Health Care (London)

Debate between Heidi Alexander and Karen Buck

Wednesday 8th January 2014 Westminster Hall

[Ms Buck]

My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) is completely correct. Lewisham hospital brilliantly exemplifies the argument.

Secondly, there must be effective partnership working between hospitals, primary care providers and local authorities in the delivery of services. It was the failure even to inform partners that elective surgery had already moved from St Mary’s hospital to Charing Cross hospital that prompted my debate some weeks ago, to which the Minister replied, and which subsequently prompted an apology for the breakdown in communication. That was not only a matter of leaving someone off an e-mail circulation list, but a complete unwillingness to collaborate even within the national health service, let alone with outside bodies such as the local council, which is responsible for social care delivery.

Furthermore, those three boroughs—Kensington, Westminster and Hammersmith—are part of a pilot scheme to demonstrate integration, yet what happened in the relationship between the Imperial College trust and those local authorities could not have been further from integration—it was like something written for a comedy sketch.

Even worse, fundamental confusion remains about how north-west London hospitals are to be configured with Hammersmith—my hon. Friend the Member for Hammersmith (Mr Slaughter) is in his place and I am sure will comment—which has a different spin on its hospital provision from Westminster, even though they are joined in a tri-borough arrangement. Even after the Secretary of State has blessed the restructuring of west London hospitals, just weeks before Imperial concludes its outline business case, we cannot even have a clear agreement on the status of Charing Cross hospital or, by extension, of St Mary’s. That goes to the very heart of whether we can have confidence in the new structure of the national health service.

Thirdly, everyone needs to keep focused on the key issues, and that takes me to the devastating impact of the Government’s ill-considered reforms on the strategic management of London’s health service. The service should be focused like a laser on delivering the vision set out by Lord Darzi, but instead it has been fragmented, diverted and injected with rules on competition when integration should be the key objective.

The King’s Fund report of only some months ago, “Leading health care in London”, stated that the recent NHS reorganisation and the abolition of strategic health authorities and primary care trusts have resulted in an “absence” of health care system leadership in London. The report states:

“The NHS reforms have created a much larger number of organisations in London and their purposes are not always well aligned; the risks of incoherence and inconsistency are high…Reorganising the NHS in London in such a fundamental way has made a challenging situation much more difficult”.

That is so significant that the country’s top emergency doctor has said that the current A and E crisis could have been averted two years ago had the Government heeded warnings of a looming collapse in casualty ward staffing.

The president of the College of Emergency Medicine has said that Ministers and health chiefs were “tied in knots” by the challenges of implementing the coalition’s health reforms from 2011 onwards, leading them to ignore the first warnings from the college of imminent crisis—that the NHS was failing to recruit enough A and E doctors. Therefore, London, which possibly has the most complex challenges and the greatest need for integrated strategic leadership, actually has the least such leadership. Had leading health care managers and professionals been able to concentrate on dealing with such tasks, we might have had some opportunity to build public confidence, carry people with us and make the changes. In fact, the exact reverse has happened.

Finally, we need community and social care and other support services that minimise unnecessary admissions, especially for chronic conditions, and facilitate early discharge. Again, we can all agree on the principle. There are some excellent specific examples of integrated practice and of people working hard to deliver it, but there are also some harsh truths of individual experiences and the funding of social care.

The reality is illustrated in letters from my constituents in response to the moving of elective surgery from St Mary’s. One letter states:

“When I had my mastectomy I was sent to Charing Cross Hosp. After the operation I went home by bus and underground holding my drainage…bottle…from my operated breast. In the same way I travelled after my cardiac arrest on my second lumpectomy due to anaphylactic shock!”

That is only one hazard of putting patients with no family far from where they live. A second letter states:

“They took my City of Westminster Taxi card from me and so I have to pay for taxis to take me to St Marys Hospital and…Charing Cross. I pay £6.50 there and the same coming home (£26 one way to Charing Cross). I cannot walk far”—

—she is unable to use public transport—

“as I get out of breath. I am 84 this year”,

diabetic and

“have had one breast removed with cancer.”

Another constituent told me:

“I have lost my…home help”—

due to the cuts in social care—

“If I’m ill, I wait for it to go away.”

