Social Care

Kate Green Excerpts

Wednesday 25th October 2017 Commons Chamber

[Barbara Keeley]

It is very important that we bear in mind that the 1.45 million workforce in care will have been local government employees and will have enjoyed local government terms and conditions. We have talked many times about the fact that they are not now paid the minimum wage or travel time. They are very badly paid, with no pensions in prospect.

[Kate Green (Stretford and Urmston) (Lab)]

As my hon. Friend knows, in my constituency, which neighbours hers, we have a real problem in recruiting and retaining care workers, many of whom tell me that they can get better paid work in the local Asda than by doing the job that they love. Does she not agree that that is in part due to the fact that private providers, who would like to pay their staff more, cannot do so because of the insufficiency of the value of the contracts that they receive from the local authority?

[Barbara Keeley]

That is absolutely the case. In fact, in a recent meeting with Unison, I was told that, in our area in Greater Manchester, one person could be paid more for putting toppings on to pizzas at Morrisons than for providing care—often to people with dementia or to those who really need that help.

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[Barbara Keeley]

My local authority has the most advanced example of an integrated care organisation in the country—we have already transferred all our social care staff to work for Salford Royal. I have just quoted a situation that shows how the pressure being put on hospitals because of delayed transfers of care is causing them to treat people such as my constituent in the way I described. Conservative Members ought to listen to that, because it is their Government and their Ministers who are causing this pressure to be put on hospitals.

We know that demand on social care is increasing as more people live longer with more complex conditions. The number of people aged 75 and over is projected nearly to double by 2039. That ought to be something to celebrate, but instead the Government have created fear and uncertainty for older people by failing to address the health and care challenges raised by those demographic changes. Indeed, the Conservative party is spending less money on social care now than Labour was when it left office in 2010. The Government seem to have no plan to develop a sustainable solution to the funding of social care in the longer term; they have talked only of a consultation followed by a Green Paper.

Furthermore—and this is raising real fears—the focus has been entirely on the needs of older people, without consideration being given to the needs of the 280,000 working-age people with disabilities or learning disabilities in the social care system. That is profoundly short-sighted, because the financial pressures on local authorities due to the increasing care needs of younger adults with disabilities or mental health problems are now greater than those due to the need to support older people.

[Kate Green]

I am glad my hon. Friend has mentioned younger adults. Does she agree that investing in the care they need will facilitate the Government’s achievement of their ambition to have more disabled people who can work in paid employment? Relatively low levels of expenditure on care for those people would pay great dividends for the Government and the country.

[Barbara Keeley]

Very much so. I thank my hon. Friend for making that point. It is concerning that planned consultations or discussions about future policy should focus so much on older people, when the needs of people with disabilities and learning disabilities are so important. We talked about learning disabilities in a debate last week.

Labour will fill the policy vacuum that exists around social care under this Government. Over the coming months, we will consult experts on how we can move from the current broken system of care to a sustainable service for the long term. We will look at funding options for social care in the long term, such as wealth taxes, an employer care contribution or a new social care levy. Those experts will help clarify the options for funding our planned national care service. Our approach will be underpinned by the principle of pooled risk, so that no one faces catastrophic care costs as they do now or as they would under the Conservative party’s dementia tax.

Our plans are for a national care service. They are based on a consultation—the “Big Care Debate”—that involved 68,000 people. People in that consultation told us that they needed a system that will support them and their families to live the lives they want, that will treat everyone with dignity and respect and that will give them choice and control over their care. I believe those needs remain the same, and they will be at the heart of our ambition for social care.

I urge hon. Members from all parties to vote with the Opposition today so that we can set the foundations for a safer, more sustainable and higher quality care system for the future and reassure those who have become worried about the Conservative party’s dementia tax mess.

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[Jackie Doyle-Price]

Again, I agree with everything that my right hon. Friend says.

To reassure the hon. Member for Worsley and Eccles South, we will have plenty of opportunity to discuss all these issues in the new year. We want to progress this by building a real consensus, because it is a strategic challenge facing us all. Not only are we all living longer, but working-age adults with disabilities are living longer. That is a matter for celebration, and we must do everything we can to make sure that we can meet all our obligations to them.

