations. The NHS would not reveal who or what that money was spent on. To date, the programme could, in total, have paid for 90 new nurses, 20 A and E doctors or 9,000 bed days at Wigan infirmary. Instead, this hugely expensive programme has caused huge anxiety across my local area, and communication has been dire. I am not alone in thinking that that is a shocking waste of money.
Despite the chaos caused by this Government, our A and E works well: it is a consistently high performer. We are a big borough, with huge transport constraints. To ask people to travel to the nearest alternative hospital in Bolton just is not feasible. It is 15 miles away, which is at least half an hour by car. What the Minister may not know or understand is that many of my constituents do not have cars or the money to take several buses or use public transport. Our borough typically has large, tightly knit families. When someone’s granddad goes into A and E, not just them and their mum and dad but the entire family visit him, which will be impossible if this shambolic programme goes ahead.
The Secretary of State has caused real anxiety by acting unlawfully in respect of Lewisham A and E, announcing the single biggest closure programme the NHS has seen at a time of unprecedented pressure on A and E, and making changes in the Care Bill that will enable the closure of high-performing hospital services such as those in Wigan. Will the Minister give me a cast-iron guarantee that decisions will be made on clinical, not cost grounds, and will he reassure us that financial constraints do not come into this? Will he tell my constituents that the real-life situation of local people—transport, family networks, income and all the things that have a huge impact on people’s well-being—will be considered by this Government before any decision is taken that affects my constituents’ lives?
Dr Phillip Lee (Bracknell) (Con)
On 27 December 1999, I and two other junior doctors embarked on a ward round at Wexham Park hospital in Slough. We had 72 patients to see that day, and it took us 13 hours to get round to them all. I say that because it was 14 years ago, yet I am hearing that this is the A and E crisis to end all crises. Every year, doctors in the national health service are worried and concerned about the pressures that the winter will bring to bear, and I do not think that this year is any different from 1999.
I want to try to be a bit challenging today and, in view of the motion, perhaps a bit counter-intuitive. We have too many casualty departments in this country. We should look at the mortality statistics—the likelihood of survival. I would say to the hon. Member for Wigan (Lisa Nandy) that, if my grandfather went into hospital, I would want him to go into the one where he had the best chance of survival, not necessarily the one down the road. I do not know about her hospital, but a large number of hospitals in this country unfortunately do not deliver the best care or the best mortality statistics. We need to reflect on that without trying to score petty political points about a variety of different issues.
Grahame M. Morris
I want to query the hon. Gentleman’s point about this crisis not being anything unusual. The Government’s own Health and Social Care Information Centre has published figures showing that the number of visits to A and E departments in England has risen by 11% in four years to 21.5 million attendances, which is 60,000 a day. The numbers are clearly increasing, and our argument is that that is partially the consequence of the Government policy of cutting social services.
Dr Lee
There has actually been a 37% increase in emergency admissions over the past decade, while 65% of hospital admissions are of people over 65. Dementia is doubling as we speak, and 25% of the NHS budget will be spent on diabetes by 2025. I am sorry, but to try to suggest that the genesis of the challenge we face has been during the three years of this Government is simplistic. The most polite way to put it is that the hon. Gentleman is making a simplistic argument.
Kate Green (Stretford and Urmston) (Lab)
I want to speak about the current situation in Trafford and some of the lessons that Ministers might want to learn from the transition we went through when the A and E department at Trafford general hospital was downgraded to an urgent care centre and closed overnight. Despite assurances that neighbouring accident and emergency services at Manchester royal infirmary and Wythenshawe hospital would be able to cope following that change, problems are already piling up. Those problems may not have been caused wholly—or perhaps at all—by the changes at Trafford, but the impact on Trafford patients is pretty dire and we must take account of that.
Those A and E departments were already exceptionally busy, with the one at Wythenshawe working well beyond capacity. It was built to accommodate 70,000 patients a year but was already dealing with more than 100,000, as my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) pointed out from the outset. We welcome the fact that the Department now appears to have unlocked a route to additional funding for capacity at Wythenshawe, but that funding, let alone the additional capacity, is not yet in place.
As the Minister will know, in the past couple of weeks Wythenshawe A and E has reached “black” status for waiting times, and privately there are indications that the quarter 3 target for waiting times at the hospital will not be met. There are also reports that waiting queues for ambulances are doubling outside Wythenshawe hospital, and pressures are mounting at Manchester royal infirmary. The other day a constituent told me that she had visited on the evening of Sunday 8 December with her diabetic daughter and there were not even enough seats for waiting patients. Some people were forced to wait outside.
Those pressures were predicted. Last year, Manchester royal infirmary and Wythenshawe hospital struggled to meet waiting time targets, and indeed failed to meet them on at least one occasion in 30 out of 35 weeks. The Secretary of State was clearly concerned about the pressures on those hospitals because one criterion he set down for the reconfiguration of services at Trafford was that neighbouring hospitals should consistently meet waiting times before the changes were made.
