Integration White Paper

Karin Smyth Excerpts

Wednesday 9th February 2022 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

I thank the Minister for advance sight of his statement, which I got about 30 minutes ago, but I confess that I read most of it some 30 years ago when I was developing joint services. After waiting an eternity for the Department of Health and Social Care White Paper, the Government are spoiling us with their third paper of the year. All these papers are necessary to try to remedy the disastrous Lansley Act—the Health and Social Care Act 2012.

We acknowledge that reversing that Act and the integration of health and social care, however it is defined, is extremely difficult, but this integration will not be delivered by the White Paper and it is certainly not well defined. It is not clear how this fits with the Health and Care Bill, which is currently in the Lords. Even the experts involved in the Committee and elsewhere are repeatedly tripping over crucial issues such as the relationship between integrated care boards, integrated care partnerships and integrated care systems. How do they work with health and wellbeing boards? Where is the clinical leadership? Where is the accountability to local people? I banged on a lot about accountability in the Bill Committee so I am glad that somebody was at least listening and that we seem to have a bit of progress, but where are the voices of local people who are increasingly being asked to pay more for less?

Like a house made of crepe paper, this gossamer-thin White Paper collapses with the faintest breeze of scrutiny. Let us be clear: it is not a plan, nor is it even a starting strategy. It is just a series of woolly claims about how things could be better, unsupported by any evidence or analysis of the resources and organisational and funding flow changes that will obviously be necessary. It could have been written at any time over the past 30 years. It contains little that is new and nothing to illustrate new thinking or new attitudes. It relies on the bogus assumption that because something may work for a while on a small scale, it will obviously work everywhere. It is not any kind of plan for integrated care that people will recognise; these are just aspirations about integrated systems.

There is little to explain how a joined-up system would be managed, how it would be accountable to the public, patients and service-users, how the funding will be allocated and shared or how performance would be assessed and weaknesses addressed. Nothing in the White Paper addresses the key issue of balancing what is locally determined against national standards and national entitlements.

Crucially, there is nothing to address the key barrier to integration—that social care and the NHS are in different empires with no level playing field. One is means-tested and one is not. One has national criteria for entitlement and one does not. The way in which they are governed and funded is totally different and they are kept going by two separate workforces with no aligned terms and conditions.

I welcome the announcement of a skills passport and we will certainly look at the detail of that. However, unless there is pooled funding on a major scale—out-of-hospital funding—there will be no system drivers to really improve integration. This White Paper is again about simply encouraging, but we have had 30 years of that.

The reality is that the White Paper is remarkable for what it does not do. It does not seem to help children and young people. It does not address the challenge of how to care for and support working-age adults with a disability. It does not really value or assist the informal workforce or carers.

Our NHS and care system is under enormous pressure after years of austerity funding made incalculably worse by the impact of the covid pandemic, but the challenges that it faces are manifest, from a legacy of a “hospital first” approach to a decades-long failure to share care records. That runs alongside chronic underfunding and devaluing of public health, huge gaps in the workforce and wholly inadequate social care provision, with more than 500,000 people waiting for assessment and hundreds of thousands more denied access to care of any kind because the barrier for access is far too high.

This is a will-o’-the-wisp White Paper: one minute it is there before us only to vanish at a glance. The truth is that there does not seem to be anything of note that cannot already be done. Fundamentally, what is the point of it? As things stand, the number of patients waiting for care will continue to rise for the next two years, and there is no plan—not even the ambition—to get waiting times and waiting lists down to the record lows seen under the last Labour Government.

Worse still, these proposals will see patients paying more in tax but waiting longer for care. The Government are blaming covid, but will the Minister tell us when the target for NHS patients in England to be treated within 18 weeks was last met? If he cannot remember, it was in fact in 2016, four years before the pandemic. It is clear from the announcement yesterday and here today—just as it is from the decade of Tory mismanagement that left the NHS ill-equipped to cope with covid—that the longer we give the Conservatives in office, the longer patients will wait. Their time really is up.

Today is not a serious endeavour; it is a greatest hits of soundbites and buzzwords, randomly assembled to make a decent press release and get an outing on the evening bulletins. It is a desperate desire to own the news cycle and calm Tory Back Benchers’ nerves. It really is disappointing and it is simply not good enough.

[Edward Argar]

It is a pleasure to see the shadow Minister in her place—she will know that I genuinely mean that, because she and I spent many happy days upstairs in Committee debating exactly these issues. This White Paper sets out clearly the next steps and builds on the strong foundations of integration that that legislation put forward, with the integrated care boards, integrated care providers and integrated care systems, which our deliberations in Committee and in this House demonstrated were clear, understandable and effective in providing locally based governance; bringing together at an ICB level NHS services within a locality, and within an ICP broader ranges of services, including housing providers and others. This has been bringing together the national health service we have with the localised delivery we all seek.

That is one of the key points of the White Paper: the next steps in how to deliver place-based solutions and allow the system to continue to evolve organically through that permissive approach that characterises the legislation we are putting through Parliament, rather than the prescriptive approach that the Labour party at times appears to prefer. The White Paper contains new thinking on new ways forward, drawing on not just the lessons of the pandemic but much longer-standing arrangements within localities, recognising best practice for integration between health and social care, and reflecting that organic development that occurs within a place as local leaders, local communities and those using the services work together to deliver services that work best for them.

The hon. Lady touched on how some of this might work in practice and talked about funding and budgets. We have made it clear—I used to use this when I was a local councillor—that section 75 of the National Health Service Act 2006, on the ability to pool budgets, has been effective, but it is time to go further and explore whether that remains the most effective vehicle by which that sharing of budgets can be undertaken, so it is right that we look at this.

