Health and Care Bill

Debate between Karin Smyth and Caroline Dinenage

Consideration of Lords amendments
Wednesday 30th March 2022 Commons Chamber

[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.

Arts, Culture and Heritage: Support Package

Debate between Karin Smyth and Caroline Dinenage

Tuesday 7th July 2020 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

I felt that the Minister was unusually disrespectful to my hon. Friend the Member for Cardiff Central (Jo Stevens), who asked a very important question about freelancers and how the package is not helping, which has been echoed across the House. There is clearly a lot of support for creative freelancers, who are not supported by the job retention scheme and cannot currently access the other schemes. In Bristol South, they are critical to supporting Bristol’s wider creative and music offer. Will the Minister please consider going back to the Treasury to find a way to help that group of people?

[Caroline Dinenage]

I did not mean to appear disrespectful; I apologise if that is how it came across. I am well aware that a number of people up and down the country have fallen through the gaps and are not being protected in the way we envisaged when we started the self-employed income support scheme. The hon. Lady may be interested to know that, alongside the Government’s significant investment, Netflix, working with UK Theatre, the Society of London Theatre and Sam Mendes, has donated £500,000 to set up a theatre artists fund, which is supporting individuals in the theatre industry who are in dire straits at the moment.

Community Hospitals

Debate between Karin Smyth and Caroline Dinenage

Tuesday 12th March 2019 Commons Chamber

[Caroline Dinenage]

The hon. Gentleman makes an incredibly strong point. I often stand at the Dispatch Box—usually during Adjournment debates—having listened to hon. Members talk about CCG decisions that they feel may not be in the best interests of their local area, but it is up to local areas to decide. The whole point of devolving money and decision making down to CCGs is that we trust them to be able to make the best decisions in the best interests of local communities to deliver services that best meet needs and priorities. If the hon. Gentleman feels that that is not happening and if he has had the opportunity to discuss that with his CCG, it could be a good idea to take the matter up with NHS England.

CCG funding allocations are decided by an independent committee, which advises NHS England on how to target health funding in line with a funding allocation formula. This objective method of allocation supports equal opportunity of access and reduces health inequalities. That way, the decision of where taxpayers’ money goes is decided in an independent and impartial manner.

As my hon. Friend the Member for Congleton will be aware, it is down to the CCG—in this case Eastern Cheshire CCG—to decide how it spends its allocation and to determine which services are the right ones for the local community it serves. One would hope that CCGs have the necessary clinical knowledge and local expertise to make informed decisions on how to spend taxpayers’ money. To support the long-term planning of services, NHS England has already informed all CCGs about how much funding they can expect to receive between 2019-20 and 2023-24. My hon. Friend may be interested to know that Eastern Cheshire CCG’s funding will increase from £270.2 million to £311.6 million over that period—a substantial increase. I hope that she will agree that that information gives CCGs the stability to plan appropriately and establish their services for the long term.

[Karin Smyth]

I do not disagree with much of the thrust of what the Minister is saying, because CCGs—I used to work for one—do spend taxpayers’ money. She will often have heard hon. Members say that there is no link between the accountability for that money, the work that we do as Members of Parliament and the decisions that are made by CCGs. The new NHS plan looks like it may want to do something about that, but will the Government send a message to NHS England and the CCGs that local democratic accountability must somehow start to be built into the CCG decision-making process?

[Caroline Dinenage]

The hon. Lady makes an interesting point, and it is one with which I have a certain sympathy. When NHS England comes up with the implementation plan for the long-term plan, I hope it will include suggestions as to how such issues might be addressed.

It is important to remember that the NHS is close to all our hearts. Fundamentally, it belongs to the people of this country. It is founded on a common set of principles and values that bind together the communities and people it serves. For that reason, it is welcome to hear my hon. Friend the Member for Congleton talk so highly of the open and honest relationship between her local NHS and the residents of Congleton. The examples she gave of the decision-making process for introducing car parking charges highlights how local people in Congleton are being listened to and, if I might say so, it says a lot for the people of Congleton. It takes a lot for the people of Congleton to demonstrate, but this shows that they do so effectively when they decide to take such action.

