Social Care

Karin Smyth Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

I do not disagree with much of what my hon. Friend says. Colleagues are talking about a crisis, but local authorities and the care sector have been put under a lot of pressure this year getting ready for winter, and they have stepped up to the plate. I pay tribute to everybody who works in that sector. They work incredibly hard and with real care. The work they do is not putting us in crisis but delivering great care outcomes for many people.

[Karin Smyth (Bristol South) (Lab)]

This is a shocking statement for thousands of families who live in this country with the misery of social care. The Minister referred to the previous Government, but the 2015 Conservative party manifesto was clear about what it was seeking to do, and about introducing a cap on care costs in 2016. A few weeks into office, the Government changed that, and moved the cap forward until 2020. I have written to the Minister about her exchanges in the House on 25 October with the right hon. Member for New Forest West (Sir Desmond Swayne), during which she inadvertently misled Parliament about the 2020 date and legislation—that was subsequently changed when I went to the Library. The key issue is that this issue is causing silent misery for thousands of people now. I am 53. Will my children be suffering the same level of misery about my care costs in the next 30 years? When will we see the actual date published?

[Jackie Doyle-Price]

I think we made it clear in the recent general election that we will be revisiting this issue. The hon. Lady wants certainty about how we fund the care system in future, and on what obligations individuals and their families will or will not have. It is therefore important to have that full public debate, and work together to bring forward proposals that will put our long-term care system on a sustainable footing. In the absence of that we will not achieve any resolution, and that is contributing to misery for people who do not currently have a limit on their overall care costs. That is what we are trying to address through this process. [Interruption.] I hear noise from Labour Members about needing cross-party consensus, then I look at the behaviour of those on the Front Bench—lacking.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Dunne]

There has been a continuing involvement of private provision of health services since the very origins of the NHS, when GP partnerships came in, as private businesses, to provide their services. Of course, competitive tendering was introduced to NHS contracts by the last Labour Government, and the rate of private provision under that Government grew faster than it has under this Government. According to the last figures, 7.7% of services were provided by the independent sector.

[Karin Smyth (Bristol South) (Lab)]

Where a foundation trust or other NHS provider sets up a wholly owned subsidiary within the public sector, would the Minister expect to see all those papers in the public domain?

[Mr Dunne]

As I said to the hon. Member for Keighley (John Grogan), the trust, which would consolidate subsidiaries in its accounts, would publish the accounts of subsidiaries as part of its consolidated accounts each year.

Social Care

Karin Smyth Excerpts

Wednesday 25th October 2017 Commons Chamber

[Jackie Doyle-Price]

I agree that we want to learn from examples in other countries. As I have said, the spirit of the consultation will be to allow a well-informed debate, as a result of which consensus can be established. In view of that, we will consider a wide variety of options, covering not just funding but lifestyle solutions and other issues.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

[Jackie Doyle-Price]

I must make some progress, because I have taken many interventions. I do apologise.

Adult social care funding is made up of Government grant, council tax and business rates. The better care fund, which was announced in 2013, has further helped to join up health and care services so that people can manage their own health and wellbeing and live independently in their communities for as long as possible. The 2015 spending review introduced an adult social care precept that enabled councils to raise council tax specifically to support social care services. By 2019-20, that could raise up to £1.8 billion extra for councils each year. As a further boost to social care, the Chancellor announced in the Budget earlier this year that local authorities in England will receive an additional £2 billion for social care over the next three years. This year, £1 billion has been provided to ensure that councils can fund more care packages immediately. The additional money means that local authorities in England will receive an estimated increase of £9.25 billion in the dedicated money available for social care over the next three years. Statistics produced today show that spending on adult social care increased in real terms last year by 1.5% thanks, in part, to the precept.

--- Later in debate ---

[Jackie Doyle-Price]

I am sorry, but that is not the case. The money will be retained by local government, but we will direct the spending to achieve the outcome the money is intended to deliver. That is exactly what we should do as a Government, and it is how we ensure value for money.

The health and care system has committed staff and managers up and down the country who are working every single day to deliver the best outcomes for people.

[Karin Smyth]

Will the Minister give way?

[Jackie Doyle-Price]

I have already taken too much time.