The hon. Lady touched more broadly on social care and the NHS. I have to say to her that we announced our White Paper for social care last September. She mentioned the plethora of White Papers. We rightly recognise the different parts of the health and social care system and have clear plans for each of them. Those different White Papers together form a coherent whole, putting forward reform proposals that will make a difference for patients and others alike. I have to say to the Opposition that, much as they may gently chide us on this, in 13 years in government they had two Green Papers, one royal commission and one spending review priority, but still no reforms to improve social care provision in this country. This Government have seized the nettle and brought forward proposals that will genuinely move us forward.

Finally, on the hon. Lady’s points about yesterday’s announcement on NHS waiting lists, this Government have been transparent with the British people about the challenge ahead of us and about our plan to meet that challenge. Our approach, which combines ambition with realism, has been welcomed by stakeholders across the health and social care space. Ours is the party of the NHS. We are the party that has put the resources into that NHS, with £33.9 billion put into law at the start of 2020, and then record funding through the health and care levy, which the Labour party voted against.

Down Syndrome Bill

Karin Smyth Excerpts

Committee stage
Wednesday 26th January 2022 Public Bill Committees

[Dr Cameron]

Absolutely. That is the important reason we are all here—to make a difference to constituents’ lives. The hon. Member has shown that the Bill will have a positive impact on her constituent’s life; I am sure that across the Chamber we have all had many similar emails. The right hon. Member for North Somerset addressed some of the hopes for other conditions, which were also raised with me. I am pleased to support the Bill wholeheartedly and to have seen it progress so rapidly.

[Karin Smyth (Bristol South) (Lab)]

I congratulate my neighbour, the right hon. Member for North Somerset, on his work and on bringing together so many colleagues across the House. Everyone has worked enormously hard on this Bill. I thank the Minister for her co-operation. We should have more poachers turn game keepers—they are all terribly welcome.

As Members have said, the families of the 40,000 people with Down syndrome are all watching and listening to the debate carefully. As my hon. Friend the Member for Nottingham North (Alex Norris) previously said, we take every opportunity to remove all the barriers and to tackle stigma and the poverty of ambition that hold back progress in this area. The Bill is the perfect opportunity to do that, particularly around housing, mental health provision and education—all key areas that can really improve and empower those with Down syndrome across the country.

I welcome the Bill and the amendments. As the Minister said in the last debate, the Government recognise that the legal duties and frameworks are already in place. The duty under the Care Act 2014 is to assess people based on need and not diagnostic categories. It is vital that every person’s needs are met to ensure that they can fulfil their potential in their lives. This Bill is about people, not a condition; as it is implemented, we need to recognise that every individual will have their own specific needs. Social care is facing unprecedented strain, so new responsibilities must come with an assessment of investment.

I welcome the Department’s commitment that new guidance will be formed in consultation with partners, and a new burdens assessment will be undertaken ahead of that guidance. As you know, Ms Elliott, having chaired some of the sittings, I spent six weeks in Committee on the Health and Care Bill throughout the autumn. The provisions about having a named accountable person on the integrated care system and the guidance are very important and welcome developments. If the Government could learn from this Bill and take that approach more widely to the current legislation and other legislation, that would be not only good practice but very welcome for Members of Parliament and our constituents.

Our constituents expect us to see guidance and perhaps be part of scrutinising it, raising objections and problems and improving it—that is the role of a Member of Parliament—before that guidance is developed by organisations that are not accountable in the same way and imposed on our constituents. Bringing that circle back, so that Parliament has a greater role in the guidance, is really a very important step, and I hope that that starts to permeate not only the Department of Health and Social Care but other Departments and, indeed, current legislation.

I very much commend the right hon. Member for North Somerset for introducing amendments 1 and 2. They will be landmark—really important. I commend the Minister for working with the right hon. Gentleman to agree to them, and I thank everybody involved in the Bill. I agree with the right hon. Gentleman: this is an example of how Parliament and the proper role of Members of Parliament can be made real. That is only for the good of our constituents.

[The Minister for Care and Mental Health (Gillian Keegan)]

It is an absolute pleasure to serve under your chairmanship, Ms Elliott; I think it is the first time. I am delighted that the Bill has received the same endorsement today from across parties as it did on Second Reading. What can I say? My right hon. Friend the Member for North Somerset has really set an example to all of us. I guess that is the voice of experience—30 years in various roles around this place, which have enabled him to optimise and maximise the situation and to get all colleagues rowing in the same direction. It is very important for a Member to do that if they are to get their private Member’s Bill into legislation; as we know, that is not typical.

Some 47,000 people in the UK have Down syndrome. It cannot be right that people with Down syndrome and their families should have to fight for access to appropriate services. I have seen this personally, as my right hon. Friend mentioned, with my nephew Joseph Gibson. Although Joseph is now happy and thriving—he is 15 now —it has not always been easy for my brother Marcus and sister-in-law Sara to secure the support that they need and that meets his needs.

That is what we want to change through clause 1, which provides that relevant authorities will be issued with guidance that they will implement locally. The guidance will enable those authorities to understand the needs of people with Down syndrome and how best to meet them. Of course, we will consult widely on the development of the guidance.

