(5 years, 3 months ago)
Commons ChamberWe are very clear that GP surgeries cannot refuse to register somebody who is of no fixed abode or has no proof of identification. Where a practice does not properly provide correct access to vulnerable groups, the commissioner will intervene to ensure that it corrects that. Ultimately, the commissioner can issue a remedial notice and can terminate a contract or practice that still does not abide by its obligations.
Has the Minister seen the report by a mystery shopper from Friends, Families and Travellers who attempted to register with 50 GP practices without ID or proof of address? Twenty-four refused to register her or would not register her; all but two of those were rated outstanding by the Care Quality Commission. The Minister says GPs must properly follow the guidance, but does she agree that the CQC needs to ensure that it uses the inspection regime to enforce that guidance?
I totally agree. I have seen the report, which I welcome; I will certainly take it up with the CQC. It is very important that we use all tools to ensure that everyone has access to the healthcare they deserve, because it is all too easy for some groups to remain discriminated against. I am grateful to the hon. Lady for shining a light on this important issue.
My hon. Friend will have heard me say in answer to the earlier question that my right hon. Friend the Secretary of State and the Chancellor are in discussions about that matter. It would be unfair of me to comment on the progress of those discussions, but we hope to resolve them soon.
The issue that the hon. Lady raises is very concerning. I would be more than happy to meet her to look at that.
(5 years, 9 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
I thank the right hon. Gentleman for his contribution towards the report. He identifies that this is an area that is often deprioritised in favour of other issues. However, we absolutely have to prioritise the health of our prison population. I agree that we should address staffing levels. We should also look at the health and wellbeing of our prison staff. Too many leave because of the pressures and the violence that they face in prison.
Although a disproportionate number of prisoners are young males, as the hon. Lady will know, the prison population is ageing, with more much older prisoners serving custodial sentences than previously. What observations did her Committee make of healthcare provision for that ageing prisoner population, and what does she think the Government need to do to make sure that those people are properly cared for?
I thank the hon. Lady for drawing attention to that. Our report mentions that the prison population is ageing, particularly as a result of older sex offenders coming into our jails. It is about dealing not only with healthcare in our prisons but with social care. We call on the Government to look specifically at how we commission for that age group and their special needs. She will also know that the average age of death in prison is 56. We really have to look at the excess mortality, which is 50% higher for people in prison than for the background population.
(6 years, 2 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
We are always very pleased to support the hon. Lady’s proposals to the Backbench Business Committee.
This is an emotive issue. Many constituents have contacted me in anger, frustration and hurt as they simply feel that their illness is not understood and that successive Governments and some in the Department of Health and Social Care have shown no desire to gain an understanding—I say that respectfully, and I understand that some might say that healthcare is devolved. That is not the case for everyone, but it is certainly how many of my constituents have said that they feel.
We are fortunate to have a Minister who has a deep interest in this subject matter. He is in deep conversation with his Parliamentary Private Secretary, the hon. Member for South Suffolk (James Cartlidge), at the moment, but I am sure he will turn round shortly and be aware of my contribution. I am sure that he will respond constructively.
I want to thank MEAction, Action for ME, the ME Association, the ME Trust, Blue Ribbon for the Awareness of ME, the Centre for Welfare Reform, Forward-ME, ME Research UK, the Welsh Association of ME and CFS Support and Hope 4 ME Fibro NI in particular. All those organisations—there are lots of them—have furnished us with lots of information, and I thank them. I particularly thank one constituent, Sally Burch, who ensured that I had all the details and information to help me. She comes to see me regularly and fills me in on all the details.
ME is a chronic fluctuating neurological condition that causes symptoms that physically affect many bodily systems, commonly the nervous and immune systems, and affects an estimated 250,000 adults and children in the UK, as other hon. Members have said—it is not just an illness in adults. Approximately 7,000 people in Northern Ireland and about 17 million people worldwide have ME.
The hon. Gentleman is right to raise the issue of children with ME. It has an impact on their education because of the lack of access to consistently available home education where that is necessary. Does he agree that the Minister may want to take that up with his colleagues in the Department for Education?
