Draft National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022

Karin Smyth Excerpts

Wednesday 15th June 2022 General Committees

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Nokes.

The Minister and I first discussed the Health and Care Bill that became the 2022 Act in February last year. That Bill was finally introduced in July that year, so there was plenty of time to prepare it and to get us all lined up for it, and the NHS was already asking for legislation. We then spent six weeks in the Bill Committee, there were some delays, and the legislation spent extensive time in the Lords, et cetera. We now find ourselves back discussing consequentials. A simple tidying-up exercise for the health service does not mean that, does it? It means months and months of bureaucracy, time and effort for Clerks and so on, and changes to the law, while the system has to try to cope with it.

We support the regulations; I accept that they are consequential and do not actually change services for people. Will the Minister say how many many more consequential statutory instruments we are to expect as part of the tidying-up exercise? Given the largest waiting lists and waiting times the NHS is currently having to manage, it is important that system managers understand what is coming down the tracks. It is currently the middle of June and the regulations have to be in place for 1 July so that people have certainty about what they need to put in place. Patients also need to be assured that they will have a seamless service wherever in the United Kingdom they live, reside or visit friends and family. It would be helpful to have an idea of whether there will be similar consequentials, if the Minister can tell us this morning.

Other than that, we hope that the regulations will go through and make things easier, and that the NHS and the Government can get on with trying to improve the health service for the benefit of all our constituents.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 14th June 2022 Commons Chamber

[Gillian Keegan]

My hon. Friend is absolutely right. We had been meeting our dementia diagnosis target consistently at the national level from July 2016 until the end of March 2020, when, obviously, we all know what happened. The diagnosis rate dropped below our target for the first time in almost four years, and reflects the impact the pandemic had on memory assessment services and GP referrals into those services. In the last financial year, we allocated £17 million to specifically address dementia waiting lists and increase the number of diagnoses. That was spent in a range of ways, including on investing in workforce to increase capacity in memory assessment services and on improving access to pre and post-diagnostic support and carer support.

[Karin Smyth (Bristol South) (Lab)]

Quality care for our loved ones depends on a well-trained and motivated care force. I think we can all agree on that, and I commend the work of the all-party group. I hear the words of the Minister, but we have had a lot of warm words about a dementia strategy and the promise of a clear date. Can she be more specific about a date for publication, and can she be clearer about the workforce plan, including training for staff, given the Government’s rejection of all workforce amendments to the Health and Social Care Levy Act 2021? We cannot give confidence to people suffering with dementia and their carers without a much clearer plan that is in place very quickly.

[Gillian Keegan]

I assure the hon. Lady that there is a lot of work happening on workforce across the whole of our health and social care services, whether in mental or physical health. Health Education England is working on the matter now and will publish a framework shortly. The workforce strategy set out in our White Paper is just the beginning. We will work closely with adult social care leaders and staff, and the people who draw on that care and support, to implement it now, and to take forward and build on those policies now and in the future. There is a lot of work, and we are serious about it; the hon. Lady can look forward to seeing a lot of documents before the end of the year.

National Strategy for Self-Care

Karin Smyth Excerpts

Tuesday 26th April 2022 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

Yes, indeed. Having sat opposite the Minister in Committee and when ping-ponging with Lords amendments, I am sure I can dredge up an awful lot to talk about for a very long time, but I will not do that. That would be unfair, although we might have another opportunity to do that tomorrow.

It is a pleasure serve under your chairmanship, Sir Charles, and I congratulate my right hon. Friend the Member for Knowsley (Sir George Howarth) on securing this debate. There are not many hon. Members here, but that belies the fact that this subject is of interest to an awful lot of people. As my hon. Friend the Member for Bootle (Peter Dowd) outlined, it covers not only physical health but mental health, and deserves time to be discussed.

As my right hon. Friend the Member for Knowsley said, self-care refers to long-term conditions and preventive health measures. It is an important component for healthy living. We all need to be clear that self-care is not passing responsibility that should be with professionals to the individual, or that we are using self-care to prop up our increasingly underfunded health and social care systems. We need to look at self-care in a positive sense, as has been discussed, as empowering people and patients to know and understand their own bodies and their own physical and mental health, but also to know how to manage the many things that life throws at us all along the way, and to do that from a young age.

Self-care is about lifestyle choices, but also about better awareness of symptoms and when it is important to seek professional advice. Our professional systems should be set up with that in mind, starting with empowering people and not telling them all the time what they should be doing or expecting them to be at the end of a professional opinion. There are many examples, but with cancer symptoms, early diagnosis is crucial and we know that can be a matter of life and death. We also need to understand when an ailment can be treated by someone themselves, and when to do that, or by talking to community pharmacists, as has been mentioned and which I will say more about as I go on.

My right hon. Friend the Member for Knowsley talked eloquently and from experience about diabetes, which is an important area. We know how many people have diabetes, what a huge area it is for the health service and how important education and self-management strategies are for people with diabetes. Before the pandemic, I worked a lot with Diabetes UK in my constituency and across Bristol, as I did in my previous life as a health service manager, to support those important local groups of people coming together. Those groups support individuals, share professional information and empower people very well. We all look forward to the results of my right hon. Friend’s work with the right hon. Member for Maidenhead (Mrs May). We wish them well and offer our support for that work in any way we can.

My area, like many other constituencies, has high levels of health inequality. I recognise the importance of improving health literacy as a way of supporting people to help them tackle some of those health inequalities themselves.

As the Minister would expect me to say, after a decade of Tory mismanagement of the NHS, with long waiting lists before the pandemic and staff shortages, record numbers of people are waiting for care. Self-care is essential for the future sustainability of the NHS. Through empowering people to take control of minor ailments, we can focus NHS resources on those who need them most.

