NHS in London

Debate between Jane Ellison and Meg Hillier

Thursday 24th March 2016 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to respond to a debate under your chairmanship, Ms Buck, I think for the first time.

The debate has been extraordinarily rich, with many excellent speeches from my fellow London Members of Parliament. We have a reasonable amount of time left, so I will try to respond to as many points as I can, but certainly on some I would prefer to write a response after the debate. In particular, I would not wish to give my friend, the hon. Member for Hackney South and Shoreditch (Meg Hillier), the Chair of the Public Accounts Committee, anything but the best information, so I will write to her afterwards about some of the details.

I congratulate the hon. Member for Ealing Central and Acton (Dr Huq) on securing the debate with cross-party support. I echo the words of the shadow Secretary of State: it is a great pleasure to see the hon. Member for Ilford South (Mike Gapes) back in this place. He made typically generous remarks about the NHS staff who cared for him, and we, too, thank them, because he is a popular Member in all parts of the House. We are delighted to see him back.

I am a London MP, so the debate is about my constituents as well. Rightly, hon. Members have taken this important opportunity to champion their local populations and their healthcare needs. However, some consistent threads have run through many of the speeches, in particular on the long-term strategic direction given the nature of London and its population. As well as responding to specific points, I want to give Members a sense of the strategic direction that the NHS wants to take in London, and some of the thinking around that.

The NHS in London serves a population of more than 8 million and spent £18 billion last year. As the shadow Secretary of State and others have said, London’s population is younger than the national average and more mobile, and its transient nature often makes continuity of care harder to achieve. In Battersea, I represent the youngest seat in England, and I see that transient, mobile population all the time, whether they are shift workers or young professionals. There are wide variations between and within boroughs in the health of the population, life expectancy and the quality of healthcare.

I will not attempt to respond to all the detailed points that have been made about housing, immigration and some of other wider determinants of health, but I fully acknowledge the interaction of all such important factors when it comes to the health of our constituents, and those factors are rightly at the forefront of the ongoing mayoral election campaign. It is inconceivable that the next Mayor of London, whoever is elected, will not have right at the top of their agenda issues such as housing in London, especially for key workers and the people who keep our important public services going. That is entirely right. I acknowledge that some of the issues that have been highlighted are important for the future of London. The population of London is projected to increase to more than 9 million by 2020, with the largest proportional increase expected in the over-65 age group. Members clearly know what that means for the increasing demand for healthcare.

The leaders of the national health and care bodies in England have set out steps to help local organisations plan over the next six years to deliver a sustainable, transformed health service. I accept that there was controversy in the last Parliament, and that the majority of Members present in the Chamber today disagreed with many of the measures enacted. Nevertheless, we have since had a general election and a majority Conservative Government were elected, having stood on the NHS architecture as it is. At the heart of the Conservative manifesto was an acceptance of the NHS in England’s own plan for its future, the five-year forward view. In a fixed-term Parliament, that gives us the opportunity for a stable system, which can look ahead across five years at how it provides sustainable and transformed services.

As in previous years, NHS organisations will be required to produce individual operational plans for the next financial year. Obviously, that work has happened for 2016-17. In addition, every health and care system will be required, for the first time, to work together to produce a sustainability and transformation plan, which is a separate but connected strategic plan covering October 2016 to March 2021. Many Members have highlighted the frustrations felt between the acute sector and CCGs, and some of the other stresses and strains between the different parts of the system. This year will be the first time that the NHS has required all parts of the local health and social care system to sit down together to draw up a five-year plan. That is strategically important in understanding how the system responds.

Those local plans represent an ambitious local blueprint for implementing NHS England’s five-year forward view locally. My hon. Friend the Member for Sutton and Cheam (Paul Scully) and many others talked about the need for long-term planning.

[Meg Hillier]

I thank the Minister for giving way, because I know she is trying to cover a lot of ground. Long-term planning is sensible, but is she not concerned about a five-year plan when at the same time major transformation is being required of acute hospital trusts through NHS Improvement—again, not a problem in itself, except that it is to be in very short order? Is there not a contradiction between a five-year plan and the short-order demands of the improvement plan for trusts, just to make their books balance?

Barts Health NHS Trust

Debate between Jane Ellison and Meg Hillier

Thursday 19th March 2015 Commons Chamber

[Jane Ellison]

I thank my hon. Friend for that question. He illustrates the fact that these problems can be addressed through this regime of extra support. I pay tribute to the staff at his local hospital, who have worked so hard to address the failings and to provide much safer care for their patients. He illustrates exactly why this regime of being transparent about issues and ensuring additional support can be given to trusts to address their problems can be successful and can benefit patients.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

I am shocked by the Minister’s tone, as there are genuine concerns about the services that my constituents and those of colleagues are receiving. Barts is the largest trust in England, and when it was formed many concerns were raised. It dilutes accountability and direct line management. Does she agree now that it was too big and that consideration needs to be given to making a number of trusts out of this large trust that are more manageable and directly accountable?