On the basis of performance in the two summer quarters, the NHS asserted that the criterion on waiting times at those hospitals had been met, despite warnings from many people—including me—that not measuring performance during the winter months would give a distorted picture of the capacity of those hospitals to cope. The Minister must recognise that that caused a great collapse of public confidence—they were not very confident about the proposals for the reconfiguration anyway—because it seemed that fudging was going on to present an impression that hospital services could cope, when it then turned out they could not. To use data that are clearly applied in a way that suits the outcome NHS managers want, rather than being in the best interests of patients, is a matter of great concern. Will the Minister say how we can have genuine and robust criteria for reconfigurations in which the public can have confidence? The total absence of clarity and the fudging over the decision at Trafford over the past few weeks has had an unfortunate effect.
When the Secretary of State announced the funding in September, neither Manchester royal infirmary nor Wythenshawe received extra money to deal with winter pressures. I was surprised because we knew by then that reconfiguration would create extra demand on those two A and E departments. I am anxious to hear from the Minister about the Department’s approach to ensuring adequate additional resource to support transition for such reconfigurations.
Grahame M. Morris
My hon. Friend makes an important point about demand in deprived areas. The Government’s health and social care information centre has identified that in each of the past five years at least twice the number of attendances have been from those living in the 10% most deprived areas, compared with those from the 10% least deprived areas. That should be reflected in the allocation of funding, but unfortunately such areas receive no additional money at all.
Kate Green
Two pressures could be highlighted. The first is the way that funding fails to take adequate account of deprivation. Secondly, there will inevitably be a hump at the time of transition, as new arrangements settle down and people adapt to the changing service configuration. When providing resources to Manchester royal infirmary or Wythenshawe, no account seems to have been taken of the effect of that transition and the likely need for additional resource to take those hospitals through that period. Indeed, in a private meeting with the Secretary of State, after the reconfiguration was announced, he confirmed that there would be no additional transitional funding. I could, however, look forward to additional funding to enable greater integration of services, although not until 2015-16. Furthermore, it would not be new funding, but funding that had been moved from the NHS to social care.
I am as strongly in support as anyone of seeing funding directed as much as possible to preventive care and care that can be provided at home in the community, but we cannot take services from hospitals before we put that care in place in the community. Such care is simply not adequate in Trafford today.
The other matter I want to raise was alluded to by the right hon. Member for Sutton and Cheam (Paul Burstow). There is utter confusion among patients about what services they should access and when. As soon as Trafford was downgraded to an urgent care centre, Trafford patients believed they could not go there. That was not the intention of NHS managers, but the impact was undoubtedly to drive more traffic to neighbouring A and E departments.
Care Bill [Lords]
Grahame Morris Excerpts(11 years, 6 months ago)
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Mr Hunt
I recognise that the right hon. Lady campaigns hard for her constituents. The four tests set out by the Prime Minister were never designed to require unanimous support from local CCGs for necessary changes. If we had to secure that, it would be virtually impossible to make any major reconfigurations. Where there is a failing hospital, it is important to resolve and address situations. There are exceptional occasions when that cannot be done in an individual trust’s area. The change in the law will not apply retrospectively to Lewisham, but it is right to ensure that, if we are to learn one lesson from what has happened in recent years, we deal much more quickly with failing hospitals, and that applies to South London Healthcare NHS Trust as well. Governments and the NHS must never again sit on coasting or failing hospitals for year after year without doing what it takes to sort them out. That is why this year, for the first time, we have put 13 hospitals into special measures. How utterly inexplicable but sadly predictable it is that the Labour party, which failed to sort out those problems, is today refusing to back the changes that mean those mistakes can never be repeated.
Another lesson from the Francis inquiry is that we need to create a culture of openness in health and social care so that, rather than being bullied and intimidated, doctors and nurses feel they can speak out about problems. The Care Bill will introduce a duty of candour as a requirement for registering with a CQC. That means that honesty and openness must come as standard for every organisation. We are also introducing a new criminal offence that will apply to care providers that supply or publish false or misleading information. Directors and other senior staff involved in committing the offence will be held to account. In addition to the Bill, the professional regulators have agreed to place a new strengthened professional duty of candour on all doctors and nurses. The Government are on the side of openness and transparency in our health care system.
Grahame M. Morris (Easington) (Lab)
I am sorry that the Secretary of State has not made any reference to part 1 of the Bill, which is about care and support. I hope he will come on to it, because it is so important. Perhaps he will also explain why Francis’s recommendations on a duty of care are being applied to organisations but not to individuals?
Mr Hunt
As the hon. Gentleman knows, we considered that matter carefully. We decided that the best way forward is to strengthen the professional duty of candour on individual doctors and nurses through their professional codes. After extensive consultation, which was supported by the medical profession, including the British Medical Association, we decided that that was a better way of ensuring that we had the right outcomes and did not create a legalistic culture that could lead to defensive medicine, which would not be in patients’ interests.
If supporting the Francis measures in the Bill is too awkward or embarrassing for Labour Members, can they not see the merits in the parts of the Bill that deal with out-of-hospital care? I am talking about not just vulnerable older people, but carers, for whom we need to do more. We need to do much more to remove the worry that people have about being forced to sell their own home to pay for their care.
