Visiting in Care Homes, Hospitals and Hospices Consultation

Helen Whately Excerpts

Wednesday 21st June 2023 Written Statements

[The Minister for Social Care (Helen Whately)]

In collaboration with my hon. Friend the Minister of State for Health and Secondary Care (Will Quince), and my hon. Friend the Minister for Mental Health and Women’s Health Strategy (Maria Caulfield), I am making this statement for the benefit of all members of Parliament to bring their attention to the Government consultation on visiting in care homes, hospitals and hospices.

Ensuring that care home residents and hospital and hospice patients maintain contact with loved ones is vital to the health and wellbeing of people receiving care or treatment. Friends and family also provide invaluable practical support and advocacy for those receiving treatment. However, the Government have heard from Members across both Houses, members of the public and campaigners of continued instances of loved ones being denied contact following the lifting of restrictions introduced during the covid-19 pandemic.

Restrictions were implemented during the pandemic to help prevent the spread of covid-19 in health and care settings. While those restrictions were in place at the time to keep people safe and control the risk of transmission from a virus that was not yet well understood, we recognise how detrimental it was for loved ones to have been kept apart and to not have had friends and family advocating on behalf of patients and care home residents. We constantly sought to enable safe visiting wherever possible and made it clear that end-of-life visiting should always be possible. Our guidance is now clear that visiting should be encouraged and facilitated in line with efforts to return to normal.

The Government recognise the efforts that so many health and care settings have made to implement guidance and facilitate visits. NHS England has guidance in place which sets a minimum expectation for visiting in inpatient, outpatient, diagnostic service settings and the emergency department, that hospitals should facilitate a minimum of two visitors to visit patients for at least one hour per day, ideally for longer. Compliance with this guidance is now a requirement in their standard contract for all providers of NHS services.

However, we know that some restrictions continued beyond the lockdown periods and continue to hear of instances where loved ones are unable to see each other for prolonged periods or provide support when someone is attending hospital. We understand the harm this can cause to the health and well-being of those receiving care as well as how distressing this is for their friends and families visiting and, in many cases, providing vital care to loved ones.

The Government are therefore announcing a consultation today that sets out our proposals for going further to tackle this issue. The consultation document outlines the current position, including current Government guidance and data on visiting in health and care settings, as well as further details on current regulations, the Government proposals, the questions for respondents, how to respond and next steps.

Current regulations

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (CQC Regulations) set out fundamental standards which must be upheld by all Care Quality Commission (CQC) registered providers. CQC assesses health and care providers against the fundamental standards and other requirements set out in CQC Regulations. Providers are required to comply with certain fundamental standards of care which implicitly cover visiting.

Although visiting is not explicitly mentioned in the current CQC regulations, it is considered best practice that visiting is not normally restricted, and that any restrictions should be reasonable, proportionate and time limited. CQC has enforcement powers to protect people who use regulated services from harm, the risk of harm, and to protect people’s rights and welfare.

In addition to the fundamental standards, other legislation may allow individuals to take legal action against their providers, set out in further detail in the consultation document.

Policy intention and proposal

DHSC wants to ensure that visiting is protected and that it remains a priority. We are therefore considering putting visiting on a statutory footing. It is important that any visiting requirement is workable, reasonable and proportionate. We therefore propose to do this by introducing secondary legislation to amend CQC Regulations to include a specific visiting requirement. This could be done either by introducing a new regulation specifically for visiting, or by amending an existing regulation to include visiting, such as “person centred care” or “dignity and respect”.

We want the legislation to have as far reach as possible and our proposal is therefore for the new visiting requirement to cover CQC-registered health and care settings. This would include NHS and independent providers—both acute and mental health—care homes and hospices.

This consultation relates to visits from family, friends and volunteers such as befrienders and includes accompanying patients attending outpatient or diagnostic appointments and emergency departments at hospitals. It is not about access to visiting professionals, and any change made regarding visiting would not override pre-existing statutory arrangements regarding visiting professionals, such as the entitlement for people detained under the Mental Health Act 1983 to meet independent mental health advocates (IMHAs) in private if they wish to.

Through this consultation we will hear directly from those most likely to be affected by this policy proposal and will gather the evidence required to determine what action should be taken on visiting in health and care settings.

[HCWS874]

Hospice Services: Support

Helen Whately Excerpts

Wednesday 14th June 2023 Westminster Hall

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Ms Nokes. I thank my hon. Friend the Member for Eastleigh (Paul Holmes) for securing this debate on hospices, and I thank all hon. Members who have contributed. Both the number of colleagues in the room and the passion of so many contributions show the strength of feeling and level of support for hospices in all our communities.

We have heard from so many colleagues this morning: my hon. Friends the Members for Darlington (Peter Gibson), for Aberconwy (Robin Millar), for Bolton West (Chris Green), for Torbay (Kevin Foster), for North West Norfolk (James Wild) and for Worcester (Mr Walker), and the hon. Members for Blackburn (Kate Hollern), for City of Chester (Samantha Dixon), for Bolton South East (Yasmin Qureshi), for Westmorland and Lonsdale (Tim Farron), for York Central (Rachael Maskell), for Barnsley East (Stephanie Peacock), for Lancaster and Fleetwood (Cat Smith) and for Strangford (Jim Shannon). In addition, many other hon. Members have contributed by intervening. In the course of today’s debate, many fantastic local hospices have rightly been praised for what they do for our communities.

My hon. Friend the Member for Eastleigh spoke about the Mountbatten hospice in his constituency and how it cared so wonderfully for his friend and colleague Sue Hall. Many hon. Members spoke about their personal experiences, which often involved family members, and the amazing ways that hospices have helped family members and themselves through difficult times. I, too, remember the amazing care that my granny received in her local hospice in Dorset when I was in my twenties. I still hold in my head the experience of visiting her there—the tranquillity of the hospice and the amazing care that she was clearly receiving, which made the last weeks of her life as bearable as possible. I remember the kindness and peace that I felt there in that hospice. I, too, have that personal experience and appreciation of what hospices do.

A theme of this debate has, rightly, been the importance of dying well—dying with dignity and dying with the right care in the place where a person wants to die, which is very often at home. Dying well depends on good end of life care, for which we in this country rightly have a good reputation. Most end of life care is provided through NHS services, but hospices are an important part of end of life and palliative care in our communities. As we know, hospices provide care in their facilities, but increasingly and very importantly they provide care to people in their own homes towards the end of their lives, and also support families through those difficult times and through bereavement.

[Stephanie Peacock]

The end of life care that I spoke about in my contribution, which is so important, remains closed at Bluebell Wood Children’s Hospice; it is the one part of the hospice that has been unable to reopen. Will the Minister commit to doing everything that she can to support the hospice to reopen, so that it can continue to provide end of life care, and not just all the other services it provides to families that need them so much?

[Helen Whately]

As the hon. Member mentioned earlier, we have indeed met and spoken about the hospice to which she refers. I have also met with several other hon. Members. I am grateful to them for coming to me to talk about the specific difficult situations faced by some of the hospices serving their communities.

That brings me to exactly what I was coming to talk about: the financial pressures on hospices, which have been a strong theme of the debate. I know very well, not just from this debate but from conversations with hospices, about the financial challenges that hospices are facing. In fact, financial challenges are being faced by many organisations that provide care in our communities, whether NHS organisations or care homes, as the hon. Member for Leicester West (Liz Kendall) mentioned. In particular, there are the extra pressures of energy costs—such organisations often use substantial amounts of energy—and the higher costs of staff pay. We know that many hospices pay their staff in alignment with the NHS agenda for change pay scales.

An additional difficult context for hospices at the moment is fundraising. That was clearly hard during the pandemic, but since then many households have been affected by the higher cost of living and therefore have found it harder to contribute to fundraising efforts in their communities, including those organised by hospices. I know how hard that context is for our hospices.

On energy costs, many hospices have been able to benefit from the Government’s energy bill relief scheme, which ran to 31 March. Eligible organisations, including hospices, will continue to get baseline discount support for gas and electricity bills under the energy bills discount scheme, which is running from 1 April 2023 to 31 March 2024. In addition, last year NHS England released £1.5 billion of extra funding to integrated care boards in recognition of the extra costs arising from inflation in the services they commission. ICBs have been responsible for distributing that funding according to local need, including to palliative and end of life care providers in our communities, whether they are NHS organisations or hospices.

[Tim Farron]

Of course, ICBs are not elected, but the Minister is. She heard what the hon. Member for Lancaster and Fleetwood (Cat Smith) and I had to say about the 0% increase that the Lancashire and South Cumbria ICB has granted—or not granted—our hospices. Will she directly get involved in that to fix it so we do not have to have the 10% cuts that St Mary’s Hospice thinks we will have to deliver?