[Jane Ellison]

As the hon. Lady knows, the site in question in this report is Whipps Cross. The priority for its management is to address the issues that the CQC has identified.

Oral Answers to Questions

Debate between Jane Ellison and Meg Hillier

Tuesday 21st October 2014 Commons Chamber

[Jane Ellison]

My hon. Friend takes a great interest in this matter and led the Back-Bench business debate on 1 September. I will certainly ask the HFEA and the expert panel to look at the study to which she refers, but I can provide the reassurance I have given before—that the wide body of expertise and information out there about mitochondrial disease is regularly reviewed over a long period of time.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

The Secretary of State makes great play of protecting the NHS budget, but NHS England, the Nuffield Trust and his hon. Friend the Chair of the Health Committee all agree that it needs another £30 billion investment, so how can he tell people that the NHS is safe under his watch?

Tobacco Packaging

Debate between Jane Ellison and Meg Hillier

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

My hon. Friend is right to remind us all that, even if the Government decide to implement the policy at the end of the review, there will still be many other things to be done in relation to this important issue. Major public health campaigns will proceed as they have been doing under Governments of all colours.

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

My hon. Friend the Member for Bridgend (Mrs Moon) pointed out that 190 health organisations were in favour of standardised packaging. While I appreciate that there may be tensions within the Government, the hon. Lady is Minister for public health. Will she tell us whether any health organisation is opposed to plain packaging?

[Jane Ellison]

We have asked Sir Cyril to conduct an independent review and to weigh all the different evidence. I do not wish to seem to pre-empt the review, because it is important that it is independent, but I will say that I am not aware of any health organisations that are not in favour of plain packaging. Indeed, as the hon. Lady can imagine, such organisations have expressed the opposite view to me with considerable strength.

Childminders

Debate between Jane Ellison and Meg Hillier

Friday 6th July 2012 Commons Chamber

[Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

It is with pleasure that I speak for thousands of parents and young children who benefit from the work of childminders up and down the country. I must first declare an interest: my husband is a non-executive director of an organisation that carries out Ofsted inspections for under-fives providers, including childminders.

There has been a great deal of activity over the last decade or so to improve the quality of child care provision. Childminders have been enthusiastic in embracing that change, and childminding has become far more professional overall. It is mostly women who are childminders, and they have revelled in the fact that they have increased their skills and been recognised as more professional for doing so. I recently met 40 childminders in Hackney who were enthusiastic about the work they do. They stressed that the changes made over the last 10 to 15 years have weeded out bad childminders. They are proud of the progress made in the sector.

Jayne Nulty, who was accredited as one of the best childminders in Hackney a couple of years ago, has talked of her concerns about some of the things that I want to raise, but she also talks about

“the bad old days when the childcarer put kids in front of the television all day and little check was made on the situation.”

She believes that the professionalism of the sector has stopped those sorts of people working in it. A parent has said:

“As a single, working parent I have had a great need of childminders; three in all through my son’s younger years. I have a huge respect for them—it’s an incredibly important job; to care for, socialise and teach young children.”

I am sure that the Minister would agree.

I will not go into great detail about the history of improvements in child care—I am sure the Minister needs no telling: she is master of her brief—but the last Labour Government did a great deal to ensure that child care in all settings was improved, including by introducing a regulation and inspection regime for childminders that is run by Ofsted. This Government have also taken quite an interest in child care, and recently received the review of education and child care qualifications by Professor Cathy Nutbrown. Among her recommendations is that childminders should have a full and relevant qualification up to level 3 by 2022. Her aim is for all under-fives to receive the same quality of child care and education whichever provider parents choose to use. I have no disagreement with the desire to improve and enhance further the professional role of childminders as essential early educators.

A recent study by the National Audit Office looked at the impact of better qualified carers for under-fives on the skills of children attending primary school. Although it is early days—these longitudinal studies need to take their course—there is clear evidence that a highly qualified early years educator can improve the education that children receive and, crucially, help other, less well qualified carers in the same setting to deliver better educational results too. The Government have already changed the early years foundation stage to reduce what they considered to be the regulatory burden. However, it is interesting that we are seeing yet another review of child care. It is important that we understand the scope. Too much change too quickly creates its own burdens and, given the Government’s desire to reduce regulatory burdens, I hope that they are considering thoroughly the impact of any changes that may be coming down the line. In a letter to me of 19 June, the Secretary of State for Education did not give any detail about the scope of this latest review, so I wonder whether the Minister could provide any more information. When will she report to the Prime Minister? Will she take submissions from organisations and individuals? What is the time scale for any changes the Government might introduce?