Once the guidance is published, the Government will keep it under regular review and update it periodically to ensure that it remains fit for purpose. It is very important that, when going through the clauses of the Bill, we put the right things in place, and that we do that with wide consultation. I thank my right hon. Friend for tabling the amendment to require the Government to lay the guidance before Parliament upon publication, because people here have a lot of experience and a lot to give. I am pleased to support amendment 1, which will bring this important guidance to the attention of Parliament once it has been published.

Draft Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2022

Karin Smyth Excerpts

Wednesday 26th January 2022 General Committees

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure, as always, to serve under your chairmanship, Mrs Murray. I will take a few moments to outline some grave concerns that we have about the legislation. I also have questions for the Minister, which I hope she will answer in her response to the debate.

There is an important reason why the extension is being made. I remind colleagues that the CQC’s work in regulating activities is vital. It is responsible for the registration, inspection and monitoring of health and adult social care providers, including independent providers, under the Health and Social Care Act 2008. All providers of health and adult social care that carry out regulated activities are required to register with the CQC and demonstrate that they meet those fundamental standards, for the safety of our constituents. The scope of regulated activities includes the treatment of disease, disorder or injury; surgical procedures; maternity and midwifery services; personal care; nursing care; and assessment or medical treatment for persons detained under the Mental Health Act 1983.

The CQC inspects and monitors the services that it registers. Although the pandemic brought about the suspension of routine inspections, the CQC still monitors providers using information such as people’s feedback, and it will continue to inspect where it sees evidence of risk of harm, deliberate abuse, systematic neglect or a significant breakdown in leadership.

Clearly, if these regulations were allowed to fall in a matter of weeks, the safety of our health and care services would be in a very serious situation, as indeed would be the safety of our constituents. Although the Government could not bring forward the review any earlier than a last-ditch attempt to change the law, the CQC managed, despite the pandemic, to produce “The state of health care and adult social care in England 2020/21”. It is an excellent report that I commend to the Minister, if she has not yet had a chance to read it. It starts by saying that, despite the challenges of the year before:

“The system has not collapsed.”

Well, for that we are all truly grateful. We are very grateful for the work of those people who made sure the system did not collapse.

However, as every Member here today or reading the report of this debate will know, the system very nearly did collapse. In fact, many of our constituents are falling foul of handed-back packages of care, and local authorities across the country are struggling to maintain those very important services for individuals and prevent the most vulnerable in our society from losing their packages of care.

I will not detain the Committee for long, but we understand the problems with recruitment, pay conditions, the 100,000 vacancies in social care, and the 110,000 vacancies in the health service. I also will not detain the Committee for too long by talking about the number of people we know are dying at home unsupported.

[The Chair]

Order. I remind the hon. Lady that her comments must remain within the scope of the legislation that we are discussing.

[Karin Smyth]

Thank you, Mrs Murray. I am just outlining the role of the CQC; if these regulations do not pass today, then all this care will not be provided by regulated services, but I will move on.

[The Chair]

Thank you.

[Karin Smyth]

I will just finish the point about our concerns about coroners’ assessments of the conditions in which people are dying early, perhaps because they could not access care. The CQC’s report, which it did manage to do, outlined ongoing concerns.

To be clear, we will support the Government today, but with grave concerns, because the CQC has itself said that it has ongoing concerns about patient safety. In relation to high-risk mental health services, it is concerned that people are at risk where there are warning signs of closed cultures. Improvements in maternity care are far too slow, with staff not having the right skills or knowledge, or poor working relationships. Other concerns include lack of engagement with women in maternity services and limited action being taken to improve equitable access. Its final area of concern is about the really important issue of deprivation of liberty safeguards during 2020-21. Those are really grave concerns about the most vulnerable people in our society. This is important to all our constituents across the country.

I am really concerned that the Government’s proposals to simply extend the 2014 regulations by three years indicates a disregard for the importance of timely reviews. The CQC and providers need clarity, which is why we will support the Government today. This is not a technical a piece of legislation. We are being asked to extend the regulations without any indication of what the review that the Government have undertaken might be saying, and I am disappointed that the Minister did not say more about that in her opening remarks, so I trust that she will do so when she concludes. If not, perhaps she could write to us—I will write to her formally if she is unable to say more today.

We are being asked simply to extend these regulations, which should have been completed by April 2020. Although the pandemic might have had an impact on the review, I would have expected the review to be ready for the printer in March. Certainly, when I conducted reviews of such a serious nature when I worked in the health and care system, I would be expected to have my draft well and truly ready for publication before the final deadline in April. Perhaps the Minister can say why that was not done before.

The Minister did not mention that the consultation received only 32 responses from health and care provider organisations. They are busy and have other things to do. Of those responses, 19 were in favour of the Department’s proposal, and 13 were against. It was noted that the 2014 regulations should not be extended without also making amendments to reflect the changes in the health and care sector since 2014, which are considerable.

When we are reflecting on those changes since 2014, we should bear in mind, for example, the fitness to hold a licence by some providers, particularly in adult health and social care. It is well documented that we are deeply concerned about some of those providers—they are essentially owned and run by hedge funds located in countries far from here, and are not perhaps paying their due level of taxation. If they did, it might provide the social care sector with a bit more stability.

We have had many years of senior Government Ministers talking about patient safety. Hon. Members recently spent six weeks on the Health and Care Bill Committee trying to improve the oversight of the CQC of whole systems and adult social care. None of this is joined up. If we are pushing this down the road for another three years, how does that align with the current legislative programme, legislation in the other place and anticipated legislation in the adult health and social care sector that is due at any moment? We need to line up some of these things, so that we parliamentarians can provide due process and scrutiny. Ultimately—the Minister knows it well—this is about patient safety.