--- Later in debate ---

[Helen Whately]

I will not commit to getting involved in a specific conversation between a hospice and an ICB. That would not be the right thing for me to do as a Minister. The hon. Gentleman and I have had several conversations over the years that I have been a Minister, so he will not be surprised to hear that I have been seeking transparency about the extent to which the funding has or has not gone to hospices. I have been seeking data on whether the rates being paid to hospices have or have not gone up so that we have transparency about the extent to which the funding that has gone to integrated care boards to support with inflation is getting through to the services that need support.

[Peter Gibson]

Although I acknowledge and appreciate everything the Government did to support hospices during covid, it is simply not the case that every ICB across the country is passing the right amount of money to the hospices from which it commissions services. Will the Minister commit to publishing information about which ICBs are stepping up to the plate and fulfilling their statutory obligations, and which are not?

[Helen Whately]

I commit to continuing to dig into getting visibility on the extent to which extra funding is going through to hospices. Of course, there is a balance to be struck when giving integrated care boards the freedom to do what we want them to do, which is to understand fully the needs for care in their populations, and make good decisions about how they fund care for their populations. None of us believes that a Minister in Westminster has the answers about what should happen and exactly how funding should be distributed in every single one of our communities. I will continue to get that visibility, because it is important that we know the extent to which our hospices are getting support for the extra financial pressures that we have been discussing.

[Rachael Maskell]

Will the Minister give way?

[Helen Whately]

I will make a bit of progress, because I am conscious that the clock is ticking.

Integrated care boards are responsible for ensuring the provision of the end of life and palliative care that is needed in our communities across England. In addition to the funding, I am working with NHS England to ensure greater visibility relating to what that means in practice and what is being commissioned.

The shadow Minister’s point about inequality of access was very important. We know that there is inequality of access to palliative and end of life care. Some communities are much better served than others, in part due to the fantastic legacy of our hospices: where there is a really good hospice, there is often much better access to end of life and palliative care around it. We want to improve equality and reduce some of the disparities in access to end of life care. As part of that, people should be able to do what most people want—to die at home with the right support in place.

I want to talk about the funding for children’s hospices, which several hon. Members brought up. Recognising the importance of palliative and end of life care for children and young people, NHS England provided £25 million specifically for that, via the children’s hospice grant during this financial year. I have, of course, heard the calls for that grant to be continued, and for greater continuity and visibility of funding further out. I cannot say more on that today, but I can assure hon. Members that I have been speaking to NHS England about that funding beyond this year. I do expect further new to be communicated about that shortly, appreciating the level of concern among hon. Members and children’s hospices in their communities.

[Rachael Maskell]

I am grateful to the Minister for giving way. The Health and Care Act 2022 put a responsibility to fund palliative care on the statute books. Will the Minister set out what has changed, to enable that funding to come forward? We know there are people in our communities who are not receiving that care, although they need to now under the law. The funding needs to be in place for them to receive the care that they need at the end of life.

[Helen Whately]

That alludes to exactly the point I made a moment ago. As flagged in that 2022 Act, ICBs have responsibility for commissioning that care, using the budgets they receive through NHS England. I am working to ensure the visibility of the commissioning, to be assured that that is taking place, so that we can be assured about the availability of end of life and palliative care for our communities.

I want to make a final point as I close; I am looking at the clock ticking. Against the backdrop of financial concerns, which I of course recognise and which we are discussing, is the strength of hospices in their communities, and the importance, as mentioned by hon. Friends, that they are not solely financially dependent on the state and the NHS for funding. They receive some NHS funding, but it is important that hospices are successful in fundraising and gaining support from our communities. That is one of the strengths of their model, and I want to continue to support that.

I pay tribute to all the volunteers and those involved in fundraising, including many hon. Members this morning who mentioned the fundraising efforts that they are personally making for hospices in their communities. I wish very good luck to my hon. Friend the Member for Eastleigh for his forthcoming skydive. All credit to him for having the courage to jump out of an aeroplane. I sincerely hope that he is successful.

[Paul Holmes]

Thank you!

[Helen Whately]

I wish him very good luck; it is fabulous that he is doing that for his own hospice. I also commend the efforts of many other hon. Members. I conclude by thanking all hon. Members for coming today and for their contributions to this important debate.

National Carers Week

Helen Whately Excerpts

Thursday 8th June 2023 Commons Chamber

[The Minister for Social Care (Helen Whately)]

I thank my hon. Friend the Member for Gosport (Dame Caroline Dinenage) for securing the debate, for her powerful opening speech and for all she does as chair of the APPG on carers. This week is Carers Week—a chance to recognise and focus on carers—but as every carer knows, if you are a carer, every week is carers week. I pay tribute to carers and young carers across the country for what they do, caring for loved ones, whether it is their mum or dad, brother or sister, a neighbour or their child, who will often be grown up, day in, day out, all year round.

Over 4 million people in England are unpaid carers. For some, caring may be a few hours a week helping a relative or neighbour with things they cannot do themselves or providing companionship. For others—in fact, nearly one in three, according to the latest census—caring means over 50 hours each week looking after someone. It is not just a full-time job, albeit unpaid, but how they are spending their lives.

My hon. Friend drew on her expertise, as a former Care Minister, and her personal experience. She spoke about how few families are untouched by caring responsibilities, about the sacrifices that carers make and how they are driven by love, but also the problem of exhaustion and burn-out for carers. She talked about the importance of identifying carers, especially young carers. She spoke powerfully about children with experience of dialling 999 because of a parent needing an ambulance but not telling anyone because of the stigma, particularly due to a parent’s mental health needs.

My hon. Friend asked whether we could build on some of the things we did for carers in the pandemic. I know, as I was Care Minister at the time, how incredibly hard the pandemic was for many carers, how isolated many felt and how many felt they did not have the support they needed. I know how difficult it was to work out how we could support carers during the pandemic, but we managed to do some things, such as identifying carers we prioritise for the covid vaccine. I will take away her request to look at how we can build on the things we did in the pandemic.

I know that the hon. Member for Worsley and Eccles South (Barbara Keeley) is a committed campaigner for social care and carers; we often speak in the same debates. She spoke about some of the financial difficulties for carers, the importance of cross-Government commitment to carers, and carers needing breaks and time off from caring.

My hon. Friend the Member for Cities of London and Westminster (Nickie Aiken) spoke about her personal experience of caring for her father. She talked about the loneliness and isolation but how cricket helped, which made many of us smile. She talked about young carers, how the sacrifices they make are often not appreciated and the long-term effects of being a young carer.

I pay tribute to hon. Member for North East Fife (Wendy Chamberlain) for her very important work in steering the Carer’s Leave Bill through Parliament. She spoke about things that employers can do more broadly to support carers and the opportunity of being a Carer Positive employer. The right hon. Member for Hayes and Harlington (John McDonnell) said that he chairs a local carers group, and I give him credit for that, whether or not it is a Labour group. That is a very important thing to do, bringing carers together to support one another and listening to what help they need. He spoke about the difficulty for carers in getting assessments. The hon. Member for Ceredigion (Ben Lake) spoke about the cost of living and the cost of heating homes for carers, particularly in his constituency, where many carers are off grid and use heating oil.

We also heard briefly from the hon. Members for Strangford (Jim Shannon), for Cardiff South and Penarth (Stephen Doughty) and for Livingston (Hannah Bardell) and my hon. Friend the Member for Henley (John Howell). That level of Back-Bench interest in this topic on a quiet Thursday in Parliament shows how strongly people feel, rightly, about the need for support for carers in our constituencies. We also heard from those on the shadow Front Benches, the hon. Members for Leicester West (Liz Kendall) and for Motherwell and Wishaw (Marion Fellows).

I know, from my own experience and from my family, that caring is something we do because it feels the right thing to do. We might not have a choice or not feel we have a choice, but nor can we imagine not doing it—not caring for the person we love. For many people, it is something that just happens to them: they become a carer without really realising it. Suddenly, they are spending hours caring—perhaps all their waking hours, and often in the night as well—without realising that they have become a carer, and without knowing that they might need support or, indeed, that they could get it. That is why recognising carers and helping them recognise themselves is important in its own right. There is a good reason why recognising and supporting carers in the community is the theme of this year’s Carers Week.

Local authorities, the NHS, schools, universities, all public services, and indeed companies need to continue to improve how unpaid carers are identified, recognised and supported in our communities. This Carers Week, I have had meetings with more than 30 unpaid carers, young adult carers and representatives from unpaid carers’ organisations, and both as Care Minister and in my life outside politics, I meet carers all the time—remarkable carers who have shared their stories with me. Those are so often stories of how hard it is to be a carer, although it is also really good to hear some positive stories. For instance, some employers are really supportive of carers and their caring responsibilities. However, sadly, that is not always the case; in fact, just on Tuesday, one carer told me that she is thinking about giving up her job due to a lack of support. Many hon. Members have spoken about that issue today.