This debate has been prompted by concerns about the focus of the Government’s review of the affordability and availability of child care, particularly as it relates to childminders. This concern stems in part from fears that the review could pick up on ideas espoused by the hon. Member for South West Norfolk (Elizabeth Truss) in a recent pamphlet. On the first day of the Budget debate, I was standing in almost exactly this place when she raised concerns about the cost of child care. On this, I can only agree that this is a real issue for parents up and down the country, particularly in London.

Let us look at some of the figures. These are supplied by the Library but came from the Daycare Trust, based on a survey it conducted this year. It found that 25 hours of childminding care for a child under two costs, as the British average, £92, but nearly £130 in London. The differential is quite stark, and that is just one example. As a mother of three children, I am well aware of the costs, particularly given the long hours of work in this place. This is a cost that parents have to live with; it is a real issue. It is right for any Government to look at the affordability of child care, especially in difficult economic times.

I am concerned about a number of points. First, changes to regulation could impact negatively on cost. At the moment, families can receive tax credits or, if they are higher earners, tax vouchers to help towards the costs of regulated child care. If we remove regulation, it is far from clear how a publicly funded subsidy for child care could be justified. I seek some reassurance from the Minister that she will be mindful of these issues; it is not just at the margins, as this can make a big difference to mainstream family incomes.

In the Netherlands, which the hon. Member for South West Norfolk looked at closely for her pamphlet, there was evidence that when changes were introduced, family members benefited from the public subsidy. The costs to the Dutch Government increased, but the number of places did not and there was a decrease in quality. In seeking to address the issue of affordability, we should never seek to water down quality. I hope that the Minister will agree emphatically with me on that point. Any parent who places their child’s care in the hands of a professional stranger should be able to reassure themselves that that professional is safe, competent and will make a positive input to the child’s education.

Two of the key proposals in the paper produced by the hon. Member for South West Norfolk are to increase the ratio of childminders to children and to introduce an agency as the local regulator and inspector of child care. She also highlights the fact that since Ofsted inspections were introduced, the UK has seen a drop in the number of registered childminders. This is a myth that needs to be nailed early on. Before Ofsted, the local council provided a list of childminders, but there was no way of knowing what quality of care was provided. The numbers went down because those not willing to meet the new quality standards drifted away. I mentioned Jayne Nulty, who had talked about children simply being put in front of a television; we do not want to go back to that sort of thing. I would not be happy about allowing someone who does not provide the right quality of care to look after my child. I represent a constituency with many young parents, and I know that they share my concerns about that.

The number of childminders in Hackney has hovered around the 200 mark since 2009, but there has been an increase in child care places. In 2009, 219 childminders provided 839 places; there are currently 198 registered childminders—a small drop—but they provide 847 places. The ratios go up and down, depending on the age of the children being dealt with; the figures can fluctuate a great deal.

[Jane Ellison (Battersea) (Con)]

My constituents also include many young parents, so I agree that this is a hot issue. Is the hon. Lady going to address the central thrust of the pamphlet produced by my hon. Friend the Member for South West Norfolk (Elizabeth Truss), which was about the much lower cost of child care generally in comparable European countries that have good, safe and well-regulated child care systems? I was wondering whether the hon. Lady was going to come on to that.

[Meg Hillier]

I will respond to that. In the Netherlands, the Government fund about a third of child care costs. That is not comparable to what is in place under this Government. We have tax credits, so the benefits usually come through the tax system. I recognise that the Government are providing 15 hours of free care for three and four-year-olds and want to extend free care places to two-year-olds—following the trajectory of the last Government—and those are welcome steps, but there is a cost to the taxpayer, and there is a need for balance. I realise that that is not easy, but I think we should see child care as an investment in working women in particular but working parents in general, helping them to maintain their place in the working world and serve as role models for their children as they continue to work.

People need more choice. Many parents in my constituency give up work or reduce their hours because paying for child care is not an option. I hope that, if the Minister refers to the scope of the Government’s review, she will give us some indication of the extent to which they will consider the issue of affordability and the available options, particularly given the current climate.

