Care Bill [Lords] Debate
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Jeremy Hunt
Main Page: Jeremy Hunt (Conservative - Godalming and Ash)Department Debates - View all Jeremy Hunt's debates with the Department of Health and Social Care
(11 years ago)
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The Secretary of State for Health (Mr Jeremy Hunt)
I beg to move, That the Bill be now read a Second time.
Our health and care system stands for compassionate care, or it stands for nothing. That was the vision when the NHS was founded 65 years ago: that anyone and everyone, regardless of background or income, should receive the best quality health care and be treated with dignity, compassion and respect. Because we have made much progress in delivering that vision, the NHS rightly remains the single biggest reason people are proud to be British. This Government want to keep it that way, which is why we are determined to root out poor care whenever and wherever it exists. Tragically, it does exist, both in the NHS and in private provision. In recent years, we have heard of patients being left in their own excrement at Mid Staffs, of patients left unchecked on trolleys for hours on end at Tameside, and of blood on the curtains and catheters on the floor at Basildon. All are issues that could and should have been dealt with by the last Government. Tragically, those problems were swept under the carpet, with devastating consequences for families across the country.
Today it gets worse, because the same people who failed to face up to those problems as Ministers will troop into the Lobby to try to vote down the very measures that will stop them ever happening again. People watching this debate will be asking one simple question: what more will it take for Labour to learn the terrible lessons of these tragedies? How many more people will need to suffer before the Labour party, the party that is rightly proud to have founded the NHS, comes to its senses and recognises that, on its watch, targets mattered more than patients and good news mattered more than good care?
Ian Lucas (Wrexham) (Lab)
The right hon. Gentleman casts those allegations around widely. Will he name the Ministers against whom he is making them?
Mr Hunt
I will absolutely go on to name the problems and the Ministers involved, if the hon. Gentleman will just be patient.
Hon. Members should not simply take my word for this. This is what Mid Staffs campaigner Ken Lownds, a former Labour party member, says about Labour’s decision today:
“It’s shocking and deeply depressing that Labour have learnt nothing from Mid Staffs. Their decision to oppose the Care Bill is a slap in the face for the campaigners and relatives who have fought for years for these measures that deliver a safer, more transparent and more compassionate NHS. Once again they have let patients and whistleblowers down by putting their political interests ahead of patient safety.”
Heidi Alexander (Lewisham East) (Lab)
The Secretary of State has come here to introduce the Second Reading of a very important Bill, yet it has taken him only two minutes to start casting aspersions on the previous Labour Government. When is he going to start acting like a Secretary of State?
Mr Hunt
I will make some progress, then I will give way.
Labour will today vote against measures that will help to implement 61 of the most important recommendations made by Robert Francis. Many of these will be policed by the new chief inspector of hospitals, appointed to be the nation’s whistleblower in chief, whose duties will be enshrined in today’s legislation, which Labour are voting against.
Andy Burnham
How can it be appropriate to introduce a debate on such fundamentally important issues as the way we care for older people with such narrow, petty, partisan, point scoring efforts? May I just say to the Secretary of State that he should not stand there and misrepresent the position of the Opposition? We will not oppose the Second Reading—we have tabled a reasoned amendment, because we do not believe his proposals for a cap are what they seem, but we will not oppose the Second Reading of this Bill. He should get his facts straight before he comes to that Dispatch Box.
Mr Hunt
The right hon. Gentleman needs to read his own amendment, because it says that he “declines to give” the Bill “a Second Reading”. If he is changing his position now, that is the fastest U-turn in history.
Let me go on to say why it is so important that the Labour party supports today’s Bill and does not, as the amendment says, decline to give the Bill a Second Reading.
Mr Hunt
I am going to make some progress. The new chief inspector of hospitals will act as Ofsted does with schools and, as with Ofsted, will inspect and rate hospitals using simple language that the public can understand: “Is my local hospital safe? Is it caring? Is it responsive? Is it clinically effective? Is it well led?” We will also make sure that the same scrutiny is directed at services outside hospitals, so the Bill makes provision for a chief inspector of social care and a chief inspector of general practice.