On the important issue of juggling employment and caring, I want to highlight the Carer’s Leave Act 2023, which received Royal Assent on 24 May. Eligible unpaid carers will soon be able to take a week’s flexible unpaid leave each year. I am so pleased to see that Bill pass into law to help carers who are juggling work and caring.

This week, I also spoke to another carer about the challenges they are facing in getting the professional care and support they need. That is one reason why the work we are doing on reforming the adult social care workforce is really important. I say to carers, “Please keep on speaking up. Keep on telling your stories, for other carers and to make sure people know what it is to be a carer. None of you are alone.”

In April, we published our reform plan, “Next steps to put People at the Heart of Care”. The enormous contribution of unpaid carers is reflected in that plan, and in writing it, we were thinking about carers as well as those they care for. This financial year, £327 million of the better care fund has been earmarked to provide short breaks and respite services for carers, as well as additional advice and support. We are finalising plans for how we will deliver the additional sum of up to £25 million that we committed to carers in the White Paper, and I will be sharing those plans shortly. I know it is taking time, but I do really want to get it right.

The Health and Care Act 2022 includes provisions for the Care Quality Commission to assess the performance of local authority delivery of adult social care duties. That duty has gone live as of 1 April with our new assurance framework, which will provide a clear assessment of how local authorities are meeting their statutory duties, including those relating to carers, such as whether local authorities are undertaking their assessment of carers’ need for support and then meeting the needs that are identified. That will address one of the questions asked by my hon. Friend the Member for Gosport, along with other Members: how we make sure carers get the assessments to which they have a statutory right, as well as the support they are identified as needing.

We are working with NHS England to streamline the ways in which unpaid carers are recorded in GPs’ health records, and we have written to all GPs in England to communicate improvements to how that is carried out. Crucially, that identification of individuals with caring obligations extends to young carers. Questions designed to identify children and students caring for family members have been added to the school census, and that important data has been published today. We are also making progress on our plans to transform social care data, better joining up the care to people, including support to unpaid carers as well as those they care for.

Meanwhile, we are taking steps to design a new survey to capture the wide range of experiences and needs of unpaid carers across England, and to commission a valuation of the support provided to unpaid carers through the better care fund, including carer breaks and respite. It might seem obvious, but different carers want different things, so it is right that we take steps to understand and build the evidence base of what works and what matters when supporting carers.

[Barbara Keeley]

Will the Minister give way?

[Helen Whately]

I am really sorry, but I have but a minute left—Madam Deputy Speaker has confirmed that. However, to address the points that the hon. Lady made in her speech, I assure her that not a penny has been taken away from funding for adult social care; in fact, more money is going into adult social care, thanks to the record funding of up to £7.5 billion over two years that we announced in the autumn statement. A crucial part of our adult social care workforce reforms is our reform of the professional care workforce: developing social care as a career for the professional workforce, developing the career pathway and investing in qualifications for that workforce. That is very important to unpaid carers, because the top issue often raised with me by the unpaid carers I talk to is the difficulty of accessing professional care.

To close, I want to say as Minister for Social Care that I care, and I will continue to champion carers’ needs as part of the work I do across Government. I am delighted to announce that I will be convening a roundtable of Ministers to work together across our Departments to identify, recognise and support unpaid carers. I thank all right hon. and hon. Members who have made contributions on this important topic today, as well as Carers UK for its work this Carers Week and its year-round advocating for carers, and the other campaign groups involved in this week, including Age UK, the MND Association, Rethink Mental Illness, the Lewy Body Society and Oxfam. Finally, I say thank you to all carers.

Oral Answers to Questions

Helen Whately Excerpts

Tuesday 6th June 2023 Commons Chamber

[Taiwo Owatemi (Coventry North West) (Lab)]

3. Whether he is taking steps to ensure that notices of decision for care homes do not lapse upon a change of ownership unless standards improve.

[The Minister for Social Care (Helen Whately)]

When a care home is taken over, the Care Quality Commission assesses and re-rates it under its new ownership. Previous notices of decision cannot legally be passed to a new provider, but they do inform the CQC’s approach to an assessment and how soon it takes place. During the time between the takeover and the CQC’s carrying out a new assessment, the legacy rating is shown on the CQC website.

[Taiwo Owatemi]

My constituents Brenda, Gary and Trina lost their parents after they were placed in Melbourne House care home, which the CQC later deemed to be “inadequate”. However, because the notice of decision lapsed on its transfer to the original owner’s family, the home, now known as Earlsdon Lodge, is able to operate as if nothing had happened. Will the Minister meet my constituents and me to explain exactly why that was allowed to happen, and what is being done to prevent it from happening to other families?

[Helen Whately]

I shall be happy to meet the hon. Member to look into that case, because I feel strongly about the importance of ensuring that everyone has access to good, if not outstanding, care in care homes.

[Richard Thomson (Gordon) (SNP)]

4. If he will make an assessment with Cabinet colleagues of the potential impact of increasing the affordability of sun protection products on levels of skin cancer.

--- Later in debate ---

[Neil Coyle (Bermondsey and Old Southwark) (Lab)]

8. What steps he is taking to improve the health of patients with arthritis awaiting NHS treatment.

[The Minister for Social Care (Helen Whately)]

NHS England has drawn on the work of Versus Arthritis, including its joint replacement support package, in the resources it provides to support people waiting for hip and knee replacements. Alongside that, we know that what people really want is faster treatment. That is why we are working so hard to cut waiting lists, which is one of the Prime Minister’s five key priorities.

[Neil Coyle]

I am glad that the Minister referenced Versus Arthritis, because it does great work, but it has significant concerns about the waits for treatment for people living with arthritis. While recognising the efforts of hard-working NHS staff, there are more than 800,000 people in England waiting for trauma and orthopaedic treatment, including more than 5,500 Southwark constituents waiting for treatment at Guy’s and St Tommy’s hospitals. Will the Minister meet staff from Versus Arthritis specifically to discuss how to better support people waiting for those treatments?

[Helen Whately]

As the hon. Member said, Versus Arthritis is doing really important work not only supporting people with arthritis while they wait for treatment, but better preparing them for surgery. What is really important, as I said a moment ago, is reducing those waits and the work that we are doing on that. We have already virtually eliminated two-year waits, and 18-month waits have been reduced by more than 90%, which is quite a contrast, we know, to the performance of the Labour-run NHS in Wales. I encourage Versus Arthritis to contribute to our call for evidence on the major conditions strategy where we are looking at what more we can do to support people with, among other things, muscular skeletal conditions.

[Bill Esterson (Sefton Central) (Lab)]

9. Whether he plans to provide funding for a new primary health care facility in East Sefton.

--- Later in debate ---

[Nadia Whittome (Nottingham East) (Lab)]

T6. More than one in 10 social care roles are vacant, and the biggest culprit in this recruitment and retention crisis is low pay. According to recent TUC analysis, a £15 an hour minimum wage for care workers would not only tackle staff shortages, but level up places such as the east midlands, introducing an £800 million economic boost. Will the Government introduce that?

[The Minister for Social Care (Helen Whately)]

I want to see the care workforce recognised and rewarded for the work that they do. That is one reason why we gave adult social care a record uplift to its funding of up to £7.5 billion in the autumn statement, for local authorities to fund care providers to pay their workforce in turn. That goes hand in hand with our workforce reforms to develop the skills and career opportunities for the care workforce.

[Sir Christopher Chope (Christchurch) (Con)]

Has my right hon. Friend the Secretary of State read the report “Safe and Effective?” produced in April by a group of senior clinicians, which is very critical of the work of the Medicines and Healthcare products Regulatory Agency? If he has not yet read it, will he do so, please?

Allergy Awareness Week

Helen Whately Excerpts

Thursday 11th May 2023 Westminster Hall

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Ms Ali. I thank the hon. Member for Dagenham and Rainham (Jon Cruddas) for securing a debate on this important issue, and for his continued work advocating on behalf of those with allergies, particularly through chairing the all-party parliamentary group on allergy.

Millions of people, many of them children, are affected by allergy, so I am sure that the points raised by hon. Members will resonate with families across the country. My brother has asthma, which at times has had a severe impact on his life, and which can be very frightening. I also have a close cousin who has multiple food allergies; I remember that when we were children, those allergies could be worrying or even frightening. Members here and many people across the country have experience, whether directly or through close family and friends, of allergies that can make life really difficult and at times very scary.

Among other things, the hon. Member for Dagenham and Rainham spoke about the huge number of people affected by allergies, their increasing prevalence, and the resulting increasing need for healthcare and support. He also spoke about how frightening and restricted life can be for people living with a severe allergy, and the need for more specialist NHS staff and generalist allergy training. He acknowledged that the UK is a world leader in allergy research, and I heard his several clear asks for Government support for people affected by allergies.