[Kate Green]

I am glad that we are spending time on this subject. The Minister will recognise, I am sure, that for working-age adults, relatively modest amounts of care may enable them to participate more fully in the workplace and in wider civil society. Will the separate but parallel work stream acknowledge that? I fear that there will be pressure just to look at the most severe and critical-level need, meaning that many people who could work with a small amount of help will be shut out of doing so.

[Jackie Doyle-Price]

I could not put it better myself. Necessarily, the system will always focus more on those with the most need, but, as the hon. Lady says, we can get a lot more return from putting in good value for money measures that will support people to live independently and to be able to work. I am very keen to explore those areas.

Valproate and Foetal Anticonvulsant Syndrome

Kate Green Excerpts

Thursday 19th October 2017 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I beg to move,

That this House notes with concern that there has been a systematic failure to inform women of the dangers of taking the epilepsy drug sodium valproate during pregnancy, resulting in thousands of children being born with congenital malformations, disabilities and developmental disorders since the 1970s as a result of fetal exposure to the drug; welcomes the launch of the Valproate Toolkit by the Medicines and Healthcare Products Regulatory Agency in February 2016 to ensure that women are informed of the potential risks of the drug, but further notes with concern a recent survey which found that 68 per cent of women have still not received these safety warnings; calls on the Government to take immediate steps to ensure that the materials in the Valproate Toolkit are distributed to all prescribing clinicians, pharmacists, and women who are being prescribed the drug; calls on the Government to require all clinicians prescribing sodium valproate to women and girls of childbearing age to discuss annually with the patient, the risks during pregnancy before a prescription is renewed; and further calls on the Government to bring forward proposals for a care plan and financial assistance to the victims of sodium valproate in pregnancy and their families.

I congratulate you, Madam Deputy Speaker, on getting through this debate’s catchy title.

I start by thanking the Backbench Business Committee, on behalf of the all-party parliamentary group on valproate and other anti-epileptic drugs in pregnancy, for facilitating this debate. I also pay tribute to Janet Williams and Emma Murphy, who are present today. They have fought tirelessly on this cause over many years, and we owe them an enormous debt of gratitude.

It is fair to say that “scandal” is an overused word in political discourse, but it is appropriate in this case: a family who have suffered as a result of a mother taking valproate in pregnancy would regard it as an absolute scandal, and we need to treat it in that way. There are many similarities to the thalidomide scandal. A group of women, over many years, took a drug during pregnancy without knowing the risks, with awful consequences, and we owe them a duty—that is the important point.

[Kate Green (Stretford and Urmston) (Lab)]

I apologise to the right hon. Gentleman for not being able to stay for the whole debate.

I, too, pay tribute to Janet and Emma for the campaign they have run. This debate is a great tribute to their efforts. Does the right hon. Gentleman agree that the real scandal is that we have known about the problems with this drug since the 1960s, but, as he says, expectant women were not told? The Government and the pharmaceutical industry knew there were dangers.

[Norman Lamb]

I thank the hon. Lady for her intervention, and I completely agree with her. Interestingly, the original product licence in March 1974 stated this, way back then:

“In women of child bearing age, it should only be used in severe cases or those resistant to other treatments.”

They knew in the ’70s, yet the appalling scandal is that so many women since then have had their life turned completely upside down, with enormous consequences for their children, because they were not told.

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[Norman Lamb]

I thank the hon. Lady for the intervention. I am aware of that figure and again it is shocking. It makes the point that this is a continuing scandal, not something from the dim and distant past.

Since the 1970s, more information has emerged bit by bit. In 2000, the information given to patients was changed to refer to the warning, but it took until then for anything to emerge. In 2005, Sanofi made an addition to this, and an interesting question is whether it downplayed the risk. That is one point that raises the question whether some sort of panel investigation needs to take place. In 2005, Sanofi said on its warnings to patients:

“Some babies born to mothers who took Epilim during pregnancy may develop less quickly than normal and may require additional educational support”.

That is putting it at its mildest, because the implications were far more serious. The question is, did it know then? These things need to be investigated further.