[Peter Dowd]

Does my hon. Friend agree that organisations such as those in the voluntary, community and faith sector have been absolutely fantastic in supporting people over the last two years and have enabled them to self-care as part of their healthy lifestyle, at a time when the NHS has been under huge stress?

--- Later in debate ---

[Karin Smyth]

I absolutely agree. The pandemic has been a terrible time for most of us, but it has provided the opportunity to look at, and to trial in real time, different ways of working with and helping people. A lot of third-sector organisations have been able to use technology, particularly in rural areas, so that people no longer have to travel to centres if they do not want to. Such organisations have been supporting people to use more online communication methods, and people have been coming together in more localised settings and been supported in a different way.

From my many years in the health service, I know that getting online appointments organised and, as the hon. Gentleman has heard me say before, managing things—for example, dermatology—using online services was a really hard task. We have now gone through that process and need to learn the lessons from the pandemic. It is a unique opportunity to promote self-care as an essential part of healthy living. We have heard from my right hon. Friend the Member for Knowsley about the numbers involved. People are keen to take this opportunity to promote self-care and improve our understanding of, and confidence in, our own health, so that people can access the right service at the right time, and we ensure that our highly professional health service and specialist services are well used.

I would like to mention local pharmacies in my constituency of Bristol South. Bedminster pharmacy has been commended several times—it has the most commended pharmacy team in the United Kingdom—by national awards. I echo the points that have been made about pharmacies, which are often overlooked by other professional organisations. Some primary care services in different parts of the country are better than others at working together across the piece. I certainly hope that is a feature of the new integrated care systems, which have a huge opportunity to support pharmacies properly so that they can do their day-to-day work.

[Sir George Howarth]

My hon. Friend makes a good point about community pharmacies and the potential they offer. Does she agree that in the past the potential of community pharmacies has been underused, just as the capacity of GP and A&E services has been overused? It is not just about sloughing off the responsibility to somebody else; it is a matter of using the expertise that already exists.

[Karin Smyth]

Absolutely. I refer back to one of my favourite pieces of legislation, the Health and Social Care Act 2012; one of the many terrible things that that Act did was to demote the role of pharmacists in local communities and affect the support they were given by primary care trusts. In my area, we had a huge team supporting pharmacies who were very much part of that local community offer. I hope that the integrated care systems recognise that that was a mistake. We have lost a decade and really should be working much more closely together. Pharmacies exist in most areas and are easy for local people to access. They can give people confidence to look after themselves and the literacy that I mentioned.

It is vital that people receive a consistent message about self-care when they look at NHS services online, call 111, or visit a GP or local pharmacist, and that requires local systems to work together. A national self-care strategy would help to embed consistency across the country. As has been mentioned, self-care is a continuum that covers adopting healthy lifestyle choices and managing long-term health conditions, be they mental or physical. We must ensure that health literacy and targeted actions to tackle health inequalities take account of the systemic barriers in place for many people who wish to live a healthier lifestyle, particularly given the rising cost of living. I look forward to hearing from the Minister about how the Government’s upcoming White Paper on health inequalities will consider the issue.

We need to remember that self-care is for everyone at all stages of life. Educating children through programmes in school is an important part of that. As I said earlier, the confidence to manage our own health with appropriate support is as important for someone in a care home as it is for a parent looking after a new baby or for children growing up, particularly those growing up with long-term conditions.

Empowering and enabling us all to take charge of our health, be that through using digital interventions, improving health literacy or providing greater support for self-care, is important not only for the long-term sustainability of the health and care service, but for patients. We must ensure that the system does not inadvertently disempower people or result in gaps in the care pathway. I very much look forward to hearing the Minister’s thoughts on this.

[Sir Charles Walker (in the Chair)]

Minister, you have been seeing rather a lot of the right hon. Member for Maidenhead (Mrs May) recently, so no doubt you are looking forward to your next meeting with her.

Health and Care Bill

Karin Smyth Excerpts

Consideration of Lords amendments
Monday 25th April 2022 Commons Chamber

[Madam Deputy Speaker (Dame Rosie Winterton)]

The problem we have is that this debate has to finish at 7.55 pm. This means that, after the shadow Minister has spoken, I will have to impose a time limit to get in a lot of Back Benchers. The time limit will start at four minutes.

I call the shadow Minister, Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

Thank you, Madam Deputy Speaker. This Bill has been significantly improved. It delivers changes to the 2012 legalisation the NHS called for. Some other issues have been addressed by ministerial assurances and many valuable new clauses have been added. I am pleased that much of what we argued for in the six weeks of the Bill Committee has finally been accepted. On two issues—the Secretary of State’s powers on reconfiguration, and procurement and modern slavery—the Lords have wrestled important concessions that we support. As a former senior NHS manager, I know that reconfiguration is necessary, important and often difficult; it is often wrongly associated purely with cuts and taking something away. We are interested in improving outcomes for people, and that sometimes requires difficult change. For two decades, a comprehensive process has existed, which includes local people, is informed by expert assessments and operates pretty well. Throughout Committee, and during numerous debates, I have heard no sound argument to change it, but the Government seemed hellbent on doing so, and it is only at the eleventh hour that they have finally agreed to some changes.

If I listened to the Minister correctly, he says that now the NHS will have to notify the Secretary of State when there is something notifiable. That is going to be as clear as mud for everybody, isn’t it? We look forward to the regulations. The point is that the Government’s initial plan inhibits improvement. If NHS managers and, in particular, clinical leaders know that the Secretary of State is hovering, they will be less likely to promote changes that may be clinically necessary but politically difficult. It appears now that the Secretary of State finally agrees and does not want this big pile on his desk, and although the amendment is far from perfect, it does enough for now. On the procurement issue, I commend the work of many people from across both these Houses and the excellent case that has been put forward. Labour has been pushing for measures such as these for many months, and I think the intentions of the Government appear to be aligned to a shared view of what is required.

