Healthy Start
Helen Whately Excerpts(7 months ago)
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The Minister for Social Care (Helen Whately)
It is a pleasure to serve under your chairmanship, Mr Dowd, and to respond to the debate on behalf of the Under-Secretary of State for Public Health, Start for Life and Primary Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom). I am grateful to the hon. Member for South Shields (Mrs Lewell-Buck) for raising this important debate about the Healthy Start scheme, and to other hon. Members who have contributed.
The Government are committed to supporting the next generation of children, who are, of course, our future, and their own will obviously depend on this as well. A child’s early life is critical to their health later in life. We want every family to receive the right support to care for their children. Growing up with a healthy diet and weight is strongly protective against ill health in childhood and adulthood. Eating a healthier diet, as set out in “The Eatwell Guide”, could increase population life expectancy by up to eight years.
We know that fruit and vegetable consumption is lower among more deprived children, and that those children may be at risk of not getting enough micronutrients. More than one in five children start primary school overweight or obese, and the numbers are higher in more deprived areas. That is a major risk factor for long-term diseases including heart disease, type 2 diabetes and many types of cancer.
Against that backdrop, the support for children to eat healthily through the Healthy Start scheme and our provision of free school meals is crucial. The Healthy Start scheme benefits hundreds of thousands of families across the country. The statutory scheme encourages a healthy diet for pregnant women, babies and young children under four from low-income households. Eligibility criteria for the scheme ensure that we target nutritional support on families who need it most.
In April 2021, we increased the value of Healthy Start by 37%, from £3.10 to £4.25 a week, therefore helping families with the increased cost of living. I welcome the support demonstrated by colleagues today for this important scheme and the emphasis placed on its uptake. I fully agree that we need to ensure that eligible families are aware of and able to access Healthy Start. I now turn to how we are doing that.
Healthy Start is delivered by the NHS Business Services Authority, on behalf of the Department. Following user research and testing by both the Department and the NHSBSA, the scheme switched from being paper based to a digitised service in 2021. An online application and prepaid card replaced the previous paper form and vouchers. The number of families being supported by Healthy Start has grown following the introduction of the prepaid card. Since September 2021, of the more than 600,000 successful applications, 45% have come from new families and the scheme now supports more than 360,000 beneficiaries on lower incomes. The uptake is 62% of people who are eligible, which is higher than in the previous paper scheme and shows the benefits of the transition to a digital scheme.
Hon. Members have raised the question of auto-enrolling eligible families on Healthy Start. Moving to auto-enrolment would require a substantial redesign of the scheme. In contrast to what I heard the hon. Member for South Shields say, such a move, unfortunately, is not a simple thing to do. I am told that the prepaid card would need to be removed because it is a financial product that, under financial services legislation, requires applicants to accept the terms and conditions on an opt-in basis, so we cannot have it as an opt-out. Creating a new delivery method and process is therefore far from straightforward and would come at an additional cost to Government, with disruption for the beneficiaries.
Mrs Lewell-Buck
As the Minister heard in my opening comments, Mastercard completely refutes that argument. It and Allpay, which administers the scheme, have been clear that it is entirely possible to do auto-enrolment; they just need the Department for Health and the DWP to talk to them about it. It is not a difficult thing to do. They have outlined it to me in a letter, and I am happy to share that with her Department, yet again.
Helen Whately
I hear the hon. Member’s point, but as I set out clearly, I understand that this is not a simple thing to do, and not straightforward. As she has offered, however, I suggest that she writes to the Under-Secretary of State for Public Health, Start for Life and Primary Care with that suggestion and the proposal from Mastercard. I have no doubt that my right hon. Friend will look into it and respond to the hon. Member.
I have been saying that it is complicated to shift to an auto-enrolment scheme under existing legislation. By contrast, the current scheme has seen increased take-up, with the switch to the prepayment card. We would not want to jeopardise that progress of increasing numbers of families enrolling on what is an important scheme. That is why the Government’s focus is on increasing the uptake and effectiveness of the existing scheme, so that more children can benefit from Healthy Start. I also assure the hon. Member for South Shields that the substantial level of investment in the scheme is in the order of £78 million per annum.
I was sorry to hear about the problems in getting access and responses to phone calls for people calling up for help with access to the scheme. It is clearly important for people to be able to get help, if needed, to access Healthy Start. I understand that the average speed of answer for calls between 1 April and 10 May was 19 seconds, but I have asked officials to look further into the problems raised by the hon. Member for Stretford and Urmston (Andrew Western) regarding accessing the phoneline and accessing help.
Multiple channels of communication are used to raise awareness and encourage take-up of Healthy Start. NHSBSA actively promotes Healthy Start through its digital channels and has created free toolkits for use by healthcare professionals, local authorities and public health teams. NHSBSA uses a range of communications to raise awareness among parents and pregnant women. For example, it has attended maternity and midwifery forum events and placed advertisements in You and Your Pregnancy magazine, which is given to pregnant women in the first trimester, and the Bounty and Badger Notes apps. As officials confirmed to the House of Lords Food, Diet and Obesity Committee on 7 May, we also have plans to write to everyone eligible for Healthy Start to ensure they are aware of the scheme and to encourage them to apply.
As I said before, the Government are committed to promoting a healthy diet for our children. Healthy Start is an important part of the support provided by Government but it is only one aspect of how we are doing that. For our youngest children, the Government are investing £50 million in infant feeding support as part of the family hubs and the Start for Life programme. We support childcare providers with the cost of milk through the nursery milk scheme. We are also working with industry to improve the healthiness, marketing and labelling of commercially available baby food and drink aimed at those aged up to 36 months. Children of all ages also benefit from restrictions on the placement of less healthy products in key selling locations, calorie labelling on menus and upcoming landmark restrictions on multi-buy offers and the advertising of less healthy products on TV and online.
For school-aged children, we have the school fruit and vegetable scheme and free school meals. The Government have expanded free school meals to more groups of children than any Government over the past 50 years. We have introduced universal infant free school meals for all children in reception, year 1 and year 2. Under the benefits-based criteria, more than 2 million of the most disadvantaged pupils are provided with free school meals; in fact, the greatest ever proportion of children are receiving free school meals, with more than a third receiving free lunches compared with one in six in 2010. Furthermore, a crucial backdrop to this debate is the latest fall in inflation—because we know that the best way to help people with the cost of living is to bring inflation down.
Infancy and early childhood is a crucial time for establishing food preferences and dietary patterns. Giving children a healthy start in life is critical to health outcomes throughout childhood and adulthood. The Healthy Start scheme is one of the essential ways in which the Government support our most vulnerable families to give their children the best start for a healthy life. I welcome colleagues’ interest in the Healthy Start scheme and assure them that although our approach may be different from the one that the hon. Member for South Shields argues for, we are committed to making sure that the children who most need help get it.
Oral Answers to Questions
Helen Whately Excerpts(7 months, 4 weeks ago)
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Antony Higginbotham (Burnley) (Con)
The Minister for Social Care (Helen Whately)
Just over a year ago, we set out a plan to improve urgent and emergency care. The plan is working. At East Lancashire Hospitals NHS Trust, 78% of A&E patients in March were seen within four hours. That is 4.5 percentage points better than last year—the biggest year-on-year improvement outside the pandemic since 2010. We know that there is more to do; that is why we are working with the NHS on year 2 of the urgent and emergency care recovery plan.
Antony Higginbotham
I am grateful to the Minister for that response, and grateful to her for agreeing to meet me and other local MPs to discuss the emergency care situation in east Lancashire. Could I ask her to go one step further? Perhaps she and even the Secretary of State could visit Burnley General Teaching Hospital in my constituency, meet the trust, and see what more we can do there, partly to reverse the disastrous decision of the last Labour Government to close the A&E there?
Helen Whately
I commend my hon. Friend and other east Lancashire colleagues for their campaigning on this matter. I look forward to the meeting we are going to have to discuss the performance of his local A&E, and I thank him very much for the invitation to visit.
Tim Farron (Westmorland and Lonsdale) (LD)
I share an integrated care board with the hon. Member for Burnley (Antony Higginbotham) in Lancashire and South Cumbria. Does the Minister agree that one reason why there are such problems with A&E waiting times is the congestion in our hospitals overall, because of the number of people who are healthy and fit to leave hospital, but cannot have a health and care plan when they return home? Some 24% of all beds in the Morecambe Bay hospitals are occupied by people who are fit to leave, but have no care package. What plan does the Minister have to address the social care crisis in Cumbria? That will include increasing the amount of affordable housing, so that people can afford to live in the area; paying carers more; and having more intelligent visa rules.
Helen Whately
The hon. Gentleman makes the point that the performance of A&E depends on the flow of patients through hospital and our ability to discharge them. That is why, as part of our work on urgent and emergency care, we have invested in supporting hospitals to discharge patients, and have been supporting social care. We have seen an increased number of discharges across the country over the last year, which has enabled hospitals to treat more people and supported the improved performance in A&E that I mentioned. We continue to work on that, and of course we are supporting social care with up to £8.6 extra billion funding over two years.