The measures I have set out have given our hard-working workforce and their leaders clarity about how the Government expect the NHS and local government to work together to achieve the joint ambition of reducing delayed transfers of care, which will be instrumental in delivering high-quality care.

To summarise, we accept that there are significant challenges in the health and care systems, which is why we are increasing funding in real terms over the lifetime of this Parliament, but this is not just about money. It is about sharing innovation and best practice; it is about integration and defining new models of care; it involves thinking about a long-term sustainable solution to the care system; and, most importantly of all, it is about supporting the 1.5 million people who work in the care system, as well as the millions of people who selflessly look after families and friends with little or no reward. We are committed to all of these.

Surgical Mesh Implants

Karin Smyth Excerpts

Wednesday 18th October 2017 Westminster Hall

[Emma Hardy]

Absolutely; that is a really important point. The BBC programme “Inside Out West” that aired just this Monday evening highlighted some of the problems with rectopexy, which is a form of rectal mesh, and the investigation a local trust is carrying out on the surgeon, Mr Dixon. I understand that one of the allegations it is looking into is that girls as young as 17 and 18 have had rectopexy.

[Karin Smyth (Bristol South) (Lab)]

On that point and the case that is being investigated in Bristol, I understand from my constituent that NHS England will set up 17 regional teams to look at this. Does my hon. Friend agree that that cannot be done on a local, ad hoc basis? There needs to be national co-ordination on this.

[Emma Hardy]

I absolutely agree with that. That hospital would neither confirm nor deny that those young girls had been operated on. For background information, all the colorectal surgeons who the programme spoke to said that the young women should have been offered other avenues before surgery. The programme also highlighted the extremely concerning practice of one surgeon attaching part of the rectal mesh to the soft tissue on the wall of the vagina. The shocking reason for subjecting women to this was explained by one consultant, who stated that if the rectopexy mesh is fitted in that way, the surgeon can charge for vaginal repairs as well as for fitting the mesh. Some of the patients being operated on were not aware of where the mesh was being attached, which raises serious questions about the warnings patients are given.

We must remember that it is not only women affected by this issue; men and women are suffering from chronic pain after having mesh surgery for hernias, using the same material—usually polypropylene plastic—used in vaginal mesh surgery. Research shows that between 10% and 15% of people who have had hernia mesh surgery suffer from chronic pain and complications after surgery. However, as with vaginal mesh surgery, not enough information is available to understand the extent of the risks of surgery.

Thankfully, there are organisations that help those affected to tell their stories. The Sling the Mesh campaign has done an incredible job in highlighting the problems, but there must be a wider effort from the Government to inform members of the public that this is an issue and to encourage them to speak out if they experience problems. Thousands of people have had the procedure over the past two decades without knowing what would happen if their body rejected the plastic mesh or if the mesh harmed their internal organs, leading to many people wanting the mesh removed. However, mesh removal is not a simple solution.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 10th October 2017 Commons Chamber

[Jackie Doyle-Price]

I thank my hon. Friend for his work in this area. I fully sympathise with anyone who has suffered complications as a result of these devices, but we do not currently have enough evidence to warrant our asking the MHRA to reclassify these procedures, and this is a view shared by other regulators across the world. I can advise him, however, that the National Institute for Health and Care Excellence strongly recommends that mesh implants not be routinely offered for the first surgical intervention on prolapse. That guidance is being updated—publication is due at the start of the new year—and will include an overarching document that looks in depth at the devices and the conditions surrounding the need for them, as well as the treatment of complications, to support better health outcomes.

[Karin Smyth (Bristol South) (Lab)]

A constituent came to my surgery to explain how this has impacted on her life. It is truly harrowing. I understand that NHS England has set up 17 regional teams to look into this. I want to be able to assure my constituent that the voice of women and how this is impacting them on will be considered. I would be grateful if the Minister could respond so that we might understand what the future holds.

[Jackie Doyle-Price]

I am absolutely aware that many women experience substantial side effects and complications following this procedure. Equally, however, many women also experience considerable relief from symptoms. We need a good review of the evidence to make sure that we adopt this procedure only when it fully suits women and that women understand the risks associated with the procedure. But I fully sympathise with the hon. Lady’s constituent.