It is important to state what the risks are. Among the general population there is a 2% to 3% risk of foetal abnormality. If valproate is taken during pregnancy, that risk rises to 11%, and possible defects include spina bifida; malformations of the face, including cleft palate; malformations of the skull, limbs and organs, including the heart; and respiratory issues. It is incredibly important not to disregard the fact that when people take valproate during pregnancy there is also a 30% to 40% risk of developmental problems, including life-changing issues such as poor speech and language skills, delayed walking and talking, behavioural problems, interaction and communication issues, low intellectual abilities, memory problems, noise sensitivity, sensory issues, attention deficit hyperactivity disorder and autism spectrum disorders. The consequences are incalculable. It is estimated that 20,000 babies have been affected since the 1970s. It is also important to remember the profound impact on the mothers themselves, who too often have been treated as if they are to blame for the problems their children face and who then face years of guilt. That is a really shameful aspect of all this.

I have some case studies. Becky Parish, a mother from my own county, Norfolk, says:

“Logan is 7 and was born with a 7 mm unilateral cleft lip and palate…which the geneticist confirmed was due to Fetal Valproate Syndrome…He also has grommets and struggled with glue ear and bronchitis as a baby”.

He has needed “constant speech therapy” and suffers ear infections.

Becky describes how Logan

“has all facial features of FVS”

and is short in height and low in weight for his age. He has

“severe aggressional and destructive behaviours, including violence against others and self-injurious behaviours”

and so it goes on. This is really significant. There is sometimes a danger when we talk in general or abstract terms, but when we hear the stories of the affected families, we realise just how awful it is.

Becky says “social”—social services—“blamed me for it”. Her assertion is that in her case social services thought that the problems related to a detachment disorder, with the implication being that the mother was in some way to blame. She says:

“Social blamed me for it and so did the school—and now I feel more guilt due to it being FVS. Because no matter how much someone says I didn’t know and it wasn’t my fault, the guilt never goes away. And sadly it never will.”

That is really shocking.

Becky decided not to continue with valproate when she became pregnant with her youngest child, who is now five. She says that it was not a difficult decision, because in her view her child’s health was “far more important” than her own seizures, but that must have been a terribly difficult judgment for her to make. Nevertheless, she stopped straight away and was not put on any alternative treatment, despite conflicting messages from health professionals. Her specialist nurse told her that—wait for it—she was being selfish, and made her upset at her 12-week scan. However, her neurologist said that coming off the drug was the best thing she ever did. So she got two completely conflicting messages.

Carolyn Allen in Southampton talks about how her son requires support for a number of the effects of the condition, including deafness in his left ear, noise sensitivity, and speech and language delay. She says:

“He has been referred to portage, speech therapy, occupational therapy, ophthalmic, hearing clinic, physiotherapy, community paediatricians and has already had one operation to release his tongue tie.”

Just imagine the massive impact of this condition on that family.

Paula Hartshorn, a mother from Leeds, says:

“The powers-that-be need to think about the devastating impact this has on families, and how these families have to just cope and instantly know how to deal with all these complex medical issue. We have been left to give up on our jobs, careers, social interactions, and everything that goes with a well-rounded life. There are no breaks for us.”

The stories are heartbreaking.

Kazzy Southam from Blackpool tells a story of not finding out about the condition until her daughter was nearly 20. Her voyage of discovery began when she met Janet and Emma in 2014. This was after her daughter had been diagnosed with learning disabilities, dyspraxia, and social anxiety disorder. She had to fight to get a geneticist to investigate and give advice. Eventually, it was confirmed that her daughter had foetal valproate syndrome. It was a shocking fight for her to get justice, and she should not have had to go through that. She says:

“To me, she is an angel and I wouldn’t change her for the world. She said to me not long ago: I wouldn’t want to be ‘normal’—I like my mad head. But it hurts me to say, she doesn’t and won’t know any different—all down to the pills I took for my seizures.”

I ask Members to imagine living with that throughout their life. The Minister really needs to reflect on this. It seems to me that the Government have an obligation to do good by these people and not just to say that they must resort to the local authority or the clinical commissioning group for whatever might be available in their locality. There is a moral duty here and we must accept it just as we did with thalidomide.

I became aware of this scandal when I was a Minister and met the campaigners in September 2013. I was horrified by what I heard, having known nothing about the condition until then. I asked the Medicines and Healthcare Products Regulatory Agency, which attended the meeting, for an urgent review of what was being done to stop more and more mothers giving birth without knowing of the risks. In October that year, the MHRA asked the European Medicines Agency to undertake a full review. That review reached the conclusion—it was very little different from what the product licence said back in 1974—that the product should be used only if all other drugs are ineffective or are not tolerated. It also advocated a strengthened warning to ensure that all mothers were aware of the issue.