My hon. Friend the Member for Old Bexley and Sidcup (Mr French) is a hay fever sufferer, but he spoke today because his constituency hosts Allergy UK, which does very important work to raise awareness of allergies, and to support people with allergies and their families. He spoke of the importance of diagnostic services, the need for specialists, and the variation across the country in the services and support available. He also spoke about the progress we have made in recent years, which includes, very importantly, the introduction of Natasha’s law, which has improved food labelling. I thank him for the work he is doing to raise awareness of allergies and their impact on people’s lives.

The hon. Member for Pontypridd (Alex Davies-Jones) spoke about her personal experience with her son, and how she found out about his allergy. It must have been extremely alarming to find out, when he was only six months old, how allergic he is to peanuts; I can imagine that that was just at the point when he might have been moving on to solid foods. Parents do not know what they will find out. I can imagine how alarming it must have been to rush to hospital with such a small child. Clearly, there are things that must make life difficult day to day for her son, but I am glad that it sounds as though he is doing well after that very frightening experience. She also talked about the hard work of campaign groups, including the amazingly effective campaigning of families who have tragically lost loved ones as a result of their allergies. She also spoke about the huge increase in hospital admissions in the last 20 years of people who have severe allergic reactions.

Like the hon. Lady and other hon. Members, I recognise the work of all the organisations that support people with allergies, including charities such as Allergy UK, Anaphylaxis UK and the National Allergy Strategy Group, which has been instrumental in ensuring that the voices of all those affected by allergy are heard across Government.

This debate has the heading “Allergy Awareness Week”, but it would be remiss of me not to take this opportunity to mention, as other hon. Members have done, other allergy debates happening next Monday, involving the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), who has responsibility for primary care and public health. One debate that he will respond to next Monday will cover vital issues about food safety, which have been raised in this debate. I will refrain from talking at too much length about those issues, because I know that he will cover them substantially on Monday.

That being said, I pay tribute to the work being done to support better food labelling, which is being spearheaded by families who have been bereaved following the tragic deaths of their children from severe anaphylactic reactions. Their campaigning has already led to Natasha’s law, introduced by the Government in 2021. I hope that it will protect and reassure those living with allergy.

Allergy Awareness Week’s focus on allergy support from GPs and specialist staff makes a lot of sense. Most people can be treated through locally commissioned services, for which integrated care boards are responsible, and GPs clearly play a crucial role as the first point of contact for many people with allergies. We know the huge demand for primary care services and the pressures that GPs are under. That is why the Government are investing in and increasing the primary care workforce. In fact, we already have a quarter more staff in primary care than we did in 2019, and 2,000 more GPs.

Looking ahead, we have increased the number of GP training places. Last year, the highest ever number of doctors accepted a GP training place; there were over 4,000 trainees—up from around 2,500 in 2014. That means that there will be more GPs who can be the primary care point of contact for those with allergies. In recent years, there has also been a 100% fill rate for doctors in the two relevant specialist training pathways—allergy and immunology. Many hon. Members spoke about the importance of specialists in this area.

The number of people with allergies is set to increase even further, and NHS England takes into account future and current demand when considering the training needs of the workforce. Hon. Members will know that NHS England is soon to publish the long-term NHS workplace plan, which will include projections for the number of doctors, nurses and other healthcare professionals needed in five, 10 and 15 years’ time.

Specialist allergy services are provided for patients with severe allergic conditions, or those who have common allergic conditions but require specialist treatment. Those services are jointly commissioned by NHS England specialised commissioning and integrated care boards, in line with the published “Prescribed Specialised Services Manual”. Specialised services must comply with the relevant specification. For allergy, that includes the need for physicians, dieticians and nurses who are trained in allergy, and who keep up to date through continuing professional development on specialised allergy services. As Allergy UK’s patient charter outlines, it is crucial that people with allergies have access to quality care, underpinned by skilled healthcare professionals, and can access services wherever they live.

There have been calls over recent years—I have heard them echoed today—for stronger leadership on allergy. I am pleased to take this opportunity to outline the allergy leadership that we already have in place. In October 2022, Dr Claire Bethune was appointed national speciality adviser for specialised immunology and allergy. Dr Bethune chairs the NHS England clinical reference group that provides clinical advice and leadership on the specialised immunology services, and advises on how specialised services can best be delivered.

Clinical reference groups, through their patient and public voice members, rightly ensure that patients and the public are involved in any changes to the commissioning of special services. The specialised immunology and allergy services clinical reference group is commencing a review of the specialised allergy services specification. The outcome will be an updated specification that references up-to-date guidance and takes into account the latest evidence base. It will clearly define the standards of care for commissioned specialised services, and notably will cover the transition to adult services.

That work is not the only thing we are doing to support children and young people with allergy. The National Institute for Health and Care Excellence has produced a range of guidance to support the care of people with allergies, including specific guidance on food allergy in under-19s. The guidance covers assessing and managing food allergy in under-19s, including referral to secondary or specialist care as appropriate. It has recommendations on what information and support should be provided to the child or young person and their family. That includes signposting to the invaluable work done by organisations such as Allergy UK and Anaphylaxis UK, which have a wealth of information on how to live well with an allergy.

NICE also has more specific guidance available on diagnostics and specific treatments for allergies. That is not limited to food allergies. I urge all those who are involved in the care of people with allergies to familiarise themselves with the information available. The NICE guidance, alongside the service specification and training materials I mentioned, represent a comprehensive portfolio of resources that healthcare professionals and commissioners can draw on to ensure that people with allergies receive the right care to live healthy and independent lives.

I hope that hon. Members will be reassured by some of the measures that I have outlined. I assure them that the Government are committed to a high standard of ongoing care and support for the many people in this country living with allergies. Together with the Minister who has responsibility for primary care and public health, my hon. Friend the Member for Harborough, I will continue to look at what more we can do to address the needs of the huge and growing number of people affected by allergies, and at the asks of hon. Members. Finally, I thank all hon. Members here for their work in keeping the spotlight on this important issue, so that allergy awareness remains constantly in the public eye, not just in Allergy Awareness Week each year.

Oral Answers

Helen Whately Excerpts

Tuesday 25th April 2023 Commons Chamber

[Rebecca Long Bailey (Salford and Eccles) (Lab)]

4. What assessment his Department has made of the impact of funding allocations for adult social care on charitable and not-for-profit providers.

[The Minister for Social Care (Helen Whately)]

This Government back social care, which is why we are giving social care a record funding boost of up to £7.5 billion over the next two years. That extra funding will help local authorities increase the rates they pay to care providers, helping those providers in turn meet extra costs and increase staff pay.

[Rebecca Long Bailey]

Frontline charities, such as United Response and Age UK, have responded that the Government’s plan falls far short of what is needed, including holding back the promised £250 million in social care workforce funding. Can the Minister promise that will be revisited with urgency, given that one in five over-80s have some unmet care needs and we are facing the highest social care vacancy rates on record?

[Helen Whately]

I can assure the hon. Member that not a penny of funding is being cut from adult social care. We are driving forward our reforms to the adult social care system, which have the workforce at their heart. We are introducing a new career path for the social care workforce, new care qualifications and new training, boosting the adult social care workforce and making sure people in that workforce get the recognition and rewards they deserve.

[Mr Speaker]

I call the shadow Minister.

[Liz Kendall (Leicester West) (Lab)]

The Minister says this Government back social care—I would love to see what the reality would be if they were against it. We already know that the Conservatives have completely failed to deliver their flagship policy of a cap on care costs, and over Easter we learned that they have broken the rest of their promises on social care too. The £500 million promised for the care workforce has been cut in half; the £300 million promised for housing in care has been slashed by two thirds; and as for the £600 million of other promises, your guess is as good as mine, Mr Speaker. They have not had the courage to announce this to Parliament or the nous to grasp that if people are not kept in their own homes, they end up stuck in hospital, with all the knock-on consequences for NHS waiting times and emergency care. Will the Minister tell us where all that money has gone? Why on earth should older and disabled people and their families ever believe the Conservatives on social care again?

[Helen Whately]

Out of that, I can pick one thing we agree on: the importance of helping people to live independently at home for longer and social care as a part of that. I say to the hon. Lady, as I said a moment ago, that we have not cut a penny of funding from our commitments to adult social care, both on adult social reform and on the historic £7.5 billion of adult social care funding announced in the autumn statement. We are forging ahead with our reforms, with the workforce at their heart, because the workforce is crucial, hand in hand with the digitisation of social care, improving data, joining up health and social care, and supporting unpaid carers.