Adult Social Care Funding

Karin Smyth Excerpts

Thursday 6th July 2017 Commons Chamber

[Steve Brine]

Indeed I can. We introduced the new, tougher system of CQC inspections, for the reasons I set out. We introduced a care certificate for support workers and healthcare assistants, and we introduced the new quality standards to clarify what excellence actually looks like in care. We brought in new criminal offences of ill treatment and wilful neglect, and we introduced a fit and proper person test to hold directors to account for care. Those are all things that have happened under this Secretary of State that never happened before.

[Karin Smyth (Bristol South) (Lab)]

The care sector is a significant employer in my Bristol South constituency, but people are being lost to other sectors. I listened carefully to the Minister’s response to the hon. Member for Totnes (Dr Wollaston), but I urge him to be much more ambitious in supporting the sector to recruit more people and build on career pathways between health and social care to encourage people who want to do those jobs.

[Steve Brine]

I thank the hon. Lady for her sensible question.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Dunne]

My hon. Friend is a doughty campaigner for ensuring that non-resident visitors to this country contribute for healthcare received here. We put in place a number of measures to enhance the appropriate charging structures and increased the funding received by the NHS from £89 million to £289 million in 2015-16. We expect similar action to result in a further increase.

[Karin Smyth (Bristol South) (Lab)]

NHS Property Services has just signed a £1 million lease on a central London location. May I suggest that other properties were available? Would the Secretary of State like me to inquire in my constituency, where NHS Property Services increased Knowle West Health Park’s rent threefold? Better value for the taxpayer is available.

[Mr Hunt]

I will be happy to look into the matter if the hon. Lady sends me the details.

Health and Social Care Budgets

Karin Smyth Excerpts

Tuesday 14th March 2017 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey, and also to serve on the Public Accounts Committee.

Whatever the right level of funding is, there must be agreement on what that is and, crucially, on what it can provide. In our Select Committee sittings over the past year, we have come to the conclusion that the promised programme cannot be delivered with the money available. Via the NHS mandate, which sets out each year what is expected, we know what the NHS is set to provide and what money is available. However, today is 14 March and we have not really had sight of what is mandated for next year.

The mandate is a requirement of the Health and Social Care Act 2012; it sets the direction for the NHS, helps to ensure accountability to Parliament and, crucially, sets objectives. We know from this year’s mandate that the indicative budget from April is £109,853,000 and the capital is £310 million, but it would be useful to hear from the Minister today when we can expect to see next year’s mandate.

The second crucial document in this debate is the NHS constitution, which we do not talk about enough. The constitution sets out the rights to which patients, the public and staff are entitled, including consultant-led care within 18 weeks of a referral from a GP and a specialist referral from a GP for urgent cases when it comes to suspected cancer. It sets out pledges and people’s responsibilities.

I agree that we need to involve the public much more in this debate. Waiting times will, I think, quickly start to increase. We have already seen today information from the King’s Fund on what is happening with hip operations. We will, invariably, go back to the days of the 1990s, with longer lists. Access to GPs and other professionals will continue to decrease and, largely, we will start to depend more on families and local care—not just for social care, but because of the consequences of not having well-accessed healthcare. Staff will become more demoralised and we know that morale is crucial for patient safety.

What I want to hear from the Government today, therefore, is how we are going to include the public in the trade-offs that are now necessary with the sustainability and transformation plans in local communities. How will that be done? Will Parliament start to debate the erosion of the NHS constitution and the rights that people have come to expect? Crucially, will the Minister say when—within the next two and a half weeks—we will see the mandate, so that we will know what funds are available and what they are set out to do?

Health and Social Care

Karin Smyth Excerpts

Monday 27th February 2017 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to be part of this debate among so many informed Members. Members may not realise that the debate is timely because the Public Accounts Committee, of which I am a member, published today our “Financial sustainability of the NHS” report, upon which I will base many of my comments. At the beginning of the report, we ask for an end to the years of arguing in public about the level of NHS funding and for the Department, NHS England and Downing Street to start working together in the interests of patients instead of bickering about funding levels.