In January 2015, the MHRA issued new information with stronger warnings, education materials, patient information leaflets and so on. Eventually, in February 2016, the toolkit was issued: I have it here. It may not look like a toolkit, but it is. It is of value, because it gives information to clinicians and patients about the risks involved. Again, the scandal is that the information has not been communicated to very many of the affected women.

In September this year, a survey carried out by the UK’s three leading epilepsy charities—Epilepsy Society, Epilepsy Action and Young Epilepsy—found that the warnings were not getting through. Some 68% of women of childbearing age had not had any of the materials released as part of the valproate toolkit. That is not acceptable.

[Kate Green]

I thank the right hon. Gentleman for accepting a further intervention. He is making a very powerful case. The hon. Member for Central Ayrshire (Dr Whitford) mentioned the paternalistic approach that the medical profession has perhaps taken in the past. Is he as shocked as I was to learn that that paternalistic approach was still in evidence some two years ago when I met the pharmaceutical company Sanofi to discuss getting information out to mothers? The company told me that it would be inappropriate to make the information available, as it was unsupported by detailed advice from doctors. Of course it is important that women should be able to discuss the matter with their clinician, but they are able to understand and interpret intelligence, too.

[Norman Lamb]

I thank the hon. Lady for her intervention and pay tribute to her for her work on the all-party group for valproate and other anti-epileptic drugs in pregnancy, and for her campaigning. Yes, the response she got from Sanofi two years ago was unacceptable. It had the effect of hiding from women the full extent of the risk. Women should be presented with the evidence so that they can have a full discussion with the clinician about what steps to take. The September 2017 survey also found that 18% of women did not know of the harm—it was not that they had not received the toolkit, but that they still did not know. The system is failing those women.

Oral Answers to Questions

Kate Green Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Dunne]

I am aware that, under the Gloucestershire STP, a proposal has been submitted for capital funding to support plans to improve the clinical environment for patients and staff at the Gloucestershire Royal Hospital. I am afraid that my hon. Friend will have to join me in awaiting the Chancellor’s announcement in the Budget as to whether there will be a second phase of capital funding for STPs. If there is any funding, it will be allocated thereafter.

[Kate Green (Stretford and Urmston) (Lab)]

GPs in my constituency tell me that because of changes to personal data rules they will no longer be able to charge for providing reports for private insurance and legal claims. Will Ministers update the House on the situation? What assessment has been made of how GPs will cope with the additional costs they will face?

[Mr Hunt]

I am happy to look into that matter and write to the hon. Lady.

NHS Shared Business Services

Kate Green Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

I note the hon. Gentleman’s comments, but he will understand that I am not in a position to pass judgment at the Dispatch Box on the behaviour of individuals. The Department for Business, Energy and Industrial Strategy has respected and well-established systems in place to ensure that people who are not fit and proper to be company directors are not able to continue with their duties.

[Kate Green (Stretford and Urmston) (Lab)]

My constituents are served not by the SBS contract, but by the Capita contract. I have raised problems with that contract to the Secretary of State on many occasions. There are still problems with the helpline, which appears incapable of logging and following through with complaints. Why is this contract, which is clearly failing, not taken back in-house by the Government?

[Mr Hunt]

Just to be clear, this is a different contract, as I know the hon. Lady understands. We have been working hard, and I know that the hon. Lady worked hard with my Department in the previous Parliament to try to get to the bottom of the problems with the Capita contract. My understanding is that the situation is improving, but I will happily look into the individual situation she mentioned.

Oral Answers to Questions

Kate Green Excerpts

Tuesday 21st March 2017 Commons Chamber

[David Mowat]

I know that my hon. Friend has introduced a private Member’s Bill in this area, and the Government intend to support it.

[Kate Green (Stretford and Urmston) (Lab)]

The support that is provided to GP practices in relation to IT, information and so on is absolutely crucial to their effective operation, but problems continue today in my constituency with the service provided by Capita. Capita cannot, for example, now get prescribing certificates for locums and new GPs. When are the Government going to get a grip on this failing contract and, if Capita cannot perform adequately, get someone else to do it?

