Child Care (London)

Debate between Joan Ruddock and Heidi Alexander

Wednesday 19th March 2014 Westminster Hall

[Heidi Alexander (Lewisham East) (Lab)]

I am grateful for the opportunity for this debate. I should say at the outset that I feel somewhat unqualified to lead a debate on child care. I am not a mum and, on the rare occasions that I am entrusted with the care of my niece, my brother often wonders whether she will come back in one piece. I am delighted that the very prospect of the debate led to a flurry of Government announcements on child care in the past few days. Clearly the power of Westminster Hall debates should never be underestimated, especially when they coincide with Budget day.

I called for this debate because the simple truth is that the cost and availability of high-quality child care in the capital is a real problem for hundreds of thousands of families. The lack of affordable nursery places, after-school clubs and childminders puts a huge financial strain on parents. It stops many women who want to go back to work from doing so, and in some cases means that children miss out on the start in life that they deserve. I welcome the signs that, after four years, the Government may be slowly waking up to the scale of the problem. They are, however, still spending less on child care than the previous Government, and there are questions about who benefits most from their over-hyped voucher scheme.

Help for families who struggle with child care costs cannot come soon enough, but the Government will not be thanked if their schemes hike up already high prices even further. I also cannot help but think that assisting families who earn up to £300,000 with the cost of their nanny, for example, is a step too far. Support is undoubtedly required across the spectrum of low and moderate-income families, but the idea that the Prime Minister struggles with his child care costs will strike most people as somewhat bizarre.

In past few days, Ministers have taken to the airwaves to talk about child care, but the problems experienced by parents have not come about overnight. Although the debate focuses on the problems in London, such problems are, of course, not confined to the capital. Rocketing fees in London in recent years, the comparatively longer journey times to work, and a growing and relatively young population, mean that the child care crunch is more severe in the capital than elsewhere. That proportionately fewer people in London than in other regions have grandparents close at hand and that many people do not work nine-to-five adds a further layer of complexity. In the past year alone, child care costs in London have increased by 19%, which is five times faster than average earnings. Nationally, since the election child care costs have increased by 30%. Add to that spiralling energy bills, sky-high rents and the increasing cost of the weekly shop, it is no wonder that Londoners feel that they are experiencing a crisis in their cost of living.

London is by far the most expensive part of the country for child care. Childminders for over-fives, for example, cost 44% more than the British average, and nursery costs for under-twos are 28% more than average— 25 hours a week of nursery care now comes in at more than £140. That sounds bad, but it gets worse. The 2014 child care costs survey, carried out by the Family and Childcare Trust, found that the most expensive nursery in London costs £494 a week for 25 hours. Over a year, a full-time place, which equates to 50 hours, would cost £25,700. Given that the average salary in London is not a great deal more than that, it does not take a genius to see the problem.

When I found out last week that I had secured this debate, I took to Twitter and e-mail to ask people for their experiences and views on child care in London. Suffice to say, I got interesting responses immediately. Barbara Mercer on Twitter simply said,

“need to do something—it’s hitting our pockets really hard.”

Bex Tweets told me:

“I just gave up my job because, had I gone back, I would have been out of pocket by £200 a week.”

Julia, a civil servant, decided in effect to work for less than nothing because of her desire to get back to her job. Her short e-mail is worth sharing with hon. Members, as it sums up the problem for many. She said:

“I have two small children—aged two and one. I work part time and take home £1,100 a month after tax and pay £1,950 to my local nursery. Obviously this is ridiculous but luckily my husband and I can just about scrape by and it is worth losing money to go to work because being at home full time with the babies drove me crazy! I earn a decent salary and can’t find cheaper child care in Surbiton where I live so you can see there is a problem. I am very lucky my husband can subsidise me working—many of my friends simply can’t afford to work so are losing their career.”

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

On that final point about women losing their careers, is that not one reason why they are held back in promotions and cannot get to the top? If they have very large gaps in their working life, the rest of their working life is affected. Women who want to take up the option of going back into work but not full time should be able to do that, but child care prevents that.