Ministers in the previous Government were repeatedly asked to strengthen the regulatory system and repeatedly ignored those requests. [Interruption.] The right hon. Gentleman says, from a sedentary position, that that is rubbish, but this is what Barbara Young, the chair of the Care Quality Commission at the time and now a Labour peer, told the Francis inquiry about the inspection system that the right hon. Gentleman introduced:
“The annual health check was so flawed in so many ways that I went and saw the Secretary of State. It was nonsense. And having argued that with the Secretary of State, I was told firmly that we weren’t permitted to change it. I was very unhappy about that.”
Well, today—
Andy Burnham
On a point of order, Mr Speaker. Is it in order for the Secretary of State to misrepresent the views of the previous Government and previous Ministers, and refuse to take interventions? He has just said that I refused to change and strengthen the regulation system of hospitals in England—that is factually incorrect. I brought forward a new system for the registration of all hospitals in England in autumn 2009, on the back of recommendations from the CQC. Again, he should get his facts straight at that Dispatch Box.
Mr Speaker
I am grateful to the right hon. Gentleman for his point of order, and I make two points in response. First, every Member and every Minister must be responsible for his or her comments in the Chamber—the accuracy and appropriateness thereof. I am afraid that, however angry people feel, on either side of the argument, these are matters of debate. Secondly, the situation would be greatly helped if the Secretary of State now, immediately, turned his mind to the presentation of the argument in support of the introduction of the Bill, which is, ordinarily, the matter upon which one anticipates a Secretary of State will focus his remarks. This is not an occasion for a historical legerdemain; it is an occasion for the presentation of the case for a Bill, to which I know that, without delay, the Secretary of State will turn his mind.
Mr Hunt
I am delighted to do so, Mr Speaker, and I know that you would think it was legitimate of me to hold the Labour party to account for its decision if it is voting against today’s Bill or declining to support it, as its amendment clearly states.
However, today is a day to rise above party political considerations, as Mr Speaker has just said, and recognise that putting these things right is overwhelmingly in the interests of patients. If the Labour party continues its stubborn refusal to support legislative underpinning for a new chief inspector of hospitals, which is in today’s Bill, how will it ever be able to look patients in the eye again? Perhaps the most shocking thing about Mid Staffs, which is one of the reasons we have so many provisions in the Bill, was not just the individual lapses in care but the fact that they went on for four long years without anything being done about them.
Barbara Keeley (Worsley and Eccles South) (Lab)
Will the Secretary of State give way?
Mr Hunt
I am going to make some progress.
When problems are uncovered, action must be swift. Robert Francis cited confusion over which part of the regulatory system is responsible for dealing with failing hospitals, so this Bill makes it clear where the buck stops. It is the CQC’s job to identify problems and instigate a new failure regime when it does so. Monitor and the Trust Development Authority will then be able to use powers to intervene in those hospitals, suspending foundation trusts’ freedoms where necessary to ensure that appropriate action is taken. If, after a limited period, a trust has failed significantly to improve, the Bill requires a decision to be taken on whether the trust needs to be put into special administration on quality grounds—and, yes, where necessary, a trust special administrator will be able to look beyond the boundaries of the trust and consider the wider health economy. As we know from Lewisham, that is not easy, but we will betray patients if we do not address failure wherever it happens.
Dame Joan Ruddock (Lewisham, Deptford) (Lab)
Why, when the Secretary of State and the Prime Minister have clearly set out the four tests that have to be met for any downgrading of hospital services, is he now introducing this clause? Those greater powers will totally undermine the clinical commissioning groups that his Government set up to meet local clinical and health needs, and not to balance the books for people outside their area.