Andy Burnham
Just as the Government’s proposal is not the Dilnot report, it is not my national care service proposal. I had a range of different proposals, and that one has to be considered in that context.
As the Minister knows, I proposed a universal approach in which everybody would contribute on the NHS principle—I seem to remember that he and I were in some agreement about that. That was a deferred payment, but this proposal is different. The Government are talking about a universal deferred payment scheme in which people will pay from what they leave behind, but—and this is the point—it will not be available to everybody. That was the promise the Minister has broken.
Grahame M. Morris
My right hon. Friend is making excellent points. On deferred payments, this proposal has been presented as something new, but is it not the case that about 90% or 95% of local authorities currently offer a similar scheme?
Andy Burnham
They are offering a similar scheme but at the moment they are not allowed to charge interest on it. That brings me to the next part of what is wrong with these proposals. What the Health Secretary has not said today is that interest will be charged on his proposed deferred payment scheme, which is not universal because it is not available to everybody. A loan to cover the average length of stay in a care home—two and a half years—would clock up extra costs of £3,500 in interest alone. That interest would not be included in the cap but would be outside it. Again, people will not feel that what they are paying is related to a cap.
Charlotte Leslie (Bristol North West) (Con)
I greatly welcome much of what is in the Bill. I am slightly disappointed by the tone of some—not all—Labour Members, who seem to suggest that the challenges our society faces with social care are in some way new. I looked after an old lady from 2003, during the economic boom times, and became very well acquainted with her care package, care needs and care challenges, and the challenges faced by her social workers. Back then, social workers were expected to get across London in 20 minutes, which was obviously impossible, so the care time that they had with my friend was severely cut down; in fact, sometimes it was 15 minutes, a figure that we have already heard. There was also a massive challenge in terms of raising the status of the profession of social work. Those challenges existed back then, during the boom times, and they still exist now. It is very brave and ambitious for the Government to be making such significant steps in unifying health and social care at a time when the economic situation is very difficult.
Other Members have dealt with the care and support aspect of the Bill more eloquently than I can, and I am sure that others will too. I want to focus my brief remarks on part 2, which is about the response to Francis and care standards.
I think that one lesson we have learned following the Mid Staffs scandal is that making rules does not necessarily mean making change. I remind the House of the 2002 “Code of Conduct for NHS Managers”, which states:
“As an NHS manager, I will observe the following principles: make the care and safety of patients my first concern and act to protect them from risk;…be honest and act with integrity; accept responsibility for my own work and the proper performance of the people I manage”.
Following the unravelling of scandals in Mid Staffs and elsewhere, it is very hard to understand how NHS managers were adhering to that code of conduct, which was written for them, and why none of them has faced the consequences of not doing so. That is a salutary lesson: we need to be wary that putting things in writing does not always mean that they will happen culturally. People have remained unaccountable for a serious breach of that managerial code of conduct, many of whom, I am afraid to say, continue to work in the NHS today.
As the Bill progresses, I want to see more detail on how the contractual obligation for a duty of candour, which is welcome, will be enforced. I understand the desire for a statutory duty on individuals, but I share fears that it may oversimplify the blame culture that this House has discussed at length. Having seen what happened with our hospitals’ complaints system and the cover-up of blame, I am very worried that a statutory duty on an individual clinician could be abused, such that blame could be parked at a clinician’s door by a management system that does not want its own failings to be highlighted. That could lead to unfortunate false allocations of blame by the system in which clinicians work.
If a contract’s duty of candour is not met, what will be the consequences? It is an issue that there have been no consequences for those who have breached things written down in guidelines and codes of conduct. It is important to understand in more detail what the consequences will be of a breach of contract.
I would particularly like to know whether managers, organisations such as NHS England, and Department of Health officials will have the same duty of candour. The reason why scandals such as Mid Staffs have been allowed to go on and on is that it was not just the hospital that was complicit in it; the entire system around the hospital should have been acting in patients’ interests, but it did not.
Some have faced consequences for their actions—their actions were good, but the consequences have been diabolical—namely whistleblowers. I know and understand that real reform of how we treat whistleblowers and enable whistleblowing will require changes to the Public Interest Disclosure Act 1998. If a whistleblower has been found to be correct in raising concerns in the NHS and those concerns are recognised, I would like to know why any future employer would choose not to employ them. If an employer is a good employer, they would welcome a whistleblower into their ranks as someone who would not go native and accept appalling care when others might do so and who would also have the moral fortitude to stand up and talk about failings when others might not. The test of a good employer is how well they employ people who have been proven to be whistleblowers.
People such as Eileen Chubb and David Drew have sacrificed their careers to highlight bad care, but they have not seen the systemic changes for which they made those sacrifices and they are still suffering the consequences. Surely that is a part of NHS and health culture that the Bill should seek to change.
I welcome the fact that the Care Quality Commission will be looking at the issue of whistleblowers and I welcome James Titcombe’s involvement in the CQC. As someone who thought that the CQC brand was so damaged that it should probably just be scrapped and we should start again, I have to say that I think David Prior has made remarkable progress, given what he started out with, in beginning to turn this monolith around.