The Government were unprepared going into the pandemic and I am concerned that this legislation is also tardy, and reflects the fact that they are not taking the timeliness of reviews seriously. Perhaps they are distracted by other matters. The Government have had two years to consider the matter. Why are systems not in place to ensure that such legislation is not left to the last minute? I hope the Minister can address my concern about why these measures were not ready in April 2020. It is not the first example. I do not want to detain the Committee, and I might go out of scope, but there are many examples of tardiness in timeliness and appointments and bringing forward regulations; that really does affect people. Members of Parliament across the House are really getting quite fed up of it.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

Surely the hon. Lady would recognise that we have been through a pandemic that has caused great uncertainty for the social care sector. Is it not more prudent while we are still in the pandemic to extend the regulations rather than changing the whole system overnight?

[Karin Smyth]

The measures were due to come in in April 2020. As I said, if I was writing the review, I would have had it ready at the printer’s in March 2020 as the pandemic started. I do not really understand—I am very happy for the Minister to clarify—why, if it was ready for April 2020, which I suspect it perhaps was not, that it has taken this length of time, and why we need another three years. There are clear concerns in the sector as to why we need three years.

We support these measures today—that is the responsible thing to do, because we cannot have the sector unregulated, but we impress upon the Government the requirement that full regulations and good governance are important. We do not expect matters to be left in such a state.

Can the Minister explain why the review was not completed in April 2020? What stage was it at? How much of it was completed by then? What steps is the Department now taking to make sure that this review is completed in a timely manner? Can she provide information on the conversations the Government have had with the CQC regarding further areas of activity that need to be brought within the scope of the Act? We hear rumours, but we would like some certainty.

The consultation received 32 responses from health and care provider organisations. As I said, 19 were in favour and 13 were against. Does the Minister consider that to be a sufficient level of review and engagement? What steps will she be taking to ensure further stakeholder engagement?

--- Later in debate ---

[Maria Caulfield]

It is a pleasure to respond. I am pleased to hear that the Opposition parties will support the statutory instrument this afternoon because it is crucial that the Care Quality Commission, which does an amazing job in maintaining patient safety, is able to continue to do so.

I see that Captain Hindsight has sent a lieutenant here this afternoon. The hon. Member for Bristol South would have had a reform package ready on the table and at the printer’s.

[Karin Smyth]

Will the Minister give way?

[Maria Caulfield]

I will continue, if I may. As my right hon. and learned Friend the Member for North East Hertfordshire pointed out, we have been through two years of a pandemic. Health care and social care staff and teams have worked so hard up and down the country but so has the CQC. It does do unannounced inspections; it has not been doing some of them during the pandemic as that puts extra pressure on an already overstretched group of professionals who are trying to keep their services going. There has been compromise with inspections between the sector and the CQC, but the commission very much does do unannounced inspections, which are an important part of the process.

There will be a time to reform and consider the regulations more fully. I have met the CQC. This morning I met the chief inspector for primary care and we were looking particularly at areas where there needs to be some change and reform. But it is important to do that properly. As the hon. Member for Sheffield South East said, it is important to involve all stakeholders in that process and not just rush through a process for the sake of it. The very specific scope of this statutory instrument is to extend regulations by three years so that the CQC is able to carry out its inspections and do its fantastic work to protect patients and support staff when they raise concerns. It does the inspections and makes recommendations to improve care.

I hope that Opposition Committee members will support us and that they will work with us on our reforms on social care or around the CQC to make sure that there are the best outcomes possible for patients across the board.

Question put and agreed to.

Skin Conditions and Mental Health

Karin Smyth Excerpts

Tuesday 25th January 2022 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Gray, and I commend the right hon. Member for Gainsborough (Sir Edward Leigh) both on having secured this debate and on his ongoing work in, and commitment to, this area. He introduced his comments by saying that yet again, he had had more ridicule through an email, which is appalling. He stands up for people, and I am sure that that is well appreciated by fellow sufferers.

The APPG’s report is very powerful. It is very sobering that, despite similar reports in 2003 and 2013, so little has changed for people suffering from these conditions, both from childhood and among adults and people who are older. The link between skin conditions and deterioration of emotional and psychological wellbeing are well documented, and have been for some time. As we have heard said so eloquently this afternoon, people with skin conditions report that they have experienced social isolation, stigmatism, depression, anxiety and in some cases suicidal thoughts and, indeed, action. There is also strong evidence to suggest that, although people with skin conditions have much higher rates of common mental health conditions, they struggle to access psychological support. Members have given some very good examples from among their constituents. This is particularly prevalent in children, as the hon. Member for Bracknell (James Sunderland) discussed. The APPG’s survey found 98% of respondents stating that their condition impacts their mental health, and only 18% saying that they could access support.

The rise of social media has exacerbated these problems. As my hon. Friend the Member for Swansea East (Carolyn Harris) has said, children and young people with these conditions are particularly reporting bullying and being mocked on social media, all of which we obviously condemn. We cannot disagree with all the evidence that has been presented today—the reports and recommendations on what is needed to support people. It is very clear, Minister: we need to improve access to specialist support, improve training and awareness through the health service, commission more psychodermatology services, improve staffing, support further research, and encourage further integration between psychology, psychiatry and dermatology. The Government need to do much more to support these people, particularly those who are battling through the primary and secondary care interface—I am particularly thinking about parents who are trying to do so. The IAPT service, with which I have worked in my previous career with the health service, offers a route through. However, as all of us know from our constituencies, IAPT is heavily over-subscribed and really struggling with current caseloads.