Mr Hunt
I recognise that the right hon. Lady campaigns hard for her constituents. The four tests set out by the Prime Minister were never designed to require unanimous support from local CCGs for necessary changes. If we had to secure that, it would be virtually impossible to make any major reconfigurations. Where there is a failing hospital, it is important to resolve and address situations. There are exceptional occasions when that cannot be done in an individual trust’s area. The change in the law will not apply retrospectively to Lewisham, but it is right to ensure that, if we are to learn one lesson from what has happened in recent years, we deal much more quickly with failing hospitals, and that applies to South London Healthcare NHS Trust as well. Governments and the NHS must never again sit on coasting or failing hospitals for year after year without doing what it takes to sort them out. That is why this year, for the first time, we have put 13 hospitals into special measures. How utterly inexplicable but sadly predictable it is that the Labour party, which failed to sort out those problems, is today refusing to back the changes that mean those mistakes can never be repeated.
Another lesson from the Francis inquiry is that we need to create a culture of openness in health and social care so that, rather than being bullied and intimidated, doctors and nurses feel they can speak out about problems. The Care Bill will introduce a duty of candour as a requirement for registering with a CQC. That means that honesty and openness must come as standard for every organisation. We are also introducing a new criminal offence that will apply to care providers that supply or publish false or misleading information. Directors and other senior staff involved in committing the offence will be held to account. In addition to the Bill, the professional regulators have agreed to place a new strengthened professional duty of candour on all doctors and nurses. The Government are on the side of openness and transparency in our health care system.
Grahame M. Morris (Easington) (Lab)
I am sorry that the Secretary of State has not made any reference to part 1 of the Bill, which is about care and support. I hope he will come on to it, because it is so important. Perhaps he will also explain why Francis’s recommendations on a duty of care are being applied to organisations but not to individuals?
Mr Hunt
As the hon. Gentleman knows, we considered that matter carefully. We decided that the best way forward is to strengthen the professional duty of candour on individual doctors and nurses through their professional codes. After extensive consultation, which was supported by the medical profession, including the British Medical Association, we decided that that was a better way of ensuring that we had the right outcomes and did not create a legalistic culture that could lead to defensive medicine, which would not be in patients’ interests.
If supporting the Francis measures in the Bill is too awkward or embarrassing for Labour Members, can they not see the merits in the parts of the Bill that deal with out-of-hospital care? I am talking about not just vulnerable older people, but carers, for whom we need to do more. We need to do much more to remove the worry that people have about being forced to sell their own home to pay for their care.
Mr Hunt
I will give way in a moment, but let me make some progress first.
I commend the right hon. Member for Leigh (Andy Burnham) for championing integration, although he chose not to do anything about it when he was in office. How, then, when a Government take steps to do that for the first time, can he possibly justify not supporting it?
Hazel Blears
At a time of austerity, when there is very little public money around, the need for innovation and creativity is much greater. On reflection, does the Secretary of State regret not being more ambitious in the Bill about the full integration of health and social care in order to maximise the impact for those who need care and support—unlike my right hon. Friend the shadow Secretary of State for Health, who has talked about whole person care and full integration?
Mr Hunt
With the greatest of respect to the right hon. Lady, who, I know, played a good role in the G8 dementia summit last week, the Bill is extraordinarily ambitious. Nearly £4 billion is going into a merger of the health and social care systems. The previous Government had 13 years to do something about this and they did nothing. We are delivering. I hope, if she believes in this, that she might at least support the Bill in the Lobby tonight and not decline to support it, as her party’s amendment suggests.
The fund will ensure joint commissioning and the seamless provision of services, preventing the nightmare of people being pushed from pillar to post with no one taking responsibility. It has led to the unprecedented step of the NHS and local authorities working together in all 152 local authority areas to plan joined-up services.
Mr Hunt
I am going to make some progress.
Thanks to our reversal of Labour’s 2004 GP contract, vulnerable people over 75 will have an accountable, named GP responsible for making sure they get the wraparound care they require.
The collapse of Southern Cross showed the risks to people’s care when providers fail, so through the Bill we are introducing provisions to help ensure that people do not go without care if their provider fails, even if they pay for their own care. The CQC will monitor the financial position of the most difficult-to-replace providers in England to help local authorities provide continuity of care in a way that minimises anxiety for people receiving care.