[Mark Eastwood (Dewsbury) (Con)]

5. What steps his Department is taking to encourage people to stop smoking.

--- Later in debate ---

[Dame Angela Eagle (Wallasey) (Lab)]

24. What steps he is taking to improve access to in-home health and social care services.

[The Minister for Social Care (Helen Whately)]

I want people to live independently in their own homes for longer with the care that they need. We are investing half a billion pounds annually through the disabled facilities grant to pay for housing adaptations, and supporting the home care workforce through our record social care funding increase and workforce reforms. Our new and expanded NHS virtual wards give people hospital-level care in their own homes.

[Mike Amesbury]

My constituent, Ewan, recently lost his grandfather. His grandfather would have liked to have spent more time at home in his last few days, but he could not because of resources—the people were not there. What are the Government doing about that? There is a real recruitment and retention crisis in the social care workforce.

[Helen Whately]

The hon. Member makes an important point about people spending their last days of life where they would like to spend them, which, more often than not, means at home. That comes down to supporting end-of-life care—hospices play a really important role in providing that care in people’s homes—and supporting the adult social care workforce. We are investing up to £7.5 billion in social care over the next two years and taking forward important reforms to support the adult social care workforce. As I mentioned a moment ago, we are increasing the amount of hospital-level care that people can get at home by expanding our virtual wards, which, by next winter, will mean that up to 50,000 people a month can be cared for to that level at home.

[Dame Angela Eagle]

Despite ministerial complacency, Age UK has pointed out that, nationally, there are currently 165,000 vacancies in social care, which is a 50% increase on last year. In the Wirral, vacancies run at 16%, which is despite the Wirral paying the real living wage. That means that only 26% of hospital patients are currently being discharged from Wirral University Teaching Hospital when they are actually ready to go. Does the Minister agree that the neglect and underfunding of social care by this Government is costing more money through wasted provision in hospitals, when social care, if it were properly provided, could give a much better experience for people who are ready to leave hospital?

[Helen Whately]

I thank the hon. Lady for giving me another opportunity to talk about what we are doing to support adult social care: an extra £7.5 billion was announced at the autumn statement to support adult social, an extra £700 million was spent on supporting discharges into social care over this winter, and we have already announced £600 million to support discharges to people’s homes with the provision of social care over the coming year, because we recognise how important it is for people to get the care they need at home. The workforce are crucial to that, which is why we are taking forward our reforms to the adult social care workforce as announced a couple of weeks ago.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

--- Later in debate ---

[Sara Britcliffe (Hyndburn) (Con)]

One of my constituents, Bethany Whitehead, suffers from functional neurological disorder, which often presents with a number of debilitating symptoms. Bethany has often been left waiting two to three years before seeing a consultant. Will the Minister meet me to discuss this further?

[The Minister for Social Care (Helen Whately)]

My hon. Friend makes a really important point. I can say to her here and now that functional neurological disorder was previously regarded through a diagnosis of exclusion. It now has a rule-in diagnosis with available treatments, which is a major step forward in destigmatising the disorder. I am very happy to meet her to discuss this further.

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

T5. As chair of the all-party parliamentary health group, I have heard from UK patients who struggle to access GP appointments from chain GP practices. Many of those practices have very low ratios of GPs to patients, including, in one case, only two GPs registered for 30,000 patients. Will the Department meet the APPG to address these grave concerns?

--- Later in debate ---

[Andy Carter (Warrington South) (Con)]

St Rocco’s Hospice in Warrington provides invaluable palliative and end-of-life care for families. However, the charities that run hospices around the UK are finding it incredibly difficult to raise funds. Will the Minister give us an assurance that she is working very closely with the sector to ensure that those services continue to be provided?

[Helen Whately]

My hon. Friend makes a really important point about the very important work that hospices do in our communities, and I fully support hospices as a sector. The funding for hospices generally comes through the NHS and the local integrated care boards that commission the services they provide, as well as, of course, from their own fundraising efforts. I am speaking to NHS England about the support it provides to hospices, because I am very keen to make sure that they get the support that they need.

[Tim Farron (Westmorland and Lonsdale) (LD)]

T8. I have in my hands the draft business case for a satellite radiotherapy unit at the Westmorland General Hospital in Kendal. If it is approved and commissioned, residents in my community who have cancer will no longer have to travel two, three or four-hour round trips every day to get lifesaving treatment; they will be able to get it closer to home. Will Ministers meet me and the clinical specialists who helped draft the business case, so that we can make it come to fruition?

[Helen Whately]

Yes, I am very happy to meet the hon. Member.

[Maggie Throup (Erewash) (Con)]

Building on the novel approach to clinical trials that was so successful for the covid-19 vaccines, what more is the Department doing to capture that success and the willingness of volunteers to come forward, as well as to streamline processes across participating bodies for clinical trials of future medicines?

Cerebral Palsy: Adult Care Transition

Helen Whately Excerpts

Thursday 30th March 2023 Commons Chamber

[The Minister for Social Care (Helen Whately)]

I thank my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for his speech this afternoon. We all draw on our own experiences in this House, and rightly so—in fact, I believe that this House is all the better for its diversity, whatever form that is in—but drawing on experience takes courage, as does doing a job in the public eye. My hon. Friend demonstrated his double courage this afternoon by telling us, as he has told me before, how he has—among other things—been mocked for his own cerebral palsy and asked, for instance, “Why are you drunk?” when he is allergic to alcohol. As I think he suggested, the Whips might wish that more of us were in that boat and always clear-minded when voting, although maybe not. I thank him very much for facing down the mockery that he might sometimes experience. It is completely wrong that he faces that, and I have huge respect for what he does in standing up to that—I wish that he did not have to. I thank him, because I see what he does in his work for his constituents and in the many areas of interest that he campaigns on. Specifically today, he has drawn on his personal experience in his once-a-Parliament speech on cerebral palsy.

I also praise and thank the APPG on cerebral palsy for its excellent report, which includes a clear set of 10 recommendations for us in Health and for other Departments, including the Department for Education and the Department for Work and Pensions, on the transition from childhood to adulthood for young people with cerebral palsy. A number of the recommendations that my hon. Friend referred to are specifically relevant to health, including the importance of having a roadmap for young people with cerebral palsy; the need for a dedicated lead professional looking out for them; the importance of empowering young people and their families to become self-advocates for what they need; the call for dedicated budgets; the call for regional hubs in integrated care systems bringing together multi-disciplinary teams of professionals; and the need for healthcare transition pathways and for upscaling cerebral palsy registers. Those are the ones that sprung out to me from that list. On some of those I can assure him we are making good progress; for others, the best thing I can do is take them away and make sure I get him a fuller response than I am able to give today.

My hon. Friend and the report argue compellingly for further action and focus on supporting young people with cerebral palsy on their transition from childhood into adulthood. I say that because we know that that transition can be very challenging for those of 100% fitness. The transition from childhood into adulthood is a mixture of exciting and daunting. The extent to which it may be exciting or daunting very much depends on someone’s circumstances, but it can be particularly daunting if they have disabilities. As my hon. Friend said, one of the challenges with cerebral palsy is the extent to which it is understood, including among experts, and the huge range of impairments that people might experience. Some can live their life completely to the full, as he demonstrates, and others face far greater challenges in their lives. In those circumstances, it is all the more important for us to make sure that, across all public services that are there to support us through our lives, there is the right support for that crucial transition from young person support into adult services, so that somebody with cerebral palsy, whatever the level of impairment of what they can do their lives, can truly fulfil their potential and lead a full and satisfying life.

I will touch on a couple of things that are specific to the healthcare side of the support for people with cerebral palsy. As I am sure my hon. Friend will know, there is National Institute for Health and Care Excellence guidance on the transition from child to adult services and specific guidance for young people with cerebral palsy. The NICE recommendations include developing clear pathways for transition and providing a named support worker for individuals. Those two things align closely with some of the recommendations in his report.

However, an obvious question follows the fact there is NICE guidance, which is, as my hon. Friend might well ask, “Is it being implemented, and to what extent? Where have these recommendations been followed?” I, too, want to know the answer to that and to be able to give it to him. I was not able to get that answer before I came to the Dispatch Box. I am therefore seeking an answer from NHS England, and I will write to him as soon as I have it. That answer will tell him the extent to which those recommendations have been followed and are in place. I anticipate that we may see variation around the country. Where we have variation, the important thing is to know where practice is good, and recognise that, but, where there is a gap in services or provision, to ensure that that is also known about and to step in.

The NHS long-term plan, published in 2019, recognised the problem of transition from children’s to adult services. That plan set out the aim of moving towards

“service models for young people that offer person-centred and age appropriate care for mental and physical health needs, rather than an arbitrary transition to adult services based on age not need.”

NHS England has updated me on this work. It has assured my Department that it is working to ensure that no child or young person will be lost in the gaps between children’s and adult services. Its children and young people transformation programme is developing resources to this end, including guidance that supports the design of transition pathways.