I want to highlight two issues. One is about the work that has been done behind the scenes on the NHS accounts. You are a keen supporter of the work of Select Committees, Mr Speaker, but today’s debate was secured with the help of not only the Health Committee, the Public Accounts Committee and the Communities and Local Government Committee, but other contributors alongside Parliament. I thank the National Audit Office for the support that it has given to me and many other hon. Members to help us understand and interrogate this year’s accounts, including a meeting in a very quiet Portcullis House in the middle of August—perhaps when other hon. Members were on a beach somewhere. Helping Members to understand the accounts and what they mean for our constituents is an important and oft-neglected part of what the public hear about Parliament.

The NAO’s report on the accounts was unprecedented, and it is worth looking at what the Comptroller and Auditor General said about them. Several one-off actions were taken this year to bring the Department within its expenditure limit, some of which were worrying and some of which were just incredibly fortunate. Given the rigour involved in the accounts, the Department’s inability to find the extra £417 million that had been incorrectly given from the national insurance fund was quite extraordinary. There were the £100 million super-dividend from the Medicines and Healthcare Products Regulatory Agency and many central readjustments, and the capital-to-revenue transfers have been discussed. I also draw attention to the guidance that NHS providers were given by Monitor and the NHS Trust Development Authority—I use the word “guidance” carefully. That and the transaction reviews commissioned by the Department, whereby two accountancy firms undertook a review of accountancy policies and how they were adopted, happened so that provider results came out much more favourably than they perhaps would otherwise have done. Again, that demonstrates the incredible lengths that the Department and all its bodies went to this year to bring the accounts barely within the expenditure limit voted for by the House.

From whistleblowing accounts, reports from health and care conferences, the board papers that some of us read, discussions with chief executives, and reports in the specialist media, it is clear that the pressure on individuals within the service is immense, which is not good for anybody. I praise staff in all parts of the health service and the Department’s work, including clinical staff and managerial staff, of which I was proud be a part for many years, but the pressure, particularly on finance directors, to produce the right result and the right answer is deeply worrying due to the effect on safety. Only a few weeks ago we had the intervention of Sir Robert Francis, who, based on his previous work, raised concerns about clinical safety in our health service.

The international comparisons on funding have been mentioned, and they are very clear. We are probably spending the money to be like Mexico, not France or Germany. My constituents expect to be treated in the same way as their European opposites. Whatever the right level of funding is, there must be agreement on that level and, crucially, on what it can provide. Over the past year, the Public Accounts Committee has held 11 or 12 sessions on what the service has promised to deliver for the money available, which takes me to my second point.

We are now in the realm of political choices, which is our responsibility as MPs. The taxpayer, the voter and the patient are not different people; they are one and the same, and they are wise. They understand that we get what we pay for, but they have to be informed. Currently, the scrappy, ill-informed public debate and the unedifying blame game are not informing them but letting them down.

It is clear to me and to many hon. Members that the Government are not inclined to fund the service to the standards that we have become used to, that we expect, that the NHS constitution gives us the right to expect and that our European neighbours have, so the Government need to be honest about the trade-offs and choices. The STP process allows that to happen. I have listened carefully to the debate, and particularly to Conservative Members. They cheer when the Prime Minister and the Secretary of State for Health say that they have increased the money given to the NHS or that the NHS was given what it asked for, but they then make passionate pleas for their own community hospital or for the various services in their area, as is their wont.

The STPs bring into sharp focus the trade-off between finance and quality, and I define quality in terms of patient experience, clinical effectiveness and efficiency. The STPs have given us a clear trade-off between the money and the mandate, and I hope the refresh of NHS funding that we expect from the “Five Year Forward View” in March, as discussed in the Public Accounts Committee, will be clear and that the public will be able to have that information at their fingertips.

Currently, patients do not have the information, and they should. They should know where the best-run and the worst-run hospitals are. I agree with the hon. Member for Lewes (Maria Caulfield) that it is unacceptable that hospitals a few miles apart with virtually the same population are operating completely differently. Patients need to know where the outcomes are best. It is not good enough to hold that information nationally and hide it from patients, or to leave it to well-informed people to interrogate board papers, and so on, to find out the answers.

The way forward is clear: waiting times will continue to increase; we will go back to the long waiting lists of the 1990s; access to GPs and other professionals will continue to decrease; the service will become largely an emergency one; the family, where there is one, will increasingly bear the cost and responsibility of social care; and access will continue to be restricted. The Government now have to be honest not just about the costs but about access. They have to be honest that there is no more money, if there is not going to be any, and they have to be honest about what that means for expectations, particularly with regard to the NHS constitution.