In the final few moments of my speech, I will pick up on the issue of teledermatology. Although people over the past 20 years might not have experienced much difference in services, the world has changed quite considerably in those 20 years. A decade ago, I was a commissioner for a primary care trust—now they are CCGs—of a teledermatology service, encouraging GPs to use that service as a way of supporting them, providing better link-in to secondary specialist care, and ultimately providing a better, quicker, more responsive service to local people, particularly for parents who can sit with children and avoid trips into hospital. It was clinically led, working with the private sector, new technology and willing GPs, and it was innovative. It was incredibly hard to achieve: at some point, I may share my stories of trying to implement a new service in the NHS. It is not easy, because new practice is always hard to achieve and savings and effectiveness are hard to demonstrate.

Although as we have heard, covid has made the situation much worse for many people, the pandemic has provided a catalyst for some rethinking of how we deliver services. Though I heed the warning in the report —also made by hon. Members today—about the loss of face-to-face services and about how important those are, I think that we can learn some lessons. With waiting lists at 6 million people and rising rapidly, I wonder how the Government will make developments in this area, as well as in many others, without thinking about more radical approaches, while clearly bringing people with them. Technology and digital access provide some of the solutions.

I have a number of questions for the Minister. Given the clarity of the evidence, will she outline how she would support embedding innovation and the lessons of the pandemic to create a more responsive, faster and better service? Will she outline how she will work with her counterparts in the Department for Digital, Culture, Media and Sport to deal with online bullying about skin conditions, which we have also talked about today? It would be helpful to understand the Government’s strategy on employing and training more psychodermatologists and, indeed, how the Minister will support GP training so that GPs understand the effect on people’s mental health of skin conditions, again as has been so eloquently outlined over the past two decades.

What plans does the Department have to invest in further research into psychodermatology and the wider mental health implications of skin-related diseases, as the right hon. Member for Gainsborough mentioned? I sincerely hope that we are not all here in another decade’s time, with another report from the APPG saying the same things. I am sure that we would all like to see some progress for people suffering from the mental trauma of their poor skin conditions.

NHS Dentistry: Bristol and the South-west

Karin Smyth Excerpts

Monday 24th January 2022 Commons Chamber

[Darren Jones (Bristol North West) (Lab)]

I am grateful to have secured this evening’s Adjournment debate on access to NHS dentistry in Bristol and the south-west. Over the past few months, many of my constituents have told me how difficult it has become to find and access an NHS dentist in and around my constituency of Bristol North West. Their accounts have been wide-ranging, from having their NHS treatment left in limbo following the closure of a local practice to having to look as far as Gloucester to try and register as a new patient with an NHS provider.

In particular, last year an NHS dental surgery in Southmead in my constituency unexpectedly closed to patients. Many of my constituents were left without an NHS dentist, often mid-treatment. One constituent explained that they had paid for NHS treatment prior to the closure of the dental surgery but had been unable to secure another appointment with a local dentist. Their dental work remains incomplete. Another constituent described contacting nine dental practices across Bristol to try and resume their treatment as soon as possible, only to be told that none was accepting NHS patients.

[Karin Smyth (Bristol South) (Lab)]

I am grateful to my hon. Friend for securing this important debate; I have similar stories from my constituents. Does he agree that we also need to think about pregnant women, for example, who have free access to care but are also being denied access to dentistry at a really important point of their life?

[Darren Jones]

I absolutely agree, and I thank my hon. Friend for her contributions, not least as a leading voice on healthcare policy, knowing that prevention is more important than cure.

A third constituent of mine rang over 25 practices across the south-west, but was unable to secure an appointment as an NHS patient—something that has affected patients who were pregnant as well as everyone else. Southmead in particular is now left without any NHS dentists at all.

Oral Answers to Questions

Karin Smyth Excerpts

Tuesday 18th January 2022 Commons Chamber

[Mr Speaker]

I welcome the shadow Minister, Karin Smyth.

[Karin Smyth (Bristol South) (Lab)]

Around 10,000 medically fit people are currently in hospital when they should be at home with their families or in a supported setting. That is a tragedy for them and a mark of shame on this Government. Short-term cash, taskforces or threatening legal action are not solutions. Social care support is a lifeline not a luxury, so will the Government now work with us cross-party in line with the joint Select Committee report of 2018 to bring forward immediate change and offer hope and respite to those receiving and giving social care?

[Sajid Javid]

First, may I welcome the hon. Lady to her new position and wish her all the very best? She will have heard in a previous answer that social care and those who provide social care, which is such a vital act and such a vital service throughout our country, are receiving record amounts of support—£3.3 billion of extra financing since March 2020. Of course I would be more than happy to work with her and her colleagues to see whether there is more that we can do together.

Antimicrobial Resistance

Karin Smyth Excerpts

Tuesday 7th December 2021 Westminster Hall

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Gary. I congratulate the hon. Member for Thirsk and Malton (Kevin Hollinrake) on bringing this very timely debate to Westminster Hall. It is timely because if we do not learn from the situation that we are in, we will end up in a very bad place; it is with that in mind that I give my remarks.

This is a really unusual subject; I have not been involved in a debate on it before, but it is one on which there is so much agreement. We have a problem, we have evidence of a problem, we agree that we have a problem, we have solutions that we generally agree on and we are genuinely world leaders. I think the Government sometimes bandy around the fact that we are world leaders when we are not; but we are genuinely world leaders in this area, and that is something to be proud of. We have some fantastic people in this country. However, why is the situation not improving? What more needs to be done, and, crucially, has enough been done in recent years? How do we know what has been done? As the hon. Member for York Outer (Julian Sturdy) said, why is there not greater interest and political pressure on this subject?