Again, we hear that NHS England appreciates the problems and is working to improve the transition, given the risk of there being gaps between children’s and adult services, and that further guidance is being developed. We are talking about transition pathways, but, again, it would be perfectly reasonable for my hon. Friend to ask where that has got to: where is that guidance, and to what extent is it being followed in practice? On that, again, I will write to him to give him a full answer, because as far as I am concerned it is no good that we should say there is guidance and recommendations. What is also—in fact, even more—important is what is happening in practice.

Specifically, one of the things in the APPG’s report was about personal health budgets and the need for people to have their own dedicated budget. On that, I believe we are making good progress. This applies not just to people with cerebral palsy, but to those with other health conditions. Across the country, there is access to personal health budgets and, more broadly, to personalised care approaches, which is an important way of giving people choice and control over their care.

I have spoken directly to people who have told me what a difference having a personal health budget is making to their lives. We are on target to reach our commitment of 200,000 personal health budgets by March 2024. That said, I have no doubt that we have further to go, as we work towards that target and beyond, in making sure that everybody who could benefit from having a personal health budget does indeed have one. Again, I know there is variation across the country on the extent to which people have them. Where there may be bureaucratic barriers to people having a personal health budget, that is something we should continue to look into, because they can make such a difference to people being able to get the care that they feel they personally need.

Talking about the importance of knowing who has cerebral palsy and knowing who needs that support, my hon. Friend mentioned how he did not receive any follow-up care after he was 13-years-old until very recently. He said how valuable that has been, but there was clearly a great big gap when he might have benefited. As he mentioned, we have the cerebral palsy integrated pathway database, which since 2019 has been supporting the development and extension of registers across all regions in England. That database is included in the NHS England plans for ongoing central funding of clinical databases. It is therefore important that we continue to build up the records, particularly of young people with cerebral palsy, and make the most of that database; as my hon. Friend said, we must not only have the database but make use of the data in it, because when we know who has cerebral palsy we can make sure they get the support they need. I am going to look into that to make sure we follow through on our aspirations.

I will take away the other points in the clear list of recommendations relating to health in the all-party group’s report and the areas I have covered in terms of the long-term plan and the National Institute for Health and Care Excellence guidance, and will get back to my hon. Friend with more details on the progress being made. The all-party group report is clear and compelling, and it deserves a full response on the actions being taken against the recommendations and the commitments already made to improve the transition for people with cerebral palsy and other health conditions as they transfer from childhood into adulthood. I want to express my gratitude to all involved in the work of the all-party group, and I specifically want to thank charities, including Action Cerebral Palsy, that work tirelessly to support and advocate for those living with cerebral palsy.

I want us to make sure the transition from childhood to adulthood is exciting for those living with cerebral palsy, rather than daunting. I do not want health conditions and disabilities to hold anyone back. I want to make sure the right health, educational and professional support is available to unlock the abilities of everyone so they can lead a fulfilling life to the full.

I thank my hon. Friend for securing this debate, for making his compelling arguments, and for bringing his own experience so powerfully into this Chamber to motivate all those listening, including me at the Dispatch Box, to do more and do better. I will of course be delighted to meet him, as he asked, to talk about this further. By the time we meet, I look forward to being able to give him more comprehensive responses to the excellent points he raised.

Question put and agreed to.

Car Parking: Care Workers

Helen Whately Excerpts

Thursday 16th March 2023 Westminster Hall

[The Minister for Social Care (Helen Whately)]

It is a pleasure to serve under your chairmanship, Sir Robert. I congratulate my hon. Friend the Member for Southport (Damien Moore) on securing this debate on free parking passes for care workers. I know it is an issue close to his heart and I commend him on his speech.

Improving adult social care and supporting care workers is one of my highest priorities, and I am delighted that my hon. Friend shares my enthusiasm, particularly for supporting domiciliary care workers. In his compelling speech, he spoke about the difficult job they do and the skills necessary for their work, as well as some of the practicalities of the job, such as the many short journeys that some care workers will be making and the challenges that result, including parking. He also spoke about the vacancy rate in social care, particularly in domiciliary care.

Recruiting and retaining staff is a particular challenge for many care providers, especially following the reopening of the economy after the pandemic. Many people had come from the hospitality or travel sectors to work in social care during the pandemic, which was hugely helpful in those difficult times, but many then often returned to those sectors. Not all did; some had found their vocation in social care, and that has been wonderful, but others, understandably, returned to their previous sector, making it harder for the social care sector to retain and recruit staff as the economy opened up. I am hearing some positive news about recruitment at the moment, but that does not mean that it is easy. It remains a real challenge, particularly with domiciliary care and in rural areas.

As my hon. Friend also said, we are seeing a growing demand for social care, as people live longer—that is a positive for us all to remember, but it does mean more people living with health conditions, and more frail and elderly people, who need people to come in and care for them. The hon. Member for Strangford (Jim Shannon) talked about the importance of living independently. We want people to be able to live longer in their own homes. There is a time when it is better for people to live in residential care—that can be the right thing for some people—but most of us want to stay living in our own home behind our own front door for as long as possible. Domiciliary care workers, who go to someone’s home, are absolutely crucial.

My hon. Friend for Southport referred to our 10-year vision for social care, which I am truly passionate about. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about the challenges that social care faces. Those challenges have been around for many decades, so we are not going to fix this overnight. I share the impatience of my hon. Friend the Member for Southport. That is one reason why I try to do things in the here and now. However, I am also realistic, and some social care reforms that we want to do will take time, hence that long-term vision.

My hon. Friend spoke very specifically about the cost of parking and rightly about the stress of looking for a parking space when the clock is ticking. He also spoke about unexpected situations, such as when care workers need to stay longer and call an ambulance. The hon. Member for Erith and Thamesmead (Abena Oppong-Asare) also spoke about that in her intervention.

I heard that my hon. Friend the Member for Southport called on his local council to fix that in his area during the pandemic. He welcomed our free parking scheme during the pandemic, so I am glad that he saw it taking good effect. That was one of many things that we tried to do to help key workers through that difficult time. That ended, and I absolutely hear his argument for a new national scheme, particularly to help care workers with parking while they are on duty.

I thank the hon. Member for Strangford. It is a pleasure to be in Westminster Hall with him at any time in the week, but particularly on a Thursday; we do this not infrequently. He spoke powerfully, if I understood him correctly; sometimes I do not pick up every word he says. He spoke about his brother, Keith. He said that, following a brain injury, Keith might well have lived in a care home, but has in fact been able to live independently with the support of family, including his mother and the hon. Member, but of course with care workers visiting. He brings a very personal perspective on the important role of care workers in our communities.

The hon. Gentleman also spoke about us working across the parts of the United Kingdom. I am always happy to talk to colleagues in other parts of the Union, because I think we can all learn from each other to try to get the best for our constituents.

Taking a step back, I want to say that I am incredibly grateful to all health and care staff. I recognise the extraordinary commitment and hard work, particularly of our care workers and domiciliary care workers, who are less frequently spoken about in Parliament. I want to ensure that care workers gain the recognition they deserve from society. I truly thank them for all the vital work they do every single day, whether in care homes, people’s homes or beyond.

Many people want to work in care because they want to make a difference to the lives of others. In my conversations with care workers, many have told me that they find their work truly rewarding. Just a few weeks ago, I had a wonderful conversation with a home care worker, who told me that she loves her job. That is great to hear, but there is no denying that it can be a very demanding job, both physically and emotionally. Domiciliary care workers play a crucial role in providing care and support to people who need it within their own home, enabling them to continue living independently even when they have substantial care needs. From going on the rounds with care workers and speaking to them, I know how committed and passionate they are about what they do.

Turning specifically to parking, I heard the points made by my hon. Friend the Member for Southport on free parking for care workers, and I am sympathetic to them. I have had many conversations with those who provide care in people’s homes about some of the challenges they face, including travel and parking costs. For instance, I share the concerns about underpayment for travel times, which is a live issue within the sector.

All social care workers are entitled to be paid at least the minimum wage—I should say, the national living wage—for the work they do. The Government are clear that time spent caring for clients, travelling between appointments and waiting to start the appointment must be included in pay calculations. I labour that point because I hear accounts, usually anecdotal, of whether travel and waiting time is being paid for. It may not be within the care worker’s control if they turn up for an appointment when, for instance, another health worker is visiting somebody and they have to wait. If they are having to wait as part of their job, of course they should be paid for that working time.