I commend my hon. Friend for the role she has played in the work to protect her local hospital and for all her activities in that direction. I also commend her for her ongoing efforts in forging constructive relationships, which are so important. These open conversations between health systems and the people they serve will, ultimately, allow us to continue building a sustainable future for the NHS.

Question put and agreed to.

Learning Disabilities Mortality Review

Debate between Karin Smyth and Caroline Dinenage

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

My right hon. Friend is right to raise the Mencap report, because in many cases it reflects the recommendations that have been put forward in this particular report. The mandate to NHS England requires a reduction in the health gap between people with mental health problems, learning disabilities and autism and the population as a whole, and requests support for them to live full, healthy and independent lives. That is something that NHS England has a mandate to deliver, and we of course support it in doing that.

[Karin Smyth (Bristol South) (Lab)]

If it is a crime to politicise the vulnerability of some people and the Government’s cuts, I stand guilty as charged. Further to the question from my hon. Friend the Member for Leicester West (Liz Kendall), what we have seen since 2013 is the complete decimation of services working together on the ground. This is a local government and health issue locally, so may I press the Minister to tell us what action will be taken to make this happen at local level?

[Caroline Dinenage]

It is not about that. This is about inquiring into the deaths of people who have died in our care. Despite all the really difficult decisions we have had to make to deal with the financial challenges this country faced, which the hon. Lady’s party will be well aware of, we have made progress on this issue in terms of transforming care and the healthcare checks on people with learning disabilities, and this very report on the learning from deaths programme proves how absolutely committed we are to ensuring that not one single one of those deaths goes unrecognised or uninvestigated.

Social Care

Debate between Karin Smyth and Caroline Dinenage

Wednesday 25th April 2018 Commons Chamber

[Caroline Dinenage]

The hon. Lady had plenty of time to make her comments, so I will make a little progress.

When the Conservative party formed the coalition Government in 2010, it is worth remembering that not only did we have to deal with the parlous state of the country’s finances, but we inherited a burning platform of social care. Of course, that meant taking difficult decisions in those early years, which were challenging times for local authorities.

[Karin Smyth]

Will the Minister give way on the cap?

[Caroline Dinenage]

I will be coming on to the cap later.

To give the Labour party its due, it recognised that we had difficult decisions to make. Had Labour stayed in government, it planned £52 billion-worth of cuts to local government budgets by 2015. However—enough of the history lessons—I intend to make progress and answer many of the shadow Minister’s questions.

--- Later in debate ---

[Karin Smyth]

The 2015 Tory manifesto was very clear on the commitment and the assurances about the cap. The 2017 manifesto abandoned that. I think the Minister said earlier that it is still part of the Government’s considerations. Will she clarify from the Dispatch Box today what we are to expect in the Green Paper with regard to the cap?

[Caroline Dinenage]

The Prime Minister said last year in the general election that we would be consulting on the cap in due course and that will be part of the Green Paper. Building a sustainable care and support system will require some big decisions, but getting this right promises a better system in which everyone can have confidence, where people understand their responsibilities, can prepare for their future and know that the care that they receive will be to a high standard and help them to maintain their independence and well-being. The paper will set out options to put the social care system on a more secure footing and address issues to improve the quality of care and reduce the variation in practice.

Oral Answers to Questions

Debate between Karin Smyth and Caroline Dinenage

Monday 10th October 2016 Commons Chamber

[Caroline Dinenage]

We recognise that the costs of providing childcare vary enormously across different areas of the country. That is why we have just completed an early years national funding formula consultation, which proposes an area cost adjustment to reflect cost differentials in both staff and premises. Some 88% of areas will see an increase and the hourly rate for Richmond Borough will rise significantly to £5.69 an hour. I will of course meet my hon. Friend to discuss this.

[Karin Smyth (Bristol South) (Lab)]

rose—[Interruption.]

[Karin Smyth]

Thank you, Mr Speaker. Following the report by the Public Accounts Committee on entitlement to free early years education and childcare and a Westminster Hall debate on the subject that I initiated in July, the then Minister promised me that the Department was due to publish the early years workforce strategy document, addressing the shortfall in qualified staff to deliver the 30 hours of free childcare. What progress has been made?

[Caroline Dinenage]

The hon. Lady asks an important question. I am clear that we need to help employers to attract, retain and develop their staff to the very highest possible quality of early years provision. The workforce strategy will be published very shortly.