It was 2013 when Professor Dame Sally Davies described this as a

“catastrophic threat”.

She said:

“If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.”

It was in 2014 that the estimated figure of 10 million people dying as a result of AMR by 2050 was mooted. I was working in the health service when that discussion was being had, back in 2013-14. I vividly remember the concern of specialists, particularly colleagues in pharmaceuticals, about that, and the actions that were being taken to support clinical practice to make sure that did not happen. However, I do not think that most people walking the streets are aware of the catastrophic prediction made then.

We have a problem—we agree on the problem—and we know the causes of the problem: inappropriate use of antimicrobial drugs in healthcare; poor infection prevention and control practices; use of antimicrobial drugs in agriculture, and accelerated spreads of AMR infections through global trade and travel. Additionally, as the right hon. Member for Chipping Barnet (Theresa Villiers) and other hon. Members have said, there are limited numbers of new drugs available to replace those that become ineffective. The former Prime Minister, David Cameron, launched a review in 2014, and the list of 10 recommendations was published in 2016. In 2017, the cost of global action was estimated at $40 billion. That is an eyewatering sum, but when compared with what is being described as the incalculable cost of covid, which reaches trillions of dollars, that $40 billion estimate starts to look quite small. Others have indicated that in reality the cost of this could be unimaginable to most of us.

There was an excellent debate in Westminster Hall on 26 April 2016, in which my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) addressed the hon. Member for Mid Norfolk (George Freeman), who is also an expert in this area. My hon. Friend said:

“Although I welcome the renewed focus that today’s debate brings, I fear we are no closer to a solution than we were two and a half years ago.”—[Official Report, 26 April 2016; Vol. 608, c. 540WH.]

I think there is concern in the Chamber that that remains the case today.

The Government have targets, although they are not terribly specific. Many are for the period 2021 to 2025—for example, being able to

“report on the percentage of prescriptions supported by a diagnostic test…by 2024.”

On the eve of 2022, I expect the Minister to be able to outline how meeting those commitments is going. The hon. Member for Thirsk and Malton made some helpful suggestions for what we should be measuring, how we should be measuring it and how that should be reported, which I am sure the Minister will address.

On animal use, which the hon. Member for Strangford (Jim Shannon) highlighted, the investment required by farmers was yet to be formally evaluated in 2019, so it would be useful to know whether the Minister has evaluated that cost. It would also be helpful to have an understanding of how we are collaborating with our European neighbours, now that we have left the European Union, because we know that collaboration is really important, particularly in the agricultural industry.

We should be prepared, and we should certainly be on track, but I fear we are not, so the crucial issue is: what do we need to do? I pay tribute to Dame Sally Davies, our special envoy on AMR, and her work to highlight this issue, which, as she has said in the last year, is a silent pandemic. As she has told us, covid needs to be a wake-up call to the warnings that she has issued over the years. I have listened to her speak on this issue, as has another all-party group, and she has recently used quite a vivid image to describe the situation: covid is like putting a lobster into boiling water, but AMR is like a lobster in cold water. It is a silent pandemic.

One of the issues is that fewer adults know about this. I absolutely agree, and I think that is also true of Members of Parliament. We need to learn from covid, including about things such as altering behaviour, washing our hands and access to water. We also need to support those on the frontline much better, including through clinical direction, to help them in the way that they need in order to treat patients.

[Sir Gary Streeter (in the Chair)]

I call the Minister. Please remember to leave two or three minutes for Kevin Hollinrake to respond.

Health and Care Bill

Karin Smyth Excerpts

Report stage
Monday 22nd November 2021 Commons Chamber

[Edward Argar]

I am grateful to the shadow Secretary of State who, while I do not necessarily agree with what he says, as ever puts it courteously. We hold true to what we put in that “Build Back Better” document. It is necessary for this one particular element to see further primary legislation, hence the amendment today.

[Karin Smyth (Bristol South) (Lab)]

Will the Minister give way?

[Edward Argar]

I am afraid that I will not give way because I do need to make some progress.

[Karin Smyth]

Will the Minister give way on that point?

[Edward Argar]

I have been very generous with my time and to the shadow Front Bench, so forgive me, but no.

[Karin Smyth]

On that point, will the Minister please give way? Six weeks in Committee and not a mention.

[Edward Argar]

Forgive me, but no.

To reiterate, as my right hon. Friend the Prime Minister said on 7 September nobody—nobody—will be “worse off” than under the current system. Currently around half of all older adults in care receive some state support. This will rise to roughly two thirds under these reforms. On the minor technical amendments that I made to other sections of the Care Act, I would not wish to belabour each one, but I can reassure the House that those changes will ensure that the legislation works as intended and that everyone who is eligible—

[Karin Smyth]

Will the Minister give way?

[Edward Argar]

I will not give way. I want to make some more progress.

--- Later in debate ---

[Edward Argar]

My right hon. Friend is exactly right. I am grateful to him for giving me an opportunity to highlight that this improves in this respect on the Dilnot proposals. I put on record my tribute to Andrew Dilnot for his work, but we believe that this is a better package, and, as he highlighted, a sustainable package from a financial perspective.

[Karin Smyth]

Will the Minister give way. We have had six weeks in Committee.

[Edward Argar]

The hon. Lady implores me, saying that after six weeks of having to sit opposite me in Committee, the least I can do is allow her to intervene.