London as a whole faces a £1.14 billion shortfall in social care funding as a consequence of the pressures on adult social care and of the extra costs likely to arise because of the cap—in principle, that is a good thing, but obviously revenue is necessary to fund social care costs. That situation is London-wide and has been set out clearly in a London Councils report. My local authority also set the situation out clearly in a report to the health and wellbeing board, which states:

“As a result of reductions in local government funding Adult Social Care…has to deliver substantial savings in 2013/14”—

£4.4 million in Hammersmith and Fulham, £2.1 million in Kensington and Chelsea, and £2.9 million in Westminster. The report continues:

“These are very large savings; the cumulative effects are much bigger than any other savings programme delivered in the local authorities in the past.”

That is on top of £8 million in cuts to the adult social care budget already coming into effect since 2011. The report states:

“Amongst big reductions to back office and support functions, the savings programmes also include reductions in the use of packages and placements, the greatest area of spend for ASC.”

Rather sweetly, it adds:

“Some of the savings projects may be difficult to deliver or may take longer than anticipated.”

It continues:

“Funding growth for packages and placements arises mainly in the Learning Disabilities, Mental Health and the Young Disabled care groups where client numbers are growing, but also in Older People, as people live longer and are supported in the community.”

There is an important point. There is an integration care fund, which is shifting money from the NHS into social care, but, as Westminster council’s report on the pressures on social care funding states, that funding will mainly be used for purposes that include:

“To sustain services, otherwise at risk from savings plans”.

We are in an extraordinary position. There is a transformation fund designed to put in place the services that would allow us to make changes in hospital care, with which in principle we agree—we would argue in some specific cases—but that funding is simply going to fill the gaps caused by the cuts in social care, which are the result of cuts to local authority budgets. In London, as we know, there has been a 25% cut in local authority funding, with a further 10% cut as a result of the Chancellor’s autumn statement. Much of that new money is simply sustaining services that would otherwise be at risk from savings.

[Heidi Alexander (Lewisham East) (Lab)]

Is my hon. Friend aware of the estimate made by London Councils for the future? Between 2016 and 2020, we might see adult social care departments facing budget pressures of £1.1 billion, owing to rising demand and some of the changes proposed by the Government. Does she agree that the future looks extremely bleak?

[Ms Buck]

I agree totally. A thoughtful and planned process throughout London that would allow us to build up community and primary services, reduce unnecessary A and E admissions, speed up unnecessary discharges and concentrate some of our specialist services in fewer sites is sensible, but the means to realise it have been pulled out because of the pressures on social care funding. Furthermore, the strategic leadership that would allow us to make changes has been undermined by a completely unnecessary, £3-billion, top-down reorganisation that we were promised would not happen.

New Housing Supply

Debate between Heidi Alexander and Karen Buck

Tuesday 5th March 2013 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

It is a pleasure to follow the hon. Member for Folkestone and Hythe (Damian Collins). I did not agree with everything he said, but I certainly agree with his last point that it is just plain wrong that, in the 21st century, we are paying money through housing benefit to slum landlords. I will probably pick up on that theme later.

I congratulate the Chair of the Select Committee, my hon. Friend the Member for Sheffield South East (Mr Betts), on opening the debate. I was a member of the Committee when we conducted the inquiry and the report was written up, and I think it should provide the Government with a lot of food for thought. I will be interested to hear what the Minister has to say in his updated response.

This Friday, I will do my advice surgery in my constituency, and I can guarantee that I will speak to at least five people who have come to talk to me about problems with housing. There could be up to 10 such people on Friday, but I know that during the course of a year, I speak to hundreds of people about their housing circumstances. More often than not, I speak to mums who come with their children and who are living in desperately overcrowded accommodation. I sometimes see whole families who are living in just one room. These people are often working, sometimes with part-time jobs, but they are living in completely unacceptable housing conditions and I believe that Members of this House, and the Government, have a duty to address the appalling conditions that many of my constituents live in.

In the three years that I have been doing my advice surgeries as a Member of Parliament, not once has anyone come to see me about a housing problem who could afford to buy a house in Lewisham. The average cost of a property there is £260,000, but the average salary is in the region of £29,000. Furthermore, the vast majority of people who come to see me at my advice surgeries cannot afford to buy through the part-buy, part-rent arrangements either. Many of the shared ownership schemes that housing associations run in London are completely out of the reach of many of my constituents, because the salary required in order to access the schemes is many times the amount that many of my constituents earn; and yet we have a situation in which people are paying out huge amounts of money in the private rented sector, often to live in very poor conditions.

I want to focus on the need to build social rented housing in London. The reality of what has happened under this Government is that the number of affordable homes being built has collapsed. Nationally, 34,000 fewer affordable homes were started in 2011-12 than in the previous year. That represents a 68% drop. We should not be surprised about that, because one of this Government’s first actions when they came to power was to cut the national affordable house building programme by 60%. They signalled their intentions for the supply of new affordable housing when they made that decision.