We also need to improve the training of health care assistants and social care support workers. For the first time, health care assistants will have a new care certificate to ensure they get training in compassionate care and the Bill allows us to appoint a body to set the standards for that training. That means that the public can be assured that no one will be assigned to give personal care to their loved ones without appropriate training or skills. My hon. Friend the Minister of State, who is responsible for care and support, will have more to say on those elements of the Bill when he closes the debate and I thank him for his outstanding work on raising standards in that area.
We also need to address the funding of care. At the moment, people fear being saddled with catastrophic costs and even having to sell their home at the worst possible time to pay for their care. The Care Bill significantly reforms the funding of care and support, introducing a duty on local authorities to offer a deferred payments scheme so that people will not be forced to sell their homes in their lifetime to pay for residential care.
We will also introduce a cap on people’s social care costs, raising the means test at which support from the state is made possible and delivering on the recommendation of the independent Dilnot commission.
Andrew George
I am very grateful to my right hon. Friend for giving way. He says that everyone will be protected, but of course the cap on care costs is not a cap on “daily living costs”, as the Bill puts it. Will he therefore confirm that the £70,000—or whatever figure the cost ends up at—will not be the end of the costs for many people going into residential care?
Mr Hunt
My hon. Friend is right. We followed the recommendations of Andrew Dilnot, who did not think that the cap should apply to hotel costs, and, indeed, the policy that the Opposition followed in their national care service White Paper. We think that it is reasonable to cap the care costs. There is a cost issue—we would like to be more generous, but by the end of the next Parliament this proposal will cost nearly £2 billion. People who would like a more generous system must be obliged to tell us where they will get the extra funding.
Mr Hunt
The right hon. Gentleman will have a chance to speak later.
We want to be one of the first countries in the world where it is as normal to save for one’s social care costs as it is for one’s pension, and this Bill’s provisions make that possible. The deferred payments scheme, with a threshold of £23,250, on which we openly consulted, excludes only the wealthiest 15% of people entering residential care. How extraordinary it is that Labour should play politics by feigning concern for the richest in society, when they failed to do anything for the poorest over 13 years when they had the chance to do so.
Mr Hunt
The Government’s response to the tragedy of Mid Staffs has been widely welcomed, which is why the Opposition’s stance today is so disappointing. Robert Francis welcomed our measures as a
“carefully considered and thorough response”
to his recommendations that will
“contribute greatly towards a new culture of caring and making our hospitals safer places for their patients.”
The BMA said that it supports
“the Government’s commitment to put patient care first and foremost”.
The Patients Association said that it believes that this
“is a move towards restoring the faith patients have in the NHS.”
This Government would prefer to proceed on vital matters such as this with cross-party support, but I must warn the Opposition that we will do what is right for patients, whether or not we have their support. If they are today refusing to learn those lessons by not supporting this Bill, the country will draw its own conclusions about their fitness to run the NHS. They will know that for Labour it is all about politics, and it is politics before patients every time. We, on the other hand, profoundly believe that if we focus on patients, our NHS can be the safest, highest quality, most compassionate and fairest health care system in the world, and we will stop at nothing to make that happen. I commend this Bill to the House.
Andy Burnham
Those are the facts. The councils that are still trying to provide support to people with moderate needs are not all, but by and large, Labour councils. They are still trying to do that, but they have lost significantly more per head under this Government than councils elsewhere. The situation is about to get a lot worse, because NHS England will meet tomorrow to consider a major change to the NHS resource allocation formula, which will reduce the weighting given to health inequality and increase the weighting given to age. That will have the effect of taking more money out of Salford and Wigan and giving more money to areas where healthy life expectancy is already the longest. The Government are making it impossible for people who want to do the right thing.
Mr Jeremy Hunt
Local authority budgets were indeed cut to deal with the deficit, so will the right hon. Gentleman tell the House whether he would reverse those cuts—yes or no?