[Heidi Alexander]

I agree entirely with my right hon. Friend. It affects not only their working life, but their home life. If parents are happy and fulfilled in their work life, hopefully their home life will be happy and more fulfilled, too.

I was talking about Julia’s child care experience in Surbiton, which is typical of many women, and indeed men, throughout London. Three quarters of parents in the capital say that child care costs affect how many hours they work. A quarter say that they are unable to work simply because of that cost. Despite being the UK’s richest city, London has the lowest maternal employment rate in the country. The economy loses out because of that: employers lose the benefit of skilled staff and the Government pay benefits when they could be collecting taxes.

Many parents decide that they do not wish to work after having children, or that they want to return on a part-time basis. I do not stand here today to tell mums and dads what they should or should not do. If families can get by and are happy on one parental income and the other parent wants to look after the child or children full time, all power to them, but I want families to be able to make a genuine choice about what is right for them and their children, and not to be boxed into a corner because of soaring child care costs.

For some parents, the double-edged luxury of having to make that sort of decision is taken away right at the start. In some parts of London, the supply—let alone cost—of suitable child care provision that matches families’ needs is a real problem. According to analysis done by the then Daycare Trust of the 2011 child care sufficiency assessments, 15 councils in London—nearly half of all London local authorities—did not have enough breakfast and after-school provision to meet demand. Another 16 councils did not have sufficient school holiday child care and 13 identified that they did not have enough suitable child care for disabled children.

For Londoners who work shifts or those on zero-hours contracts, it can be nigh on impossible to find appropriate, flexible child care. As many as 1.4 million jobs in London are in sectors in which employment regularly falls outside of normal office hours and, as mums and dads know, if a job’s working hours are outside of nine-to-five, they also fall outside normal nursery hours.

The lack of suitable provision may be one of the factors that explains why only 51% of parents in London whose two-year-olds are eligible for the Government’s free 15 hours of child care have actually made use of the scheme. That level of take-up is significantly lower than elsewhere in the country, and it does not really make sense in the context of the relative strength of the London economy. I suspect that there is a range of factors at play to explain why take-up is lower in London than elsewhere. However, I cannot help but think that the serious gaps in child care provision may be part of the problem.

[Dame Joan Ruddock]

My hon. Friend is making a most excellent speech. Does she agree that the current shortage of primary school places is exacerbating the situation, with parents having to take their children much further than before to get to a local school, which again is because of Government policies that prevent councils from providing more primary school places?

[Heidi Alexander]

I entirely agree with my right hon. Friend, whose constituency neighbours mine in London. She will know the significant problems that exist for families, particularly for parents in work, when they have to take children to different locations, whether it is for primary school or child care. Despite having met the Minister for Schools at the Department for Education last year to discuss this issue, I am not convinced that enough funding is being made available to London to meet the rising demand for school places, not only at primary but at secondary level, where the demand for places will soon feed through.

In December, the Government announced extra money to help to stimulate the supply of flexible child care in London, but I am simply not convinced that that money will go far enough to deal with the problem. I am also not convinced that this week’s announcements make up for the reductions in support to parents that the Government pushed through earlier in their term of office. We know that in April 2011, changes to the child care element of working tax credit led to a reduction in the amount of help that parents get with child care costs. For example, in December 2013, average weekly payments for those benefiting from that element of working tax credit were around £11 less than they were in April 2011. The Government’s changes also led to a drop in the overall number of families receiving such support. In April 2011, 455,000 families were benefiting from that support, but that dropped by 71,000, and in December 2013 only 422,000 families were benefiting. Given those clear figures, it is not unreasonable to suggest that the Government are guilty of giving with one hand while taking away with the other.