Absolutely. I thank my hon. Friend for making that point. I am a big believer in digital. As colleagues in the House know, I often talk about it. The ability of digital communities to connect the ME community to help them share experiences and realise they are not on their own is especially important, and I pay tribute to all the people like my hon. Friend’s constituent who do so much.
I want to talk about the effect of ME on young people. The condition affects people of all ages, but sometimes the most acute effects are felt by those whose lives have effectively been taken away at such a young age. Dawn reached out to tell me about her son who is 16 years old and suffers from ME. It was initially brushed off as a migraine and a growing pain and she was told children sometimes get stomach aches. She wrote:
“My intelligent, sporty, active son has now spent over two years virtually housebound. This horrible illness has robbed my son of his teenage years. He only has one friend, has huge gaps in his education, won’t be at the School Leavers’ Assembly, nor the prom. He had to give up football and badminton, his real loves. And all we can do is wait until he gets better.”
The stories of young people with ME are especially powerful, because we all recognise the potential in young people and what amazing things, given the right opportunities and support, they can and will do. For many young people with ME that potential is taken away, and it is especially acute because losing time during their school years affects not only their education but their societal development and the friendship networks they build around them.
My hon. Friend will be interested to hear of the 17-year-old son of my constituent, who first contracted the illness as a young child. It took seven years to get a diagnosis. That is an incredibly large proportion of a young person’s life in which to suffer appalling ill health with no proper medical intervention.
Absolutely.
I want finally to mention Maya, who got in touch about her sister, who is affected by ME. She says:
“Chronic illnesses need far more support and recognition than they get.”
Her sister—like Maya herself, who has fibromyalgia—
“faced repeated uphill battles to get the help she needs, and that’s even been with health professionals.
It’s so little talked about that even doctors and nurses have been stumped as to how to help her. This disease cripples and takes lives and we need to be doing more.”
There is something that we can take from the debate today, which was mentioned by the hon. Member for Cheltenham in relation to brain tumour research—the fact that the power of talking about a condition can bring about change. We saw that with Baroness Jowell, and it is happening today with motor neurone disease, as it is global MND Awareness Day. People are talking about their condition. We also see it in the work on fibromyalgia being done by my hon. Friend the Member for Chesterfield (Toby Perkins). It is a matter of talking about things that are not often talked about. The importance of debates such is this is in raising awareness. People with ME are not invisible. They are as human as we are, and need to be seen and heard. That means investing in proper medical research and in medical education for practitioners, and in a relentless fight against stigma for all people with ME.
(6 years, 2 months ago)
Commons ChamberThe hon. Lady is right to ask that question, and I encourage her to hold her local NHS to account on that. There are some simple metrics, which we can share with her, that can tell us whether the NHS is using the money wisely, and one of them is whether her local hospitals are managing to reduce their emergency admissions by providing better care in the community. She is right that it is the litmus test of whether the money is being spent wisely.
May I press the Secretary of State on his answer to my hon. Friend the Member for Battersea (Marsha De Cordova), particularly in relation to profoundly disabled adults, who need not just excellent healthcare, not even just excellent physical and social care, but access to services that maximise their social participation? Will he say a little more about the work being done in parallel with the social care Green Paper?
I want to reassure the hon. Lady that, in all our discussions about core social care funding and the funding accessed by local councils, we discuss working-age disabled adults every bit as much as the frail elderly. They are central. Many councils actually spend more on that group than on older people. We will not crack the social care problem unless we take that group of people extremely seriously.
(6 years, 3 months ago)
Commons ChamberEvidence from cities such as Manchester and London is very clear that centralising stroke treatment in hyper-acute stroke units considerably improves outcomes, with patients having access to a specialist at all times and immediate access to imaging and investigative facilities, giving them the best chances in terms of outcome.
My 82-year-old constituent, Freda, is recovering well from a serious stroke, but she has been told that there is an 18-week wait for physiotherapy and that this is the NHS standard. Does the Minister think that that is good enough?