NHS Shared Business Services

Kate Green Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

The hon. Lady should have listened to the facts when I told her. When this came to light, more than 700,000 records were checked: 2,500 of the higher-risk ones are being checked by two clinicians—80% of them have already been checked. A huge amount of work has been done to clear up the situation. I completely agree with her that it was unacceptable that it happened in the first place, but I gently say to her that we are not the first Government to be let down by suppliers.

[Kate Green (Stretford and Urmston) (Lab)]

A few moments ago, the Secretary of State alluded to teething problems with the Capita contract. I must tell him that GP practices in my constituency told me only a couple of weeks ago that those problems not only continue but are worsening. How much longer will the Secretary of State give Capita to perform under the contract it has with the Department of Health? If it cannot perform, how quickly can we expect the Secretary of State to decide to take that work back in-house?

[Mr Hunt]

If Capita does not perform what it is contracted to do, we will take all necessary measures, including ending the contract. The hon. Lady is right that there have been a number of problems with that contract in its early days. We believe that the situation on the ground is beginning to improve, but a lot of progress still needs to be made.

Mental Health and NHS Performance

Kate Green Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I thank the hon. Gentleman for his interest in that issue. Sometimes, this is a challenging area. We legislated for parity of esteem, with cross-party support, in 2012. The danger is that such a concept can be nebulous, which is why we asked Paul Farmer, the chief executive of Mind, to look independently at what would be reasonable, fair and sensible progress towards parity of esteem by 2020. He said that he thought it would be a 10-year process, but that this was the right ambition for 2020. It was his report that the Prime Minister accepted this morning. We are making progress against benchmarks that independent people have looked at. The hon. Gentleman is right to say that we will not get there by 2020, but we must make sure that we deliver on that commitment while he and I are both MPs.

[Kate Green (Stretford and Urmston) (Lab)]

Very seriously mentally ill people rely on support from a whole range of services, including—obviously—mental health services, but also housing, social services, sometimes the criminal justice system and, crucially, family support services. What is being done to ensure a whole-Government strategy to raise the standard of care, particularly for very severely ill people who need protection from harm both to themselves and, sadly, sometimes to others in society?

[Mr Hunt]

The hon. Lady is absolutely right. One example where that is particularly true is in addiction services. Highly vulnerable people whom we are trying to help kick a drugs habit may also have a housing problem, a debt problem or a work problem. Unless we solve those problems holistically, we are unlikely to be able to address the health problem that sits at the heart of those challenges. In essence, that is what the STP process is trying to address—I am talking about providing more joined-up integrated services. I am happy to have further discussions with her as to how we can make more progress in that area.

Oral Answers to Questions

Kate Green Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Speaker]

Order. This question is about England, rather than Scotland or Wales.

[Kate Green (Stretford and Urmston) (Lab)]

Will the Minister advise GP practices in my constituency, who have been massively inconvenienced by the chaos of the Capita contract, that full compensation will be available for the inconvenience they have been put through?

[Nicola Blackwood]

At the moment, NHS England and Capita are focusing very hard on improving service delivery, which I think must be the top priority, but we are also looking into exactly what inconvenience and costs GPs have suffered, along with dentists and optometrists, and that will be considered and discussed with GPs.

Social Care Funding

Kate Green Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

I am not aware of the specific issue that the hon. Lady has raised about the respite care centre in Sheffield that is on the point of closure, and I would be happy to discuss that with her so that I understand it better. I can only repeat that today is not the day that we are going to announce a royal commission into funding.

[Kate Green (Stretford and Urmston) (Lab)]

Care providers in my constituency tell me that they are losing staff to Asda because they cannot compete on pay and conditions, because the council cannot commission care at a price that enables them to do so. What is the Minister going to do to stem the haemorrhaging of careworkers from the profession and, therefore, the haemorrhaging of the provision of care?

[David Mowat]

There is an issue with that, and that issue exists in various parts of the country. We acknowledge it and we need to manage it. We also need to manage the total number of beds in the system and the total number of domiciliary providers in the system. The total number of beds, as I said earlier, is the same now as it was six years ago. The total number of domiciliary providers is around 40% higher.

Capita Contract (Coventry)

Kate Green Excerpts

Tuesday 8th November 2016 Commons Chamber

[Mr Robinson]

My hon. Friend speaks pointedly to the issue. She is absolutely right in every respect, and I thoroughly agree with her. I would go a little further and say that the irony is that we have ended up with a terrible service that is costing more than the previous service ever would, because the company was not properly prepared, did not have a commitment to providing the service, and was unable to do so, and because of the competing and irreconcilable claims about short-term gains in the form of profits and illusory savings for the health service.