[Karin Smyth]

Several times in that Committee, I offered to help the Government in a cross-party way. The Minister has been dealt a bad blow here tonight, having to come here and defend this proposal. In those six weeks—I think 21 sessions—not one iota of this proposal was mentioned or brought forward. We all know about bad legislation, rushed legislation, and legislation that does not have the commitment on something so important. I have commended the Government for starting this conversation, but this is a poor legislation move. I am sure that Members here would support the Minister tonight if he were to withdraw this proposal, go back to the Chancellor and ask him to think again. We would all be behind him if he took that opportunity.

[Edward Argar]

I did wonder whether I would regret that intervention. It was typically courteous, although I have to say that when a Member of the Opposition says that, “We’re here to help you”, I am not always sure. [Interruption.] Of course, when the hon. Lady does it, I know that she is sincere about it. The point I make is that this important change is necessary to deliver on the pledge we have made. It is being introduced on Report. While ICBs and integrated care systems, which we will speak about shortly, are hugely important, I suspect that this matter will dominate the debate in this group on Report. Equally, I suspect that it will be fully debated and scrutinised in the other place.

--- Later in debate ---

[Sir Charles Walker]

I caught your eye half a minute ago, Madam Deputy Speaker, and you indicated to me with that look that I was next. My heart rate quickened. I am always nervous when I speak in this place because we do really important stuff here—all of us do—and this is an important Bill.

Before the Health and Social Care Bill became an Act in 2012, it was amended by the Conservative Government. It was amended in pursuit of parity of esteem. The Coalition Government changed general references to health to “physical health and mental health”, which was not a courageous thing to do—it was entirely the right thing to do.

I have tabled a series of amendments—10, if I have counted them correctly—for debate over the next two days. They ask the Government to change all general references to health to “mental health and physical health”. It is a call to arms. These changes are not just totemic, but hugely important. Over the next few years, we need to recruit 9,000 more mental health nurses to look after our constituents and more than 800 new psychiatrists, and we need to give all organisations charged with delivering healthcare that nudge, that push, that call to arms that they need to make these important things happen. We also need to send another message from this place—on top of all the other messages that we have sent over the past nine years—that we believe that there is no physical health without good mental health, and that good mental health means good physical health.

I am looking at the Minister because he has made a couple of staggering interventions on colleagues tonight. Colleagues in full flow, prostrating themselves at the feet of Government, have suddenly been rewarded with his stylish, charming intervention of, “The Government have heard your cries, and they shall act on them.” I looked at the joy that spread across the face of my right hon. Friend the Member for Basingstoke (Mrs Miller), and across the face of my right hon. Friend the Member for South West Surrey (Jeremy Hunt), the former Secretary of State, who spoke before me. I look at the support I have from my right hon. Friend the Member for West Suffolk (Matt Hancock), the most recent former Secretary of State—there are a few of them—and from a former Prime Minister. May I ask the Minister to make one of those generous interventions on me this evening? I am still here. I want to sit down, but if he is not going to make that generous intervention right now, I shall be back tomorrow. I shall also be travelling up to the other place and knocking on its door to make sure that these amendments are tabled there, so that, eventually, we get our way.

[Karin Smyth]

I came to this place largely on the back of the disastrous Lansley Act, and I am pleased to see it banished to the dustbin of history, which is what this Bill essentially does. It also banishes to the academic shelves that example of how not to make policy. Lansley took a sledgehammer to our work in primary care trusts, to partnerships, to morale, and to our capacity to forward-plan. Along with the austerity funding that came with it, the Act directly led to the poor state in which we entered the pandemic, and that must be front and centre of any review of the pandemic.

This Bill is a seminal point in the history of the NHS, because it banishes again to the history books experimental competition as an organising principle and a driver of efficiency. The key issue is what replaces it. Now we have in its place local cartels dominated by hospital trusts, and the supreme power of the Secretary of State to interfere in all local decisions. There is no power here for local elected representatives, no power for primary care or community care or mental health, no voice for patients, no voice for the public, and no voice for the taxpayer, who is asked to pay ever more. As we move to an ever more costly health service, accountability and transparency of our NHS in this role has to be at front and centre in order to bring people with us on that journey of paying more.

I have tabled two amendments to this part of the Bill. One is on the need for the local boards to be cognisant of palliative and end-of-life care. The other is on local improvement finance trusts, the local public private sector bodies introduced under the last Labour Government that are instrumental in providing good primary and community care estate—something that this Government are allowing to wither on the vine. My own South Bristol Community Hospital needs more support through these trusts in order to thrive, so that people have decent, good-quality estate from which to receive their care.

I also draw hon. Members’ attention to my new clause 23 on a good governance commission, which will be discussed tomorrow. I genuinely offer it as a helpful way forward. If it were enacted by the Government, it would avoid the cronyism that we have become used to, and would ensure that local bodies are more democratically accountable to their populations and more cognisant of the needs of their local populations. It would ensure that the people leading the local bodies are fit and proper, meet basic criteria regarding what is expected of them and have crucial accountability to local populations. It is akin to the Appointments Commission, which was abolished in the abolition of the quangos; that was a huge mistake. If the Government took notice of it, the new clause would really help us to get around some of the real concerns about how our local health services are governed.

Let me finally address new clause 49 on social care. It is a disappointment and unexpected. We had six weeks in Committee. In that time, we could have looked carefully at the proposal and shone a bit of light on it. The right hon. Member for West Suffolk (Matt Hancock), who is no longer in his place, clearly tried to say what this provision is really about, in that one part of the state should not be subsidising another part of the state. He started to say that that was a true Conservative principle and he was absolutely right. This provision will remind people who are in receipt of benefits that they are in receipt of those benefits, and that anything they may have built up should not be counted towards their future. It is a punitive property tax. I am old enough to remember what happened to the last Conservative Government who introduced a regressive property tax; this Government really ought to think again.