I cannot comment on the individual case, but I can say that NHS England and we at the Department are working closely with the Stroke Association to develop a new national plan for stroke in England which we expect to publish this summer. The hon. Lady’s constituents and mine will benefit from the national policy narrative, but they will also benefit from some brilliant charities that work on the ground with constituents. Yesterday, I saw Chandlers Ford Stroke Support Group at the amazing Funtasia in my constituency. That group does a lot to support people in stroke as well.
(6 years, 3 months ago)
Commons ChamberWhat is unacceptable is that people with learning disabilities have poorer health outcomes than the rest of the population, which is why NHS England commissioned this piece of work and why we are determined to address it.
What steps is the Minister taking to ensure that people with learning disabilities can confidently access good quality sexual health services? What work is she doing with her counterparts in the Department for Education to ensure that young people with learning disabilities receive excellent sex and relationships education?
This is an important aspect, and I will get in touch with the hon. Lady with a more detailed answer to her question.
(6 years, 4 months ago)
Commons ChamberI am grateful to my hon. Friend for pointing out the very high percentage of care homes being found to be inadequate or requiring improvements—the figure is over 40% in my local authority. Does she agree that in many cases this is about care not being safe in those care settings? The real worry is not just that the settings are a bit grotty but that the care is unsafe.
Yes, indeed. My hon. Friend takes me ahead in what I was going to say, but I know she has been involved with Age UK in understanding the state of care in her own local area, and I applaud her for that. Cuts have resulted in providers giving poor-quality care, and that is having a serious impact on the lives of people who need care. It means people not being washed or going hours without receiving a meal or being given a drink; it means people being left without help to go to the toilet; and in some cases, as she just said, it means people not being given crucial medication.
Care quality has become so bad that Age UK’s recent report was entitled, “Why call it care when nobody cares?” Many Members went to the launch of the report and listened to the older carers who were there. The anger of those older carers who spoke at or attended the event was palpable. Some told me that they and their families were often at breaking point, that they felt betrayed by a system of care that left them with little or no affordable support, and that they faced rising care costs which they described as crippling, although the care for which they paid was often not good enough.
I know that the Minister was present at that event. She may have talked to one carer there, Elaine from Northamptonshire, whose council is battling insolvency. Elaine gave up her job to care and has cared full-time for her husband ever since, but rather than giving her any extra help, the council recently tried to increase the weekly cost of care support at home from £88 to £178 per week. That was another battle for a carer to fight to obtain the care support that she needed at a price that she and her husband could afford.
Labour Members recognise that unpaid family carers need more support. We understand how much families are doing to look after their family members, and how hard that is for many carers but the Government have not even developed an updated national strategy for carers, having scrapped the planned strategy back in October. Since then, they have even failed to publish the action plan that was promised for January. What does that say about their attitude to carers?
I utterly agree. Obviously, we recognise the change in title of the Secretary of State. I am sure that many of us across the House hope that that would mean a move towards a more joined-up approach to health and social care. The pressure on the NHS is absolutely exacerbated by problems in social care.
There is an inconsistency between funding through continuing healthcare as part of NHS provision and the funding that is available to support people through social care. Does the hon. Lady intend to suggest that that discrepancy should in some way be rectified so that there is not a difference between the routes through which someone comes into the care system?
Many relatives and patients complain about the fact that, depending on which illness people have towards the end of their life, they will either be supported in an NHS or hospice system or they will pay for it in the social care system. A fragmentation has resulted from the Health and Social Care Act 2012 and the change in structure. Someone’s treatment may be delivered under NHS England as a specialist service for so many days, but then they go back to the clinical commissioning group and the ongoing care is suddenly not there. It is all very disjointed. In actual fact, we require an entire approach that joins up health and social care for the entire patient pathway. We should not expect patients to navigate from one pothole to the next.
We have exactly the same challenges with an ageing population. Indeed, the Scottish population is older and ageing more quickly than the English population. In all these debates, I always say that we must not look on this as a catastrophe. Having spent over 30 years of my life trying to get people to live longer, I ask Members to remember the alternative—living shorter. However, without public health changes and a game-changing approach, we are not ageing well; and we need to age well. But that will take a long time to turn around. We need to look after the people who require care right now.