However, there remain two substantial issues, workforce and the care cap, where I hope the Government, even at this late hour, will listen to reason. Many experts have spoken, and many ideas, alternatives and suggestions have been put forward, but we have had very little engagement from the Government. On these two matters, we speak for the stakeholders, experts and Members from all parties, who are united in opposing the Government’s proposals. Workforce planning is a huge issue in its own right, but it is also fundamental and cuts through everything we are talking about on health and social care. Chiefly, the problem is that unless we face up to the scale of the workforce challenge, the Government will not deliver the shorter waiting times that patients need. Until this Government break out of their straitjacket—unless somebody can make the Chancellor see reason—nothing is going to change for all our constituents. The Government should start today—otherwise patients will be left wondering why they are paying more and more in taxes but waiting longer for care.

Time precludes my repeating all the arguments. I could simply repeat what the Chair of the Select Committee said last time or I could offer the wise words of the previous chief executive of the NHS and more—who can add to the variety and strength of the evidence? The logic of this approach escapes me. Every MP knows that our family, friends and constituents are now in a cycle of long waits in pain and discomfort, with worry. All that is asked for in this Lords amendment is a proper report that sets out the system to address the likely staffing requirements—that is so obviously necessary. If this amendment falls, we, as legislators, have failed. If the Secretary of State will not show leadership, NHS England must step up and produce its own requirements and projections. Additionally, the Local Government Association could commission work across the country, in every local authority, on the needs for social care and public health staff. I suggest that every MP asks their own integrated care system and local authority what workforce requirements and projections they have, and how credible these plans are. Unless we do that, how can anyone have confidence in the delivery for the people we are elected to represent?

Finally, we come to the proposed changes to the care cap calculations. Those were snuck in at the last moment and were not subject to any scrutiny in our six weeks in the Bill Committee. They have not been discussed in any detail at all. The proposals are a less generous version of what was in the Care Act 2014 and this is a massive step backwards. Once again, I could read out a ring binder full of analysis and evidence provided by the legion of stakeholders, none of it complimentary. We hear the repeated claim, “This solves the problem of social care. It is fixed.” It simply is not. Let us leave aside the deeply insulting attitude that the care and support of people in need, who could live better more fulfilled lives, is a “problem” to solve; we should be celebrating the fact that people can live better, for many years longer, with multiple conditions, with decent support and care. We all know that to be true.

The proposals the Government have put forward do not deliver any more care; they just change who pays for it. Money will go to those with assets, and the less you have, the more they will take. The proposals will have no real impact for years, but we all know that people need help now. They will not improve the quality of care by anything like what is needed and will not stop those 15-minute visits. The proposals do nothing to assist working-age adults who have a disability. They do not stabilise the collapsing market for care home place provision. They do not shorten any wait for care or reduce any waiting list. They will have no impact on improving access to care for hundreds of thousands of people currently excluded. They do not address the issues around a care workforce with many vacancies and poor terms and conditions. They do nothing to address the catastrophe of the past decade of cuts to local government. This is not a solution to social care. This ill-thought-out idea should not have been pasted into the Bill. Some more informed Conservative Members have also recognised the unfair impact on the poorest, especially those in parts of the north; levelling up this certainly is not.

Health and Care Bill

Karin Smyth Excerpts

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

We believe that the approach I have set out is fair and is a significant improvement on the situation today, so we must insist that the House disagrees with Lords amendment 80 and the clause is reinserted.

[Karin Smyth (Bristol South) (Lab)]

I am reminded of some training I had a few years ago, when my trainer said, “Karin, people will often thank you for your brevity at this time of night,” so I shall not detain the House for too long.

As the Minister kindly alluded to, I spent some six weeks in the Bill Committee trying but failing to alter the original Bill from the Back Benches. I therefore praise the work done by my colleagues and others in the House of Lords. The list of improvements that have already been made is impressive. Unlike in Committee, when the Minister batted away every single proposal for change, the Government have adopted some changes and there has been some progress.

We support Lords amendment 90, on palliative care, which is a really difficult and complex subject that involves distressing issues for the people affected. The Government should further consider that amendment.

On unpaid carers, we support the finely crafted solution in Lords amendment 51 to protect carers. The intent behind the amendment is to prevent any further problems with discharge to assess. We need to enhance people’s rights as carers, not take them away. I know from personal experience that the removal of an assessment prior to discharge may result in less priority being given to the assessment once someone has left hospital. Families clearly worry that patients may be “out of sight, out of mind” once they have left hospital. It would be helpful if the Minister clarified the Government’s commitment to ensuring that carers are consulted as part of the discharge process. It is vital that steps go much further than simply “involving” the carer; we need to ensure that the carer is both willing and able to provide care for the patient and that the necessary community services are in place. Community services and primary care are currently badly stretched.

In Committee, I raised many issues relating to the membership of integrated care boards, particularly in respect of their lack of accountability to local people. None of my proposals made it into the Bill, so I was delighted to see that one proposal made it through the House of Lords. We are happy to support the approach agreed in Lords amendment 105, to give some positive recognition to parity of esteem for mental health. The broader issue of who else gets to be on an integrated care board will rumble on for years, but this is a good first step, and we expect it to happen. It is vital that there is a mental health voice on our integrated care boards, but as well as the Minister confirming that he expects that to happen, it would be really helpful if he could clarify what recourse or consequence would be available should that mental health representative somehow be blocked at a local level from serving on the ICB.