[David Simmonds (Ruislip, Northwood and Pinner) (Con)]

I draw the attention of the House to my entry in the Register of Members’ Financial Interests in that I am married to an NHS doctor, who is employed by a hospital trust that serves my constituency.

Let me turn first to new clause 49. Those of us who have been in the world of local government for a long time will have seen the attempts by Governments of various parties to address the financial settlement around social care. I chaired a social services committee that pushed through the charging policies introduced by the last Labour Government in an attempt to address these costs. I also chaired a social services committee that had to balance the demands of the fair access criteria, and saw the last Labour Government drive a coach and horses through a lot of local provision.

I recognise that we should all seek to ask questions of Governments about how we address in particular the impact on working-age adults. In response to the people asking whether we are proud of what we are here to do tonight, I would say that we should be proud of the fact that we are willing to take what are sometimes difficult decisions to ensure that we balance the books and have a sustainable financial settlement that supports social care for our constituents. It is too late for my two grandparents, who went through the process and saw very modest assets consumed by the cost of long-term care, but I welcome the fact that my constituents, and people up and down the country, will benefit from what this Government are seeking to achieve.

I will move on, briefly, to new clause 55, which addresses the responsibilities for ICSs regarding the provision of services and planning for services for our youngest children. My right hon. Friend the Member for South West Surrey (Jeremy Hunt) made a helpful intervention, in which he pointed out the effectiveness of Ofsted-style regulation in ensuring the quality of provision at a local level.

We had an excellent debate in the Chamber just a few weeks ago, discussing the work done by my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), which was reflected in the budgetary decisions that were brought forward previously. Having had that debate, it seems clear to me that in tabling an amendment supported by more than 70 organisations in the field of children’s care, we have an opportunity—one which was debated and touched on through various assurances from Ministers in Committee. It is an opportunity to ensure the right level of rigour and accountability in what we ask of ICSs, so that we can make sure that our youngest children, babies, neonatal care, and indeed young people up to the age of 25 who are already covered by statutory provisions in respect of special educational needs and care leaving, are appropriately covered.

Covid-19 Update

Karin Smyth Excerpts

Tuesday 9th November 2021 Commons Chamber

[Sajid Javid]

I hope my hon. Friend appreciates that there were a lot of questions. The impact statement will be published today, and the impact assessment will be published before he and other Members are asked to vote. Those documents will help to answer their questions. I also draw his attention to the experience thus far of the condition of deployment measure that we took in a similar way with care homes, and how dramatically the numbers were cut from the point of announcement.

[Karin Smyth (Bristol South) (Lab)]

Of course NHS and care staff should all be vaccinated—that is what we expect for our loved ones—and of course they should all be wearing masks. The Prime Minister parading around a hospital yesterday without a mask was a disgrace, and I hope that the Health Secretary is talking to him about that.

I support the questions that other hon. Members have asked about more detail in the impact assessments, because I want to know whether those 10% of un-jabbed staff are in Bristol, or whether the figure in Bristol is 20%, 30% or 2%. If the Health Secretary knows that information, I, as a Member of Parliament for Bristol, should also know it. If all staff and associated people in healthcare settings are to be vaccinated, will there be a covid passport for people to visit hospital and care settings?

[Sajid Javid]

I gently say to the hon. Lady that she really should not try to play politics with the story that she is perpetuating about the Prime Minister on a hospital visit yesterday. As the hospital trust said, and as I am sure she knows, the Prime Minister and his team followed all the rules that they were required to follow, whether they were about face masks or otherwise, in that hospital. Something tells me that she knows that, but sadly she has decided that she wants to play politics with such an important issue.

As for information on vaccination rates in Bristol, the hon. Lady knows that every region of England has a director of public health. She probably knows who hers is, and they will be able to supply a lot of information. If she is having any difficulty getting that information, I will certainly help her in any way that I can.

David Fuller Case

Karin Smyth Excerpts

Monday 8th November 2021 Commons Chamber

[Sajid Javid]

I very much agree with all the words of my right hon. Friend, especially when he talks about the shock, hurt and pain of all the families, many of them his constituents. He asks specific questions on three points: whether the victims will be allowed to give evidence to the inquiry; whether the recommendations will be for the whole of the NHS and be public; and whether the inquiry will publish its findings on other sectors beyond the NHS. Absolutely, the inquiry will do all three things. I can give him that assurance.

[Karin Smyth (Bristol South) (Lab)]

This is truly one of the most horrific things any of us will have heard of or encountered. Our thoughts are with the families and those conducting the investigations. Following on from the right hon. Member for Tunbridge Wells (Greg Clark) who highlighted that access has happened elsewhere in the country, the Secretary of State said in his statement that he has written to NHS England to ask all NHS trusts to report directly to him on what they find in terms of compliance. Will he outline how he will share the information from NHS England with local communities who are now very concerned about that and with us as their representatives?

[Sajid Javid]

Yes, I am very happy to expand on that. The NHS has, first, written directly to all trusts and asked them to look into the issues of mortuary access and other post-mortem activities, and to judge them against current guidance to ensure that it is all being applied. In the first instance, that information will go back to NHS England. It will then be shared with me and I will certainly want to find the best way of sharing it with both the House and everyone who is interested.