Having failures in social care traps people in hospital. In Scotland, although we have a long way to go as well, delayed discharges from hospital have dropped in every year since 2014, when the integration started. Between 2010 and 2017, the average hours delivered through home care have doubled from six to 12 per week. In future, a quarter of us will die in a care home, so what kind of quality of care do we want to have, and what kinds of palliative care skills would we like our nursing homes and care homes to have? We need to create links between the hospice movement and care homes so that those skills and that supportive approach are shared.
It is a great pleasure, as a Manchester MP, to follow a Yorkshire Member from the other side of the Pennines, my hon. Friend the Member for Keighley (John Grogan). I am pleased to have an opportunity to contribute to the debate and want to make a few points that have not come up very much in the debate and that particularly affect my constituents in Trafford.
We have a relatively elderly population in Trafford, compared with Greater Manchester as a whole, which creates a higher level of need in the borough. We also suffer from a high level of delayed transfers of care— in February we had 737 days of delays in the system because of a lack of places in nursing homes, residential care homes or domiciliary care. We also have a disproportionate number of self-funders, which makes it more difficult for the local authority to shape the market. It also means that many self-funders have no connection with the social worker, so they do not necessarily get good advocacy to ensure that their care needs are met.
In Stretford and Urmston we have relatively few large chains supplying residential or domiciliary care; the market is characterised by small businesses, often long-established and family-owned. Those businesses struggle with a lack of reserves, and they are often in buildings that they have occupied for decades and that were not purpose built as care homes. They are now unable to raise the funds to enable them to upgrade their facilities to meet modern standards, not least because of the relative inadequacy of funding from the local authority. Only the other day another small local business decided that it will have to close its doors. As we heard from my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), that is a cause of great anxiety and stress for residents and their families.
Many hon. Members have talked about the pressures on the workforce. That is a particular problem in Trafford, where there are many job alternatives—people can work in the Trafford Centre or in MediaCity, or they can travel into Manchester to work in the many businesses in the city centre. I am sorry to say that I think that position will become worse as a result of Brexit, because we rely heavily on European Union nationals to serve our care sector.
One thing that I think the Government could helpfully do is talk of care jobs as skilled jobs. They might be low-paid jobs and they might have relatively low qualification entry requirements, but they are skilled jobs. If we have to replace workers from the European Union with more workers from our domestic workforce, we will need to make social care jobs seem attractive to them with good pay and conditions, training and career paths, and by talking up the quality and importance of those jobs.
I am sorry to say that the pressures on Trafford put us in a very bad position. According to Independent Age, we have the seventh worst CQC inspection record in the country. The CQC has found that 43% of residential care homes and 45% of domiciliary care providers in Trafford are either inadequate or require improvement.
I turn to what I hope will be in the Green Paper. Let me say first how concerned I am that the CQC system, although it provides assessments, seems to lack real bite when it comes to bringing about improvements. It seems that providers are given poor assessments and have six months to try to raise their standards, during which time the local authority has some conversations with them but there is a lack of sustained external attention and pressure to ensure that they actually improve, and that by the time the CQC comes back they have not much improved. When a care home or care setting receives a poor assessment, the local authority rightly is no longer prepared to place residents there, which of course means that its income drops further, making it even harder to improve. I would be grateful if Ministers, in preparing the Green Paper, paid particular attention to how we could make that CQC process work better so that it drove improvement, rather than simply providing a picture of what is going wrong.
We have talked about family carers. I absolutely recognise and applaud the work they do. Age UK recently held a focus group in my constituency with family carers, who said they felt it was difficult to find co-ordinated information and support. Very few people plan or choose to be a family carer, and it is incumbent on us to think about ways we can get much better co-ordinated information to them about the support that is available and how they source it. We must also recognise that family care is not always appropriate. Some family members will not be able to provide family care—someone’s needs may be too high or the family member may have other commitments. In some cases, the person who requires care will not want a family member to provide intimate care to them.