Let me turn to the broader issues. As I said in Committee, this is fundamentally another NHS reorganisation Bill. It is a restructuring of the NHS and a centralisation of power within the NHS. It does not nothing to achieve integration and nothing to improve accountability to the public, to patients and to communities. With the publication of the Ockenden report and the deeply worrying staff survey and patient satisfaction surveys, it is not a good day for the health service. It is clear that centralising control in the NHS is very much the wrong approach. Local representatives need much more power over local services, and accountability needs to be much better at a local level.

The Bill also does nothing to improve the appalling state of social care provision. No wait for care will be shortened because of this Bill and nobody excluded from care will now receive it, but we do now have a Bill that lays to rest the worst of the Health and Social Care Act 2012, the Lansley Act. Those of us who were on the other side of that Act and its implementation—in fact, it was that Act that brought me to this place, so appalling was it—and who fought and campaigned against it really should be having a bit of a party to celebrate the disappearance of some of the worst excesses of that Act.

With the changes to procurement and the many assurances given from the Government Dispatch Box, the main threats detected in the original Bill have largely been allayed. Compulsory tendering has gone; we have preferred provider in all but name. Procurement from the private sector must now be on a proper, open and transparent basis, which means no more crony contracts or jobs for friends and family, and Virgin Care and other large corporates no longer influencing commissioning.

With Lords amendment 11 excluding private interests from commissioning, we see a dramatic shift that is most welcome. We may start to get back to a public service model. That could start a journey to build an NHS where adequate investment and support means that patients do not have to start relying on the private sector.

The most serious issue in this bunch of Lords amendments has been ducked. The dead hand of the Treasury has clamped down and common sense has departed. Shoehorning the change in the calculation of contributions to the care cap into the Report stage of this Bill was parliamentary sharp practice of the highest order, designed to minimise scrutiny and stifle criticism. Our position is encapsulated by Lords amendment 80. This provision should never have been in the Bill. It is hugely significant to our constituents, and it has never been properly considered and cannot be today. I listened very carefully to the Minister outlining various scenarios. I, too, could outline various scenarios from the Dispatch Box, but I will not do so today. This is not the place to do that; there needs to be proper consideration and proper scrutiny. The Department has sneaked out the view that restricting contributions to the cap for those being means-tested for their care charges would save an estimated £900 million by 2027-28 in cash terms. Surely that means that there is time to look at this properly, and we are willing to work with the Government to do just that.

Let us be clear: if that is the true estimate, then that is what the Treasury is talking about saving from the poorest—from working-age adults with a disability and older people with few assets. That is where that money comes from. That is not fixing social care; that is asking people with less to pay more to protect the assets of the wealthiest—the less a person has, the more the Treasury will take.

Members of Parliament from across the north-east of England, Yorkshire and the Humber and the midlands really need to take note, because, from what we can gather at the moment—we do not know enough about this to be totally clear about how it impacts people—it looks like those areas will be worst hit by the Government proposals. Why are those MPs not here? Why are they not outraged by this? I suspect that it is largely because they do not know, and the Government do not want them to know. It is so hard to follow the detail of this.

It has been almost 3,000 days since the Care Act 2014—a carefully crafted piece of legislation, agreed across party lines and after a huge engagement with stakeholders— was granted Royal Assent. If the calculation towards the cap is to be changed, that change must come the same way, through cross-party working with the sector, patients and people involved, understanding the evidence on impact and considering the consequences—not through this half-arsed addition to an NHS reorganisation, which is essentially what the Government are doing.

If the Government are determined to leap into action, they should accept amendment 81 and get on with implementing the Care Act and the Dilnot proposals as originally agreed. I followed the implementation of the Act very carefully when I came to this place in 2015, and I think I have heard from the Government Dispatch Box today for the first time that it was never agreed, that it was undeliverable and not financeable. That is not what the people producing the Care Act or the Conservative Government of the time led us to believe. They moved the implementation to April 2020, expecting there to be a general election in that year, and never really came back to explain the rationale.

We will not get mired in details tonight because, as I said earlier, this is not really the place for it, but our constituents are being led up the garden path by this Government. This place should be considering the proposals properly. That is what the Lords have asked us to do, and the Opposition will support them in doing that. This question is too important to be left to a last-minute addition.

[Dame Caroline Dinenage]

I will speak briefly in favour of Government amendment (a) in lieu of Lords amendment 51. I draw hon. Members’ attention to my entry in the Register of Members’ Financial Interests and the fact that I am co-chair of the all-party parliamentary group on carers. My predominant interest is that this is a cause that I care very deeply for.

Ultimately, the aim of Lords amendment 51 is to focus on carers and the safe discharge of hospital patients. The Government’s amendment (a) in lieu will achieve most of what the noble Baroness Pitkeathley originally attempted to achieve in her amendment, ensuring that carers are involved at the point of hospital discharge.

Across the UK today there are about 6.5 million carers supporting a loved one who may be older, disabled or seriously ill. That is one in every eight adults providing unpaid care for their family or friends, whether around the clock or for a few hours a week. It is an enormous contribution and saves the health and social care system billions of pounds a year. It has an untold impact on carers’ own lives and livelihoods, but for the people they care for, it is literally a lifeline.

The amendment in lieu recognises the vital role that carers play and avoids any suggestion of their losing their rights, which could have been an unintended consequence with the wrong wording. It is important that carers are recognised in this legislation; it is clear that the Government have listened and reflected the strength of feeling about that, and I am grateful. We must do more to equip carers to care safely and well, and to juggle other aspects of their lives. That is why the requirement to consult carers prior to patient discharge is so important. The Lords amendment had cross-party support in the House of Lords, and I hope the amendment in lieu will achieve the same thing in the Commons.

According to Carers UK, there are still some worrying statistics on discharge: 56% of carers were not involved in decisions about discharge from hospital and what care and treatment the person they cared for needed, 82% of carers did not receive a carer’s assessment and 68% of carers were not asked about their willingness and ability to care at discharge. I am sure the House will agree that those are deeply distressing statistics, and that we have a lot of work to do to address them.