Dr Rosena Allin-Khan (Tooting) (Lab)
Stephen Metcalfe (South Basildon and East Thurrock) (Con)
Will my hon. Friend join me in recognising the good work that the Essex Partnership University NHS Foundation Trust has been doing to improve mental health outcomes, including the creation of a pioneering 24/7 urgent mental health care centre, providing urgent help when it is needed. Is that a model that could be rolled out across the country to improve access to mental health for all?
The Minister for Social Care (Helen Whately)
My hon. Friend rightly flags the excellent work going on to improve access to mental health services across the country. Last year, 3.6 million people got mental health support. That is an increase of around 30% in just three years, supported by record funding of over £16 billion into mental health care.
Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)
Mandatory fortification of flour with folic acid could save many thousands of children from spina bifida, so why is it happening so slowly, at such a low level and applied to too few products?
Stella Creasy (Walthamstow) (Lab/Co-op)
Ten days ago I went to the Whipps Cross A&E department to see for myself the pressures that the brilliant team there are under—pressures that are heavily exacerbated by the failure to redevelop the hospital. Originally, we were promised that the new hospital would be open by 2026, but we have still not agreed with the Department a plan and timetable to submit to the Treasury for that redevelopment. As a result, the hospital is having to spend huge amounts of money trying to stem the damage as well as being able to treat patients. It is costing us all. For the sake of patient care and NHS budgets, will the Minister meet me to work out where the hold-up is in getting Whipps Cross redeveloped?
Helen Whately
The hon. Member raises the performance of the A&E department in her local hospital. I have worked closely with the NHS over the past year to improve the performance of urgent and emergency care. Since this time last year, we have seen ambulance response times improve by over a quarter and waits in A&E cut. I am happy to meet her to talk about her specific A&E department.
Dean Russell (Watford) (Con)
I again thank the Secretary of State for visiting Watford General Hospital earlier this year, where we shared exciting plans for the new hospital, with preparation work starting this year, and construction starting by the end of 2026. I spoke with the West Hertfordshire NHS Trust leadership team this week, who confirmed that they are on track for that delivery within those timescales. Will my right hon. Friend please join me in thanking them for their hard work on that?
Hospice Funding
Helen Whately Excerpts(8 months ago)
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The Minister for Social Care (Helen Whately)
I thank my hon. Friends the Members for Hastings and Rye (Sally-Ann Hart) and for Darlington (Peter Gibson) for securing this debate. The number of speeches this evening reflects the strength of feeling, and the support, for hospices across the country. As the Minister with oversight of end of life care, I share the passion of many hon. Members for hospices and for what they do, caring for people towards and at the end of life, providing respite for carers and supporting families both before and after the death of a loved one. Many hon. Members have rightly praised the work of the hospices that serve their constituents and made special mention of the extraordinary work of hospices for children and young people. I also thank the hospices for all they do, and for all they are doing right now, as their staff work around the clock.
Beyond that, I thank everyone who gives palliative and end of life care, as part of hospice teams but also working in the NHS. How you die, how your loved ones die or how you live towards the end of your life, matters. As the hon. Member for Birmingham, Erdington (Mrs Hamilton) said so eloquently earlier this evening, and as all of us here this evening know, that is why palliative and end of life care matters. It matters when that care is provided by the NHS, as it is for the majority of people, and when it is provided by hospices. I emphasise that point, because there is sometimes a misunderstanding, which I have heard a few times this evening. The fact is that most palliative and end of life care is provided by the NHS, whether in hospitals, by primary care or through community trusts. Alongside and in addition to that, hospices do the wonderful work that they do. Recognising the importance of palliative and end of life care, we specified in the Health and Care Act 2022 that integrated care boards must commission these services to meet the needs of their populations.
Some hon. Members have argued this evening for hospice funding to be centralised, taken away from integrated care boards and, I assume, allocated by either NHS England or the Department of Health and Social Care. While I understand their motivation in making that call, I do not agree. We purposefully set up ICBs to understand the healthcare needs of our local communities, to plan and commission services to meet those needs and, in so doing, to reduce health disparities. Our communities and their needs, and the services they already have in place, are different, and rarely is a one-size-fits-all decision made in Westminster the right answer. I stand by a more localised approach, in which there is, of course, variation.
Another source of variation is historical. The hospice movement has grown organically, and the location of hospices has not been planned to meet demographic need, for instance. There are, therefore, inequalities in access to hospice services, especially for those living in rural and more deprived areas. This variation in access to hospice care has to be taken into account by ICBs in the decisions they must make to ensure that people have access to end of life care, whether or not they live in an area served by a hospice.
Peter Gibson
My hon. Friend makes an important point about the organic way in which our hospices have developed and emerged. Does she agree that our ICBs have the opportunity to use our hospices to address those shortfalls in certain communities by directing funding specifically to them to meet needs that have not previously been met?
Will the Minister further clarify one small point? She has made a clear distinction between NHS-provided care and hospice care, but there are many cases around the country where the NHS is funding, in full or in part, specific services from hospices. How would she distinguish between them? Is it NHS care or hospice care if it has been fully commissioned and fully funded by the NHS?
Helen Whately
I will pick up on a few of those points.
On the NHS providing palliative and end of life care, I have heard a misunderstanding in some speeches, both this evening and on other occasions, that all end of life and palliative care is provided by hospices. It is more mixed. Integrated care boards do, indeed, commission hospices to provide care, but hospices also provide care independently, and NHS services do so, too. These teams also work together collaboratively. That diversity is a strength.
In seeking to address inequalities, ICBs can look to hospices to do more in underserved areas, for instance. At other times it may be more appropriate for them to look to NHS services. It will vary by area, which is one reason why these decisions should be localised, rather than made by somebody sitting in my place saying, “This is how it should be done across the whole country.”
Although I do not agree with centralising hospice funding, I am working on the transparency and accountability of ICBs to their communities and hon. Members, as representatives. That is why I have regular meetings with NHS England leads on palliative and end of life care, and it is why I am pleased to have secured NHS England’s commitment to including palliative and end of life care in the topics discussed at its regular performance meetings with ICBs. It is also why I am pushing NHS England and ICBs to improve the data they collect on the access to and quality of palliative and end of life care.
NHS England has developed a palliative and end of life care data dashboard to help ICBs understand the needs of their populations and then address and track inequalities in access to end of life care. This is progress, but I want the transparency to go further so that we all have the data we need to assure ourselves that our ICBs are commissioning the care that our constituents need.
I have heard the calls for more funding for hospices and the stories of some fantastic fundraising efforts, from the “star trek” night walk and the “Santa sprint” to the magnificent marathon runners who have joined us in the Chamber tonight fresh from yesterday’s London marathon. I congratulate those who ran, and particularly those who did so on behalf of hospices, which is timely for this debate.
That said, I disagree with the hon. Member who said that people running a marathon for hospices is “sad”—it is not; it is a wonderful thing. It is a sign of the tremendous support that hospices have in our communities and that people are willing to choose to fund hospices, not just when the taxman comes along; they are choosing to have a hospice providing services to people in their area. It is a good thing because that fundraising gives hospices an independent funding stream, the freedom that goes with that to serve their communities as they see fit, and the strong ties with their communities and with all those people who fundraise for their hospices.
Caroline Ansell
My hon. Friend is so right in what she is saying. In my constituency of Eastbourne, people are not just prepared to run for the St Wilfrid’s Hospice, but they will walk over coals for it. Will she congratulate them on their outstanding work?
Helen Whately
I do congratulate those people on their fundraising efforts; although I hope their feet are all right!
As hon. Members know, the Government have provided dedicated additional funding to hospices; in the pandemic, when I played a part, we were helping them with energy bills and through the children’s hospice grant, which the NHS has confirmed will go to hospices for this financial year too.
Looking ahead, I fully appreciate the ask for longer-term certainty of funding—of course I understand that. However, funding for hospices, end of life care and many other things beyond the current financial year depend on a future spending review. I am sure that all hon. Members will understand that I cannot pre-empt such a review, and ICBs similarly will not know their funding until that review. Although committing funding beyond the spending review period is not in my power, I am pushing for our healthcare system to encourage and enable more advance planning by individuals to consider and set out what they want at the end of their life. Inevitably, some of us will die in hospital, and for some of us that will be the right place, but given a choice many people would rather die at home. We should all be setting out a plan that includes our preference of place of death and what sort of treatments we do and do not want. As my right hon. and learned Friend the Member for South Swindon (Sir Robert Buckland) and my fabulous health colleague my hon. Friend the Member for Colchester (Will Quince) said, we should talk more about death and plan for it.