I want to draw Ministers’ attention to a second phenomenon in my constituency that is putting further pressure on the system. The south Asian community in particular has relied heavily on family care, but traditional family patterns in that community are breaking down. We must look to the point in 10, 15 or 20 years’ time when we have raised the education and aspirations of women in those communities and they are no longer prepared to stay at home and care for auntie and granny, as previous generations have. We desperately need attention to be paid to building up the provision of culturally appropriate care.
Integration has been much talked about. We are finally making progress with the health and social care partnership in Greater Manchester. I welcome that, because we have talked about integration in Trafford without many visible results for many years. Members touched on working-age adults, for whom integration with just health is missing the point. Many of them are not unhealthy, but they do need integration with employment, education, transport, housing and so on. I hope the Green Paper picks up on that point.
Let me join other hon. Members in talking about funding. We need much greater clarity about what is means-tested and what is universal. We need to think that through in a strategic and rational way. We have all said that it is not right simply to expect those who need care to bear the whole cost of it. We must begin to set up a system that properly enables us to pool and share cost and risk. I am with my hon. Friend the Member for Leicester West (Liz Kendall) in thinking that that requires us to use a range of measures through progressive taxation. I am also with my hon. Friend the Member for Keighley (John Grogan) in saying that that means that inheritance tax, and taxes on assets, have to be part of the mix. That is necessary to ensure intergenerational fairness and fairness between my constituents in the north of England, where house prices are relatively lower and all someone’s assets will be used up paying for care, and those in London and the south-east with much more valuable properties, who may be left with more assets after they pay for their care.
Finally, I say to the hon. Member for Redditch (Rachel Maclean), who sadly is not in the Chamber, that council tax can be only a very small part of the answer, because it produces a very uneven pattern of funding given the very different council tax bases in constituencies around the country.
I would be grateful if the Green Paper picked up, in addition to all the other points that have been made this afternoon, on the specific points I have made. It would make a big difference to people in my constituency who need care today, to their families and to all of us in the future if, finally, this matter was properly and strategically addressed.
I think the hon. Gentleman will find that we actually have a very progressive tax paying system none the less.
I want to celebrate those areas that have continued to deliver their social care responsibilities in challenging circumstances. We have heard a lot about what has gone wrong, but let us just remember this statistic: 81% of people in care homes are in homes that have been rated good or outstanding. I think that is an achievement, and something to be celebrated. I also want to compliment those councils that have really stepped up to the plate to deliver an improved performance on delayed transfers of care. Stoke and Trafford in particular have cut their delayed discharges by more than half. This comes down to leadership and determination. Where councils show real leadership, that will deliver improvements and change—[Interruption.] I have just named those councils: Stoke and Trafford.
The Minister is right to say that we are making progress on delayed transfers of care, but the figures have been very high. It really comes down to the fact that we just do not have enough well-funded places to enable people to be discharged from hospital quickly and get into the care in the community that we all want them to have.
I do not disagree with that point. That is why we need to embark on a process of reform and really get it right. We are embarking on the process on that basis.
A number of Members, including the hon. Member for Blaydon (Liz Twist), mentioned sleep-ins, and I just want to restate what was said, because it seems to have been misunderstood. We fully recognise the pressure on the sector resulting from the ruling on sleep-ins and the fact that the historical liabilities could be a problem. We are working closely with providers, in liaison with the European Commission, to come up with a solution. Hon. Members will understand that the matter is too commercially sensitive for me to say any more than that—[Interruption.] We are working with providers and meeting them on a regular basis.
(6 years, 6 months ago)
Commons ChamberUrgent Questions are proposed each morning by backbench MPs, and up to two may be selected each day by the Speaker. Chosen Urgent Questions are announced 30 minutes before Parliament sits each day.
Each Urgent Question requires a Government Minister to give a response on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
My hon. Friend points to a key point that I have made throughout this session. It is not just about how much money is put into the NHS, but about the outcomes that are delivered as a result. He is right to allude to the fact that in Scotland the SNP has not delivered the improvements it promised on the NHS. That is why there is so much dissatisfaction in Scotland with what is happening in the NHS there.