There are a few important points of clarification and assurances that I would like from the Minister. He mentioned earlier that young carers were covered, but the language is a little opaque, so can he confirm for me that he is talking about not only young carers who are looking after adults, but young carers who might be caring for brothers or sisters? Some young people perform that incredibly difficult task at enormous disadvantage to themselves, and I want reassurance from the Minister that this House and this Government have not forgotten them.

The second point of clarification is that the original amendment 51 included a test on whether a carer was willing and able to care, as in the Care Act 2014, and I want to ensure that this amendment in lieu will secure that. There are also important clarifications to be made around what “feasible” means; I hope the Minister can help me with that, so that carers are absolutely sure what he means by their rights.

Unpaid carers are so often invisible, their efforts unacknowledged, and I am pleased to see the Government taking steps to address that through their amendment in lieu. It is a start. There is much further to go to give unpaid carers the support and recognition they need—that is a discussion for another day, but it is a discussion I intend to have.

Covid-19: Impact on Social Work

Karin Smyth Excerpts

Wednesday 23rd March 2022 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Robertson. I thank my hon. Friend the Member for Lancaster and Fleetwood (Cat Smith) for bringing the debate before the House, and for the work she does with the hon. Member for Ruislip, Northwood and Pinner (David Simmonds) on the all-party parliamentary group for social work. The debate has been less well attended than some, but it has been high in quality. As parents, none of us really knows what our offspring think of us or what they will say in future, but it was good to hear my hon. Friend talk about her father, Alan Smith—the work he has done in social work, and what she heard from her friend—and for her to bring that experience here today and have it drive her work. I am sure he must be very proud, and we are grateful that she is doing it. Perhaps Parliament sometimes seems aloof to workers in the social work sector, but we all have our own personal stories and we bring them to this place to inform the debate.

Since becoming an MP, I have realised that my inbox is a fairly good indicator of what is happening in my constituency. In Bristol South, the high impact of violence against women in the home has driven my casework in the six years for which I have been a Member of Parliament, but children’s mental health and family crisis have become an increasingly substantial part of my inbox. Often, those cases have children at their core—those are the most heartbreaking, and are very difficult for our staff to deal with. As the hon. Member for Strangford (Jim Shannon) said, we are not the frontline of those cases; often by the time parents, family members or friends have come to us, things have gone very wrong, and what we see in our inboxes is the tip of that iceberg. Social workers are at the forefront of the response, and what we have heard today and from the representative bodies in their briefing is really alarming.

I will focus my comments on two key issues: the workforce and more complex work. Every debate I have been involved in since taking on my role as shadow Front Bench spokesperson for health and social care has been dominated by one issue, which is the lack of people available to do the jobs we so desperately need. I say gently to the Minister that next week the Health and Social Care Bill will be back in this place after some excellent debates in the Lords, particularly on workforce, following the work done by the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt). It would be good if the Government could come back with some support for a workforce plan that is credible, is funded, and will give hope to all the people who are keeping our society functioning at that level. We know there are some battles to be had with the Treasury, but everyone in this room is right behind the Secretary of State and his Ministers in that battle.

As we have heard, vacancy rates are up to 9.5%, which starts to mirror the workforce crisis across many areas in the health and care sector. Some 5,000 children and family social workers have left a social worker post in England, which is a massive increase over five years. The vacancy rate is at a five-year high with about 6,500 vacancies and that is part of the wider trend, with the pandemic exacerbating the issue. It is important to note that the situation was not caused by the pandemic, but has been exacerbated by it. The wider trend, from high-pressured jobs to the undermining of support services such as Sure Start, has left social workers to pick up the pieces.

As we have heard, burnout is a worrying problem. A survey by the Social Workers’ Benevolent Trust found that throughout the pandemic 75% of social workers were emotionally and mentally exhausted. That is true across much of the workforce, but we are now asking these people to pick up the pieces and go forward. Some good news from the Government on that would be welcome.

We know that the pandemic has increased the complexity of cases that social workers are dealing with, because of what is happening in the rest of society. Again, the situation has been exacerbated by the pandemic. I pay tribute to social workers in my constituency of Bristol South and across Bristol for the work they have done throughout the pandemic. In a survey of the sector, 67% of respondents who worked in children’s services agreed or strongly agreed that they had seen an increase in referrals or their caseload since the return to schools and colleges in autumn 2020. Members of Parliament know from discussions with headteachers in our constituencies that where children, young people and families are presenting in schools, the vacancy rates and the lack of ability to pick up those cases are causing massive problems throughout the sector.

My hon. Friend the Member for Lancaster and Fleetwood talked about care homes and the experience of disabled adults throughout the pandemic, which is shocking. The Care Quality Commission’s report about death rates in care homes should alarm us all. I know the Minister is very open to meeting with representatives of the sector and I am sure she will look favourably on my hon. Friend’s request for a meeting. It would be valuable to bring that issue directly to the Government and, I hope, get a more positive response.

The hon. Member for Ruislip, Northwood and Pinner made an excellent point about foster care support, and I know he has a lot of experience in the sector. Where families become most vulnerable, we need that support for the people who are coming forward. People lead different lives from those they led even 10 or 20 years ago, and Bristol City Council has led a lot of good work in encouraging people to come forward for foster care. People should know there is support available for them from the social work sector and that will help those children who we want to see succeed and thrive.