To conclude, there are no easy answers to the questions raised this evening—there rarely are. I do not have a pot of money otherwise going unspent for hospices; neither do ICBs and nor does NHS England. I will, however, continue working with NHS England to ensure that palliative and end of life care is given the attention it deserves and needs so that it is considered important, just as we consider services that prolong life important, and that the NHS is held to account for doing that. I will continue to agree with hon. Members on the importance of hospices and the important work they do. I see this as a Minister, as a constituency MP and from my own family experience; I will never forget saying goodbye to my grandmother in a hospice near Yeovil, and I will always be grateful.
Madam Deputy Speaker (Dame Rosie Winterton)
I call Sally-Ann Hart to wind up.
St Peter’s Hospital, Maldon
Helen Whately Excerpts(9 months, 1 week ago)
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The Minister for Social Care (Helen Whately)
I thank my right hon. Friend the Member for Maldon (Sir John Whittingdale) for securing this important debate about the future of NHS services for his constituents. I know that St Peter’s Hospital, which has a long history of delivering local NHS services, is close to his heart and those of many people in his area. He spoke of the dedication of the staff who have worked there over the years and of many debates about the future. I welcome his sustained efforts to bring together stakeholders and ensure that his constituents’ voices are heard. We also heard from my right hon. Friend the Member for Witham (Priti Patel); she, too, made sure that her constituents’ voices are heard in this place. It is not the first time that she has raised this matter with me.
I want to assure both my right hon. Friends that the Government believe that NHS reconfigurations should be locally led, and based on clinically evidenced decisions. Any decision about St Peter’s will reflect our commitment to investing in health and care services for Maldon and Mid and South Essex. Let me start by reiterating that no decision has been made on the future of St Peter’s, and that a local consultation will run until 4 April 2024. As my right hon. Friend the Member for Maldon is aware, the local NHS is concerned that the hospital does not meet the required standards for services because of issues with the age, condition and suitability of its buildings. Indeed, he spoke about that a moment ago. St Peter’s was built as a Victorian workhouse and has deteriorated in recent years. That makes the building costly to maintain and it would be expensive to refurbish. The cost of getting the facility up to the standard needed is estimated at more than £18 million.
The St Peter’s site has also struggled to staff services properly, despite the increase in the NHS workforce in the past few years. When the birthing unit was at St Peter’s, it had to be periodically closed due to staff shortages, and there were also clinical safety concerns about the isolation of the unit; there were no other 24-hour services in the building. I heard my right hon. Friend explain that in the past there had been more than 300 births a year in the maternity unit, and I believe that my right hon. Friend the Member for Witham had her baby there.
I understand that stroke rehabilitation services in Essex community hospitals are not currently staffed in line with national best practice for specialist stroke units. I am sure that my right hon. Friends’ constituents want services not only on the doorstep, but to be staffed to provide the best possible care. That will be crucial, be it for mothers giving birth and their new babies, or for patients recovering from a stroke, for whom getting the right rehabilitation can make a huge difference to future quality of life. That is why ways to treat and care for patients and better equip facilities with the right level of specialist staff are being considered by the integrated care board.
I understand that other locations in and around Maldon are being considered by the ICB for the other patient services provided at St Peter’s; this will keep services such as out-patient appointments close to the current location. It is crucial that the ICB gets a full understanding of how these proposals will affect local people—of whether expected standards are met, not only of care, but of access. People usually understand that they may need to travel to get to a more specialised service, but it is essential that the services that people need are accessible. As well as considering patients, the ICB must consider families, carers, who need to be able to visit, and of course staff.
My right hon. Friend the Member for Witham emphasised the size and scale of Essex, and both she and my right hon. Friend the Member for Maldon spoke of house building and the growing population in the area, which clearly needs to be taken into account by the ICB. I have been assured that the local NHS is engaging and seeking to understand the views of residents before making any final decision. When that decision is made, the ICB must clearly set out how a decision will benefit the constituents of my right hon. Friends and people in the wider area.
I understand that my right hon. Friends are concerned about the adequacy of local consultation on the proposed changes. I am assured by the local NHS that multiple events are being held to discuss the proposals, and at least three have already taken place in Maldon. As we heard earlier, public meetings have already been held, involving my right hon. Friend the Member for Witham. Almost 3,000 people have already completed the online survey since 25 January.
I thank my right hon. Friend the Member for Witham for raising the closure of St Peter’s in a Westminster Hall debate earlier; my right hon. Friend the Member for Maldon raised it in oral questions the other day. I am glad to hear that the NHS will consider the results of a survey undertaken by my right hon. Friend the Member for Maldon, and that those views will be fed into any decision. The local NHS is giving people more time to come forward, and this week it announced an extension to the consultation by an additional two weeks.
Mid and South Essex is already one of the best parts of the country for the NHS getting patients back home and to appropriate care settings to recover from a stay in hospital. That strong performance has been supported by Government investment. That includes significant capital funding of £20 million for accident and emergency across 2020-21 and 2021-22; £18 million for the targeted investment fund in 2021-22 and 2022-23; and £7 million for a community diagnostic centre across the same two years. We have invested £61 million in operational capital in 2023-24, and £182 million across the 2023 spending review, which can be used for capital projects and work. I am sure that my right hon. Friends will be in no doubt about the Government’s commitment to the health of their constituents.
I can also assure my right hon. Friends that we have now delivered on our manifesto commitment for 50 million more general practice appointments per year, with nearly 370 million appointments booked across the last 18 months. Our primary care recovery plan is making it quicker and easier for patients to get the help that they need from primary care. On facilities for GPs in Maldon, integrated care boards have delegated responsibility for commissioning primary care services and can prioritise capital funding for an essential system of allocation to invest in primary care estates as needed.
In closing, I thank my right hon. Friends the Members for Maldon, and for Witham, for speaking in the debate and focusing our attention on healthcare in Essex, specifically on the future of St Peter’s Hospital. They have both done an excellent job of ensuring that the views of their constituents are heard, and I have no doubt that they will continue to do so. I am very much looking forward to meeting them to discuss in greater detail the questions we debated today. I am confident that the local NHS has been listening, and I know the importance of St Peter’s to the area. Any change in NHS services must be made with the utmost sensitivity to local views.
Question put and agreed to.
Health and Social Care
Helen Whately Excerpts(9 months, 1 week ago)
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Helen Whately
…we have been putting in place changes to Care Quality Commission regulation to make visiting a fundamental right, a fundamental part of care and a fundamental standard of care to ensure better access for loved ones to their family members in care homes and in hospitals. I know in particular how important that is for people with dementia, among others. The CQC is consulting on the implementation of the regulatory change, which will be live shortly.
[Official Report, 6 March 2024, Vol. 746, c. 939.]
Letter of correction from the Minister for Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately):
An error has been identified in my speech in the debate on Dementia Care in Hospital. The correct statement is:
Helen Whately
…we have been putting in place changes to Care Quality Commission regulation to make visiting a fundamental right, a fundamental part of care and a fundamental standard of care to ensure better access for loved ones to their family members in care homes and in hospitals. I know in particular how important that is for people with dementia, among others. The CQC has consulted on guidance on the implementation of the regulatory change, and that guidance will be live shortly.
Dementia Care in Hospital
Helen Whately Excerpts(9 months, 2 weeks ago)
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The Minister for Social Care (Helen Whately)
I sincerely thank my right hon. Friend the Member for Chipping Barnet (Theresa Villiers) for securing this Adjournment debate, and for her powerful speech. She really brought the subject to life through the examples from her constituency of people’s experiences in hospital. They were very difficult stories to hear, and I am very sorry to hear of times when it sounds like the care for people’s loved ones has fallen short.
My right hon. Friend made some powerful points that I want to address, starting with the fact that, as she said, there are many thousands of people living with dementia, and the number is only expected to increase; indeed, there will be more than a million by 2025. Many people with dementia will also be living with other health conditions. At the moment, it is estimated that around a quarter of the beds in hospitals are being used by patients with dementia, so ensuring that people receive the right care when they are in hospital with dementia is really important, as is doing our utmost to avoid unnecessary admissions and ensuring that people are discharged from hospital on a timely basis.
It is really worth emphasising the point that my right hon. Friend made about dignity, and the fact that every single person counts, at whatever stage of their life. There are challenges to ensure that people living with dementia have that dignity, particularly when they are in hospital. I, too, pay tribute to the many unpaid carers who are looking after their loved ones with dementia. I know what a huge burden and challenge that can be. However much someone loves somebody, there is a huge demand on them when they are caring for somebody with dementia. It can be very difficult, very distressing and absolutely relentless, however much they love them. I pay tribute to all carers who are doing that.
My right hon. Friend spoke first about Lisa Rutter, who very sadly lost her mother, who was living with dementia, during the pandemic—in hospital, if I heard my right hon. Friend correctly. I thank Lisa Rutter for the work that she is doing as the founder of Dementia Club UK. It is fabulous to be supporting other people to look after loved ones with dementia, or indeed those with dementia themselves. My right hon. Friend talked about the time Lisa’s mother spent in hospital, and how, for instance, Lisa knew what her mother needed but felt that she was not listened to, and that it may have contributed to her mother’s death. My right hon. Friend also talked about the visiting restrictions during the pandemic. I will talk about those in a moment.