Of course, that money also enables other housing to be built. What I mean by that is that some of the grant that goes into developments to deliver social or affordable housing enables a mixed-use scheme with mixed tenures to be created. Last year, when the Prime Minister and the Secretary of State for Communities and Local Government launched their NewBuy scheme, they chose to come to Lewisham. They stood in a development there that had been constructed only because of a £25 million grant from the Homes and Communities Agency. The scheme, which is providing nearly 800 new homes—about 200 of which are affordable—was coming out of the ground only because of the capital grant from that agency.

I cannot overstate the need to build social rented homes in London, yet in the period between April and September 2011, only 56 new homes for rent were started by councils or housing associations. That was 56 in a six-month period in a city of 7 million people. That is not acceptable.

My own local authority, Labour-run Lewisham council, is due to build 250 new homes, but that is a drop in the ocean compared with the number of families on the housing register there. We have talked about ways of getting more finance into building affordable homes, and I support the comments made on the need to lift the borrowing cap placed on local authorities.

I ask the Minister to consider what more the Government could do about the number of overseas buyers purchasing property in London. Roughly 60% of new-build homes in London are being bought by foreign investors, which is ramping up the London housing market, pushing prices even further away from my constituents. If London is seen to be a safe haven for foreign investors in the London property market, we must surely be able to find a way to capture some of that investment in our great capital city to plough back into the delivery of affordable homes.

[Ms Karen Buck (Westminster North) (Lab)]

Does my hon. Friend share my concern about the scale of the buy-to-let market in ex-social housing in particular? Does she share my shock that there can be two next-door properties, of which one will be in the social rented sector at a rent of, say, £100 a week, while the other will be in the buy-to-let market in social housing with a rent of £500, £600 or in some cases even £700 a week? In what way does that provide any kind of value for money?

[Heidi Alexander]

I totally agree with my hon. Friend, and our hon. Friend the Member for Hammersmith (Mr Slaughter) made a similar point. We are lining the pockets of private landlords on an industrial scale. There are no two ways about it.

Another suggestion I would put to the Minister relates to public land. The Government often talk about releasing public land to deliver new homes. There is a lot of rhetoric about this, and we do not see a huge amount of progress. In my constituency, we are experiencing the possibility of Lewisham hospital having two thirds of its land and buildings sold off. There are many hospitals in London for which significant land disposals are going to take place. What discussions has the Minister had with his colleagues in the Department of Health? If these disposals are going to happen—let me be clear that I am very much against it for Lewisham—can we secure requirements for 50% of the land to be used for affordable housing, as these are considerable sites of public land?

I would like feedback from the Minister on what he is doing with other public sector bodies to parcel up land to make it available to small and medium-sized builders. When this country was building the amount of housing it needed to meet the demand many decades ago, we saw small and medium-sized builders providing a far greater proportion of the homes built. At the moment, 75% of new homes come from seven of the largest house builders. If we could find a way of parcelling up the public sector land, enabling small and medium-sized builders to get hold of it for building purposes, that could be a win-win situation.

Gangs and Youth Violence (2011 Riots)

Debate between Heidi Alexander and Karen Buck

Tuesday 4th December 2012 Westminster Hall

[Ms Karen Buck (Westminster North) (Lab)]

I am extremely grateful to have the opportunity of the debate today, which I secured for two reasons. First, given that the riots of 2011 were so dramatic and one of the most momentous events in modern British history, justifying the recall of Parliament, it strikes me as somewhat extraordinary that we have not found an opportunity in the 15 months since to discuss them, their aftermath and what actions can and should be taken to ensure that such violence is not repeated. The Government gangs strategy was released in November last year, so we are at its anniversary, and the Government have reviewed progress, but we have not had an opportunity to discuss the events, certainly in Government time. I find that extraordinary, and I am grateful for the attendance of hon. Friends who represent boroughs affected by the riots for the most part, or by serious gang and youth violence, to talk about some of the effects on their communities.

Secondly, for a related reason, I very much want the opportunity to stress to the Minister, in the hope of reassurance, that the modest amount of money that has been invested in tackling gangs and serious youth violence over the past year, whether through the Home Office or the Mayor’s office, should continue beyond March next year at its present level at least. I will refer to that as I move on in my contribution.