I shall keep my comments short because we want to hear from the Minister. We want to know that the sector has the Government’s support as they take us out of this pandemic, and that hopefully people can start to thrive. It would be helpful if the Minister could outline how the Government will work with local authorities to address the rising vacancy rates in the social work sector. The hon. Member for Ruislip, Northwood and Pinner made some interesting comments about the different ways in which local authorities often lead innovation and how they are prepared to learn and recognise that sometimes innovation does not work out. That is part of the learning cycle, which we need to support and encourage. I would welcome the Minister’s comments on that.

Has the Minister assessed the impact of the rising cost of living on social workers? This afternoon, we have the spring statement and it would be good if there were some positive news for people who are living on medium wages and experiencing the cost of living crisis, as well as for the families they support, who are feeling the impact of inflation and fuel costs. That is particularly the case for people who are in their homes and people with disabilities, who are feeling the pinch from the increasing fuel and heating costs. They could do with some good news, too.

I gently take the Minister back to the decision to cut universal credit, which pushed more families into poverty. We have started to have a discussion on that serious issue, which affects all countries of the United Kingdom, causing unnecessary hardship for families who are already dealing with complex social issues and escalating the cost of living crisis. As my hon. Friend the Member for Lancaster and Fleetwood said, we could lessen the load if people were not being plunged into greater poverty.

It would be good to hear from the Minister about rewarding the social workers on the front line, who, as we have heard, are a key part of the infrastructure. Thankfully, most people do not encounter them, but for those who do, they are absolutely key to the sort of country that we want to be, and we thank them for their work.

Irish Diaspora in Britain

Karin Smyth Excerpts

Thursday 17th March 2022 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

I rise proudly to speak as the vice-chair of both the British-Irish Parliamentary Assembly and the all-party group on Ireland and the Irish in Britain. I thank my hon. Friend the Member for Rochdale (Tony Lloyd) for securing this debate.

In 2018, I spoke in one of the Brexit debates on the eve of St Patrick’s Day. I said then that, although we did not know where St Patrick was from, we knew that he was probably not Irish, but he did wander and roam across much of these islands. I also talked then about the Bristol merchants who, under Henry II, went to Dublin in 1171 to defend Dublin castle and were rewarded with the establishment of trading posts between Bristol and Dublin. The point is that the movement of people, trading to deliver economic prosperity, is what has fashioned our political relationships across these islands for centuries, and today is no different. In so many other respects, though, today is so very different and thank goodness for that.

My own parents were part of the post-war ’50s exodus of young people from rural Ireland to London. Their older siblings had to come, but my parents came for the craic, because, frankly, it was a lot more fun here than it was in rural Mayo or Cavan. We all know that they faced some challenges, but what fantastic opportunities England gave to them and has given to us, no more so than, in one generation, my being elected here as an English MP, of which the entire family is enormously proud.

Here in Britain, that post-war community established support networks. Since the 1970s, as we have heard from my hon. Friend the Member for Rochdale, the work of Irish in Britain, as an umbrella organisation, has supported individuals and groups throughout the country. Colleagues can check on its website, but, on average, there are at least 1,000 Irish people in each of our constituencies. The charity supports culture, heritage and health. I and the hon. Member for Lewes (Maria Caulfield), who is in her place, proudly supported the Green Hearts campaign a couple of years ago.

The post-war exodus was facilitated by the common travel area—loosely defined, securing centuries-old exports of Ireland’s youth to the powering of Britain’s economy between the then separated countries in 1922. Covid has highlighted for most of us many, many difficulties, but, for me, effectively losing the common travel area was particularly difficult. Trying to visit my older family members, some in care homes, across the border in Cavan and in Northern Ireland with different rules, added needless bureaucracy, cost and stress to thousands of families. We were an afterthought for the Government in Dublin, and it took them a long time to listen to the pressure from us here and through the embassy here in London as they tried to balance their responsibilities to their greatest and oldest neighbour with their responsibilities within the European Union. This will continue to be difficult—we understand that. As we heard last week, Ministers mistakenly suggested that Ireland and the common travel area is an unchecked backdoor to Britain; it is not. None the less, we say to both Governments that, as the diaspora, we will continue to roam freely across these islands, and both Governments need to learn from our experience the social, political and economic benefits of the CTA.

Ireland has changed beyond recognition with membership of the European Union. I want to highlight briefly one area of particular importance that is joyful for me, which is women’s rights. Women were at the heart of Irish politics and culture throughout the battles for home rule and independence, but the consolidation of the Irish state, with the dominance of the Church, meant that very quickly women were relegated to the private sphere. Indeed, although much divides Unionists and nationalists, as the dust started to settle, there was one thing on which they could all agree and that was keeping women in the home. That is where I learned my formative politics: watching and listening to Irish women; learning that what was said in public was not the same as what was said in private.

My nan, sat by her peat fire in Mayo—I can still smell it—and the women would call round. She sat there talking. My Mum carried on this tradition in London, with women coming round for a chat. After a long night of talk on every conceivable subject, my mum passed on to me what she had heard at home, saying, “up the chimney with that now”. Up the chimneys and around the tables of thousands of Irish homes, women talked differently than they did in the public sphere from which they were effectively barred. It ill behoves any politician who does not know what goes up the chimney.

Once in the EU, Ireland, like the UK, had to accept the social change along with economic support: equal pay, maternity rights, non-discrimination on marital status, and finally those votes on divorce and abortion. What I learned from the private conversations around the chimney I also learned from women here in the British Labour party: individuals in private do not change the world. Women have to occupy the public space. Women have to have political power to secure our rights to equality with men and to change the laws that dictate the private sphere, and all legislators across these islands have a long way to go. It has been a privilege to be part of the solidarity among the women of these islands—north, south, east and west—and we still have much work to do.