My right hon. Friend talked about another constituent, whose wife was in hospital. She rightly talked about the importance of mobilising somebody with dementia, and how her constituent’s wife was nearly given the wrong medication, which could have been fatal. She spoke about the importance of his intervention. She also spoke about a constituent who was a carer for their father, and the importance of mobilisation, and some of the communication challenges for somebody with dementia.
My right hon. Friend talked about one person who had been screaming all night, as described by the staff. Actually, the family member who knew them understood that they were calling for help, as they needed to go to the toilet. That brings to life how difficult it can be when somebody has dementia and is not necessarily able to articulate their needs and what they want. Those who know them well will often know what they are trying to say or communicate, but that can be difficult in hospital when they may be being looked after by staff who simply do not know them well enough to know what they mean.
My right hon. Friend talked about food being left uneaten. If somebody is not eating in hospital, clearly they are likely to lose weight and their condition may deteriorate. She also talked about medication being stopped, and she talked particularly about somebody whose partner had early onset dementia, and had been coping fairly well at home. He walked into A&E, and that was very sadly the last time he walked. That emphasises the challenge of keeping people moving and maintaining their ability to be mobile during a hospital stay. She also described the fight to visit outside visiting hours.
I very much hear my right hon. Friend’s asks on visitor access, volunteers being trained in dementia care, as well as staff training, and avoiding discharge delays, among other things. I will pick up on some of those.
First, on the challenge of caring for people with dementia when in hospital, many hospitals have worked hard to do better for patients with dementia, for example creating dementia-friendly environments by changing the colour and lay-out, ensuring that staff are trained in dementia, and having dementia leads and dementia-lead nurses, as well as having training for volunteers. Standard training in caring for people with dementia is available through NHS England for staff and volunteers.
Clearly, my right hon. Friend the Member for Chipping Barnet described examples where care fell short. I have no doubt that across the NHS, with the work already taking place, we can go further. I will raise the points that she made about secondary care with my colleague, the Minister for Health and Secondary Care, so that we can work together on ensuring that care is right in hospitals. He also has oversight of workforce, and we should focus on whether the training that I know is available is being taken up by enough staff, considering the number of people in hospital with dementia.
On visiting, my right hon. Friend spoke about a subject that is close to my heart. Having been involved in some of the decisions about social care visiting restrictions during the pandemic and knowing how hard those decisions were—weighing up the infection control concerns and ensuring people could spend time with loved ones—we have been putting in place changes to Care Quality Commission regulation to make visiting a fundamental right, a fundamental part of care and a fundamental standard of care to ensure better access for loved ones to their family members in care homes and in hospitals. I know in particular how important that is for people with dementia, among others. The CQC is consulting on the implementation of the regulatory change, which will be live shortly. I believe we have taken a significant step to address concerns expressed about visiting.
Another thing my right hon. Friend spoke about was faster discharge. I am very alert to the risk of patients deconditioning in hospital, particularly patients with dementia. That is why over the past year or so, we have worked hard with the NHS to get better at identifying patients at greater risk of deconditioning, in particular those with dementia, on their admission to hospital. We have done earlier discharge planning and have been getting care transfer hubs established all across the country, which will do the work on more complex discharges. Often someone with dementia may need more access to social care. We may need to increase the access to, availability and supply of social care, so that it is there for those who will need it when they leave hospital. We have made some real progress on that over the past year.
Helen Whately
I have very little time, so I am afraid I will not give way.
My right hon. Friend the Member for Chipping Barnet talked about the social care workforce, another subject close to my heart. We have a strategy for the care workforce. We are building care as a career, in particular to boost recruitment and retention among our home-grown workforce. We recently published the first ever national career structure for care workers, and we are launching a new national qualification to boost the supply of care workers.
Avoiding admission is another priority for me. Clearly, some people should be—absolutely must be—in hospital for the treatment they need, but we know that patients with dementia in particular can deteriorate in hospitals, so we are doing more work with the national health service and social care to avoid admission when it is not truly necessary by putting in place alternatives or, at the other end, supporting earlier discharge through the roll-out of the Hospital at Home initiative, or virtual wards, under which we committed to at least 10,000 hospital-at-home beds or equivalent as part of emergency care recovery plans. The NHS has over-delivered on that, so we now have more than 11,000 Hospital at Home beds, which help people who would otherwise be in hospital receiving acute care. They receive that care and are able to recuperate at home, avoiding the risk of a longer hospital stay and deconditioning.
My right hon. Friend talked about dementia research and the new treatments coming onstream. The Government have committed to doubling our investment in dementia research during this Parliament, and we are on track to do that with our dementia mission. We are also working very closely with NHS England to be ready for the breakthrough treatments lecanemab and donanemab coming onstream. I should be clear that we know very well—I have received clinical advice on this—that those treatments have quite significant side effects, so they will not be suitable for everybody and I put a note of caution there. We are waiting to hear whether they are approved by the Medicines and Healthcare products Regulatory Agency and the National Institute for Health and Care Excellence. In the event of approval, NHS England is taking steps to be ready to put in place the levels of diagnosis required to be able to support those treatments.
That goes hand in hand with the work that we are doing with NHS England to improve the diagnosis rate for dementia. We have a target dementia diagnosis rate of 66.7%. That dropped during the pandemic because dementia services and assessment had to be closed, but it has been gradually building up, and I expect NHS England to get back up to that level during the course of this year. That is really important, because having a diagnosis helps people—the individual with dementia and their carers, for example—to access the support and back-up that they should be receiving.
I am conscious of the clock ticking, so I have tried cover some of the territory that my right hon. Friend set out in her speech, which I thought was very powerful in raising these significant issues for those with dementia receiving care in hospital, their carers and loved ones. I completely agree about the importance of dignified treatment and treating those with dementia with dignity at all times. I know that that can be particularly challenging in hospital, but we have to ensure that that is the case.
We will ensure that we get all the necessary care in place outside hospital, which avoids unnecessary admissions; support people to be discharged from hospital quicker; get ready for the arrival of new dementia treatments; and raise awareness about the significant proportion of dementia cases that can be prevented or at least delayed by looking after our health. In fact, the risk factors for dementia are similar to those for heart disease and other things, and there is relatively low awareness of that. We will see more people with dementia in the years ahead, but we can do more to raise awareness of how people can maintain their health and stave it off.
Helen Whately
I am just coming to a close.
I thank my right hon. Friend for securing the debate. I will continue my work to pursue the topics that we have discussed this evening.
Question put and agreed to.
Oral Answers to Questions
Helen Whately Excerpts(9 months, 2 weeks ago)
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Andrew Lewer (Northampton South) (Con)
The Minister for Social Care (Helen Whately)
A year ago we set out a plan to improve urgent and emergency care, and the plan is working. Performance this winter has been better, with ambulance waits down by nearly a third, and we are learning the lessons from this year to make further improvements in the year ahead.
Mary Robinson
It is welcome news that the brand-new £30 million A&E campus at Stepping Hill Hospital is nearing completion. However, other buildings on this ageing site are failing and urgently need replacing. Will my hon. Friend ensure that Stepping Hill remains at the heart of hospital facilities in Stockport with rebuilt units, and support new hospital investment and specialist diagnostic hubs across Stockport?
Helen Whately
I am delighted that Stepping Hill Hospital will soon have a new emergency care campus, with all the benefits that that will bring to my hon. Friend’s constituents. I know that she is a great campaigner for her local NHS and has already met the Secretary of State about the concern she raises. As well as making her argument so clearly in Westminster, I would encourage her to continue discussions with her local NHS integrated care board, which is responsible for local decisions on capital investment.
Mrs Drummond
Up to £900 million for a brand-new acute hospital is coming to mid-Hampshire and health experts are making the case that it will make huge improvements in care, despite some politically inspired and misinformed opposition. Can my hon. Friend reassure my constituents that those running our local NHS should be listened to, and also that the doctor-led urgent treatment centre in Winchester will continue to provide for three quarters of urgent cases including X-rays, MRI scans and other tests after the new acute hospital is built, which we hope will be at junction 7?
Helen Whately
I commend my hon. Friend for her hard work on supporting the new hospital, for the leadership she is providing and for her work on encouraging residents to have their say in the consultation. I cannot prejudge the outcome of the consultation but I agree with her that the new hospital will be great for patients, with its modern facilities. She is right to say that an urgent treatment centre can provide excellent emergency care for the majority of people who attend A&E.
Andrew Lewer
Northampton has been the beneficiary of many welcome new or improved facilities in recent years, including a children’s A&E, a main A&E and the announcement of a community diagnostic centre. However, the missing piece of the jigsaw is an urgent treatment centre, for which I have been campaigning for many years now. Will the Minister inform me on the progress on that centre?