Statutory independence of the CQC is very long overdue. I think that everyone in the House has been concerned about the fact that the CQC’s mission seemed to be reputation management for itself and the NHS, and not a brave and courageous stand on behalf of the patients it was supposed to be protecting. In order to ensure that the CQC remains independent from Government—independence in words is fine, but independence in culture is what really matters—it might be illustrative to look back to the era before the CQC and other regulatory bodies were in place, when royal colleges used to send their members into hospitals. They would do so not to inspect hospitals as such, but for reasons of medical training. However, by getting a granular view of the training on offer they could see whether or not it was sufficient. If not, the royal colleges could, under bodies such as the hospital recognition committee, withdraw training from a hospital, which gave the inspection teeth. It was the royal colleges that went in—often without any pay at all; just enough to cover expenses—and interviewed junior doctors and consultants individually, and problems naturally came to light because the interviews were often confidential.
A Wigan hospital fell foul of an inspection in 2001 and its chief executive did not take kindly to it. Funnily enough, just after the inspection took place, the chief executive, who was quite close to Alan Milburn and the then Prime Minister, went into the Department of Health and abolished the system whereby professional clinicians could get a granular view of what was going on in hospitals, replacing it with the postgraduate medical education training board and then the medical training application service, which was disastrous. The more we can put those who do not have an interest in bolstering the Government of the day—namely the professionals, clinicians and members of the royal colleges—on the ground and doing granular investigations, the more confident we can be that the CQC will be independent.
Grahame M. Morris
I am not sure that I share the hon. Lady’s enthusiasm about the transformation of the CQC; nevertheless, some progress has been made. Does she share my concern that clause 85 proposes to dilute the CQC’s powers with regard to investigating the commissioning of adult social services and social care by local authorities? Is that not a step backwards, particularly if the hon. Lady is concerned about the issue of 15-minute visits and the impact that has on quality?
Charlotte Leslie
I am afraid that the quality of care and social care could be the next boil of scandal to erupt as we gain a more granular view of what is going on. Organisations need not just more effective tick-box inspections, but more effective granular inspections. I do not agree with the hon. Gentleman: I think the CQC is taking great steps forward. I am very sceptical, but I am cautiously optimistic of progress and will continue to look at what the CQC does.
I will make progress, because I do not want to prevent other Members from contributing to the debate. Essentially, the Bill can only put down regulation. One of my favourite things is to warn against systems so perfect that nobody needs to be good, yet this House really only has levers to change systems. We cannot always enable people to be good, but we can devise systems that enable them to be good. This House is attempting to turn around a massive cultural tanker and it is unrealistic to think that we can do so through the scope of a single Bill. I think, however, that the Bill takes very important steps forward in a very difficult context. I am disappointed that it is not supported throughout the House, although I think that constructive amendments and changes to it will be welcomed in the interests of the patients we are all here to serve. I heartily recommend the Bill to the House.
Paul Burstow
I give way to the hon. Lady because she tried to intervene first.
Heidi Alexander (Lewisham East) (Lab)
It is a pleasure to follow the hon. Member for Newton Abbot (Anne Marie Morris), who made a measured, thoughtful speech. It is sad that the Secretary of State did not strike the same tone at the beginning of the debate. I want to speak briefly about the proposals for the funding of elderly care and express my deep concerns about the Government’s proposed changes to the trust special administration process.
I have spoken before in this place about the care crisis in this country, not least because of my own family’s direct experience. When my nan had to move out of her home seven years ago, my family had no idea what was about to happen to the very modest assets she had built up over her lifetime. My nan was not an extravagant woman. She never once went abroad. She simply worked hard and brought up her family. When vascular dementia took hold of her mind and her body, she could no longer stay in the semi-detached house in Swindon she had bought with my grandfather. She had to sell it. She moved to sheltered accommodation but, after a few years, she deteriorated rapidly and soon had to move to a nursing home. Before she died, she spent £130,000 on care in that home over three to four years, using up all but £23,000 of her lifetime assets. If she had known that, it would have broken her heart. She would not have thought it fair that everything she and my grandfather had worked for could not in any meaningful way be passed down to her children. My family are neither rich nor poor; we are like families up and down the country for whom the hand of fate intervened resulting in catastrophic care costs for their loved ones.
The Bill’s proposals to cap those costs and to raise the amount of money that an individual’s family can keep after paying for care should be welcomed, but we should welcome them cautiously. The cap does not cover all care costs, and the complexity of the process of valuing people’s assets and calculating their personal contribution means that many people will still end up paying very significant sums. Presenting the proposals as the answer to the country’s care crisis is disingenuous and risks spreading even more confusion about what support from the state families can expect.
If individuals are to pay less, the state will pick up more of the tab, and the financial front line in that respect will be local authorities. They are already buckling under the strain of providing social care. London Councils, the body representing the capital’s local authorities, estimates that the costs of resetting the means-test threshold, added to the rising demand for care, will see social services departments facing a shortfall of more than £1 billion in the years between 2016 and 2020. The money set aside by the Government to deal with that is inadequate. Be it this Government or the next one, we have to wake up to the scale of the financial challenge and answer the tough questions about where the money is going to come from.