[Kate Green (Stretford and Urmston) (Lab)]

The situation in Coventry that my hon. Friend describes is also being experienced by GP practices in my constituency. GP practice managers have told me that the system was trialled in west Yorkshire and proved unsatisfactory, yet the contract was rolled out regardless. Does my hon. Friend not agree that that is a further irony?

[Mr Robinson]

Well, we learn something every day. I did not know that, and I am grateful to my hon. Friend for bringing it to my attention. That fact was not mentioned to me in Coventry, where people felt that the new system had been sprung on them completely without trial. When I was a Minister, I was a great supporter of the idea of trialling programmes. After all, we trialled them for a purpose, which was to see whether we were ready for them and whether the contractor was able to provide them. However, that seems to have been ignored in this instance. I shall say a few words at the end of my short contribution about learning lessons. This is not the first time we have been in this position. It is not as though we have suddenly discovered that contracts are not easily transferred, and there are lessons to be learned.

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[Mr Robinson]

I am so sorry, dear. I shall not live that one down in a hurry, but I thought I had detected a Scottish accent. I welcome my hon. Friend to the debate. She is the only one who did not tell me she would be participating tonight, Madam Deputy Speaker. I do apologise, but I cannot correct Hansard and I am afraid to say that the error will stand. I am sure she will forgive me, even if others may enjoy the mistake I have made.

There is no doubt that we are facing a major threat with this situation, and we hope we can stop it before we get to a major incident or catastrophe of some kind. That is the point of tonight’s debate. There is no doubt that this threat exists in Coventry, and we want to see what the Minister has to tell us about it. It is also clear from the interventions, which I have been pleased to take and to respond to, that this problem is widespread in England as a whole. As we have heard, in Bristol and in Manchester, and in the constituencies of those others who have made interventions, the problem is growing, not waning. Given the situation, we have to take steps.

Although we have risen to the challenge put out by Mr Paul Conroy, it is not enough for any Member just to speak up and expose this situation. That is a public duty we have as Members of this House, and the BBC has a duty as the national broadcaster to speak about these problems. We have all had experience of this. Not only have I had my business experience, but I have had experience of problems of this kind while in ministerial office and from others. Everybody in the country knows—it is no secret—that these privatisations, unless they are carefully controlled and well thought out, go wrong, so why do we keep doing them? This particular one involves Capita—it is in the hot seat tonight. It should know what this is about by now, as it has been through several of these and got them all wrong—Capita seems to learn nothing either. Ministers change, and it may be that the Minister knows about it but then gets moved. That is the nature of our appointments system, and I would not want to change anything there, but the civil servants who run these Departments should start to understand these things.

Contract management has many attractions to Ministers and to Government, who contract the problem out and lose direct responsibility for things. Everybody then heaves a sigh of relief and closes the file as if the thing is nothing more to do with them, but that is an illusion, because it comes back to bite them harder than it would have done had they kept the problem under their direct responsibility. It is an illusion to think that we can contract out. The responsibility for a contract remains with the person issuing that contract, and where it is for a major national public service, that contract must be taken seriously. What I did learn in the private sector is that the best companies spent more time preparing the bids for a contract, the assessments of the validity of the contracts and the validation process for a contract than they ever spent in negotiating the thing, which civil servants and Ministers often like to think they are good at. They say, “We had a hard-nosed negotiation on that one. We got them down from Y to X and we saved all this. It is great. We really screwed the private sector, didn’t we?” That is all a total illusion.

The most important thing when we do a contract of this complexity and of this kind is to get to the basis of the issues: to see who is really competent to take it on; who can make the savings that are being claimed in the real world; and who can do the other elements of the contract that have to come into play in a difficult situation competently. It is a question of competence.

[Kate Green]

My hon. Friend brings his extensive business experience to the debate about value for money when issuing private contracts. Does he agree that whatever the cost savings that may apparently be achieved under this contract, the cost to GPs and to practice managers of coping with the chaos, chasing records and trying to contact the help desk but failing to get through has been substantial? Does he also agree that those GP practices deserve compensation for the additional costs they have incurred?