Responsibility for setting the terms and conditions for parking permit schemes and delivering social care is devolved to local authorities. Some local authorities, such as Cornwall and Devon, already run health and care parking permit schemes. I am glad to be talking about this important issue today and it is right that, at the very least, the national Government support the sector by raising awareness of and driving forward innovation and best practice. I therefore encourage local authorities who are not already undertaking similar projects to look and learn from those areas that have implemented their own parking schemes, especially as we know about the recruitment and retention challenges in adult social care. I also commit to working with my colleagues across Government, in particular in the Department for Transport and the Department for Levelling Up, Housing and Communities, to consider what more can be done to help care workers with the cost of parking.

More broadly on the adult social care workforce, the Government recognise the current workforce challenges in social care.

[Andrew Gwynne]

I want to take the Minister back to where she rightly said that terms and conditions are matter between the employer and the employee. She was, rightly, very robust on the expectations of the national living wage being paid for waiting to do work. Does she also take a strong view that employers should reimburse their staff for any incurred parking costs?

[Helen Whately]

The hon. Gentleman will allow me to pause, because I do not want to find that I have unintentionally misled anybody. I am very happy to write to him on that specific question. What I am completely happy to do here and now is reiterate the importance of social care workers being appropriately paid for the work they do. At the very least they should be paid at the legal level to which they are entitled and reimbursed for the expenses of the job they do. I hope the hon. Gentleman is happy with that response.

As I said, we recognise the recruitment and retention challenges in the social care workforce. The Government are supporting local authorities and providers with the recruitment, from both home and abroad, and retention of workers. For instance, we have been running a national recruitment campaign with continuous activity across job boards, video on demand, digital audio, radio and social media to encourage people to come and work in social care. That campaign will run until the end of this month.

In addition, in February last year we made care workers eligible for the health and care visa, and added them to shortage occupation list. The latest data published by the Home Office shows that a total of 56,900 visas were granted for care workers and senior care workers in 2022. I do not suggest for a moment that international recruitment is the whole answer to our recruitment challenges in social care, but given that we have such a substantial need for care workers, it is really important to help boost our care workforce. I have heard from many care providers who really welcome it, as it helps them to recruit and fill vacancies, and bring valuable staff into our workforce.

More broadly, the Government are making available up to £7.5 billion over the next two years to support adult social care and discharge, with up to £2.8 billion available this coming financial year and £4.7 billion the following year. That is an historic funding boost to put the adult social care system on a stronger financial footing and help local authorities to address waiting lists, low fee rates and workforce pressures in the sector.

Another way councils are able to support their adult social care workforce is through the market sustainability and improvement fund. At the autumn statement, the Chancellor announced that £400 million of new ringfenced funding would be made available for adult social care in the next financial year. We have combined that with £162 million of fair cost of care funding to create the fund. We are allowing councils to use the new funding flexibly on three target areas: support for the workforce measures; increasing fee rates paid to providers; and improving social care waiting times, which will improve adult social care market capacity and sustainability. My hon. Friend the Member for Southport might be pleased to know that Sefton Council will receive £3.6 million through that fund. Many local areas have chosen to use a significant proportion of the adult social care discharge fund on measures that support the adult social care workforce, including those who work in home care.

The hon. Member for Denton and Reddish talked about the importance of commissioning—I think he referred to ethical commissioning. I assure him that I think how local authorities commission care is really important, because it influences the terms and conditions on which care providers employ their workforce. That is one reason why, in April—just a couple of weeks away—we are starting the Care Quality Commission assurance of local authority social care provision. That will increase oversight of how local authorities are implementing the Care Act 2014, and part of that is very much about how they commission care. It will enable us to identify local authorities that are doing a really good job and will give us more information about those whose commissioning does not support their market or leads to some of the practices that we have been talking about.

As I said at the beginning, we want quick answers. My hon. Friend the Member for Southport wants change here and now, and so do I, but we also have to look to the longer term for our social care reforms. People at the heart of care must set out a longer-term vision for social care. I will shortly be publishing a plan setting out our next steps for the reforms. It will include substantial reforms to the adult social care workforce to strengthen careers and opportunities, and make adult social care a better sector to work in. That will help attract more people to work in social care and retain those valuable staff members.

I thank my hon. Friend for making the case and other Members for showing support for domiciliary care workers. I share my hon. Friend’s aspiration to support his care workers. In fact, I believe I have shown that in practice—for instance, through the support I put in place during the pandemic for the social care workforce; things I am doing right now with the funds such as the market sustainability and fair cost of care fund; and things that I will do in the future, including with our adult social care reform. I am happy to consider his proposals further as part of the work I am doing to boost our support for the care workers our constituents depend on.

Cancer Care

Helen Whately Excerpts

Tuesday 14th March 2023 Westminster Hall

[The Minister for Social Care (Helen Whately)]

It is a pleasure, Mr Paisley, to serve under your chairmanship.

I thank my hon. Friend the Member for West Bromwich East (Nicola Richards) for securing this debate on cancer care. According to Cancer Research UK, one in two people—half of us—will develop cancer at some point in their lives. There are around 290,000 new cancer diagnoses a year, or nearly 800 every day.

When we cite statistics such as these—as is the case with NHS waiting lists, for instance, across the board—I always remember that every one of the figures is about a human being. Whether it is a parent, a child or a grandparent, they are someone’s loved one. And every one of them will be worried, or even scared, about their diagnosis; their lives are disrupted and they may be living in pain.

My hon. Friend brought that to life in her speech from her own personal experience. May I express my very sincere condolences to her for the loss of her mother? Such a loss is so sad, especially as it came too soon; I believe that her mother was only in her 50s when she died last year. My thoughts are also with her staff member Bradley, who she mentioned, whose mother would have been 58 today. Also, the hon. Member for Westmorland and Lonsdale (Tim Farron) mentioned his mother, who very sadly died of cancer. So this is a moment to think about mothers, perhaps particularly with mother’s day coming up. My best friend in childhood lost her mother to cancer when we were in our teens, and I clearly remember how that was for her. And there are so many other people who have lost loved ones to cancer, too often before their time. That is why diagnosis and treatment of cancer is so important to so many of us.

My hon. Friend rightly spoke about the importance of early diagnosis and prompt treatment. They are important for everybody. However, she particularly talked about areas with higher rates of cancer and the above-average levels of cancer in her own area. As she said, health disparities are part of the problem and they must be tackled, too.

Clearly, and rightly, my hon. Friend keeps a close eye on the performance in her area. I see my job as a Minister to look across the whole country and to help our healthcare system to tackle variation in performance, and indeed to level up where there are inequalities, because everybody should have access to early diagnosis of cancer and effective treatment for it.

Right now, I have three priorities for cancer: one is to recover from the pandemic and reduce the pandemic backlog; the second is to improve early diagnosis and treatment, using the tools and technologies that we have; and the third is for there to be investment in research and innovation, and for those innovations to be developed to make a difference to people’s lives and to the diagnosis and treatment of cancer. We know that technologies such as genomics and artificial intelligence, for instance, have the potential to truly transform our ability to diagnose and treat cancer effectively as a society.

[Peter Dowd]

Yesterday, I received an email from Sarah Taylor on behalf of the #CatchUpWithCancer and Radiotherapy4Life campaign. Among other things, she indicated that in May 2022 over half the heads of radiotherapy departments wrote to the Health Secretary and warned that

“radiotherapy is at crisis point”.

However, to our knowledge, so far they have not had a reply from the Department. Will the Minister try to chase that up if I provide her with further information?

[Helen Whately]

I will come on to talk about radiotherapy, but I can say to the hon. Gentleman here and now that I will indeed look into what has happened to the response to that letter.

However, I will start by talking about the waiting times, recovery from the pandemic and reduction of the pandemic backlog. Our elective recovery plan included the ambitious target to return the number of people waiting for more than 62 days for an urgent cancer referral back to pre-pandemic levels by this month. Since the publication of that recovery plan, the NHS has seen enormously high demand for cancer checks. More than 2.8 million people were seen in the 12 months to January 2023—up by 19% compared with the same period before the pandemic. The return in demand, with people coming forward for cancer checks, is very positive after the falls we saw in the pandemic.

When giving evidence to the Health and Social Care Committee last week, Dame Cally Palmer, NHS England’s national cancer director, said that

“we are not going to meet the pre-pandemic target by the end of March, simply because of those record levels of demand.”

That is already in the public domain. However, I assure hon. Members that we are working closely with NHS England to reduce the time people are waiting to receive a diagnosis, or an all-clear, and to start treatment, and we are making progress on that. The latest published figures show that the 62-day cancer backlog for the week ending 26 February stood at just over 22,000, which is a fall of 35% since its peak in the pandemic. However, that is 22,000 people too many who have had to wait 62 days, and many of them will have had to deal with the anxiety of waiting for a diagnosis or an all-clear, which is why we are working so hard on this issue with NHS England.