Helen Whately
I congratulate my hon. Friend on his successful campaigning for healthcare in Northampton, which is, as he says, benefiting from upgrades to the children’s A&E and the main emergency department and will soon have one of our 160 new clinical diagnostic centres. He will know that his local NHS integrated care board will decide whether to fund a new urgent treatment centre, and I have every confidence in his ability to persuade it of doing so.
Sir Chris Bryant (Rhondda) (Lab)
It is one of the great successes of the past few years that we now save the lives of a lot more people with an acquired brain injury. Although we might save them in acute and emergency care, however, a national strategy for acquired brain injury is a really important part of ensuring that people have the proper care thereafter. The Government appointed me and the Minister for Health and Secondary Care, the right hon. Member for Pendle (Andrew Stephenson)—he is just passing the hon. Lady a note to inspire her on the subject—to try to publish one. When does she hope that there will be money available to ensure that that strategy is one worth having?
Helen Whately
I know that the hon. Gentleman is a great campaigner on this issue; he has worked very hard on it with me in the past, and he now does so with my right hon. Friend the Minister for Health and Secondary Care. I assure him that we are in the process of revising the draft strategy, taking on board feedback from patients, their families, charities and the NHS, and we will publish the strategy in due course. I thank all stakeholders for their continued efforts.
Helen Morgan (North Shropshire) (LD)
In January, the average category 2 response time for west midlands ambulance service was over 43 minutes. We know that the problems are worse in Shropshire, following stories such as that of a lady who waited 18 hours before seeing a doctor, having contracted an infection following radiation therapy for her cancer treatment. The situation in Shropshire does not seem to be improving as fast as we would like. What steps is the Minister taking to resolve the problem?
Helen Whately
Across the country, ambulance response times have come down by a third. We have worked very hard, particularly with areas that face greater challenges, including Shropshire. I have spoken to leaders in the local health system about the ongoing challenges. We are learning lessons about what has worked over the past year, and from where we have not made so much progress, to ensure that we do better in areas such as the hon. Lady’s over the year ahead.
Jim Shannon (Strangford) (DUP)
I thank the Minister for her positive answers; they are really appreciated. Bearing in mind the pressure that GPs are under, which is leading to more pressure on emergency provision, what steps are being taken to provide greater incentives for medical students to take on positions in GP surgeries? That would make a big difference.
Helen Whately
The hon. Gentleman is absolutely right to talk about the whole health system. One thing we are doing as part of our work on urgent and emergency care is preventing people from being admitted to hospital unnecessarily, or from being brought to A&E in the first place. Primary care is part of that. In our investment in expanding medical school places, we are particularly encouraging medical schools, such as the new Kent and Canterbury Medical School near me, to train students to work more outside hospitals, including in primary care.
Karin Smyth (Bristol South) (Lab)
Despite watering down the targets for ambulance response times and the A&E four-hour wait, the Government still cannot meet them. We have heard from Members across the House this morning how patients are waiting longer. The new targets say that there will be further improvements in 2024-25, and the Minister has said that again this morning. Can she let us in on what exactly they will be?
Helen Whately
I am not going to pre-empt the publication of targets for the coming year, but, as I have said, we will continue to learn lessons from the progress that we have made this year, including on ambulance response times, which are down by over a third. Anyway, I will take no lessons from Labour, because we know the state of the NHS in Wales.
Peter Aldous (Waveney) (Con)
The Minister for Social Care (Helen Whately)
We are making great progress on our 10-year vision for adult social care reform. We have introduced the first ever national career structure for care workers, and we have introduced new assessments by the Care Quality Commission, which will shine a light on how well councils are delivering their social care duties.
Peter Aldous
I am most grateful to my hon. Friend for that reply. In Suffolk, where the population is increasingly elderly, social care is under enormous pressure, and it is a significant challenge to recruit carers, pay them fairly and provide them with a proper career path. Therefore, I heard what my hon. Friend said, but will she consider commissioning a long-term workforce plan for adult social care equivalent to that for the NHS?
Helen Whately
My hon. Friend is right about the importance of the social care workforce: social care is its workforce. I can assure him that we already have a plan for the care workforce, set out in the “People at the Heart of Care” White Paper, and now we are putting it into practice. Our care workforce pathway is already being implemented, our new accredited qualification for care workers will be launched later this year, and we are backing social care with up to £8.6 billion in extra available funding.
Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)
I was concerned to hear that a constituent of mine was initially denied access to social care for his mother who suffers from Alzheimer’s despite her inability to administer her own medication. Will the Government look to broadening the criteria of the Care Act 2014 to include those requiring support with administering medication?
Helen Whately
We very much want everybody who needs care to get it and everyone who is eligible for financial support should get it. That, of course, is assessed by local authorities. We are introducing Care Quality Commission assurance of social care commissioned by local authorities, to make sure people get the care they deserve and to shine a light on where local authorities are doing a really good job and where others could do better.
Tom Hunt (Ipswich) (Con)
The idea of a social care cost cap has dropped off the agenda slightly. I know it is incredibly expensive, but I continue to be contacted by constituents who face losing everything. When often their loved ones have dementia and it is already emotionally an incredibly traumatic time, they have the added anxiety of how they are going to pay for care. The only thing that should matter is what works and is best for their loved one, but there is a cloud of anxiety hanging over society, which we all worry about. Will the Minister confirm that this issue has not lost her attention and that we will continue to consider whether we can introduce a cap?
Helen Whately
I thank my hon. Friend for his important question on concerns about the cost of care and how much it costs some people. As he may know—I remind him—the charging reforms were delayed in 2022 by the Chancellor after we listened to local authorities.
Tim Farron (Westmorland and Lonsdale) (LD)
A fifth of the social care roles in Westmorland and Furness are currently vacant and unfilled. Coincidentally that is the same proportion of beds in Morecambe Bay that are occupied by patients who are unable to get a care package and therefore leave hospital. The reasons for this are blindingly obvious: the pay and career structures are derisory for hard-working wonderful people and there is a complete absence of genuinely affordable homes for people in those sorts of roles to enable them to live locally. Does the Minister agree that fixing that crisis in my community and others should be the priority for the Chancellor tomorrow, not silly electoral gimmicks?
Helen Whately
I recognise the challenges in the hon. Gentleman’s area, although nationally vacancies in social care have fallen by over 20,000. We are reforming adult social care careers to make care a career for the UK workforce. We are putting extra funding into social care—up to £8.6 billion over two years—and introducing CQC assurance to make sure local authorities are doing their best on social care. I would encourage the hon. Gentleman to talk to his local authority and make sure it is paying a fair rate for the care it commissions.
Peter Grant (Glenrothes) (SNP)
Joanna Cherry (Edinburgh South West) (SNP)
The Minister for Social Care (Helen Whately)
Care is a skilled profession and I want care workers to get the support and recognition they deserve. In January we took the next step in our ambitious care workforce reforms, launching the first ever national career structure for the care workforce alongside our new nationally recognised qualification.
Peter Grant
I know the Minister will want to join me in thanking every single person who dedicates themselves to working in the social care sector, including perhaps particularly those who have come to the UK from overseas to do so, but it is not sustainable to rely on incoming workers forever. The Migration Advisory Committee has found that Scotland is now less reliant on migrant workers in the social care sector than England, through the simple expedient of paying a decent wage. That might, by the way, also be a good way to stop doctors in England going on strike; the Minister might want to look at that. Has the Minister asked the Chancellor to provide funding in the Budget so that social care workers in England can enjoy the same pay and conditions as their colleagues in Scotland, and if not, why not?
Helen Whately
I agree with the hon. Gentleman that we are grateful to all who work in social care, including those who have come here from other countries to care for our loved ones. We also agree that international migration is not a long-term answer to our care workforce needs. That is why we are reforming social care to work as a career, and we are backing that with extra funding—up to £8.6 billion extra for social care over two years.
Sarah Owen
I am afraid the Minister’s warm words about the social care workforce do not meet the reality check for most people. The Government’s own statistics show that there are at least 152,000 vacancies in social care in England alone, leaving my constituents waiting up to 10 weeks to be discharged from hospital. The Government have been using international recruitment to plug the gaps and as a result have filled over 11,000 vacancies in the past few years, so can the Minister confirm whether recruitment and retention in social care will be better or worse due to Government plans to prevent overseas social care workers bringing family members to the UK?
Helen Whately
As I said a moment ago, vacancies have fallen and the care workforce grew by more than 20,000 last year. We are seeing better retention of care workers as well, but we need to go further. That is why we are reforming social care careers, introducing the first ever national career structure for the care workforce and new qualifications and training.
Joanna Cherry
Edinburgh Trade Union Council recently described changes to the healthcare worker visa route as cruel and inhumane. Many of my constituents who have relatives in care share its concerns, as do I. We know the valuable contribution that foreign care workers make to the sector. Ideologically driven change to visas could further exacerbate the recruitment and retention crisis that other Members have so eloquently described. Given that the Government skipped consultation on these changes, will the Minister commit to meeting trade unions and social care leaders in Scotland to understand the impact of these harmful changes?