I could speak for much longer about the care proposals in the Bill, many of which I welcome, but I now wish to address part 3, chapter 4, which extends the powers of special administrators appointed to failing hospital trusts. The changes are only a small part of the Bill, but they have serious implications for hospitals and the health service across the country. The introduction of even more draconian powers for special administrators will hamper the public’s ability to have their say on key hospital services and could lead to a chaotic and rushed system of hospital reorganisations that will not be in the best interests of patients or our democracy.
Grahame M. Morris
My hon. Friend is making important points about clause 118, which has become known as the “Lewisham clause”. Given the recent experiences of the length of time the trust special administrator has to consult the general population, does she think that 100 days is long enough?
Heidi Alexander
In my experience, it is wholly inadequate. The consultation period is being slightly extended through this Bill, but I still do not believe it can lead to a genuine, open and honest debate between the people trying to lead change and the public, who have a right to make their voice and views heard.
I wish to discuss our experience in south-east London of the first ever use of the trust special administrator regime when the South London Healthcare NHS Trust was placed into administration last year. It is important for the House to understand that this process is totally different from any other hospital reconfiguration. It is a very fast process—roughly six months from start to finish—led by an administrator who is brought in from outside the organisation primarily to balance the books. The administrator is appointed to a specific failing trust, but what happened in our corner of London was that the administrator determined that in order to sort out the financial problems of the failing trust he needed to look beyond its confines, and that is where Lewisham hospital came in: a separate, successful, neighbouring hospital was told that its full accident and emergency department, its maternity service and its excellent paediatric department would have to go to solve the financial problems elsewhere.
The people of Lewisham did not think that that was very fair. The case was fought in the courts and the Secretary of State was told, not once, but twice, that he was acting unlawfully—hence clause 118; he fought the law and lost, so he is now trying to change it. He wants administrators to be able to specify and force through massive service changes at hospitals that are not part of the trust to which an administrator has been appointed. In effect, he wants to do elsewhere what the courts told him he could not do in Lewisham. When the trust special administrator regime was first legislated for, guidance was issued by the Department of Health stating that the process should not be used as a “backdoor approach” to reconfiguration. That is precisely how it was used in Lewisham, and had the law not been on our side, our full A and E and maternity service would now be closing, and half our hospital would be up for sale.
The TSA process is a brutal and rushed one. It starts with the need to save money, with questionable clinician input. When the starting point is the accountant’s bottom line, the public are understandably sceptical about whether the medical and clinical input has just been shaped to suit the desired financial end point. The speed at which the process takes place leads to shoddy and haphazard work. The administrator in south London recommended to the Secretary of State that he make decisions about Lewisham hospital based on an understanding that the whole process would cost £266 million and would take three years to implement. After the Secretary of State took his decision, it emerged, from the office of the trust special administrator, that it would cost twice that and take twice as long. The quality of the condensed public consultation was atrocious: people were struggling to find copies of the consultation document in local libraries; we had an online response form that did not even contain a direct question about Lewisham’s A and E; and hundreds of people had to stand outside packed public consultation meetings because they could not get in. That is not the way to deal with a subject that understandably arouses such passions in people. People care so much about the health service because it is often where they experience the worst and best moments of their life. They want to have their say in how their services are organised, and giving even more draconian powers to special administrators erodes their ability to do that.
I understand that hospital services have to evolve—some services will have to close or be relocated—but to get public support for change, we have to get the process right for persuading people of the case for change. An augmented special administrator process, acting as a steamroller for the closure of hospital services, makes it less likely that those arguments are won, not more. These changes are at complete odds with the Conservative party’s manifesto commitment to
“stop the forced closure of A&E and maternity wards”.
The changes take power from the very doctors the Government say they are giving power to and could destroy trust in those who are central to leading the case for change and improvement in our NHS. For that reason, as well as others, I will be voting for the Opposition amendment, and it is why I believe that clause 118 should be deleted from this Bill as it progresses through Parliament.
Grahame M. Morris (Easington) (Lab)
I am pleased to have the opportunity to speak in this debate. Like several colleagues who have spoken, including the hon. Member for Totnes (Dr Wollaston), I served on the Joint Committee on the draft Care and Support Bill, under the chairmanship of the right hon. Member for Sutton and Cheam (Paul Burstow), and I also serve on the Health Committee, so I have a particular interest in this Bill. I had originally intended to make a more wide-ranging contribution, but I will confine my remarks to part 1, which deals with care and support.
I had hoped that the Secretary of State would conduct a hearts and minds exercise in trying to selling the Bill, so I was rather disappointed that he turned it into a political knockabout, jumping straight into the most contentious elements, and clause 118 in particular, which sets out the trust special administration arrangements.