Andy Burnham
I am not sure that I agree with the hon. Lady. Some older people in my constituency probably do not have as good a quality of life in later life as some in her area, because there are ex-miners with chronic obstructive pulmonary disease and other things, who have very extensive needs caused by the dangers they were exposed to during their working life, and that places a burden on our health service. Of course, people are more likely to be living with chronic disease in more deprived areas, and both those things have to be recognised in the funding formula. If the change goes ahead, it will cause great volatility and move a lot of money around the system, but it will not allow areas such as the one I represent to invest in the home-based, high-quality, integrated services that the Secretary of State said he wanted.
To return to the costs of care charged by councils, let us call the hikes in charges what they are—stealthy dementia taxes that seek out the most vulnerable people in our society. The more vulnerable someone is and the greater their need, the more they pay. People who are paying more for care under the current Government and often receiving a worse service will not be convinced by the Secretary of State’s claims for his Bill today. It will feel like a con, and that feeling will only intensify when people understand more about the proposed cap.
Although we welcome the principle of a cap, this one is not what it seems. It is set at £72,000, despite Dilnot warning that a cap above £50,000 would not provide adequate protection for people with low incomes and low wealth. The Health Secretary has repeatedly said that people will not have to pay more than £72,000 for care.
Andy Burnham
The Secretary of State is nodding, but I hope he will be honest enough to admit today that that is simply not the case. In reality, the average pensioner could pay more than £150,000 for their actual residential care home bill—£300,000 for a couple—before they hit the so-called cap. I will explain why. It is because the cap will be based on the standard rate that local authorities pay for a care home place, not the actual amount that self-funders are charged, which is often much higher than the council rate. It is estimated that in 2016-17, when the cap is due to start, the average council rate for residential care will be £522 a week, and the average price of a care home place will be £610 a week. That is because self-funders pay more than councils. However, that will not be taken into account when the cap is calculated.
Andy Burnham
They are offering a similar scheme but at the moment they are not allowed to charge interest on it. That brings me to the next part of what is wrong with these proposals. What the Health Secretary has not said today is that interest will be charged on his proposed deferred payment scheme, which is not universal because it is not available to everybody. A loan to cover the average length of stay in a care home—two and a half years—would clock up extra costs of £3,500 in interest alone. That interest would not be included in the cap but would be outside it. Again, people will not feel that what they are paying is related to a cap.
Andy Burnham
I noticed that the Secretary of State was not very good at giving way, and I hope in future he will bear that in mind.
Andy Burnham
I was proposing a fundamentally different policy in a national care service. I ask the Secretary of State politely whether it is about time he stopped trying to say that everything is about the past? Why did he not stand there, explain and justify his own policy? Would that have been a good thing for him to have done today, instead of leaving it to me to explain what he is proposing?
Andy Burnham
That illustrates the confusion that is currently at the heart of the NHS. No one knows who is in charge of anything. What if CCGs and the boards of foundation trusts disagree with the conclusions of the TSA? How will that be resolved? Were we not told that doctors were sovereign? Were they not supposed to decide everything? Was that not the big call when the Government introduced their Bill? It seems that that is no longer the case: everything can be done “top down” by the Secretary of State. It takes power away from every Member and could be used as a back-door way to railroad through unpopular changes.
The real danger of the proposal comes when it is seen in the context of the competition regime created by the Health and Social Care Act 2012. Of course, it is sometimes necessary to make changes to local health services beyond just a failing trust. That is best done through partnership and collaboration, but such sensible changes are now being blocked by the market madness imposed by the Act. We recently saw the ludicrous spectacle of the Competition Commission intervening in the NHS for the first time to stop the sensible collaboration between Bournemouth and Poole. Since when did competition lawyers decide what was best for patients?
Andy Burnham
One reason the Lewisham clause is so worrying is that simple collaboration between hospitals to solve financial problems is no longer an option to ease financial pressures. That is what it has got to do with the Care Bill. The Government are making a case for all hospitals standing or falling on their own, and in that context, the weakest can be picked off by the Secretary of State and closed without consultation. Given the financial pressures on many organisations, this special administration process is likely to be used on an increasing basis, putting more hospitals at risk. That should send a shiver though every community represented in the House today.