Gangs and serious youth violence have been a feature of our cities for far too long. They are distinct but overlapping phenomena with similar roots. As I am sure colleagues will mention in their contributions, certain elements of the 2011 riots were specific to the time and place in which they occurred but, in general, the factors driving the gang and serious youth violence of recent years, which exploded into the riots, have the same stem. If we are to understand what happened and, ideally, to prevent and bear down on such phenomena in future, we need to understand both of them.

Acres of debate have been generated in the media and academia since the 2011 riots, which is one reason why not having the opportunity to discuss such findings to any extent in Parliament has been unfortunate. So much of the media coverage, however, was extremely unhelpful to our understanding. A lot of the reporting was wrapped up in language that betrayed the worst stereotypes, with talk of “feral youth” or “the underclass”, and reinforced a powerful sense of “the other”, a modern enemy within in our society. That distracts us from understanding the causes of such behaviour.

I was struck by some of the media commentary on the trials and convictions of 18 young people involved in the death of Sofyen Belamouadden at Victoria station in 2010, which casts a different light on some of our analysis of the problem. I met the principal of the college concerned a fortnight ago to discuss some of the issues. Paul O’Shea, that inspirational principal of St Charles sixth-form college, which was attended by almost all those involved in the murder, described his experience thus:

“All but two of the 18 were four-A-level kids. We had nothing in our files to suggest they could behave like this. Their attendance rates were high, and one of the boys had that very morning been given two achievement certificates.”

The idea that we can happily stereotype all young people involved in gang or serious youth violence, or indeed in the riots, as members of a feral underclass is demolished by that very experience, which requires us to think more carefully. As the Centre for Social Justice report was labelled, it is “Time to Wake Up”.

We have to accept that such issues are complex and multifaceted, with emotional, cultural, economic and social causes. We have to grapple with ancient impulses. The behaviour of teenage boys in particular has caused grief to adults for 2,000 years, although now we have to deal with some of the new tools that create new means by which behaviour can be channelled through very rapid communication. As I describe it to myself, the space-time between impulse and action is completely eradicated, which has important implications. What happens through the use of the BlackBerry Messenger service, YouTube or social media has fundamentally changed not how behaviour is expressed but how it can be organised and how young people organise themselves.

[Heidi Alexander (Lewisham East) (Lab)]

My hon. Friend is talking about some of the new technology that can lead to the fast propagation of some of the behaviours associated with serious youth violence. Does she agree that the issue is not only about the speed with which such behaviour can be spread, but about the material online that can escalate and foment a situation, leading to greater problems of retaliation between different gangs or competing groups involved in serious youth violence?

[Ms Buck]

I absolutely agree. My hon. Friend has been a powerful advocate of our better understanding of social media and how they can interact with long-standing patterns of behaviour and yet change that behaviour, increasing the ability of groups to taunt and confront each other through the posting of gang videos. She is absolutely right.

From all the analyses from across the political spectrum, left and right, from politicians, the media, think-tanks and academia we have a whole range of different contributory factors. Family breakdown, unemployment, the absence of effective role models—in particular for young men—poor relationships between young people and the police, the role of social media, excessive consumerism and poverty have all been analysed and put into the mix. We have yet, however, to translate our understanding of all such different factors into a comprehensive strategy for responding to the violence that has plagued our streets generally and to ensure that there is no repetition of the terrible events of 2011. Are we doing enough to translate our understanding of the causes of such behaviour into a specific understanding of, for example, where flashpoints can occur, postcodes, the role of social media or how adult criminals are directing the behaviour of younger members of the gangs? Such adults are sometimes directing from inside prison or even from outside the country. Young people involved in gang behaviour often say that they are dealt with by the police—quite rightly—but adult serious criminal behaviour is often behind the drug dealing or other criminal activity underpinning some gang behaviour, and those adults are not gone after or challenged. Work is being done in all those respects but I can fairly say that it is patchy, inconsistent and simply not good enough to insure against a repetition of the events of 2011.

In London, the number of people who died on our streets as a result of gang and serious youth violence peaked in 2008. It would be extremely unwise, however, for any of us to feel that that might have been a high-water mark for gang and serious youth violence, because it clearly was not. Serious youth violence was surging in 2011, up to and after the riots, and that would have been a more important element of media commentary had the riots not, understandably, distracted so much of our attention. We are only just beginning to appreciate the role of serious sexual violence, and the way in which girls are being drawn into the gang structure and abused.