I do not think that we can consider the Bill without giving some thought to the background. Let us not forget that over this Government’s tenure, £2.68 billion— at 20% of the net adult social care spend, that is not an inconsiderable sum of money—has been cut from council budgets. Although we were talking about the principle of well-being in relation to clause 1, which I think all Members support, in practice cuts of that level mean that fewer people are getting help with paying for their care and more people are being charged for vital services, such as help with getting washed and dressed and with eating—the basic things that most of us take for granted.
I have no doubt that councils, particularly those in the north that I am familiar with, are doing their best to save money and provide services efficiently by changing the way care is provided and, where they can, working more closely with the NHS. However, the scale of the cuts means that they are being forced dramatically to reduce services and increase charges to balance the books. All the evidence that has come to the Select Committee and the anecdotal evidence that Members receive indicates that is the case.
The Secretary of State got into a little argument in his opening statement with regard to eligibility thresholds, which is a really important point. In 2010-11, 38 councils provided free care to people with “low” or “moderate” needs, and 114 provided free care only to those whose needs were considered “substantial” or “critical.” Those needs really are substantial and critical, as we can see if we look at the definitions, which are set out in the guidance. Now, however, only 15 councils continue to provide care and support to people with “low” and “moderate” needs and 137 provide care only to those assessed as having “substantial” or “critical” needs. That means that in many areas preventive services have all put disappeared. Setting the threshold at such a high level is therefore a false economy.
According to Age UK, as a result of tightening eligibility criteria, 800,000 people in the UK have a care need but are not getting any support. As my right hon. Friend the Member for Stirling (Mrs McGuire) mentioned, there is another care crisis, because a third of the total of those requiring care are working-age adults. Indeed, four in 10 working-age disabled people who receive social care say that it does not meet their basic needs, including eating, washing, dressing and getting out of the house. One in three says that cuts in social care have prevented them from working or volunteering.
Charges for vital care services, such as home help and meals on wheels, are increasing fast. In effect, that is a tax on some of the most vulnerable people in our society, people who have already been hit the hardest by benefit changes. Some Government Back Benchers talked about the need to cut the deficit. There is a need to address the economic situation, but not on the backs of the poorest and most vulnerable. To my mind, it is a question of political priorities. I am proud that my party has pledged to scrap the bedroom tax, which I think brings great shame on the coalition Government because of its impact on disabled people.
Other Members have mentioned the consequences of price variation. I do not want to repeat those arguments, but it certainly is a factor when calculating the care costs for the cap. For example, in Tower Hamlets home care is free, but in Cheshire East—I am not sure which hon. Member represents it—it costs £20 an hour. In east Durham, the area I represent, it is about £10, so there is wide variation in costs.
We cannot improve the quality of care for older and disabled people without improving the working conditions of the 1.5 million people employed in adult social care, many of whom are on low pay and lack job satisfaction. In many cases that can lead to poor care for some of the most vulnerable people in society. Care workers do an incredibly valuable and important job, yet the TUC has estimated that between 150,000 and 220,000 of them are not even paid the legal minimum wage, and over 300,000 are employed on zero-hours contracts.
Sheila Gilmore
Does my hon. Friend agree that the problem of low pay and poor conditions, which he is outlining so well, is a concern for not only the workers, but ultimately the people receiving the care, for example because of the lack of continuity of care?
Grahame M. Morris
My hon. Friend makes an excellent point. That ties in with home care visits. The United Kingdom Homecare Association has indicated in a briefing that three quarters of home care visits now last 30 minutes or less and that one in 10 last only 15 minutes. There must be deterioration in care if carers are there for only 15 minutes. Care rationed in 15-minute slots is simply unacceptable, and I think that the House should reflect on what is happening. This is important because older people end up in hospital unnecessarily and stay longer than is necessary. There has been a 42% increase in delayed discharges from hospitals since figures were first collected in August 2012. Indeed, last month saw the largest number of delayed days in hospital ever recorded, and there were 78,400 such days in October alone. These delayed discharges now cost our NHS £20 million each month. That money could be used to fund about 1.5 million hours of home care for vulnerable older people and help to keep them out of hospital when they can be supported in their own homes.
Ministers claim that they want joined-up services, but through the Health and Social Care Act 2012 they legislated for fragmentation. Their integrated transformation fund contains no new money but is made up of £3.8 billion that is coming out of existing NHS and social care budgets. I accept that the Bill provides a framework and establishes important principles, and there are things that we can agree with. However, fine words are all very well, but we need immediate action such as the measure proposed by my right hon. Friend the Member for Leigh (Andy Burnham) to use £700 million from this year’s NHS underspend to help tackle this crisis now. We need some vision from all parties but especially from the Government parties.
I looked at some old early-day motions to see how some of these proposals were tackled in the past. My hon. Friend the Member for Sefton Central (Bill Esterson) suggested that this should be paid for through general taxation, and I agree. In one old EDM, a number of Members from all parties agreed with that principle; I see some of them nodding now. It is not such a radical or revolutionary step.
We clearly need a wholesale change in how we deliver health and social care. We need a whole-person approach and a national care service. We need the same ethos that applied during the establishment of the NHS, which brought together disparate entities and groups into one body. We need to bring health and social care together into a single service that provides all the care an individual will need throughout their life.