Many of those who struggle most with the cost of child care in London are lone parents on low incomes. My constituency in Lewisham has approximately 9,000 single-parent families, and it is estimated that in London as a whole there are more than 325,000 single mums or dads. Contrary to media stereotypes, the single mums I meet are often desperate to find work, but they find it hard to organise their life in a way to make it possible for them to work. Child care is central to their difficulties.

The need to make work pay for those single mums and dads cannot be overstated. One of my big concerns, before yesterday’s announcement, was that the Government were set on a course with universal credit that would have made work not pay but hurt for some of the poorest single parents, who are struggling to get back into low-paid, part-time work. The Government’s U-turn on the amount of child care costs to be covered by universal credit is welcome, but it is fair to ask whether they instinctively understand the issue when their flagship welfare policy was initially designed with such flaws.

The truth of the matter is that the Government have been forced to promise action on child care costs because they know that Labour’s commitment to increase the amount of free child care available to the parents of three and four-year-olds makes complete sense to increasingly hard-pressed families.

Accident and Emergency Waiting Times

Debate between Joan Ruddock and Heidi Alexander

Wednesday 5th June 2013 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

It is a pleasure to follow the Chairman of the Select Committee, the right hon. Member for Charnwood (Mr Dorrell).

The speech that we heard from the Health Secretary was pathetic. He spent 25 minutes making up excuses for not taking action but not telling us anything about what this Government plan to do.

When I stood for election three years ago, A and E services were not an issue on the doorsteps of Lewisham East but now, as a result of this Government’s determination to decimate services at Lewisham hospital, it is the most frequently cited concern. My constituents are at a loss to understand why, when there is such pressure upon A and E, this Government want to get rid of the full A and E service at their local hospital. This situation is not limited to Lewisham. It is happening all over the country.

[Dame Joan Ruddock]

My hon. Friend will know that on every occasion when she and I have had exchanges with the Secretary of State—it is a great pity that he has left the Chamber—he has justified the downgrade of Lewisham hospital on the basis that 100 lives across the south-east of London could be saved. We can find no evidence for that. Both my hon. Friend and I have written to Sir Bruce Keogh—I did so on 14 May—who the Secretary of State always says is the man who made this recommendation. The Secretary of State takes no responsibility.

Hospital Services (South London)

Debate between Joan Ruddock and Heidi Alexander

Tuesday 22nd January 2013 Westminster Hall

[Heidi Alexander]

My hon. Friend has a long history of working and campaigning on health issues in south-east London, and I agree with his analysis that the scheme that he refers to may have been one of the places from which these proposals for Lewisham hospital emerged. I said earlier that these changes are unwanted. In addition, I want to say today that they are also unfair, unsafe and unjustified. I will now take a few minutes to tell Members why that is the case.

Why are these proposals unfair? The closure of Lewisham’s A and E department and its maternity department has been recommended to the Secretary of State for Health by the special administrator to the South London Healthcare NHS Trust. In July last year, the special administrator was appointed to the trust, which is made up of the three hospitals to the east and south of Lewisham—Woolwich, Sidcup and Farnborough hospitals. The administrator’s job was to find a way to balance the trust’s books. It was the first time that a special administrator had ever been appointed in the NHS, and the first time that the unsustainable providers regime—that is, the process for sorting out failing hospital trusts—has been used anywhere in the country.

The trust had, and still has, serious financial problems. I should be clear: Lewisham is not part of the trust; nor does it share the trust’s financial problems. Lewisham hospital is a solvent and successful hospital. Its management has worked hard during the past five to 10 years to improve standards of care and to make the hospital more efficient. Yet, because Lewisham hospital is next to the South London Healthcare NHS Trust, because it has only a modest private finance initiative, so there are not as many constraints on the site as on the two big PFI hospitals at Woolwich and Farnborough, and possibly because of its location in relation to surrounding hospitals, the special administrator decided to recommend the closure of its A and E and maternity departments.