[Mr Robinson]

I entirely agree with every single word my hon. Friend says. I would add, by way of a warning, that it is not a question of trying to punish the private sector by making it pay for this. Capita has to put the necessary resources into trying to correct the problem, and that must be its first priority. Something must give in the drive for profit, the drive to cut the costs of the services and the drive to improve the services. Those are irreconcilable objectives to start with, and in rectifying them the first thing that has to go is the drive for profit. Capita must realise that when it comes to put this right, it has to put the resources behind that. Compensation for GPs is important—I do not disagree with my hon. Friend for a minute on that—but I put it secondary to the provision of resources to get the contract right. I am sure that she would agree.

One other aspect of this shows an unacceptable, unpleasant and displeasing aspect of the privatisation process. It appears—I do not know this first hand—that Capita has turned to CitySprint to deliver these things. The effect of that is that we are employing drivers with no contracts, no sickness benefits and no breaks. This continual turning of the screw downwards is leading to a low-wage, low-productivity, low-output and impoverished economy. The workforce is suffering from that and it seems to be characteristic in many areas. For the public service to be involved in that process and almost to accelerate it, tightening that screw, is unacceptable.

This is another aspect of the commitment to negotiation and to the evaluation and validation process. The Government must learn to consider the quality of the service being provided and the quality of the means by which they intend to provide that service. CitySprint does not measure up to the standards we would expect from a good public sector contractor or employer.

To return to the main theme of tonight’s debate, what do we learn from this? The Government—principally the civil service, but Ministers, too—must learn to evaluate and validate the process of contracting out services. They cannot be driven by short-term savings, which are invariably illusory, but must consider the quality of the underlying contract. That is an art that must be learned, but I think it can be.

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[Nicola Blackwood]

The hon. Gentleman’s point about scrutinising whether Capita was competent as part of the tendering process is purely common sense and obviously that should have been done as part of the process. If he will allow me, I will come to the other points in the course of my speech. I would like to concentrate on how we resolve the problem that we find. We need to make sure that GPs and their patients receive the service to which they are entitled.

We want to restore acceptable services, and the contract contains sufficient financial incentives to ensure that Capita shares that goal, which is an important part of the contract and process. Let us be clear that the problems encountered with medical record transfers and overdue payments are entirely unacceptable. The Department shares that view. Both Capita and NHS England are co-operating fully with the Information Commissioner’s Office to address the implications for information governance, and I accept the need for urgent action to address the impact that this is having on patients and practitioners. That is why I have been holding regular meetings with Capita’s chief executive for integrated services, Joe Hemming, its new managing director for primary care support, Simon England, and NHS England’s national director for transformation and corporate operations, Karen Wheeler, and I will continue to hold such meetings.

Both NHS England and Capita openly acknowledge that the service has not so far been good enough. NHS England has demanded and received rectification plans from Capita for the six most affected service lines and has embedded a team of seven experts within Capita to support it as it resolves these issues.

As the hon. Member for Coventry North West said, it is also about having the right resources in the right place at the right time. Capita has informed me that it is adding around 500 more full-time equivalent staff to the service, at its cost, and that it is improving the training provided to ensure that new staff understand the importance of the service to both patients and practitioners.

I know that these problems have caused great inconvenience and distress, but with reference to risk—the hon. Member for Bristol South raised this point—NHS England has assured me that it is not aware of any direct cases of patient harm that can be attributed to service issues. However, NHS England is working closely with regional and local medical directors, so that we can be assured of patient safety. In particular, Dr Raj Patel, medical director of NHS England Greater Manchester, has joined the embedded team to ensure that clinical risks and concerns are appropriately addressed.

The priority now is to deal with any backlogs, particularly with medical record requests, and to ensure that services are stabilised with the capacity to deal properly with new requests. There has been progress on that, which is encouraging. The backlog of medical record requests has reduced from 17,262 to 3,465 in the past two weeks. Capita assures me that it has an effective triage system in operation for new requests and is confident that the situation will not recur. However, I will be monitoring the situation closely.

[Kate Green]

On the point about reducing the backlog, which is something the Bodmin Road practice in my constituency has raised with me, it is not just Capita that needs to put in extra resources; the GP practice is now receiving an onslaught of incoming records, but it does not have the personnel to manage them.