Helen Whately
I am grateful to international care workers who have come to the UK to look after loved ones. Their work has contributed to reducing vacancies and increasing the supply of social care, but we need to get the balance right between international recruitment and our homegrown workforce. We are carrying out ambitious reforms of our adult social care workforce, and therefore it is right, alongside that, to ensure that we have the right numbers of people coming here from overseas for social care. That is why we have worked with the Home Office on changes to visas.
Andrew Selous (South West Bedfordshire) (Con)
The managers of the wonderful care home I visited in Dunstable on Friday were annoyed by the number of job applicants for care places who were making the interview stage and then not arriving on the day. Can the Minister have a word with ministerial colleagues at the Department for Work and Pensions to ensure that job coaches are certain that jobseekers are not wasting the time of care homes? It is not fair, and those who work in care homes are busy people with a lot to do.
Helen Whately
I work closely with colleagues in the Department for Work and Pensions on the recruitment of people looking for jobs in social care, and I will raise that point with my colleague in the Department.
Andrew Gwynne (Denton and Reddish) (Lab)
It was the Minister’s party that promised to fix the crisis in social care “once and for all”. With vacancy rates almost three times above the national average and turnover rates for new staff at more than 45%, it is clear that the Government failed. Labour’s plan for a national care service with clear standards for providers and a new deal for staff will give social care the fundamental reset it needs. The Government have done it with our workforce plan, and they have half-heartedly tried it with dentistry. Does the Minister want to copy our homework once again?
Helen Whately
Let us be honest, Labour has no plan for social care. Whatever the shadow Minister says, it is unfunded. There is no funding committed to it and it is not meaningful. Those of us on the Conservative side of the House are reforming adult social care. We not only have a plan, but it is in progress.
Amy Callaghan (East Dunbartonshire) (SNP)
I have asked the Secretary of State a number of times how she intends to recruit and retain social care staff, particularly with the visa changes coming into effect next Monday, stopping those from overseas coming to fill skills gaps from bringing their spouse or dependants with them. I ask again: how does the Secretary of State intend to improve the recruitment and retention of staff in the social care sector while her colleagues effectively work to undermine her?
Helen Whately
We are grateful to international workers coming to support us in social care and improving supply, but we have to get the balance right between international recruitment and our domestic workforce. In England, we are reforming social care careers to make social care work a career for our homegrown workforce, and I encourage her to make sure the SNP does the same in Scotland.
Dame Nia Griffith (Llanelli) (Lab)
The Minister for Social Care (Helen Whately)
As the hon. Lady will have heard me say earlier, we are grateful to international care workers who come to care for our loved ones in this country. We need to get the balance right between international recruitment and our home-grown care workforce. On the question specifically on dependants, I say to her that every care worker who comes here to do work in the UK has a choice as to whether to come here or not.
Vicky Ford (Chelmsford) (Con)
Priti Patel (Witham) (Con)
Mid and South Essex integrated care board is seeking to remove vital community health services from St Peter’s Hospital in Maldon. Will the Minister meet me and our right hon. Friend the Member for Maldon (Sir John Whittingdale) to discuss the proposals? They will affect both our constituencies and are causing a great deal of concern.
Helen Whately
I would be very happy to meet my right hon. Friends to discuss those concerns.
Christine Jardine (Edinburgh West) (LD)
I thank the Secretary of State for her offer to help cut waiting lists in Scotland. I listened to the frankly delusional statements from the SNP Benches about the state of the NHS in Scotland. We are in dire straits and suffer the same problems, particularly about GPs and appointments disappearing. When are we going to see an improvement in appointment availability?
Richard Foord (Tiverton and Honiton) (LD)
Wendy Hart had a high white blood cell count when she was discharged from the Royal Devon and Exeter Hospital. Her husband, Terence, described a dreadful, pointless 60-mile round trip home and back to hospital before Wendy died of sepsis. Will the Minister consider distances between acute hospitals and rural communities when reviewing hospital discharge guidance?
Helen Whately
I am very sorry to hear about what happened to the hon. Gentleman’s constituent. I send my condolences to her family and loved ones. Clearly, it is very important that discharge decisions are led by clinicians, who can make a clinical decision about whether somebody is medically ready to be discharged. I have no doubt that the family may well take up that decision with local NHS organisations.
Will Quince (Colchester) (Con)
No doctor wants to be on strike, so I welcome the new deal with the consultant unions. It shows that by being reasonable, pragmatic and acting in good faith, unions can deliver for their members. Does my right hon. Friend agree?
Young Adults with Spinal Injuries
Helen Whately Excerpts(9 months, 3 weeks ago)
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The Minister for Social Care (Helen Whately)
I thank the hon. Member for Dulwich and West Norwood (Helen Hayes) for securing this debate and for her powerful speech telling us about Tom Lazarides’s experience, his tragic accident and his injury. I welcome his family, who the hon. Lady said are here in Parliament today. I offer them my sincere condolences on the loss of Tom, who sadly died in November 2023.
I listened carefully to the hon. Lady’s speech, although I did not have advance sight of her comments, and I will do my best to respond. I assure her that I am happy to write to her with further details about the points she has raised this afternoon. I am responding as the Minister with oversight of continuing healthcare and discharge, so I will be able to say more on those points. Particularly in her summing up, she talked more generally about care for people with spinal injury, which can have such a devastating impact and can mean that a person needs a great deal of care from multidisciplinary NHS teams.
I could go into the way NHS England commissions services for spinal cord injuries—there is a national specification and a range of support—but I think I could make better use of the time today by picking up on the question of continuing healthcare and the discharge situation, which the hon. Lady outlined. She described how Tom’s family feel that the system failed him and his clearly complex health needs as a result of his injuries. She described the long time he spent in hospital and the long-term rehabilitation he needed, which meant he needed significant ongoing clinical care. She described how he was considered for continuing healthcare and the experience of the eligibility assessment, and how Tom and his family felt it did not take into account his injuries and health conditions, and did not take full account of his medical records. She described how he and the family were then told that he was not eligible. They subsequently and rightly appealed, and I heard how difficult the hon. Lady said that process clearly was for the family and for Tom, with the lack of transparency, the uncertainty, and the feeling that meetings happened without them and their involvement. I heard how Tom felt under pressure to move into a care home, when he really wanted to live well at home. All of us can completely understand that. Anyone, whether a young person such as Tom or someone of old age, wants to live as independently as possible, whatever their health needs at home. I also heard about the experience with discharge to assess.
Clearly, a process is in place for accessing NHS continuing healthcare. The intention of the process is to consider the individual’s clinical needs, the combination of those needs and how they come together, and therefore to assess whether somebody is eligible. The intention is to design a package of care around the individual to support them where they wish to live, be it at home or in a care home. First, a checklist is used, which leads to someone having an eligibility assessment. If I understood it correctly, Tom experienced and went through the eligibility assessment, but, as the hon. Lady mentioned, the initial decision was that he was not eligible. I am happy to make some inquiries. As a Minister, I cannot make a call on any particular decision that is made on an individual, but clearly I want always to be assured that the right process has been followed. It is probably helpful if, with the help of officials, I try to seek some further information outside the Chamber from the hon. Lady to see what I can do to understand fully what happened and to be assured as to whether there is anything we need to do to make the process work better, particularly in the circumstance that she has described, where somebody such as Tom has clearly had some severe injuries. I am also happy to meet her and Tom’s family to understand this process better.
The hon. Lady raised a point about discharge to assess and how it did not work for someone with a catastrophic injury. Again, we should pick that up in a conversation outside the Chamber. In general, the purpose of discharge to assess is a good one: to avoid people having long and unnecessary stays in hospital, where we know that frail and elderly people, in particular, are likely to decondition and live less independently as a result. She knows that well from the work that she does on social care. Once somebody has been discharged home, they are often able to live with more independence and regain mobility in a way that was not clear when they were assessed in hospital. Sometimes assessment in hospital will lead to delays and a longer stay in hospital, and to what is called over-prescription, with somebody ending up living longer in a care home when they might have continued at home. In general, discharge to assess is a good thing but, as I say, I am happy to look into the specific question of whether there might be circumstances, such as when somebody has had a very serious injury, when the process works differently. I will take that away.
The hon. Lady made a point about the involvement of patients in decisions about their care. It is fundamental that patients should be involved in decisions about their care, as should families and carers. In many circumstances, the patient and those around them will be the experts on what they will need. They need to be involved in the ramifications of whatever decisions are made. That should take place, but let us investigate further outside the Chamber whether that is working as it should be, together with the points she made about transparency and trying to ensure that people are involved when continuing healthcare is being assessed and considered.
I receive a significant amount of correspondence about continuing healthcare. The NHS has a challenging job to ensure that the decisions go the right way. I know the process can be long and hard for those involved in it. I want to ensure it works as well as it possibly can, so that those who should be eligible receive such care. I understand in Tom’s case that, after the appeal, the decision was made that he should be receiving continuing healthcare. How sad that that came after his death and after all the suffering that he and those close to him must have gone through.