As I said, the draft proposals were published at the end of October. There ensued six weeks of the worst public consultation that I have ever seen. There was no direct mailing to the people affected, and there were opaque and complicated questions in the consultation document. There was not even a direct question about the closure of Lewisham A and E. To add insult to injury, there was no question at all about the sale of the land at the hospital.

Not only are my constituents up in arms about the so-called consultation, but they are rightly asking how Lewisham got dragged into this. Why does it have to pay such a heavy price for financial failures elsewhere? How can it be right that a process set up to sort out financial problems in a failing trust has led to services being cut at a separate, well-performing, financially stable hospital? I cannot answer those questions; nor can I explain why such a significant reconfiguration of emergency and maternity services is being proposed.

The statutory guidance to trust special administrators and the written statement that the former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley), made to the House when he enacted the special administration regime last summer clearly state that the process should not be used as a back-door approach to service reconfiguration. I laughed out loud when I read those words in the statutory guidance, because that is exactly what is happening in south London. If closing A and E and maternity departments is not a service reconfiguration, I honestly do not know what is.

[Dame Joan Ruddock (Lewisham, Deptford) (Lab)]

I congratulate my hon. Friend on securing a debate on the hospital, which my constituents share with hers. When I brought the current Secretary of State for Health to the House to answer an urgent question, he seemed to imply that, in fact, reconfiguration is a major consideration. He said that giving details at that stage

“would prejudice my duty to consider the recommendations with care and reach a decision…I have made it clear that any solution would need to satisfy the four tests outlined by the Prime Minister…with respect to any major reconfigurations”.—[Official Report, 8 January 2013; Vol. 556, c. 169.]

The Secretary of State clearly does believe that reconfiguration is a major consideration. The next day, I asked the Prime Minister about the four tests, and he said:

“I specifically promised…there should be no closures or reorganisations unless they had support from the GP commissioners, unless there was proper public and patient engagement and unless there was an evidence base.”—[Official Report, 9 January 2013; Vol. 556, c. 313-14.]

My hon. Friend will agree that none of those tests is met in the trust special administrator’s proposals.

[Heidi Alexander]

I do agree, and it would be incredibly helpful if the Minister confirmed when she responds to the debate that the four tests would apply to any changes made as a result of the TSA’s recommendations.

The thing that really sticks in my throat about the proposals to shut Lewisham’s A and E and maternity departments is that they are fundamentally driven by money. If we start by saying that a process is being set up to sort out the financial woes of part of the NHS, how can people ever have any confidence that the clinical input and so-called clinical evidence that come later have not just been moulded to suit the accountants’ bottom line, which was there from the off?

I appreciate that there are financial pressures in the NHS, and I accept that it cannot be preserved in aspic for ever. For example, I support the recent changes to the way in which emergency care in London is provided for major trauma, heart attacks and stroke. However, where is the evidence that the changes on the table will result in more lives being saved and better health care overall?

That brings me to my second main point: the changes are not only unwanted and unfair but unsafe. It is proposed to replace the A and E at Lewisham with an urgent care centre. Initially, the special administrator told us that the centre would see 77% of the people who currently go to the A and E. In his final report, that was revised down to 50%. Based on an analysis of their case load, doctors at Lewisham suggest that the figure would be closer to 30%, so who is right? GPs in Lewisham, including the chair of the clinical commissioning group, suggest that the number of people who would go to an urgent care centre at Lewisham has been overestimated. They suggest that they would be inclined to send people to hospitals where they knew specialist opinion was available.

If I was a mum and my five-year-old woke up in the middle of the night in dreadful pain, where would I go? Would I go to a place that I was not sure had the appropriate staff and equipment to deal with my son or daughter, or would I go to an all-singing, all-dancing unit in central London or at King’s? I am not a mum, but I know where I would go. If people do not use the urgent care centre, the extra demands placed on neighbouring A and Es will exceed the numbers forecast in the plans before the Health Secretary. Ultimately, there may not be enough capacity elsewhere for people to be seen and to be seen quickly.