Today, I have my slightly wilting shamrock and my British-Irish parliamentary brooch. As a child, I was sent to school with the shamrock, but I did not often wear it on St Patrick’s Day through the ’80s. That was due in part to my moving away from my childhood, seeking an identity of my own, and in part due to the fact that being Irish here in the late ’70s and ’80 was hard. We were expected to have a view and to take a side in the constant struggles, but we did not often have a side. I knew that there were many sides, and I knew that I had a stake in them all. The 1980s changed the narrative of having sides. That decade allowed us to have many sides, and we all wanted the same thing: to live in peace and prosperity.

The 1998 Good Friday agreement was not just about Northern Ireland, Ireland, or a border; it was about the freedom of movement of people across these islands, about our deep roots, about mutual interest and respect, and about shared security and prosperity. Our duty now is to build upon it in full.

Finally, one of my predecessors as a Bristol MP is Edmund Burke. I think he was Bristol’s last Irish MP, whose statue still stands proudly in the centre of our city—a city he apparently visited only twice. He lasted six years, which is a milestone that I have only recently passed. During that time, he had a somewhat acrimonious time with the Bristol Merchant Venturers whose patronage was needed in those days in order to be able to hold office. Burke, as is befitting the father of modern conservatism, recognised that restrictions on people—as with the anti-Catholic legislation at the time—and restrictions on trade from Ireland meant an ever-impoverished Ireland, and that, he felt, was economically unwise for England. His riposte to the anti-Irish protectionism of the Bristol merchants should be heeded by us all today:

“England and Ireland may flourish together. The world is large enough for us both. Let it be our care not to make ourselves too little for it.”

Breastfeeding: Government Support

Karin Smyth Excerpts

Tuesday 8th March 2022 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

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

I thank the hon. Member for Glasgow Central (Alison Thewliss) for securing this important debate, which warrants more time and discussion. I agree that, as we participate in this debate, we are thinking about those women in Ukraine who are either giving birth or are about to give birth in the most extraordinary of circumstances and about the difficulty they face in feeding their children. For those of us who have given birth in normal circumstances, that is a truly horrific thought.

We know that the first few months of a child’s life are crucial for their later development and that parents need support in their choices for their children. I welcome the Minister’s commitment to additional funding for breastfeeding support, but it is clear that the cuts, particularly to Sure Start, were a really bad false economy, with centres having closed, parents lacking support and advice, and children being let down. I was proud to be a governor of a Sure Start early years centre and I know how valuable such centres were.

We have heard that women’s isolation during the pandemic was exacerbated because more services were cut. It was horrific to hear the evidence given by my hon. Friend the Member for Putney (Fleur Anderson) that it was only when she rang up that she found out that the centre she mentioned had closed. We already know that there is a shortage of such venues and that we need more of them.

Disadvantaged mothers are more likely to have babies of low birth weight, and low birth weight is associated with raised blood pressure and coronary heart disease, as well as reduced educational attainment, qualifications and employment. Sure Start centres help to level up and supporting them would be a really easy, quick win for the Government to support women in optimal infant nutrition, particularly breastfeeding.

We know how much breastfeeding increases children’s chance of a better life. According to analysis from the millennium cohort study, by the age of five breastfed children were already one to six months ahead of those children who were never breastfed.

I was fortunate to have three healthy children. I fed them all myself, with variable results; it was difficult with some of them and not with others—I will not say who, because they might at some point watch this debate, and you can never have favourites. When breastfeeding works, it works well, and when it does not work, it is extraordinarily difficult and stressful.

We also know that those households in the lowest socioeconomic groups have significantly worse health outcomes. We know that women in those households need support and that such support yields results in later life. This is an important debate, particularly on International Women’s Day, and I hope that we can have some positive news from the Minister to support women across the country.

[Clive Efford (in the Chair)]

As the Minister knows, we will be suspending the sitting at 4.55 pm, but if she can make a start now perhaps I can give the mover of the motion longer for summing up at the end.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 1st March 2022 Commons Chamber

[Mr Speaker]

I call the shadow Minister, Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

The Government seem to think that there is some kind of magic staffing tree, but there is no increase in capacity, no elective recovery and no fixing of social care without an immediate and ambitious workforce plan. We have legislation in this place, and we have seen a tsunami of White Papers, but none of that includes a credible workforce plan. Given the estimated 93,000 NHS vacancies and more than 110,000 vacancies in social care, when will we have that plan?

[Sajid Javid]

The hon. Lady has just stood up and said that there is no increase in capacity. I am afraid she was probably not listening a few minutes ago when I said that in the last year the number of people working in the health service had increased by 44,000, and that we had 11,000 more nurses and nearly 5,000 more doctors. As for a plan, the hon. Lady may know that I have already asked the NHS to work on a long-term plan—a 15-year workforce plan. If she really wanted a new workforce plan, she should have thought about how we could fund it, and should not have voted against the increase in spending that the Government proposed.

Access to NHS Dentistry

Karin Smyth Excerpts

Thursday 10th February 2022 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Ali.

I am delighted to respond to this brilliant debate, in which we have had 23 speakers from all parties. Before I go further, however, I feel that I ought to thank my own dentist. Aidan has served me and my family well for more than 20 years. I will always follow him, wherever he sets up practice, and I have told him that he is not allowed to retire, ever.

I pay tribute to the hon. Member for Waveney (Peter Aldous) and my hon. Friend the Member for Bradford South (Judith Cummins) for their diligent work in this area and for securing the debate. It is clear that the current situation simply is not working. As we have heard, staff are leaving the profession in droves, patients are struggling to access the appointments they need, and staff have been left undervalued, under-resourced and under-appreciated for far too long. This Government are putting the future of NHS dentistry at risk, and we have heard about some of that today in the choices confronting the sector.