I thank the hon. Lady for bringing Tom and his family’s situation to my attention. I commend her for her powerful speech and how clearly she put across the concerns. I look forward to speaking about this further outside the Chamber.
Mr Deputy Speaker (Mr Nigel Evans)
I pass on the deepest condolences of everybody here at the House of Commons to Tom’s family, friends and all who mourn his passing. It was a very moving speech.
Question put and agreed to.
Internationally Recruited Health and Social Care Staff: Employment Practices
Helen Whately Excerpts(10 months, 3 weeks ago)
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The Minister for Social Care (Helen Whately)
I am grateful to my right hon. Friend the Member for Spelthorne (Kwasi Kwarteng) for opening the debate and setting out some of the challenges we face in international recruitment in health and social care. I pay tribute to our international health and care workers, who play an important part in our health and care system, looking after people and bringing their skills, equipment and compassion to look after loved ones. We benefit enormously across the UK from their knowledge and skills. In return, it is imperative that employers, whether in health or social care, provide a safe and supportive environment for their staff to work in.
I want to be clear that international recruitment is not the long-term answer to our health and social care workforce needs. We have been clear about that as a Government, and I have been clear about that personally. That is one of the reasons why, on the NHS side, we have our long-term workforce plan, investing in training our home-grown healthcare workforce. On the social care side, we have a 10-year vision for social care, which includes ambitious workforce reforms, which are in progress, including the first ever national career structure for care workers and new national qualifications. I am determined that care workers—indeed, care professionals —be recognised for their skills and supported in their work and career.
I would say to the SNP spokesperson, the hon. Member for East Dunbartonshire (Amy Callaghan), that she should read up on these care workforce reforms, as should the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), who called a moment ago for a care workforce pathway. I know he is relatively new to this role—we have not done that many debates opposite each other—so I ask him to go take a look online. He will see our care workforce pathway programme, which we have published and which we worked closely with the sector on to develop this national career structure. We did so exactly because it was one of the things we knew was missing from social care, and because when people come into social care, they want to see that they have an opportunity to progress in that career. We are also developing national training that will be recognised across different employers. Those are just two of the headline policies of a truly ambitious reform programme for the social care workforce.
Amy Callaghan
I do not particularly appreciate being given homework by a Minister who is doing so much damage to the health and social care sector in Scotland. I have certainly done my homework already—I do not need to be given some by her.
Helen Whately
I think it is probably helpful if I move on, rather than our having some sort of back and forth.
I turn to the question in hand, which is specifically to do with international recruitment and the reasonable concerns raised by my right hon. Friend the Member for Spelthorne about the exploitation of some workers who come to support us in this country in health and social care. One of the things he spoke about was the code of practice. He is absolutely right that we have a code of practice for the international recruitment of health and social care personnel, which sets out ethical recruitment and employment standards that employers must adhere to. The code is kept under regular review. In fact, my right hon. Friend referred to the update of the code last year. I can assure him that my Department works closely with the Royal College of Nursing and other trade unions and stakeholders to strengthen that code and make sure it addresses the current issues and ethical concerns. For instance, we have set out stricter principles on the use of repayment clauses in employment contracts, and the code is now explicit that charging recruitment fees is illegal under UK employment law. I absolutely agree with my right hon. Friend that we should continue to make sure the code of practice truly captures all that it needs to, and is as effective as it can possibly be.
Alongside the code of practice, we have the ethical recruiters list. This contains a cohort of recruitment agencies that have agreed to operate in accordance with the rules of the code. The list is run by NHS Employers, and it makes it easy for employers in the NHS and the social care sector to check that recruitment agencies are signed up to meet the high ethical recruitment standards we expect. Any organisation suspected of breaching the code will be investigated, and can be removed from the list.
Most overseas staff have a positive experience working in the UK, but I acknowledge that, regrettably, this is not the case for all. We know there are some rogue agencies and employers that take advantage of people who want to come to the UK to work. We have published guidance for prospective overseas candidates to help them make informed decisions and prepare for life in the UK. The guidance sets out what candidates should check in their employment contracts before signing them, what working rights and standards they can expect in the UK, and how to recognise and deal with exploitation, should that unfortunately be something they experience.
My Department is working with colleagues in the Foreign, Commonwealth and Development Office to disseminate that guidance effectively, so that it reaches prospective candidates at an early stage and helps make informed decisions and avoid scams and unethical practices. We want them to be able to do that in their home countries, before they even apply to work here in the UK.
My right hon. Friend the Member for Spelthorne mentioned punitive repayment clauses in employment contracts. We are clear that those are unacceptable, and in certain cases illegal. There are some instances where repayment clauses may be used legitimately to cover some up-front costs incurred, should an employee decide to leave their job after a short time. But in all cases, employers must make it clear in contracts what is to be reclaimed, and how and when that will take place. Instances where repayment clauses are excessive, or extended over a lengthy period, have the effect of trapping international workers into jobs, and that is unacceptable. Repayment clauses cannot be used by employers to cover the cost of agency fees, certificates of sponsorship or the immigration skills charge.
As I mentioned, the code was updated to address that issue. The NHS has gone further, producing additional bespoke guidance for NHS employers to explain how to implement the code’s principles when using repayment clauses. That will ensure transparency and fairness in employment contracts for all international recruits working in the NHS.
Another issue raised by my right hon. Friend is that of recruitment agencies charging international candidates high fees to find them work in the UK. For UK-based agencies the law is clear: charging a candidate any recruitment fee to find them a job in the UK is illegal. The Employment Agency Standards Inspectorate is the organisation responsible for regulating employment agencies, and it will investigate such misconduct and prosecute where appropriate.
However, we do face the challenge of agencies based overseas that fall outside the UK’s jurisdiction. Regrettably, we have limited direct levers to stop the unethical treatment of workers overseas, but we have taken steps to try and mitigate the risk as far as possible. First, our international candidate guidance, which I mentioned a moment ago, warns potential candidates that they should not be paying any kind of fee to find work in the UK, and that they should not work with any agency that requests such a fee. Secondly, our embassies and high commissions are actively working with higher-risk countries to tackle exploitative practices by recruitment agencies overseas. NHS Employers, as holders of the ethical recruiters list, undertakes regular spot checks of agencies on that list to ensure they are complying with the code of practice.
As a Department, we are working collaboratively with the labour enforcement agencies that take action against those breaking the law in the UK. Those include the Gangmasters and Labour Abuse Authority, UK Visas and Immigration, and the Employment Agency Standards Inspectorate. We therefore have a multi-agency approach across Government which uses our collective intelligence, capabilities and resources to respond to concerns about exploitation. That includes providing insight, advice and guidance to businesses and supply chains in relation to possible labour market offences.
My right hon. Friend mentioned language skills and the potential challenge for somebody whose English might not be fluent, to navigate the landscape and know their employment rights, for example. It is clearly important that the language skills of anyone providing care in England are good enough to communicate with their employer, the people they provide with care, and other care and healthcare professionals.
Care providers must ensure that their chosen candidates have the skills needed to work in care and should assess a candidate’s English proficiency at the interview stage of recruitment. For somebody to work in social care, employers should ensure a good standard of English. For staff from overseas, the Home Office sets English language proficiency requirements. Individuals are required to prove they can speak, read, write and understand English to at least level B1 on the common European framework of reference for language scale.
My right hon. Friend also asked about cross-Government work in general on tackling exploitation. I can assure him that we are working across Government. My Department is working particularly with the Home Office and UKVI, both at official and ministerial level. I have had several conversations with Home Office Ministers about our care worker visa scheme and what we are doing to tackle the risk of exploitation and abuse.
I worked closely with Home Office colleagues on the recent changes to the care visa. We agree about striking the right balance with overseas care workers, who are supporting us in some of the challenges of meeting the social care and healthcare need in the UK. We also need a balance between international workers and our home-grown workforce, ensuring that there are safeguards for international recruits.
Following those conversations, we have announced changes to the care visa scheme, as referred to during this debate. One is that, as of March, we will no longer allow care workers to bring dependants with them. Another safeguard is that we are restricting sponsors to CQC-registered care providers. At the moment, as long as someone is providing social care, CQC-registered or not, it depends on the sort of care provided.
The Government do not have all the answers at the centre, and I feel strongly about that. That is one reason why, as we have introduced the care worker visa, we put £15 million funding into regional partnerships of local authorities, to have established leads around the country for international recruitment, to support employers and recruits. I meet our regional leads, to hear what it is like in their areas, and to discuss what they are doing on the ground to support employers and social care staff. For instance, they are supporting providers with legal and HR advice on recruiting and employing international staff.