The Bill has many positives, but it is fundamentally important to deal with the eligibility threshold. If it is set above “moderate”, it will do little to help working-age disabled people.
If the Minister does not mind, I would like him to clarify whether the duties of openness and transparency in the Bill will apply equally to all organisations that provide NHS services, including private contractors who provide outsourced services; he will be aware of my ten-minute rule Bill. I urge people to consider the Bill and to support Labour’s amendment.
NHS Funding (North-East and Teesside)
Grahame Morris Excerpts(11 years, 8 months ago)
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Tom Blenkinsop
My right hon. Friend predicts the final part of my speech. I hope the Minister will take the opportunity to put our fears to rest. Unfortunately, the information that I have received to date does not reassure me.
Grahame M. Morris (Easington) (Lab)
I compliment my hon. Friend on securing such a timely and important debate. I completely agree that one of the most worrying aspects is the potential changes to the funding of clinical commissioning groups. Easington would lose £62 a head. Does he agree that that could be seen as political gerrymandering, with the poorest areas deprived of funding and the wealthiest, such as east Hampshire, getting increases of as much as £164 a head? The areas with the best health outcomes will get the biggest increases in resources.
Tom Blenkinsop
My hon. Friend has mentioned that in Health questions and in the Select Committee on Health, of which he is a doughty member who provides a lot of input. Someone from a poorer socio-economic background has a lower likelihood of reaching the age at which they would receive more funds under the allocation—it would probably never happen. This becomes a self-defeating, vicious circle of a lack of investment in people who might need it the most.
As I was saying, the proposals in a recent working paper issued by NHS England on the allocation and the indicative target allocation would have led to a per capita reduction in funding for CCGs throughout the north-east, and my constituents would have lost out. Meanwhile, CCGs in the south would have had a per capita increase; for example, those covered by Coastal West Sussex CCG would each gain £115, those in Hailsham £136, and those covered by South Eastern Hampshire CCG £164. That is clearly not a one-nation NHS. I received ministerial assurances that that formula was not ultimately used for 2013-14, but a response to a parliamentary question that I asked confirmed that
“No proposals or decisions regarding allocations for 2014-15 have yet been made.”—[Official Report, 22 October 2013; Vol. 569, c. 76W.]
The hon. Member for Stockton South (James Wharton), who is in the Chamber, told the Evening Gazette on 23 October that it was indeed “right” that NHS England was considering reducing health funding for his constituents and the north-east, but—
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
It is a pleasure to serve with you in the Chair, Mrs Riordan.
A lot of political smoke has been blown across the Chamber today by the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop). I have a lot of time for him personally, and he came to see me earlier in the year to express some legitimate concerns about the performance of his local trust. On the basis of our meetings, I hope to reassure him that there has been considerable progress locally in his area.
More broadly, it is worth setting the record straight on some of the points made today. We have had discussion about the ambulance service, which I will come to, and we have talked about winter pressures, which I will address. First, however, on the funding formula, my hon. Friend the Member for Stockton South (James Wharton) was right to point out that it is set independently of the Government. Before we handed independent formula setting to NHS England, the Government made it clear that deprivation is a factor and it is taken into account in the current arrangements. There is a 10% weighting for deprivation in the funding formula, which as a Government we ensured was preserved in the formula. Under the new arrangements, there is more political independence in setting the funding formula.
Dr Poulter
Not at the moment. The independent Advisory Committee on Resource Allocation, or ACRA, as hon. Members have mentioned in the debate, historically has advised that the funding formula should be readjusted to take into account demographics and the increased health care needs of older populations in other parts of the country. The Government, however, in the past chose to maintain support for deprivation as a factor in health care funding, but the decision is now not one for the Government. It is now for NHS England to listen to the independent advice, but I would find it strange were there a sudden change in the funding formula that did not factor in deprivation, as done in the past.
It is important to set the record straight. The decision is not political; in the past, the Government preserved a weighting for deprivation, but now the decision will be taken separately by NHS England. Its decision will be made on the basis of clinical need, although of course deprivation will be a factor.
Dr Poulter
My predecessor was in place when setting the resource allocation was in the Government’s gift. As the then Minister made it clear, a weighting in the formula for deprivation would be preserved—he stood by his word and that weighting was preserved. NHS England, not the Government, now sets the funding formula—to avoid political interference—and those in NHS England, in conversation, have made it clear that they also value a weighting apportioned to deprivation.
Dr Poulter
No, I will not give way. I have said things clearly for the record, without any political smoke.
As a Government, when we had control of the funding formula, we clearly put in a weighting for deprivation and for some of the poorest communities. I am proud that we did so, but it is now for an independent body to look at the case and at the independent advice that it has been given. I would find it extraordinary, however, if it were not to factor deprivation into its decision making, although there are other factors that it will want to put into the equation, such as the fact that older people are the greatest users of health care, so places with lots of older people also need to be recognised. A number of factors will be taken into consideration, and deprivation will be one of them. I have been reassuring about that, and I will not allow the Labour party or any hon. Member to make mischief with something that the Government have stood by.