Between March 2011 and March 2012, the number of registered child minders nationally actually rose. It is interesting that that should happen even in difficult economic times, but it is probably because a number of people, mostly women, are looking for work and want child care that will give them some flexibility. It is also the case that the numbers fluctuate because people go in and out of the profession.

Childminders are currently regulated and inspected by Ofsted. They pay a small fee and are inspected regularly. That is important for two reasons. As well as guaranteeing a quality of care, it allows parents to use child care vouchers to pay for childminding and to receive tax credits. The salary sacrifice schemes and tax incentives that are offered by many employers and supported by the Government are invaluable to parents. They also serve as a key driver, encouraging parents to seek out the best quality care, because they do not have the option of going for something cheap and cheerful but not very good if they have to seek out regulated child care. I hope that the Government will be mindful of that in making any future plans, because the link between public subsidy and quality is important to parents and to ensuring that we educate our next generation appropriately.

As a working parent myself, I am aware at first hand of the challenges of securing good quality child care. I do not want to return to the old days when, although the council had a list of local childminders, it was just a list of names which did not tell a parent anything about quality. Now, some years on, I am again the parent of a toddler, and can make a better comparison between examples of nursery, school nursery and childminding provision on a like-for-like basis. It is important to give people information about quality-based choice.

A recent survey by the National Childminding Association revealed that 86% of childminders believe that being regulated by Ofsted helps them to reassure parents that they are professionals delivering a good quality rather than a second-rate service, and 80% feel that proposals to move to an agency model of inspection, removing Ofsted's role of individual inspection, would have a detrimental effect on their professionalism.

Concern about increasing ratios has been expressed by both childminders and parents. Dealing with five under-fives, as proposed by the hon. Member for South West Norfolk, would be very challenging. Just getting five children to the park at that age is a challenge. Parents seeking quality care tell me that they choose childminders partly because of the generally lower ratios that they offer.

I have raised the issues covered in the pamphlet not because they are Government policy, but because they have been greeted with real concern by childminders and parents who fear that this may be the Government’s direction of travel. I hope that the Minister will comment on that. It is understandable that, given the Government’s announcement of a review at the same time as the publication of the pamphlet, people will tend to link the two. I hope that the Minister can shed some light on how much influence the views of the hon. Member for South West Norfolk will have on the Government’s review.

According to the results of the NCMA survey, people who had been childminders for some time felt that their professional status had increased since they started; 42.5% said that that was mainly because they now had to deliver the early years foundation stage, while 39.5% said that it was because they were registered and inspected by Ofsted. They are proud of their professionalism, and that contributes greatly to the quality of child care. I think that the House should recognise what has been achieved.

The survey’s findings underline concern about any model that would water down that clear national standard. The idea that agencies would be allowed to carry out inspection and training locally fills me with dread. I do not say that lightly; I say it with feeling, because of my experience of care at the other end of the age scale. Anyone who has had to work with agencies that provide care for older people in a domiciliary setting will see the impact of this. Those agencies—just like those proposed in places such as the Netherlands—were supposed to ensure quality and carry out inspections, but in domiciliary settings meaningful inspection is rarely carried out. Carers are paid a lot less than the fees paid to the agency by the client, so a tidy percentage in profit is creamed off along the way. I am not entirely sure who would benefit from the proposed move. We would not necessarily see a decrease in child care costs—in fact, an increase would be likely—and childminders would have to pay a fee for the benefit of registering with an agency.

Childminders value the direct relationship they have with parents. They are also concerned that they would see a cut in their fees. Childminders typically make less than £10,000 a year. They can charge what they choose, but the sum is around £4 an hour per child. Even when looking after four or more children, that does not provide a large income when costs such as food, nappies and tax are deducted. There can only be two outcomes: fees go up for parents, who already struggle with the costs, or childminders’ income reduces.

The Dutch model espoused by the hon. Member for South West Norfolk has aroused much concern. Are the Government considering the Dutch model of regulating childminders, and in particular increased ratios and the use of agencies as intermediaries between parents and childminders? Will the Government be looking at the role of Ofsted in relation to childminders?

I represent a borough where about one in five residents are under the age of 16, so these issues are pertinent to more than one fifth of my constituents. That, coupled with the excellent progress made by local childminders and our 12 Sure Start children’s centres, makes Hackney an ideal place for the Minister to carry out a field visit. The Hackney childminding network would be pleased to learn more from her about Government thinking, and to contribute constructively to continuing improvement in the quality of child care and education for under fives and school-age children. I hope the Minister will visit Hackney South and Shoreditch, and I offer her as much support as I can give in ensuring we continue to improve child care, while also working hard to address the challenging affordability issues that working parents face.