It is not just integration that will solve the problems in the social care sector. In Trafford, social care providers are being promised £14.61 an hour from this April—well short of what we need to sustain the home care market. What will the Minister do to ensure that there is adequate funding for home care providers?
The hon. Lady raises a very valid point. It is exactly why we will have a Green Paper this summer looking at what steps need to be taken to address this issue. On both sides of the House, we recognise that more needs to be done on how we address these concerns, and that is what the Green Paper will tackle.
(6 years, 8 months ago)
Commons ChamberThe truth is that we do not yet know enough about e-cigarettes. I welcome the Science and Technology Committee’s investigation into them. We have asked Public Health England to include messages about the relative safety of e-cigarettes in its Quit Smoking campaign next month, but it is for local organisations and businesses to implement their own policies on e-cigarette use in the workplace.
(6 years, 9 months ago)
Commons ChamberYes, that is incredibly concerning and I think it is a really bad decision of the Government to award money from the tampon tax to that organisation.
As this House tonight rightly marks the milestone of the Abortion Act, we should also reflect on whether the Act is still fit for purpose. The Abortion Act was never intended to be the end of the campaign for women’s reproductive rights. That point was put succinctly by the late Madeleine Simms, a former campaigner at the Abortion Law Reform Association and one of the architects of the original law. She said:
“The 1967 Abortion Act was a half-way house. It handed the abortion decision to the medical profession. The next stage is to hand this very personal decision to the woman herself.”
I want to turn to why the abortion law needs reforming. Britain’s abortion laws are governed not just by that 50-year-old Act, but by the 88-year-old Infant Life (Preservation) Act 1929 and the 156-year-old Offences Against the Person Act 1861. Taken together, this is the oldest legal framework for any healthcare procedure in the UK. It is a framework that, astonishingly, still treats the act of abortion as inherently criminal and punishable by life imprisonment. As I have mentioned, one third of women, and the healthcare professionals who support them, are stigmatised by these laws. As Madeleine Simms highlighted, the 1967 Act did not give women authority over their own abortions; it merely handed that authority to the medical profession, subject to the consent of two doctors. No other medical procedure requires the sign-off of two doctors, and nor does that requirement exist in most other countries in which abortion is legal.
While other healthcare areas have moved towards more patient-centred provision, with a better doctor-patient relationship, the provisions of the 1967 Act are, despite the best efforts of healthcare professionals, holding back similar progress in reproductive healthcare. Furthermore, as Professor Lesley Regan of the Royal College of Obstetricians and Gynaecologists said:
“No other medical procedure in the UK is so out of step with clinical and technological developments”.
Since 2014, the majority of abortions in England and Wales have been carried out medically, using pills. The 1967 Act was not designed with medical abortions in mind; it was passed when the overwhelming majority of abortions were carried out through surgical techniques.
I regret the fact that, in the 50 years since the Abortion Act was passed, Parliament has mostly shied away from debating issues such as those I have just set out. In March, the House of Commons heard the First Reading of my ten-minute rule Bill on the decriminalisation of abortion in England and Wales. In the 50 years before I introduced the Bill, previous MPs had introduced 11 Bills to amend our abortion laws—seven were private Members’ Bills and four were, like mine, ten-minute rule Bills. All 11 attempted to restrict abortion in some way; not a single one was about improving provision or better supporting women. It seems peculiar that for a procedure so common—one that affects a third of women—the overwhelming parliamentary focus has been on ways to restrict the practice. Had this procedure affected a third of men, it is hard to imagine that we would have debated it in the same way.
I congratulate my hon. Friend on securing this debate. Does she agree that parliamentary opinion on this matter is massively out of step with public opinion? The vast majority of people in this country favour safe and legal abortion.
My hon. Friend makes an important point, although the House did give my ten-minute rule Bill to decriminalise abortion its First Reading. It will be interesting to see the result if it is debated again in the new Parliament.