There is a specific example relevant to this debate. East of England has commissioned Unseen to run seminars and provide one-to-one support for care providers on safeguarding and spotting signs of exploitation. I continue to work with those leads to get the best possible insight on the ground on the extent to which internationally recruited workers may face difficulties. That could happen if someone has been brought here for a job with a particular sponsor who loses the licence to employ them, and the leads are working hard, trying to support recruits in that situation. I am also setting up a meeting directly between our regional leads and the Home Office and UKVI, to ensure that they share their intelligence directly, making the most of the leads’ work and insights.
I want to come briefly to some of the points made by the hon. Member for Westmorland and Lonsdale (Tim Farron). He mentioned the connection between social care supply and delayed discharge in his local area, which is something that I have done a huge amount of work on over the past year. I want to be clear, particularly on this topic, that social care does not exist just to discharge and support the discharge of patients from hospital. Social care is absolutely an end in itself, supporting both older people and those of working age with care needs.
We know that there is a connection between discharge delays from hospital and social care, because some people who are delayed in hospital, when they are medically optimised for discharge, are in need of social care packages. That is why we put in an extra £600 million in funding to support discharge over the past year, and there is another £1 billion coming this year. We have also put in an extra £570 million of funding to support social care. Just this morning, I was talking to a number of directors of adult social services from local authorities who assured me that that funding has made a meaningful difference to social care funding and supply.
I know that there are still significant financial pressures, and the national living wage increase puts an additional pressure on care providers and local authorities for the coming financial year. While that increase is a good thing for those at the bottom of the pay scale, it also places financial pressure on employers and those funding social care. I assure the hon. Member for Westmorland and Lonsdale that that increase in supply, thanks in part to the extra funding, has helped to speed up discharges over the past year and reduced some of the delays, and we have seen an increase in the number of people being discharged both overall and particularly with social care support. We have made progress on that point.
I come back to this point in closing. I want to be categorically clear, in the light of this debate, that no member of staff in health or social care should face abuse of any kind, and illegal and unethical international recruitment and employment practices will absolutely not be tolerated. Internationally recruited staff play a really important part in caring for people across health and social care. They have helped us to build and increase our health and social care workforce. On the NHS side, we have achieved our manifesto commitment of 50,000 more nurses. On the social care side, we have over 20,000 more care workers in the care workforce. We have seen vacancies come down and retention improve, so we have been making progress on both the social care and the NHS workforces. While international recruitment plays an important part, it goes hand in hand with our work as a Government to build up our home-grown workforce both on the NHS side, with our NHS long-term plan, and the social care side, with our ambitious social care workforce reforms.
Oral Answers to Questions
Helen Whately Excerpts(10 months, 4 weeks ago)
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Sarah Green (Chesham and Amersham) (LD)
The Minister for Social Care (Helen Whately)
Discharging people on time is better for them and frees up hospital beds. We are changing how our health system works to do that: joining up health and social care and care transfer hubs; helping people to recover at home, with more than 10,000 new virtual ward beds; and investing in social care. And it is working. Last month, delayed discharges were down 9% compared with the end of December 2022 despite almost 1,000 extra urgent admissions to hospitals every day in December.
Sarah Green
Nearly one in six beds in my local healthcare trust in Buckinghamshire continues to be occupied by patients fit for discharge. A recent King’s Fund report found that the Government’s current practice of providing one-off funding to reduce delay, while welcome, comes with insufficient advance notice to allow for effective planning. What steps is the Minister’s Department taking to ensure the best use of this funding?
Helen Whately
One reason we distributed discharge funding back in April last year was to give more advance notice to organisations, so that they could put in place what is needed to speed up discharges. I say to the hon. Lady that our plan is working. That is why, in her own trust, discharges at the end of December were down by a third compared with the previous year.
Will Quince (Colchester) (Con)
I note the progress that my hon. Friend referenced, but delayed discharges are still a major issue. Patient flow through a hospital is a critical factor, especially at the front door through emergency departments. We know the role that electronic bed management systems can play in helping that flow. What steps is my hon. Friend taking to ensure that more hospitals roll out that technology?
Helen Whately
My hon. Friend is right. I know how much work he did when he had oversight of urgent and emergency care services, which included his contribution to our urgent and emergency care recovery plan that was published almost a year ago. That plan included a host of steps to improve the flow through hospitals, including investment in bed management systems, as he described. The plan is working, which is why we are improving the flow through hospitals and seeing reductions in delayed discharges.
Mr Rob Roberts (Delyn) (Ind)
Clive Efford (Eltham) (Lab)
The Minister for Social Care (Helen Whately)
Care is a skilled profession, and I want care workers to get the support and recognition they deserve. This month, we took the next step in our ambitious care workforce reforms, publishing the first ever national career structure for the care workforce alongside our new nationally recognised care qualification.
Clive Efford
Ambitious care workforce reforms—it is all blah, isn’t it? We have had 14 years of Conservative Government, and we have a crisis in every area of the NHS. Job insecurity, poor working conditions and low pay—one in five care workers is living in poverty—are all reasons why we have a recruitment and retention crisis in social care. Is not the truth that that is a damning indictment of 14 years of Conservative Government, and the only thing that is going to sort out social care and the crisis in recruitment and retention is a general election?
Helen Whately
I am actually really shocked by the way the hon. Member referred to the care workforce, with terms like “It is all blah”—very shocking. I am determined that care workers should get the recognition they deserve. We have a 10-year plan for social care, and it is working: the care workforce grew by over 20,000 last year, vacancies in social care are down, and retention is up. We are reforming social care so that it works as a career. That is why, as I said a moment ago—I wish the hon. Member had been listening—we have introduced the first ever career pathway for social care workers and a new national care qualification.
Helen Whately
We have a plan for the social care workforce, and it is working. The social care workforce increased by over 20,000 last year, and it is still going up. But I will take no lectures from the hon. Member. In fact, his hon. Friend the Member for Bristol South (Karin Smyth), early this morning on television, made it clear that Labour does not have a plan for social care—or if it does, it is clear that it will cost a lot of money and is yet another unfunded Labour plan.
Sir David Evennett (Bexleyheath and Crayford) (Con)
Mark Pawsey (Rugby) (Con)
The Minister for Social Care (Helen Whately)
Almost a year ago, we published our urgent and emergency care recovery plan. The NHS has already halved the waiting times for category 2 ambulances and brought down waits in A&E. We are determined to cut NHS waits, and our plan is working.
Mark Pawsey
Rugby is one of the fastest growing places in the UK. While we have had additional services introduced at our local Hospital of St Cross, my constituents have insufficient accident and emergency provision. Thousands of local residents have signed my petition for doctor-led accident and emergency care at the Hospital of St Cross. I know it is a matter for the integrated care board, but will the Minister give her support? As a previous Minister, my hon. Friend the Member for Colchester (Will Quince) and the previous Secretary of State have visited in the past few months, and I invite this Minister to do likewise.
Helen Whately
I thank my hon. Friend for his invitation. He has been a tireless campaigner on this issue on behalf of his constituents. The future of healthcare is about getting people the care that they need, where they need it and when they need it, and Rugby is no different. New local NHS services are bringing care closer to home in his area, such as the new imaging unit at the Hospital of St Cross that opened in September.
Mr Gregory Campbell (East Londonderry) (DUP)
Access to urgent and emergency care can be greater facilitated when greater protection is offered to staff, particularly the many who suffer attacks in emergency departments at hospitals across the United Kingdom—often by people who are intoxicated.
Helen Whately
The hon. Member makes an important point. The safety of our staff in the national health service is important, including those in urgent and emergency care departments, as well as the ambulance services. He is absolutely right to point that out, and it is never acceptable for anyone, including patients, to be violent towards staff.
Jeff Smith (Manchester, Withington) (Lab)
Andrew Gwynne (Denton and Reddish) (Lab)
Mike Reader, Labour’s candidate for Northampton South, shared with me the horrific experience of Stanley, who had severe abdominal pain and called an ambulance, only to be told it would take hours and to go to A&E. There, he was told to wait for assessment on a patio chair outside. It was 3°. Who is to blame?
The Minister for Social Care (Helen Whately)
I am very sorry to hear of the experience of that specific constituent. Because of challenges that the NHS faces, particularly our urgent and emergency care services, almost a year ago we set out our urgent and emergency care recovery plan, to speed up care for people in A&E and reduce waits. That plan is working. We are seeing ambulances get to people quicker, and people treated quicker in A&E.
Andrew Gwynne
That is not a one-off. Why will the Minister not take a shred of responsivity for the chaos that her party has caused our NHS? The last Labour Government achieved the shortest waits and the highest patient satisfaction in NHS history. The Conservatives have delivered the longest waits and the lowest patient satisfaction in history. Let us have that general election, so that she can defend her abysmal record to the public.
Helen Whately
The hon. Gentleman obviously was not listening to my answer; in fact, he was reading aloud. Our urgent and emergency care plan is working. It is reducing rates in A&E, and ambulances are getting to people faster. Meanwhile, I am sorry to say that in the Labour-run NHS in Wales, more than half of patients are waiting more than four hours in A&E.
Andrew Lewer (Northampton South) (Con)