Dr Poulter
I will not give way because the hon. Gentleman should listen to the answers to some of his questions and realise that his local health care services are improving thanks to the Government’s increased investment in the health service—[Interruption.] Hon. Members have been incredibly political in everything they have said today, and I am putting answers on the record. If the hon. Gentleman does not want to hear them, he should not have raised the debate.
The latest data for 27 October 2013 show that South Tees Hospitals NHS Foundation Trust’s performance against the 95% standard for A and E waits is 96.8%. Over the last 23 weeks, it has met the national 95% target for A and E four-hour waits. The local trust is performing very well in treating patients in a timely way when they arrive at A and E. That is contrary to the points that the hon. Gentleman was trying to make.
At James Cook university hospital, the acute admissions unit is adjacent to the A and E department, so enabling the trust better to manage the flow of patients and to ease pressure on A and E. The trust has recruited two additional consultants and six additional junior doctors to the acute medicine departments, so easing pressure on the A and E department. Considerable investment is being made, and additional nursing staff have been recruited to support 50 more acute hospital beds that will be in place this winter. The hon. Gentleman must be aware that there is a lot of investment locally, with more beds, more staff and better care. It is a pity that he could not acknowledge that in his speech. I am putting it on the record, so that his constituents are aware of it.
Grahame M. Morris
The Secretary of State announced an additional £250 million to relieve pressure on A and E, but none of it was allocated to any of the hospitals in the constituencies of my right hon. and hon. Friends here.
On the incidence of ill health in deprived areas, half of the people presenting to hospitals suffering from hepatitis C, which is completely treatable and curable, come from the poorest 20% and three quarters come from the poorest 40%. Is it not right that additional resources are provided to those poorest areas to tackle such diseases?
Dr Poulter
The hon. Gentleman is absolutely right, and that is why the Government have given local authorities the power to deal with sexual health services. He will be aware that a major cause of hepatitis C—for the record, it is not curable—
Dr Poulter
Indeed, but it is not curable as the hon. Gentleman stated. He should get his facts right before making statements in the Chamber. It is not curable, but it is treatable and the best treatment is prevention, which is why we have given a considerable amount of money to local authorities to take on the public health responsibility and to ensure that local authorities are in the right place to look at primary prevention of transmissible sexual diseases. He will be aware that hepatitis C is sometimes transmitted via the sexual route. The Government have put us in a better place to deal with sexual health issues and to tackle them in future.
There has been talk about ambulances, and it is worth highlighting that the most recent data, for September 2013, show that the North East Ambulance Service NHS Foundation Trust is meeting the category A8 red 1 measure 80.6% of the time and the A8 red 2 measure 80.8% of the time against an operational standard of 75%. The ambulance service is doing marvellously well in the north-east. It is meeting category B19 with a performance of 97.7% against an operational standard of 95%. That is a good performance in the north-east by anyone’s standard. The ambulance service is performing very well. Other ambulance services that may receive more generous funding are struggling, sometimes due to mismanagement, particularly in my part of the country in eastern England.
It is very difficult for the hon. Member for Middlesbrough South and East Cleveland to make any case for lack of funding or other problems with his ambulance service when health care funding for the north-east is going up under this Government and the ambulance service is performing well according to national performance indicators. Those are the facts, and if he did not want them on the record, he should not have raised the debate.
It is more in sorrow than anger that I make those points. When the hon. Gentleman and I had a constructive meeting earlier this year to discuss local health care services, there was not the political smoke or the chorus backing him that there has been in this debate. Genuine issues were raised about his local health care service, and he and I, with local commissioners, worked to put improvements in place. As a result of that meeting, there are more staff, more winter beds and more investment in his local trust. The local community hospitals that he was so concerned about are in a much better place.
I am sure the hon. Gentleman will come back to me if further issues arise, but his part of the country is much better placed than many others to deal with the pressures of winter. He should be proud of that, and I hope he will take the opportunity after this debate to champion his local NHS and the good work at local level by front-line staff who are delivering improvements. I hope he will take that opportunity and that we will not have to come back here and listen to him running down his local health services.
Changes to Health Services in London
Grahame Morris Excerpts(11 years, 8 months ago)
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Mr Hunt
I would be more than happy to meet my hon. Friend and his local pharmacists. There is a lot that pharmacists can do. One change we are making that could make a big difference, where proper protections are in place for patients, is allowing pharmacists to access GP records so that they can give people the correct medicines, know about people’s allergies and things like that. There are lots of other things as well, though, and I look forward to the discussion.
Grahame M. Morris (Easington) (Lab)
The statement has broader implications beyond London, although I accept that colleagues from Islington and Ealing want to ensure they have their A and E facilities. On smaller A and E facilities outside London, however, the Secretary of State said there would be no political fixes, yet when he announced additional moneys to deal with winter pressures on 53 NHS trusts, there were none in the north-east of England. What assurance can he give my constituents that hospitals in the north-east will have sufficient resources to meet the demands placed on them in winter?