As I said, it is good that more people have come forward for cancer checks but, in response, we must increase our capacity to diagnose and treat cancer. That is one reason why we have been investing in community diagnostic centres, and we have more than 93 centres open and operational. That is why the NHS is rolling out what we call fit tests to speed up diagnosis for people who may have, for instance, bowel cancer. That is why the NHS is rolling out teledermatology to speed up diagnosis for people who may have skin cancer, and speeding up access to MRI scans for people who might have prostate cancer. Those are the three types of cancer with the most people waiting for a diagnosis or an all-clear or, if they have a diagnosis, to start treatment, and I am determined to reduce those waits.

When I meet charities and clinicians, the one message I consistently hear is how important early diagnosis is for improving patient outcomes and care, and that was something my hon. Friend the Member for West Bromwich East referred to. She talked about the ambition in our long-term plan to be diagnosing 75% of cancers at stages 1 or 2 by 2028. As part of achieving that, we are extending targeted lung health checks, with more than double the number of community lung truck sites. The targeted lung health checks programme had diagnosed 1,625 lung cancers by the end of December 2022, with 76% of those diagnosed at an earlier stage.

To help people get a cancer diagnosis or an all-clear more quickly, since November GPs have been able to directly order diagnostic tests such as CT scans, ultrasounds or brain MRIs for patients with concerning symptoms who fall outside the National Institute for Health and Care Excellence’s guideline threshold for urgent referral. Alongside that, community pharmacists in pilot areas are helping to spot signs of cancer in people who might not have noticed symptoms or realised their significance, and we continue to see non-specific symptom pathways rolled out. As of December 2022, more than 100 are live across the 21 cancer alliances.

To encourage people to contact their GP if they notice, or are worried about, symptoms that could be cancer, NHS England has run the “Help Us, Help You” campaign, which seeks to address the barriers deterring patients from accessing the NHS if they are concerned they might have cancer. In March and June 2022, we saw a 1,600% increase in the number of visits to the NHS website’s cancer symptoms landing page, so the campaign had a huge impact on the number of people looking to see whether they might have cancer symptoms. NHS England is in the process of planning “Help Us, Help You” activity for 2023-24, to make sure we continue the momentum and continue to encourage people to come forward if they have worrying symptoms of something that might be cancer.

However, we all know that diagnosis is just the first step on a patient’s journey, so we are also taking steps to improve cancer outcomes by rolling out innovative new treatments, such as the potentially life-saving drug pembrolizumab for one of the most aggressive forms of breast cancer, and mobocertinib to treat a specific form of lung cancer. The National Institute for Health and Care Excellence has made positive recommendations in all 18 of its appraisals of breast cancer medicines since March 2018, and those medicines are now available to NHS patients. NICE is also able to make recommendations to the cancer drugs fund, which has benefited more than 88,000 patients, with 102 medicines receiving funding for treating 241 different cancers.

My hon. Friend the Member for West Bromwich East mentioned radiotherapy equipment, as did the hon. Members for Westmorland and Lonsdale and for Bootle (Peter Dowd). Since 2016, more than £160 million has been invested in radiotherapy equipment so that every radiotherapy provider has access to modern, cutting-edge radiotherapy equipment. That investment enabled the replacement or upgrade of around 100 radiotherapy treatment machines and in some cases the roll-out of new techniques, such as stereotactic ablative radiotherapy. On top of that, £260 million has been invested in establishing two services to deliver proton beam therapy in London and Manchester.

On the workforce, from 2016 to 2021, the number of therapeutic radiotherapy staff grew by more than 17%, and the number of clinical oncologists by more than 24%. From 2021, there has also been an uplift in the number of entry-level places available, with 108 in clinical oncology, up from an average of around 60 per year in previous years.

I want to pick up on the claim that only 27% of cancer patients are treated with radiotherapy. That claim is outdated and incorrect, as it includes radiotherapy only as part of a patient’s primary treatment for cancer and does not capture a substantial proportion of patients who receive radiotherapy as a subsequent treatment. Also, I am told that the data is from 2013-14, so that is also out of date. NHS England has assured me—I have looked into this—that those who need radiotherapy treatment can access it.

[Tim Farron]

Will the hon. Lady give way?

[Helen Whately]

If the hon. Gentleman will allow me, I want to move on to the major conditions strategy, which my hon. Friend the Member for West Bromwich East mentioned as well. I want to talk about going beyond the immediate action we are taking here and now to improve people’s access to cancer diagnosis and treatment and about what we are doing looking further ahead.

In January, we announced that we will publish a major conditions strategy, which will tackle the conditions that contribute most to morbidity and mortality across the population in England, one of which is cancer. Many people now experience major conditions as part of a wider set of illnesses or needs, known as multi-morbidity. A 2020 academic study of cancer patients in England found that most had at least one co-morbidity and nearly one in two had multiple co-morbidities, so many people with cancer also have another long-term condition. We want to support individuals by diagnosing them earlier, helping conditions to be better managed and improving the overall co-ordination of treatment and care for those who have cancer and other major conditions.

The strategy will draw on the previous work on cancer, and hon. Members mentioned the long-term plan on that. It includes more than 5,000 submissions that were provided as part of our call for evidence last year. I can assure hon. Members that we will continue to work closely with stakeholders, the public and the NHS, including those involved in cancer care, in the coming weeks and months as we work up the details of that strategy. We will look at the health of people at all stages of life and, in reference to the point my hon. Friend the Member for West Bromwich East made on health disparities, focus on the geographical differences in health that contribute to variations in health outcomes.

[Tim Farron]

Will the hon. Lady give way?

[Helen Whately]

I just want to spend a little time on research, and I am conscious of the clock ticking.

[Tim Farron]

She mentioned a couple of points about the figures.

[Helen Whately]

If the hon. Gentleman will allow me to proceed, I want to talk briefly about the third priority—research—which is so important to improving cancer outcomes.

The Department of Health and Social Care invests £1 billion a year in health and care research through the National Institute for Health and Care Research. The NIHR spent almost £100 million on cancer research in 2021-22. I should also say that, among other charities, Cancer Research UK makes a huge contribution to funding research. Thanks to the generosity of the British public, it spent £388 million in 2021 on research activity.

There is a huge amount of research for us to be excited about. For example, the NHS-Galleri trial looks for markers in blood to identify signs of more than 50 cancers, and a vaccine taskforce-style approach is being taken to invest over £22 million in cancer research as part of the life sciences cancer mission. A memorandum of understanding that the Secretary of State for Health and Social Care signed with BioNTech SE will aim to deliver 10,000 doses of personalised therapies to UK patients by 2030.

As another example, just last week I visited Imperial College London. I saw some truly exciting research that could help us to diagnose pancreatic cancer and other upper gastrointestinal cancers early through a relatively simple breath test. It is in its early stages, but it could make a huge difference for cancers such as pancreatic cancer, which can be so hard to diagnose early.

Before I close, I will mention the hospital that my hon. Friend the Member for West Bromwich East talked about. The exciting rebuild of the Midland Metropolitan University Hospital, as part of our new hospital programme, will bring together urgent care centres from three hospitals across the region into one state-of-the-art site, providing services to 500,000 people. As my hon. Friend said, construction has already commenced, and the hospital should be completed and open for patients in 2024.

The hospital will introduce a new model of care, which means that out-patient clinics, day case surgery and routine diagnostics will be provided from the Sandwell and City Hospital sites, while maternity services, emergency care, general surgery and medical wards will all be based at the Midland Metropolitan University Hospital. The new hospital will be a centre of excellence for clinical care and research. The new therapeutic model of care will encourage patients to maintain mobility and independence during a hospital stay. I spend a lot of time looking at the downside of people having long stays in hospital. Maintaining independence and mobility is an important thing for us to try to achieve. I share my hon. Friend’s excitement about the forthcoming opening of the new hospital.

To conclude, I once again thank my hon. Friend for raising this issue. Improving cancer care is a priority for the Government, and I assure her and other hon. Members that we will continue to work hard to beat this terrible disease.

Health and Social Care

Helen Whately Excerpts

Tuesday 14th March 2023 Ministerial Corrections

The following is an extract from the Opposition day debate on NHS Workforce Expansion on 28 February 2023.

[Helen Whately]

I was talking about some of the things that we have done to vastly increase the number of healthcare professionals in the NHS. As part of our ambitions for the future, more than 26,000 students were accepted on to nursing and midwifery courses in England last year—a 28% increase on 2019.

[Official Report, 28 February 2023, Vol. 728, c. 678.]

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 the speech I gave in the Opposition day debate on NHS Workforce Expansion.

The correct statement should have been:

[Helen Whately]

I was talking about some of the things that we have done to vastly increase the number of healthcare professionals in the NHS. As part of our ambitions for the future, more than 26,000 students were accepted on to nursing and midwifery courses in England last year—a 16% increase on 2019.