I should add to that the heroic assumptions in the proposals about reducing the need for acute care in the first place. I am all for tackling the reasons why so many people turn up at hospitals, but I know how hard it is to change people’s behaviour and to organise adequate community-based care to reduce the need for acute admissions.

[Dame Joan Ruddock]

One hallmark of the work at Lewisham hospital is that extremely important steps have been taken to integrate with community care. That is relevant for the elderly, who may have to be admitted for a short time before going back into the community, and for the young people with mental health problems, who need there to be integration between those who see them when they have an episode and those who receive them back into the community. All that will be lost if the proposals go ahead.

[Heidi Alexander]

My right hon. Friend is right to highlight those issues. I would add that the close working between Lewisham hospital and Lewisham council on child protection has been recognised across the country, and I would not want that to be compromised in any way if the proposals go ahead.

I fear that other A and Es will end up hopelessly overstretched, resulting in worse care for my constituents and many other people in south London. I am also concerned that although clinical evidence exists for centralising some emergency care, such as that for those who are involved in bad traffic accidents or who have suffered a stroke, I have seen nothing showing that better outcomes can be achieved by centralising care for other medical emergencies.

When I was in my 20s, my brother got bacterial meningitis. When he arrived in hospital, after an initial incorrect diagnosis by a GP, the hospital doctors said he had got there just in time—a few more minutes and he might not have survived. He had to have a lumbar puncture taken, and it was only after getting the results that he could be treated. It was one of the worst days of my life seeing a grown man lying in a hospital bed. We were unable to do anything, and we did not know what the problem was. That is why I worry about how long it takes people to get to A and E.

Closing the A and E at Lewisham will mean longer journeys for people who need access to emergency care. It is said that, in a real emergency, people will be in an ambulance, and that may be so, but anyone who lives in south-east London and who has ever been stuck in a traffic jam on the south circular will know how hard it can be, even for ambulances, to get through.

I have spoken at length about the plans to shut the A and E at Lewisham, but may I also raise the impact of the proposed closure of the maternity department? The A and E and maternity departments at any hospital are intrinsically linked. Sometimes things go wrong in labour, even with supposedly low-risk births, and emergency support needs to be available there and then to sort out problems.

More than 4,000 babies are born each year at Lewisham. There has been an 11% increase in the number of births at the hospital over the past five years, and the birth rate is rising. Unlike other health services, maternity care cannot be rationed or restricted. Nationally, we are witnessing the highest birth rate for 40 years—it is particularly high in areas such as Lewisham—and the Government want to close a popular and much needed maternity department.

--- Later in debate ---

[Heidi Alexander]

rose—

[Dame Joan Ruddock]

rose—

Local Government Funding

Debate between Joan Ruddock and Heidi Alexander

Monday 6th December 2010 Commons Chamber

[Heidi Alexander (Lewisham East) (Lab)]

This time last week, my constituency was the scene of violent protests about local government cuts. Town hall windows were smashed, four individuals were arrested and 15 police officers were injured as Lewisham council met to consider budget cuts of £16 million. Although the violence was due to a small minority intent on making trouble, there is no doubt that my constituents are angry, and they are right to be.

Lewisham bore the brunt of public outrage about local government cuts last week. Sadly, the £16 million worth of savings agreed by the council is probably just the tip of the iceberg. In the next four years Lewisham expects to have to save somewhere in the region of £77 million, just under a third of its total revenue budget.

[Joan Ruddock]

Did my hon. Friend hear the Secretary of State suggest that Lewisham council should look to its £60 million worth of reserves to deal with the issue? She knows, as I do and as he does, that of those reserves, the majority is for capital spending. The general fund is simply 2.5% of total budget. Does she agree that it would be utterly irresponsible to spend emergency reserves and do nothing to deal with cuts of up to £70 million?

[Heidi Alexander]

Indeed. My experience on Lewisham council was that the only occasion on which reserves would be considered for use was when that would be a fiscally responsible thing to do.