It is estimated that around 250 gangs are operating in London alone, and that around 88% are involved in violence. Some 18% of individuals in gangs are linked to drug supply, 20% to stabbings, 50% to shootings and 14% to rapes. The Minister may say that we are calling for additional public spending to respond to some of the challenges, but the reverse is true. I want less to be spent on the consequences of that serious criminal activity, and on holding young people in youth offending institutions and prisons. A place in a youth offending institution sometimes costs £60,000 of public money a year. If only a fraction of that could be invested in prevention strategies, we would make a contribution to tackling the deficit as well as criminal behaviour.

When gang violence leads, as it has done, to serious concern about flashpoints in Pimlico, Parliament should regard that as a wake-up call. I am pleased to see the hon. Member for Cities of London and Westminster (Mark Field) in his place, and he may make a contribution. That was a powerful wake-up call for people on Westminster city council because Pimlico is not the sort of place normally associated with the gang culture.

When a Westminster head teacher tells me that

“Hearing gun shots from my office yesterday really brought home to me how close we are to yet another tragedy”,

that should be a wake-up call. When a busy Oxford street store is the scene of a confrontation ending in a teenager’s murder, as happened last Christmas, we are reminded that gang violence cannot be swept out of sight and consigned to the usual suspect areas, such as Tottenham, Hackney and Lambeth. It can explode into everyone’s consciousness.

Given that background, we might have expected the problem to continue in summer 2012, perhaps with a repeat of the riots, and certainly a continuation of that surging youth violence that we saw throughout 2010 and 2011, but the picture is much more complicated. There has been a significant fall in serious youth violence locally in Westminster and across the Metropolitan police area with falls of nearly one third in knife injuries and 21% in gun-related incidents. The number of young people arrested has also fallen, gratifyingly, in recent times. But that makes my case more, not less pressing. If recent months are not to turn out to be an aberration, we must understand what contributory factors bore down on that youth violence, and how we can continue them.

We are definitely seeing the benefits of gang initiatives in my constituency and Met-wide, supported by some outstanding individuals and organisations which are delivering results with better information sharing, such as through the Gang Multi-Agency Partnership—the GMAP process, which monitors individual and gang activity—gang mediation and intensive family support.

I pay tribute to some of those involved in that work, because they do not receive sufficient recognition. They include Matt Watson, who runs Westminster’s gangs unit, and his team; the outgoing Commander Bray in Westminster, under whose watch a police gangs unit was set up and maintained despite all the other pressures on local policing; front-line gang workers, such as Twilight Bey and the Pathways to Progress team; Manni Ibrahim and the youth workers at clubs such as the Avenues, Paddington Boys, the Feathers and others, who have had to deal with the realities of gang violence on the front line; schools and colleges that have worked together; parent and family groups, such as the Tell It Like It Is campaign and Generation to Generation; and individuals who are doing creative work trying to tackle youth unemployment, such as Circle Sports.

It would be good to describe that as an infrastructure, but it would be unreasonable because, important as that work is, and invaluable as those individuals are, it is held together by gossamer threads. We simply do not know how much of the fall in serious youth crime in the last few months is due to the combination of statutory and community activity, and how much is due to other factors. That is an important challenge for Ministers. We may simply be seeing a lull in violence in the aftermath of the riots, when so many people were convicted and imprisoned and the shock waves went to communities in cities up and down the country.

The Centre for Social Justice report warned that the arrest strategy of recent months has weakened the leadership of some of the more responsible elders in gangs and created a greater risk of a more anarchic gang structure growing up in its wake. I do not know whether that will happen, but nor does anyone else, and that is part of the problem. What I do know is that we cannot afford to relax our grip for one moment. There is no evidence that the tide has turned, and in many respects, the underlying conditions for some of that behaviour are worsening because of factors such as the disproportionate cut suffered by the youth services as local government has been squeezed, and the pressure on family poverty and homelessness.

I was struck by a report that was published today by the Human City Institute. It says that social tenants have lost 10% of their purchasing power over the last couple of years—a total of £3 billion. Grainia Long of the Chartered Institute of Housing, who wrote the foreword to the report, said that it

“is very concerned that the combined effects of austerity and welfare reform run counter to the government’s fairness principle, and…that tenants are…disproportionately taking the strain of deficit reduction”.

That sort of upheaval and social stress cuts across some of the work that we are trying to do in tackling gang behaviour.

Long-term youth unemployment is at catastrophic levels, with unemployment of black and ethnic minority young men and women particularly worrying. The youth unemployment rate for black people has increased at almost twice the rate as that for white 16 to 24-year-olds since the start of the recession, and young black men are the worst affected.