I look forward to the Minister’s response.

--- Later in debate ---

[David Mowat]

The 0.7% budget for overseas aid is not being discussed here today and it is not my ministerial or my Department’s responsibility. I am proud that we are one of the few countries in the world that meets that commitment, and many of the other countries among our EU partners that have been mentioned do not make that commitment. However, I shall not be diverted any further down that road today.

We have of course had a difficult winter in the NHS. We know that A&E targets are on about 86% rather than the 95% we expect; and ambulance targets are at 60% rather than the 75% we expect. As we have heard, delayed transfers of care—not “bed blocking”—have probably doubled over the past three years. In response, I make one point that I am always keen to raise in these discussions: we do not talk enough about cancer. There are cancer metrics, and we should be proud of the fact that NHS England, is meeting seven of our eight cancer metrics. The trend is towards meeting them more easily than in the past. We have heard quite a lot this evening about how well they are doing in Scotland. In fairness, to redress the balance that we have heard about in respect of A&E, I make the point that Scotland is doing somewhat worse than we are on those cancer metrics.

[Karin Smyth]

I regret to say that it has been a disappointing response thus far. We have had a very informed debate, so we do not need to have the figures regurgitated to us as if we have not. Will the Minister address my comment that the money is what it is, but is it sufficient to deal with the programme of care and support in the NHS that has been promised? That has been the subject of the Public Accounts Committee’s report for every single month since last January. Is the money enough to do what has been promised?

[David Mowat]

The money is what we were asked to provide by NHS England’s senior management, and we provided it. At that time, the chief executive said that the Government had listened and acted. That is what we did, and that money is now available. That is not the same as saying that we do not accept that the system is under pressure in certain ways. Again, though, we talk about the money that is being spent in France and Germany. In Munich, 15 of the city’s 19 hospitals stopped taking people in over this winter. Right across the world—this is the point—there are challenges in national health systems, and we need to work to ensure that money is spent as effectively as possible. We know that £120 billion will be in our health system in 2020. What this Government have to do and what this ministerial team is doing is ensure that every penny is spent as effectively as possible.

We have talked about the five year forward view, and I accept that we are two years into it, but we know that the health system must tilt back towards community health, and the STPs are part of making that happen. We know that we need to get better than we are so far in terms of mental health and parity of esteem.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 7th February 2017 Commons Chamber

[Nicola Blackwood]

My hon. Friend has raised this difficult case with me before, and my sympathies go to his constituent. He is right that the High Court has judged that the current provisions for parental orders are discriminatory. The Government are obliged to act within a reasonable timescale, so we will be introducing a remedial order this spring. I am pressing for that to happen by May, but I am in the hands of the business managers. I shall keep the House and my hon. Friend updated.

[Karin Smyth (Bristol South) (Lab)]

6. What plans he has to ensure that the implementation of recommendations in Sir Robert Naylor’s review on the NHS estate is compatible with local sustainability and transformation plans.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Sir Robert Naylor’s report on the NHS estate will be published shortly. In developing his recommendations, he has worked and engaged with leaders from across the NHS. This will ensure that his recommendations are informed by sustainability and transformation plans, and are designed to help to support their successful delivery.

[Karin Smyth]

I look forward to seeing the report, which has been due “shortly” for a while. Knowle West health park in my constituency is exactly the sort of community-based model that we should be promoting in STPs. It was established by the NHS and the council to prevent illness, to promote good health and to assist recovery after medical treatment. However, the NHS Property Services regime means that its bill has increased more than threefold—from £26,000 to £93,000. What assurances can the Government give that the Naylor report will ensure that there is co-operation on estates planning so that my constituents, who rely on the health park’s contribution to preventing ill health, can face the future with confidence?

[Mr Dunne]

We have already accepted one of Sir Robert Naylor’s recommendations ahead of the publication of his report, which is to look into bringing together NHS Property Services and other estates services in the NHS. With regard to allocations to the clinical commissioning group, the Department of Health has provided £127 million to CCGs precisely to contribute towards increases in the move towards market rents for property.