I am sure that the Minister will tell us about a plan, I am pretty sure that she will tell us that she has heard the concerns that have been expressed today, and I am very sure that she will blame the last Labour Government. However, I think we need to ask, “Where is the action?” We welcome the additional funding for the NHS—the £50 million injection—but it ignores the wider structural issues affecting dentistry. It will fund less than 1% of the 40 million appointments we have lost since the start of the pandemic; it is a mere drop in the ocean. The impact of those lost appointments is clear. “The Great British Oral Health Report”, published in August, showed that a third of the population is estimated to be suffering from undiagnosed tooth decay. That is particularly problematic among children, as we have heard, with a child being admitted to hospital for tooth extraction every 10 minutes in the UK. That is a shocking statistic.

We know that some of our most vulnerable communities rely on NHS dentistry, and increasing barriers to access only fuel inequality. My hon. Friend the Member for York Central (Rachael Maskell) spoke particularly cogently about that inequality. Before the pandemic, tooth decay among children in the most deprived communities was 3.8 times higher than among those in the least deprived communities. That severely affects my constituency of Bristol South.

Again, as many have said, we need a proper long-term strategy to address the workforce crisis affecting the whole of our NHS, as well as reform of the broken contract system. The Minister has said on many occasions how broken that contract system is. It has been in place since 2006. As we know, it was negotiated by the Labour Government. We know times have changed, but we also know the Government have been trying to change the contract since 2011, which may give some indication of how difficult it is. I have some sympathy with that, but a decade should be enough time to get on with sorting the problem.

Even as recently as Monday’s Adjournment debate, we have heard Ministers say, “We’ve started work on that reform.” We are all desperate to hear how it is progressing and, to be honest, for the Government to get a bit of a move on with it. It was a commitment in the Conservative manifesto of 2010—12 years ago. It would behove the Minister, after the number of debates that we have had, to come forward and say when we can expect to see the fruits of that decade of discussion. It is a problem that urgently needs tackling, not kicking further into the long grass.

When the Minister talks about there being a shortage of dentists wanting to do NHS work, I wonder whether she really understands why that is the case. Surveys by the British Dental Association have shown that 80% of owners of predominately NHS practices say that morale is low or very low. The hon. Member for Bath (Wera Hobhouse) talked about the mental health stresses of the workforce. Some 76% said that their job was extremely or very stressful, and 45% want to leave dentistry within the next 12 months. Of the 93% who struggled to recruit a dentist to work in their practice, more than half cited associates’ reluctance to work in the NHS as the main reason they struggled to fill the vacancy. With morale through the floor and recruitment near impossible for many practices, is it any wonder that NHS dentistry is in the state it is?

Of course, this is true across so much of our NHS and social care sector: workforce is the critical problem. Many hon. Members—notably the Chair of the Health and Social Care Committee, the right hon. Member for South West Surrey (Jeremy Hunt)—frequently urge the Government to bring forward a credible workforce strategy for all parts of the NHS. It is long, long overdue.

I will briefly share some testimonies from NHS dentists working on the frontline. One dentist in Shropshire said that the date of this debate

“exactly matches the last day that I will be providing NHS dentistry after 17 years of service.”

They said that the contract has not been fit for purpose for a long time and that covid has broken what was already a strained system. We thank them for their service and wish them well, but we are sad to lose them.

A dentist in east Devon who had lost two members of staff said:

“A large number of our patients are on benefits or have low incomes and with a huge increase in energy bills on the horizon this number is bound to increase. I have had 3 days off during the last 12 months…I’m tired, not sleeping, close to burning out.”

These are shocking testimonies from the frontline.

It is not just dentists who are seeing these problems; patients are feeling the impact of this situation harshly, as hon. Members across the House will know from their casework. In a recent Adjournment debate about Bristol and the south-west, I raised the issue of a pregnant constituent who was unable to access care at that critical time. This is the No. 1 issue raised by Healthwatch. Patients are struggling. As we know from YouGov and as we have heard today, 20% of patients are resorting to DIY dentistry. The security that NHS dentistry provides to so many people in this country is being eroded, and it will be eroded until that safety net is no longer there.

We have heard some severe challenges from Government Back Benchers about the Government’s long-term view on the survival of NHS dentistry. With the cost of living crisis squeezing households across the country, people will be faced with choosing between their health, heating their homes or putting food on the table. As my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) said, people are being priced out.

The hon. Member for North East Bedfordshire (Richard Fuller) was very kind about some of my expertise in the field. We have worked together collegiately in other areas—on trailer safety, notably. Generally, I think devolved budgets and personal budgets are a good thing, and I have always advocated empowering patients, but, sadly, their use has been reduced in social care and they are not being utilised. I am not sure that they are the answer in this particular area, but something radical clearly needs to be done about the contracts.

I say gently to the Conservative party that that the Labour party does not think it acceptable that young children are in hospital or toothless while £4.6 billion-worth of loans float out of the Treasury, while the personal protective equipment contract is written down, or while whatever other ill management of the Budget we have seen from this Government happens. I personally look forward to a debate between the hon. Member for Thirsk and Malton (Kevin Hollinrake) and my hon. Friend the Member for Bootle (Peter Dowd) on the efficacy of the Government’s management of the economy. That would be a well-informed debate and I would certainly back it.

I say to the Minister that we have seen no evidence about dentistry being a priority for the Department of Health and Social Care. The new White Paper, which came out yesterday, talks about better integration across primary and community health, adult social care, public health and housing, but there is no mention of dentistry. Again, as a lot of people have said, making dentistry part of our general community service would be a good thing.

The debate has highlighted that the problem was urgent even before the pandemic. There is no data; it is clear that dentistry is an outlier of public and community health. That is a long-term problem. I am afraid that I do not think that the Government have taken it seriously in their recent White Papers. We would all support the Minister in that battle at the Department of Health and in bringing forward something to address referrals to the contract much more urgently.